25A-095 (3) incur in good faith in connections with this Agreement, as well as receiving payment for my 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.
WARRANTIES:
I will grant you, as part of the Total Price, a Limited Warranty, a copy of which is attached to this Agreement. I
will use materials that are currently acceptable for their intended use in performing work. You should be aware
that it may be determined that some of these materials may cause health problems. If there are any materials
that you do not want used in the work, list them on the attached Scope of Work form.
EXHIBITS:
The following Exhibits have been attached to this Agreement:
Scope of Work
Limited Warranty
ARBITRATION:
THE CONTRACT AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT
IN THE EVENT THE CONTRACTOR HAS A DISUPUTE CONCERNING THIS CONTRACT, THE
CONTRACT 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.
KEITER BUILDERS HOMEOWNER
/
03 - -,a , 2_ QI0
By Cott Keiter, (DBA Keiter Builders) Date Date
��h U `� 3, di 0 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.
4
•
CONSTRUCTION AGREEMENT
I, Scott Keiter (DBA Keiter Builders), of Northampton, MA whose Federal Tax Identification Number is 26-
4579629, Contractor's Registration Number 163295 (Exp. 06 -01- 2011), and License #102457 (Exp. 06 -20-
2012), am entering into this Agreement with you Dan & Carolyn Kibe of 354 Bridge Street, Northampton, MA.
ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO BE
REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND
STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES
CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME
IMPROVEMENT CONTRACTOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301,
BOSTON, MA 02018 (617) 727 -8598.
SCOPE OF WORK:
I will perform the work set forth in the attached Scope of Work on your home, or the property located at
354 Bridge Street, Northampton, MA. If you would like to change any work to be performed or materials used,
we will have to make such changes through a Change Work Order, which may also change the total price and
extend the date for completion. Change Orders will be handled on a time and material basis. I reserve the right
to make minor changes in any plans and to substitute materials of equal or better quality.
Should I encounter any unknown conditions below the surface of the ground, or concealed or unknown
conditions in any existing structure, you will agree to make an equitable adjustment with me under a Change
Work Order, which shall increase the total price and extend the date for substantial completion of the work.
PERMITS:
To perform this work, I, or subcontractors I hire, will obtain, on your behalf, the following permits
(if required):
x Building Permit Electrical Permit Smoke Certificate
Plumbing Permit Demolition Permit Certificate of Occupancy
IT IS MY OBLIGATION TO OBTAIN THESE PERMITS AS YOUR AGENT. IN THE EVENT THAT
I DO NOT OBTAIN THESE PERMITS, AND YOU OBTAIN THEM, OR IF I AM NOT REGISTERED
WITH THE BOARD OF BUILDING REGULATIONS, YOU WILL NOT BE ENTITLED TO OBTAIN
ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS
GENERAL LAWS CHAPTER 142A.
My obligation to obtain permits is limited to those permits directly related to performing the work I agree to do.
To the extent that other permits or governmental or regulatory agency approvals, such as, but not limited to,
zone changes, variances, special permits, site plan approvals, or approvals of conservation commissions, are
required to be obtained before I can obtain my permits, it is your obligation to satisfy such requirements and
you shall meet those requirements at your cost.
STARTING AND ENDING DATES:
I will apply for the permits within 3 day(s) of our signing this Agreement or your satisfying any conditions
required to be met prior to the permits being used, whichever date is later. I will start work within 7 day(s) of
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
The Commonwealth of Massachusetts
-401■111■1 Department of Industrial Accidents
==.1 Ari
ET Office of Investig,ations •
600 Washington Street
•=7
Boston, MA 02111
lrF. , www.mass.gov/dia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legiblv
Name (Business/Organizationandiviennt):
Address:
City/State/Zip: Phone.#:
Are you an employer? Check the appropriate box: Type of pioject (required): /
1.0 I am a employer with 4. 0 I am a general contractor and I
6. 0 New construction
have hired the sub-contractors
A employees (fulland/or part-time).*
2 pill I am a sole proprietor orpartaer- listed on the attached sheet. 7. EZP.Aruodeling
These sub-contractors have
and have no employees 8. 0 Demolition
working for me in any capacity. employees and have workers' _ .
9 u Building addition
coup.i
[No workers' comp. insurance _ nsurance.t
requirecL]
5. 0 We are a corporation and its 10-0 -Electrical repairs or additions
3. 0 I am a homeowner doing all work officers havetxercisecl their
11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.
insurance required.] t c. 152, §1(4), and we have no 0 Roof rep
alp
employees. [No workers' 13.Pther
comp. insurance required.j
*Any applicant -drat checks box #1 must also fill out the section beta* showing their worlcers' compensation policy information_
t Homeowners yvho submit this affidaVit incficating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employe es. lithe sub-contractors have employees, they must pn:nride their workers comp policy number.
lam an employer that is providing workers' compensation insurance for my employees. Below is the polig and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. # Expiration Date:
• Job Site Address: City/StafriZip:* - -
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as re • d inider Section 25A 'of MGL c. 152 can lead to the ihipOsitibir of criminal; Penalties of a
fine up to $1,500.00 and/or .. -year imprisonme4 as well as civil penalties in the form of a STOP WORK ORDER and a fine
ofup to $250 00 a day a the violator. Be a.clviseci That a copy of this statement may be forwarded to the °Mice of
Efestleitions of D ' f. ins. •ce co • e se cation.
!do hereby certzft u th, of perjury that the information providettaboveisince_azzd_correct______ _
VS<_gnature: Aw .4 A Date: : j — . O2 / O..
. _ . .
Phone #: (
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. Electricalinspector 5. Plumbing Inspector
• 6. Other p. •
Contact Person: Phone #:
V I A 8 - CONSTRUCTION SERVICES
' / 8.1 Licensed Construction Supe 'sor: Not Applicable ❑
V Name of License Holder : , �,�_ �= � -- / 0 Z �C7
c� ,E L_� T. 1�� _0�..rtitkait��N Any (Q e J z N umber o / z._
Addres � ) Expiratio Date 0"..._ Y (3- 32o�-703S Licens
Si ture Telephone
,
, Rectistered-Name fniii r vtfertttantitacf ri .. „ r Wa . . a Not Applicable ❑
I/ 4
Imo Cr c�� S 1(4
Company Name Registration Number
C'l \i/t1-10-1) 0(. -01. 10 ii
Address . Expiration Date
N ot f t N � M■ 1 Telephone 4r? -376 '9'O3%
-
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 ❑ No ❑
The current exemption for "homeowners” was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature ,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) [J Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0]
Brief Description of Proposed
Work: 1&V■ ic-Ascok -9 iN60 T 2) ti.r•
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
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 .
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
, as Owner /Authorized
Agent hereby dec , e t =t the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed unde p - ins and penalties • perjury.
Print Name orator
Signature IJEZUMIIIVAIMIF Date
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 1 1
Setbacks Front l I
Side = i .
". R:
L. L: ____J ? R: i
Rear
Building Height J
Bldg. Square Footage 1 t % I
Open Space Footage
(Lot area minus bldg & paved I I I _i j I _ I
parking)
# of Parking Spaces
Fill:
(volume & Location) i s _ i s
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW Q YES 0
IF YES, date issued:1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book ' Page! ' and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
I.
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
F
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 Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
, a
k
City of Northampton S . _ ® < = , -`� ,,
s i
Building Department �. _ _ . 4 i F
212 Main Street - �� - 9 fi • :fi
;
Room 100 , ta: ; , 1
1 t „
�� Northampton, MA 01060 s r
A. phone 413 -587 -1240 Fax 413- 587 -1272 = ,, ,, tot 441-
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1.1 Property Address:
This section to be completed by office
S -7 ? U - .2t�6a. sT Map Lot unit
horZ.rakN V\A,A Zone Overlay District
Elm St. °District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
t tv 4— Q4o1..yJJ k' a E. S
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Sco gttTe-(L gi Q \ TT'iet,D ST. . , klva:TiN f4ttrt>
Name (Print) -, Current Mailing Address:
"Aj L I/ - 3 L -9e1S
Signatu - Telephone
SECTI 9 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building I ',coo (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) �--
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) S 1,S t' Check Number Atyif / 4
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
354 BRIDGE ST BP- 2010 -0757
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A - 095 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0757
Project # JS- 2010- 001131
Est. Cost: $1500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. ft.): 14810.40 Owner: KIBE DANIEL E & CAROLYN Y
Zoning: URB(100)/ Applicant: SCOTT KEITER
AT: 354 BRIDGE ST
Applicant Address: Phone: Insurance:
51B HATFIELD ST (413) 320 -9035
NORTHAMPTON MAO 1060 ISSUED ON :3/2/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK :REPLACE TRIM /FASCIA & WINDOW TRIM
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: OK 3 It 1 (U Co 1(
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL ON OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of OccupancyC_ Sisnature:
FeeType: Date aid: Amount:
Building 3/2/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo