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23A-003 (6) 27 MEADOW ST BP-2020-0350 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A- 003 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2020-0350 Proiect# JS-2020-000593 Est. Cost: $85000.00 Fee: $553.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 10802.88 Owner: GUNTHER JOHN F&DANAE MARR Zoning: URB(100)/ Applicant: KEITER BUILDERS AT. 27 MEADOW ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.9/18/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCH BATH RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/18/2019 0:00:00 $553.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit gg212 Main Street Sewer/Septic Availability L. ., Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REAPAIR, RENOVA�TyEnOR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. I l E This section to be completed by office Map Lot Unit 27 Meadow St SEP 1 7 2019Zoni Overlay District Dist ict CB District SECTION 2-PROPERTY OWNERSHIP/ UTHW X"4=,MAo 06t NS 2.1 Owner of Record: Danae Marr and John Gunther 27 Meadow Name(Print) Current Mailing Address: See attached signed contract Telephone Signature 2.2 Authorized Agent: Keiter Builders, Inc. 35 Main Street Florence, MA 01062 Narn rint)) Current Mailing Address: L�f P,..J,.*r4 ee.Z 413-586-8600 Sig ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 68,500 2. Electrical (b) Estimated Total Cost of 6,000 Construction from 6 U 3 Plumbing Building Permit Fee 9,000 4. Mechanical(HVAC) 1,500 5. Fire Protection 6. Total =0 +2 + 3 +4 + 5) 85,000 Check Number l This Section For Official Use Only Building Permit Number: _ Date Issued: Signature: 10 A -L— Building Commissioner/Inspector of Buildings tate BGrant @ KeiterBuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L:_ R: I,:— ---- R:— Rear Building Height Bldg.Square Footage 11/c Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW Q YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement windows Alteration(s) 0 Roofing ❑ Or Doors 171 1 Accessory Bldg EJ Demolition ❑ New Signs [0) Decks [CJ Siding [C]] Other[O] Brief Description of Proposed Kitchen and Bathroom remodel Work: Alteration of existing bedroom Yes x --- No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x _No Plans Attached Roll -Sheet 6a. If New house and or addition to existina housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? \ Yes No . I. Septic Tank City Sewer\ Private well._ City water Supply\ SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Danae Marr , as Owner of the subject property hereby authorize Keiter Builders, Ince to act on my behalf, in all matters relative to work authorized by this building permit application. See attached signed contract 9.16.19 _ Signature of Owner [date I, Keiter Builders Inc as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Scott Keiter Print N P's-4-k& BL 9.16.19 Sign re of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Kelter __ CS-102457 License Number 51 A Hatfield St Northampton, MA 01062 _6.20.20 Addre Expiration Date P f k &,f Z7 413-586-8600 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Keiter Builders, Inc. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.21 Address Expiration Date Skeiter@KeiterBuilders.Com Telephone 413-586-8600 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... M No...... ❑ City of Northampton Massachusetts rt DEPARTMENT OF BUILDING INSPECTIONS »� �{ 212 Main Street •Municipal Building Northampton, MA 01060 v Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 27 Meadow St (Please print house number and street name) Is to be disposed of at: Valley Recycling (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: USA Waste_ (Company Name and Address) �_dtyL 9.16.19 ----Aagnaiure of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents _ - y Office of Investigations 1 Congress Street,r s Suite 100 t� Boston,MA 02114-2017 �- www.i+nass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Keiter Builders, Inc Name (Business/Organization/Individual): Address:35 Main Street City/State/Zip: Florence, MA 01062 Phone #: 413.586.8600 Are you an employer? Check the appropriate box: Type of project (required): 1.9 1 am a employer with 4. 0 1 am a general contractor and 1 6. ® New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. M Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. employees and have workers' Y p Y� 9. ® Building addition [No workers' comp, insurance comp. insurance.* required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.® 1 am a homeowner doing all work officers have exercised their 1 l.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] + c. 152, §1(4),and we have no employees. [No workers' 13.® Other_ comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section belo\� showing their workers'compensation polio inl6rmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors exist,ubmit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and stun whether or not those entitics have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for nzy employees. Below is the policv and job site information. AIM Mutual Insurance Company Name:___ — MCC20020005382019A 6.11 .2020 Policy# or Self-ins. Lic. Fxptration Date: Northampton, MA Job Site Address: 27 Meadow St City/State/Zip: _ _ _. .__.__ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rtify undde the pains and penalties of perjury that the information provided above is true and correct. 9.16.19 Signature: President, Keiter Builders, Inc. Date: _ Phone#: 413.586.8600 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License #_._ Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _ Phone #: _ AC" 7R ® DATE(MM YY) C� Q `..►��! CERTIFICATE OF LIABILITY INSURANCE os/o3/2019/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CONTACI Cyndie Iienderson CISR.CPIA Webber&Grinnell PHONE (413)586-0111 niC No): (413)586-6481 8 North King Street E-MAIL SS: chenderson@webberandgrinnell.Com ADDRE INSURER(S)AFFORDING COVERAGE NAIC p Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: A.I.M.Mutual/A.I.M, Keiter Builders,Inc. INSURER C Attn:Scott Keifer INSURER 0: _ 35 Main Street INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2020 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 1 HE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 AMAGE TO RETE CLAIMS-MADE 1 OCCUR PREMISES Ea occurDrence $ 500,000 - -i MED EXP(Anv one person) $ 15,000 A S2265567 06/01/2019 06/01/2020 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2.000,000 POLICY ❑PRO- JECT EJ Loc2,000,000 PRODUCTS-COMP/OPAGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000,000 Ea aacadent ANY AUTO BODILY INJURY(Per person) $ A OWNED Ix SCHEDULED A9105217 06/01/2019 06/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments s 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000.000 A EXCESS LIAB CLAIMS-MADE S2265567 06/01/2019 06/01/2020 AGGREGATE $ 5.000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION "%I PER TE X OR TW AND EMPLOYERS'LIABILITY YIN STA1,000.000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA MCC20020005382019A 06/1112019 0611112020 E EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If Yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E 1. DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD If the work is stopped or delayed, either in whole or substantial part, for a period of thirty (30) days under an order of any court or other public authority having jurisdiction,or as a result of an act of government and due to your fault or negligence, or as a result of an act within Owner's control; or if the work shall be stopped or delayed either in whole or substantial part, for a period of thirty (30) days due to Owner's failure to make a payment on time, or make Contractor feel insecure, or if Owner should commit a material breach of any of Owner's responsibilities or obligations under this Agreement, then Contractor may, upon giving Owner seven (7) days written notice, terminate this Agreement and recover from Owner payment for all work performed; for any unpaid costs of and fees for the work; for any liability, obligations, damages, commitments, and/or claims that Contractor may have incurred or might incur in good faith in connections with this Agreement, as well as receiving payment for Contractor's attorney's and legal fees and all lost anticipated gross profits on the work not performed as of the date of the termination. NOTICE Notice will be deemed if delivered in hand or if sent by certified mail, return receipt requested, to the address listed on the front page of this Agreement. ARBITRATION THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISUPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVIED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN MASS. GENERAL LAWS,C.142A. KFATER BUILDERSaNC. (CONTRACTOR) OWNER r" By Ott Weiter,President Date Date Date NOTICE THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT. DISPUTE RESOLUTION AND ATTORNEY'S FEES Any controversy or claim arising out of or related to this Agreement involving an amount less than $5,000 (or the maximum limit of the Small Claims court) must be heard in the Small Claims Division of the Municipal Court in the county where the Contractor's office is located. Any dispute over the dollar limit of the Small Claims Court arising out of this Agreement shall be submitted to an experienced private construction arbitrator that shall be mutually selected by the parties to conduct a binding arbitration in accordance with the arbitration laws of the state Ir 10 � V.�n Contractor �, _� Owner V where the project is located. The arbitrator shall be either a licensed attorney or retired judge who is familiar with construction law. If the parties can not mutually agree on an arbitrator within thirty (30)days of written demand for arbitration,then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attorney's fees, costs, and post judgment interest at the legal rate. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or verbal representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable, the parties agree that all other provisions of this Agreement will remain in full force and effect. Any future modification of this Agreement should be made in writing and executed by Owner and Contractor. MISCELLANEOUS This Agreement is a Massachusetts contract, contains the entire agreement between us, any representations or warranties not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs, executors, successors and assigns. This Agreement may be modified only by an instrument in writing signed by both of us. This Agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Massachusetts General Laws and its corresponding regulations. YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO BY FORWARDING YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR 13Y DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. By signing this Agreement, you acknowledge that you have received a complete and loriginal signed copy of the entire Agreement and attached Addenda. Contractor may not start work until after this Agreement has been signed. DO NOT SIGN THIS CONTRACT IF THERE .ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD CONSULT WITH ANA TTORNE Y BEFORE SIGNING. KEITER BUILDERS, INC. (CONTRACTOR) OWNFR by,,$ 0 eiter, President Date `� Date Date ADDENDA Contractor�____= Owner _