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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 BY
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 original 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 AN ATTORNEY BEFORE SIGNING.
KEITER BUILDERS, INC. (CONTRACTOR) HOMEOWNER
4 /Z A L 2
by, S r Keiter, President Date Date
Date
ADDENDA
The following have been attached to this Agreement:
1. PAYMENT SCHEDULE
2. SCOPE OF WORK
3. COPY OF INSURANCE
4. LIMITED WARRANTY
5. CHANGE ORDER (COPY AND EXPLANATION)
11
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.
KEITER BUILDERS, INC. (CONTRACTOR) HOMEOWNER
(13 cel
By/14
y ott Keiter, 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 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 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.
10
ALLOWANCE work, all Owner - furnished materials, and all work of Owner's separate contractors who
are working on site at same time as Contractor. The amount of the Additional Work will be reasonably
determined by the Contractor, and will be subject to Contractor's profit and overhead as noted above.
Contractor's profit and overhead, and any supervisory labor will not be credited back to Owner with any
deductive Change Orders (work deleted from Agreement by Owner).
RATES CHARGED FOR ALLOWANCE - ONLY AND TIME AND MATERIALS WORK
Journeyman Carpenter: $45 per hour; Apprentice Carpenter: $35 per hour; Laborer: $30 per hour;
Contractor: $50 per hour; Subcontractor: Amount charged by Subcontractor. Note: Contractor will charge
for profit and overhead at the rate of 25% on all work performed on a Time - and - Materials basis (on both
materials and labor rates set forth in this Agreement) and on all costs that exceed specifically stated
ALLOWANCE estimates in the Agreement.
PEOPLE AUTHORIZED TO SIGN CHANGE ORDERS
The following people are authorized to sign Change Orders:
(Please fill in line(s) above at time of signing Agreement)
PERMITS
To perform this work, Keiter Builders, Inc., or subcontractors hired by Keiter Builders, Inc., will obtain, on Owner's
behalf, the following permits (if required):
x Building Permit Electrical Permit Smoke Certificate
Plumbing Permit Demolition Permit Certificate of Occupancy
IT IS THE OBLIGATION OF CONTRACTOR TO OBTAIN THESE PERMITS AS YOUR AGENT. IN THE
EVENT THAT CONTRACTOR DOES NOT OBTAIN THESE PERMITS, AND THE OWNER OBTAINS
THEM, OR IF CONTRACTOR IS NOT REGISTERED WITH THE BOARD OF BUILDING REGULATIONS,
OWNER WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND
ESTABLISHED UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 142A.
Contractor's obligation to obtain permits is limited to those permits directly related to performing the work Contractor
agrees 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 Contractor can obtain their permits, it is the Owner's obligation to satisfy such requirements and to meet
those requirements at the Owner's cost.
PAYMENT SCHEDULE AND PAYMENT TERMS
The total price for performing the work and supplying the materials under this Agreement is
Twenty Two Thousand, Eight Hundred and Sixteen Dollars and Twenty Eight Cents ($22,816.28) DOLLARS. Payments
against work completed and materials delivered will be made within 2 days from when Contractor notifies Owner that
Contractor has reached different completion stages. Payments will be made in the amounts as described in the addendum
named "Payment Schedule ".
All sums not paid before substantial completion of the work will be due and payable upon substantial completion.
Payments due and unpaid under this Agreement shall bear interest from the date payment is due at the annual
4
DECK (APPROXIMATELY 450 SQUARE FEET)
This contract is for a pressure- treated deck extending approximat feet off of the north side of the new
addition. This deck will be L- Shaped and run approximately eet in the east /west direction. The section
running down the west wall of the new addition will extend approximately 7 feet off of the wall. The deck
will carry down this same west wall to the secondary exterior door that leads to the kitchen area.
This contract includes the following:
• All excavation and site work. PeAfi S e ,
• Concrete footings.
• Framing and structural assembly.
• Pressure treated deck planks. /1/k7-G
• Pressure treated railing assembly.
• (2) sets of stairs to grade.
• Lattice beneath deck.
• Fascia beneath deck.
PeA SC_ ;
s 4, t(z.
SIGNATURE DATE
I
ik BUILDERS I
SCOPE OF WORK
June 24th, 2012
CUSTOMER NAME: Therese Kim
ADDRESS: 125 Barrett Street
Northampton, MA 01060
PROJECT ADDRESS: 125 Barrett Street
Northampton, MA 01060
ESTIMATED START DATE: August, 2012
ESTIMATED PROJECT RUN TIME: 2 — 4 Weeks
ADMINISTRATION
• Keiter Builders, Inc. will manage the following aspects of the project:
■-; o Building permit application and fee
o Standing all necessary inspections
o Subcontractor oversight and management
o Materials ordering and delivery
o Site set -up and break -down
o Certificate of Occupancy for Deck
WINDOWS
Please see the attached document named "Quote #S3JE61V" generated on 06 -23 -2012 from Marvin. This
document is (5) pages in total. All window specifications are listed in this document and Owner agrees that
she has read, understands, and approves all specifications as said. Contractor has reviewed all
specifications with Owner in person.
LABOR & MISC. MATERIALS:
• (7) New Construction Windows - (5 in bedrooms, 1 in bathroom, 1 large unit in living room)
o These are `full tear -out' windows — Remove and dispose of existing window sash and frame units,
storm windows, interior and exterior trim (i.e. Bring window opening back to rough framing) - -
Install new window units, all pan flashing, caulk, foam insulation, exterior trim using white pvc flat
casing, interior trim to match existing.
• (3) Window Inserts — (3 casement window inserts in living room)
o Remove and dispose of existing sash units and storm windows, prepare opening, install new Marvin
window inserts, all caulking and insulation, new interior window stops.
trVOt P(L ( �C S � c iN(L - 4� 6 A{ p it t t ►LG STA-1 )
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I �Q Descriptor /Area
C
.1 Fr/B
1168 sgfk
B: Fig
375 sqft
30 ?F -- --, :30 C:2Fr ?B
t 600.} 600 sgfk
15 `0
40
FG
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_ 26
616E0
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15
8
16
CERTIFICATE OF LIABILITY INSURANCE
06/01/2012
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 policyiies) must 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(sl.
PRODUCER CONTACT
NAME
Webber & Grinnell Ins. Agency, Inc. PHONE FAX
Ext� 4 13. 586.0111 Not 413. 586.6481
8 North King Street E- MAIL
Northampton, MA 01060 PRODUCER 00021099
CUSTOMER ID p
INSURER(S) AFFORDING COVERAGE l NAIL
INSURED
INSURERA: Travelers Casualty of America
Keiter Builders, Inc. INSURERB: Travelers Indemn. Co. CT 125682
51A Hatfield Street INSURER C:
Northampton, MA 01060 INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: Master Exp 06/13 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR 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 _ - -- '.ADOL SUBR' - - -- POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE I INSR WVD I POLICY NUMBER (MMIDDIYYY` ) (MMIDDFI'WY) LIMITS
GENERAL LIABILITY I6806319N661AC312, 06/01/2012'' 06/01/2013 1,000,000
X = 300,000
5,000
A 1,000,000
2,000,000
2,000,000
•
AUTOMOBILE LIABILITY
UMBRELLA LIAR -
EXCESS LIAR _ - --
WORKERS COMPENSATION I EUB 2A 56 5 ] 8 212' 06/ 11 /2012 06/11 /2013
AND EMPLOYERS LIABILITY i IA
• 1 Y I N • 100,000
- - i_
N
L
(Mandatory in NH) •.n r f• 100,000
E L E
500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule ifmore 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
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE f_� rl
'-ice`" l�dlAdr✓
For Information Only ' °`''' Cynthia Henderson, CISR /CINDY
® 1988-2009 ACORD CORPORATION. All rights reserved.
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
IMMO ' Boston, MA 02114 -2017
`" r =" www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information pp Please Print Legibly
Name ( Business /Organization /Individual): )-A_ OV,LbE .A S S_N
Address: 51A 1 ATE
City /State /Zip: NocLT ,71Ztv, VM4 Olv6 p Phone #: y13 - 32 - 70 3S
Are you an employer? Check the appropriate box: Type of project (required):
1. Naam a employer with 3 4. ❑ I am a general contractor and 1
employees (full and/or part-time).* have hired the sub contractors 6. El New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
g Y P h 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 1 0.❑ Electrical repairs or additions
officers have exercised their 11. Plumbing re
3. ❑ I am a homeowner doing all work g airs or additions P
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities 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 my employees. Below is the policy and job site
information.
Insurance Company Name: Lek 5 SJVs.A.,ANC7= ,
Policy # or Self -ins. Lic. #: )._E v,(3 a.A 5 GC - 7$011 oL Expiration Date: ( - I — i3
Job Site Address: 12c dA cum ST. City /State /Zip: N c41...114AAAMAL O k Ot
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 fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c ify under a pains and penalties of perjury perjury that the information provided above is true and correct
Signature: , t,resc del Ve t vi(. E that.S 1 -1,A. Date: 7 -3 0- 12.
Phone #: 4 /x'3'320 -703c
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit /License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
�/
Name of License Holder : JC orr PEE ' i-e-n- / 0 2 YS 7
License Number
S 1 A 1..4.4 N ortTl-F 1 . T N t MA- o vc.‘c o (o - .2 0 — 14.
Addr s Expiration Date
74 ,,3_32.....03,-
. ature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ke t' k e 1/4,, L. betLN , s N C • )4,3-2.9S-
Company Name Registration Number
5% - A ST. Nv211 -A�t M+4 oiob o (o (— 13
Address Expiration Date
Telephone L/,3 "321. 9 )3$
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 ❑
11. - Home Owner Exemption
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 1083.5.1.
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 building 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) ❑ Roofing ❑
Or Doors El
Accessory Bldg. El Demolition ❑ New Signs ED] Decks [kr Siding OD] Other j ►n!
Brief Description of Proposed
Work: NEW \.J \N bso ..) S 1 �s:GK
Alteration of existing bedroom Yes X No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes )( No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing 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 w- lands? 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
R_G — Ab e,. SEE A rnAC -keb . S\ G N€ C rR,AC.T , 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
I, co r \4 `rt - , 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.
ca \f/..E % . 1 - E 6L —
i f - Na n
/ Ph S k n L`K- 5c. icbet5, l NG. 1 2- 30 - 1 _
Sign( re of • ner /Agent 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
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
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? YE_ O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
j JUL 0 2012 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
L phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
DE.:
NCRThr:iv`
Other Specify
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
i. S tgAafze'r ST. Map Lot Unit
N O 411a0.,q'',Z7t1/4.) , ./.., A o t 0 to o Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
if 671.65 6., k t ■%/ /2S ei1 '1'r ST'. IV o al to.w-Q'i &v , ►^1 A
Name (Print) Current Mailing Address:
h 44/3 - SBS - 0 6 4
`'LE E SC E Va...irn.A CT. Telephone
Signature
2.2 Authorized Agent:
ke,Te& at,�LAD uc . 51 A N F1eL_D s-r. / fvo� TINY i On IN
Name ' int) Current Mailing Address:
/, .- r iQ04-siol k• L4t3 • 32_0 -9o3<
Sii ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building $ 2 . , 31 $ (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 �7
6. Total =(1 +2 +3 + +5) 4 22 $
,16• Zed _ Check Number d ) ' . !3'[
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0117 o
APPLICANT /CONTACT PERSON SCOTT KEITER
ADDRESS /PHONE 51A HATFIELD ST NORTHAMPTON (413) 320 -9035
PROPERTY LOCATION 125 BARRETT ST
MAP 24A PARCEL 048 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �3 r? .y 1 7
Fee Paid 4 �
Typeof Construction: CONSTRUCT L SHAPED DECK & INSTALL REPLACEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102457
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9l.MATION PRESENTED:
f Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
,lition Delay
ature of i r 'din! • fficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
125 BARRETT ST BP-2013-0117
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A - 048 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck • BUILDING PERMIT
Permit # BP- 2013 -0117
Project # JS- 2013- 000189
Est. Cost: $22816.00
Fee: $137.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. ft.): 25918.20 Owner: KIM THERESE MARIE
Zoning: URB(100)/ Applicant: SCOTT KEITER
AT: 125 BARRETT ST
Applicant Address: Phone: Insurance:
51A HATFIELD ST (413) 320 -9035 WC
NORTHAMPTON MAO 1060 ISSUED ON: 8/6/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT L SHAPED DECK & INSTALL
REPLACEMENT WINDOWS
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 8/6/2012 0:00:00 $137.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner