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10-023 (4) - - - CERTIFICATE OF LIABILITY INSURANCE I L. ICVV " "uU'r"" 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 policy(ies) 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(s) PRODUCER CONTACT NAME: Webber & Grinnell Ins. Agency, Inc. c °�o,Ex�: 413.586 0111 !���N�, 413.586.6481 8 North King Street ADDRESS: Northampton, MA 01060 PRODUCER CUSTOMER ID11 00021099 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A. Travelers Casualty of America Keiter Builders, Inc. INSURER 8 : Travelers Indemn. Co. CT �2 5682 51A Hatfield Street INSURER C Northampton, MA 01060 INSURER 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 R TYPE OF INSURANCE ' T EFF i MM,DorY (MMtODf LT '' ADDL ISUBR? '� INSR 11/WD POLICY NUMBER ! ! (h1h1fDDIWI� �: MMIDDfYW1') , LIMITS GENERAL LIABILITY ' I I6806319N661ACJ12', 06/01/2012106/01 /2013 .. -,- ! r 1,000,000 X , -HU- ! r ... . -, 300,000 5,000 A — { 1,000,000 2,000,000 I I ; - F_;- ,- f r 2,000, 000 I i I, AUTOMOBILE LIABILITY F `E - _L UMBRELLA LIAB - - _ ', r- _ - i; - c _.. _. EXCESS LIAB I r . i i t . WORKERS COMPENSATION I EUB 2A565 ]8 21 21 06111/2012 !06/11/2013 M T E L I I n T L d P1ET r f a.r - _ _II t� , 1T J AND EMPLOYERS 100,000 LIABILITY Y / g _ - E ,F LJ 1 - N 0 I (Mandatory in NH) F i _ C . CI. F. 100,000 1• 500,000 1 i DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES (Attach ACORD 101. Additional Remarks Schedule. 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE kAt fer ki °,;. For Information Only �° ' °' . -° Y '"'•`'" Cynthia Henderson, CISRjCINDY ©1988 -2009 ACORD CORPORATION. All rights reserved. SE V 1 E v • � �'ntS and contain jLI AND MODIFI ,F s the enure agr eement and understanding b etween the p � p +,� L g parties. Prior '' 1 t 9 representations by Contractor or Owner that are not contained in this Agreement are not a . .-- ment. In the event that any provision of this Agreement is at any time held by a Court to be ° the parties agree that all other provisions of this Agreement will remain in full force and '' .:_.re modification of this Agreement should be made in writing and executed by Owner and :' r . , ; ELLANEOUS ;.`" .,: _- is a Massachusetts contract, contains the entire agreement between us, any representations or warranties , a: essly contained in it are not a part of the Agreement, and it is binding upon our heirs, executors, successors and � _ -5. This Agreement may be modified only by an instrument in writing signed by both of us. agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Massachusetts General _a.: s 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. K' BUILDERS, INC. (CONTRACTOR) KEI HOMEOWNER l e !II Al 1-2 (0 - f 2-- b` ,../-,47,,/,') Y—.,2-4/ - 1 2 , Sco Keiter, Pres D ate 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 1 1 1 s� 4 � E 1 • Furnish and install all wiring for (3) ductless mini -split units (Pending Change Order) • Generator o SUBCONTRACTORS: • HVAC: Please see attached estimate from Orchard Valley • Generator installation: allowances are included below to formulate a budget for the project. a meeting should take place to review the specifics and revise pricing • 500 gallon LP tank with excavation, permits, and gas piping to the generator and a 2nd trench to the main house basement (to allow us to re -pipe the gas supply) (excavation costs may vary based on digging conditions) • Interior gas piping to remove the old gas main from the obsolete tank • Exterior tank work will require lawn repair, possible irrigation system repairs... pricing for this is not included in our budget Kohler 20 KW generator will be installed on the rear side of the home. Unit will rest on a PT 4x4 base that will be clad in copper and filled with crushed stone. Gas pipe will be connected from the nearby regulator (installed by tank co). Factory startup is included. Interior wiring includes a 100 A RXT advanced load management center and wiring to isolate necessary circuits and connect the generator • Option: Add Kohler On Cue- remote access system to the generator. • Electrical: Please see the attached estimate from Steve Wilson, Electrician • Furnish and install electrical wiring for generator • Generator and transfer switch supplied by Orchard Valley • Furnish and install underground conduit and conductors from utility room to generator (location to be determined) • Network o All network wiring as specified by customer in hand drawn schematic • Remove and replace (2) faucet sets to allow for new countertops • Flooring & Tile: Please see the attached estimate from S.T. Floor Covering • Furnish and install backer board with vapor barrier • Furnish and install custom shower pan • Furnish and install tile wall recessed shower niche without divider • Furnish and install ceramic tile on floor, walls and ceiling • Countertops: Please see the attached estimate from Deerfield Cabinets • Furnish and install (2) granite countertops • Bedrooms 1 & 2, Hallways, Master Bedroom, and Bonus Room o Remove and install new baseboard in all locations where carpet is being replaced with hardwood flooring ($2.25 /lineal foot allowance for baseboard) o Prime and paint all new baseboard o Remove and dispose of existing carpet, pads and nail strips o Furnish and install 2 '/4" red oak floor with (3) coats of polyurethane • Master Bedroom Closet o Furnish and install window ($650.00 window allowance) MISCELLANEOUS • Air Conditioning o SUBCONTRACTORS: • HVAC: Please see attached estimate from Orchard Valley • Mitsubishi ductless split cooling options: • Furnish and install (2) 18K btu Mitsubishi MSZ- FE18NA hyper heat (can provide supplemental heating down to -13F outdoor temp) on the 1st floor of the residence. Each system qualifies for a $500 rebate from the electric utility. Systems operate at 19 seer in the cooling mode and use a remote control type device for operation • 1st floor Mltsubishi systems (2 complete systems) • Furnish and install a Mitsubishi MSZ- FE09na hyper heat ductless split system on the west wall of the guest bedroom (over garage). Heat pump will be located below. System qualifies for a $500 rebate from the electric utility • Install (1) Mitsubishi hyper heat msz- fe09na ductless mini -split system - $500 rebate from utility • Electrical: Please see the attached estimate from Steve Wilson, Electrician o Furnish and install window in new shower area ($650.00 window allowance) o All carpentry associated with shower / toilet project (Pending Change Order) o All carpentry associated with removing and replacing counter tops o Estimate includes a $1,200 allowance for glass shower door and installation o SUBCONTRACTORS: • Electrical: Please see the attached estimate from Steve Wilson, Electrician • Remove existing exhaust fan/light and switching in water closet • Furnish and install new shower light switch outside of shower • Furnish and install (2) 5" recessed light fixtures in shower • Furnish and install new outlet at relocated toilet • Cost per fixture to change to new customer - supplied fixture (pendant, sconce, or any existing surface - mounted fixture) = $55.00 • Please note that estimate does not include light fixtures • Plumbing: Please see the attached estimate from John Thomas Plumbing • Furnish and install plumbing associated with relocating shower and toilet • $800.00 allowance to repair radiant floor heating in master bath • Remove and replace (2) bathroom faucets and (1) tub faucet • Please note that estimate does not include plumbing fixtures • Flooring & Tile: Please see the attached estimate from S.T. Floor Covering • Furnish and install backer board with vapor barrier • Furnish and install custom shower pan • Furnish and install tile wall recessed shower niche without divider • Furnish and install corner bench • Furnish and install ceramic tile on floor, walls and ceiling • Furnish and install ceramic tile on floor and walls in new toilet area. • Countertops: Please see the attached estimate from Deerfield Cabinets • Furnish and install (1) granite countertop • Girls Bathroom o Demolish and dispose of existing shower insert unit o Remove current soffit above shower o All carpentry related to shower and counters o SUBCONTRACTORS: • Electrical: Please see the attached estimate from Steve Wilson, Electrician • Remove existing light in shower area soffit • Furnish and install new recessed light above shower • Cost per fixture to change to new customer - supplied fixture (pendant, sconce, or any existing surface - mounted fixture) _ $55.00 • Please note that estimate does not include light fixtures • Plumbing: Please see the attached estimate from John Thomas Plumbing • Furnish and install plumbing for new shower • Furnish and install new circuit for range hood and remote blower • Furnish and install circuit for wine cooler • Furnish and install new circuit in island for microwave • Disconnect existing and reconnect new dishwasher • Disconnect existing and reconnect new trash compactor • Add (2) GFCI protected outlets in island backsplash • Change existing 240V outlet to 120V for new dryer (Pending Change Order) • Cost per fixture to change to new customer - supplied fixture (pendant, sconce, or any existing surface - mounted fixture) = $55.00 • Please note that estimate does not include light fixtures • Plumbing: Please see the attached estimate from John Thomas Plumbing • Remove kitchen sink and dishwasher • Replace with new dishwasher • Kitchen sink in same location • Install new sink in new island • Furnish and install new gas line to new range and dryer (Pending Change Order) • Connect and convert new appliances • Vent new range hood and new gas dryer to exterior • Please note that estimate does not include plumbing fixtures • Flooring & Tile: Please see the attached estimate from S.T. Floor Covering • Remove and dispose of existing tile and underlayment • Furnish and install new subfloor base • Furnish and install new ceramic floor tile in kitchen, laundry and mudroom • Furnish and install new tile backsplash • Cabinets and Counter Tops: Please see attached estimate from Deerfield Cabinets • Furnish new island and cabinets as specified in kitchen plan • Furnish and install counter tops as specified in kitchen plan • Customer to provide all appliances • FORMAL LIVING ROOM, FORMAL DINING ROOM, LIBRARY/ MUSIC ROOM, FAMILY/DINING ROOM, FAMILY ROOM o Please see attached estimate from S.T. Floor Covering o Sand and refinish existing hardwood floors using (3) coats of polyurethane 2" FLOOR • Master Bathroom o Demolish and prepare existing water closet for tile o Please see attached floor plan showing room layout o Site preparation & layout o Framing & drywall o Contract includes a $200.00 allowance for (1) solid core bathroom door and hardware o Contract includes a $1,200.00 allowance for (2) double, exterior doors and hardware o All baseboards, door casings, and trim for columns (base, post, and crown) o Contract includes a $1,188.00 allowance for (6) 1/4" x 3' wide x 6' tall mirrors o Carpentry necessary to add bathroom vent o (1) coat of primer and (2) coats of paint o SUBCONTRACTORS: • Electrical: Please see the attached estimate from Steve Wilson, Electrician • Furnish and install exhaust fan/light in bathroom • Furnish and install (6) outlets • Furnish and install (1) GFCI outlet in bathroom • Furnish and install (10) 2' x 2' fluorescent fixtures in Exercise Room • Plumbing: Please see the attached estimate from John Thomas Plumbing • Furnish and install plumbing for new half bath in basement, connected to existing rough plumbing • Please note that estimate does not include plumbing fixtures. • Flooring: Please see the attached estimate from S.T. Floor Covering • Furnish and install Johnsonite Replay Sport Flooring (1/4 ") in Exercise Room • Furnish and install all transitions • Furnish and install ceramic tile on floor and walls in bathroom • Ceiling: Verbal quote from Rocky's Acoustics - - pending actual quote • Furnish and install 2' x 2' flat finish, beveled edge ceiling tile and grid • Estimate assumes a $4.00 / square foot allowance for labor & material 1 FLOOR • KITCHEN, MUD ROOM, AND LAUNDRY o Remove and store existing cabinets, island, fixtures, sinks, counters, etc. o Remove and install new baseboard trim in tiled areas ($2.25 /lineal foot allowance) o All carpentry to install new cabinets, island, and trim as specified in attached kitchen plan o Prime and paint baseboard o Carpentry required to run new duct from kitchen to exterior o Furnish and install new exterior mounting block for vent system o SUBCONTRACTORS: • Electrical: Please see the attached estimate from Steve Wilson, Electrician • Furnish and install under - cabinet lighting • Furnish and install new circuit for dual -fuel range • PLEASE NOTE THAT THE FOLLOWING REVISIONS TO THE ORIGINAL PROPOSAL HAVE BEEN MADE: o Flooring &Tile pricing has been updated to reflect customer choices. o Cabinet & Countertop pricing has been updated to reflect customer choices. o HVAC Estimate #713 was used for this contract. $3,630.00 (plus 15 %) was added to the HVAC estimate to include (1) mini -split unit for the new exercise area in the basement. o The original plumbing quote was used for this contract. Anticipated changes include: Removing the cost to convert the dryer to gas (already gas), remove the cost to replace one tub faucet in the master bath, and adding the cost associated with replacing the master bath counter. o The original electrical quote was used for this contract. Anticipated changes include: Adding the cost to wire (1) mini -split in the new exercise area, removing the cost of wiring for the wine room, and removing the cost of converting the dryer from 110V to 240V. o The `Wine Room' has been eliminated from the scope of work. o Changes to the master bath shower wall are pending further onsite review with customer. o Carpentry labor has been added for the master bath counter area. o Carpentry labor has been added for the new baseboard and crown molding detail in the kitchen. o Lockset replacements are pending further review with customer. o The material and labor cost to add (1) octagon window in the master bedroom closet has been added. EXCLUSIONS: The following items are excluded from this contract: • Building Permit Fee — Following the Building Department fee assessment, Keiter Builders, Inc. will pay the fee and add the amount (plus 15% mark -up) as a change order to the contract price. • Customer will provide the following: o All kitchen appliances including, but not limited to: • Refrigerator • Microwave • Oven / Range • Range Hood and vent system • Wine Cooler • Dishwasher • Garbage Disposal o Toilets o Washer and Dryer o Sinks o Light fixtures o Plumbing fixtures o Vanity (basement 1 /2 bath) o Mirror /medicine cabinet BASEMENT • EXERCISE ROOM AND '/2 BATH BUILDERS, SCOPE OF WORK August 26, 2012 CUSTOMER NAME: Howard & Dianna Smith ADDRESS: 441 Kennedy Road Northampton, MA 01053 PROJECT ADDRESS: 441 Kennedy Road Northampton, MA 01053 START DATE: September 4th, 2012 ESTIMATED PROJECT RUN TIME: 6 — 8 Weeks GENERAL ADMINISTRATION: • Keiter Builders, Inc. will manage the following aspects of the project: o Building permit application (Building permit fee is not included in contract— Pending Building Dept.) o Standing all necessary inspections o Subcontractor oversight and management o Materials ordering and delivery o Site set -up and break -down o Waste management and removal o Portable toilet o General touch -up painting o Certificate of Occupancy GENERAL NOTES: • Included in `General Administration' is a professional cleaning, following all construction. Please see the attached estimate from Double D Cleaning Services for more information. • This is a `fixed price' contract for all non - subcontractor work. Keiter Builders, Inc. will act as a project manager for all subcontractor work. Please note that Keiter Builders charges a 15% fee for subcontractor procurement and management. All individual `subcontractor' proposals and invoices will be forwarded to Customer. Please note that subcontractor pricing may fluctuate due to changes in scope of work or other unforeseen circumstances. Any changes will be communicated to Customer and handled through a change work order. 441 Kennedy road, Northampton, MA Proposed Exercise room 4 1/2 math in easement Exterior Jr 3' -2" I 6'.p" I' _ T L_ VIII i e 5' -0" 5' -5" I IIIW \ THEATER 'T II - ,11 Ili EXEFRC1SE ROOM 4 Duct -, `r--- PJ -O " � �1 -O �b 5'-814" - m s" 'Q' a " - Ilk f !I1 5 -O" 2-6, i STORAGE o o , 5ATI4 { ! A { I 14 t -0" L L 1 22' -'1" 1 __,X____ The Commonwealth of Massachusetts Print Form Department of Industrial Accidents k1 . = ' Office of Investigations » Congress Street, Suite 100 �« • • z; Boston, MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): /o 4 r . a j:72 UIC. b&2 $ y i JC. Address: S I A I-4 A1.—.0 L-t, si City /State /Zip: /llot -N,te ti J rLt it Di 61.9 Phone #: y r 3 F- S" - LOU Are you an employer? Check the appropriate box: Type of project (required): 1 . I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Ig8euwdeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 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. t Homeowners who submit this affidavit indicating 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 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: f j 7 AU - S SE'SQ2*SCE Policy # or Self -ins. Lic. #: T 6 U 6 Q A 5 (0 5 - 7 c) a Expiration Date:: I (Q it 1 Job Site Address: 1 I ut -t y 20150 2 C City /State /Zip: d V r'K77.1 f ) 2'1 A 0 ! c' C c 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 certi a der the pains and penalties of perjury that the information provided above is true and correct. Signature: i '� li Date: 1 - ld -/L 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. 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 : ( O,D ` S License Number cs A T 6 tZ ) / V ikti?-}-A •A.A (3 ni M Of 0 tc 0 ( ,_ .2_ - .a ai 4- Addr-Al Expiration Date ,nature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ co 329S Company Name Registration Number e S 2: C, ( - 1 — Z C ■ Address Expiration Date •Tf v fcz , .1 Telephone ` '"C . ' '( ct) 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 ilding permit. Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not pos > ' 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 w.' he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or -tacked structures accessory to such use and/ or farm structures. A 8 • rson who constructs more than one home ' a two- ear • • riod shall not be considered a homeowner. Such "homeowner" shall submit to the Building Offici. , on a form acceptable to the Building Official, that he /she shall be res . , nsible for all such work • • rformed under , e buildin I emit. As acting Construction Supervisor your pre ce on the job site will be required from time to time, during and upon completion of the work for which this pe •• it is issued. Also be advised that with reference t• hapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resul ' g in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for 'ou under this permit. The undersigned "home. - ner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordi . • es, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner : gnature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding [D] Other k Brief Description of Proposed P LC7 -' T ki --r , rt �' ✓ 1 & Work: 4 A � �� �F � O K. Alteration of existing bedroom Yes No Adding new bedroom Yes ,LNo Attached Narrative / Renovating unfinished basem ip No Plans Attached Roll {fin o �{� le t/! mew( /.Iik iv[i v , ` va€N-L- 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 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 1, , 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. PLoksE Sf6 ,4I77VJ FD Beebe- -b CoArr L- it c t Signature of Owner Date I, JCz7'r" ke'T -''— , 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. fr A 7C -4--- Pri ame n f/ ,� ( ^s,d,, p k,,, r c _i S _, X>vC !Y % - I G' - (Z--- ignature of Owner /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 O DONT KNOW O 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 DONT 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? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Department use only City of North - p - - ECEIVEU S tatu. of Permit: Building Dep. nt ur• Cut/Driveway Permit 212 Main ' o sEp j o 2012 Sew . r/Septic Availability Room 1 ' O Wa -r/Well Availability Northampton, Pi I • wows Twi Sets of Structural Plans phone 413 - 587 -1240 - • • ''' PIo Site Plans 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 l i&ENry &a am Map Lot Unit 1-C -e>S r MA Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 4: 4 i A eu N r4 Snit (T7h Name (Print) Current Mailing Address: FAs E S Ek Sic A E'3j Co NTit. ti- r Telephone Signature 2.2 Authorized Agent: f3 "e l c2 , C . Q A N A't`°4'I C 1.-I5 ST . kb aT7fA p iC i MA Name t) ' Current Mailing Address: As1.1, ,3- .c '6 to CL)0 e; � 4 =ture Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 13o, 3 06 (a) Building Permit Fee 2. Electrical 9;7 3S 6`9 (b) Estimated Total Cost of Construction from (6) 3. Plumbing 9, 8 c2 e3 v Building Permit Fee 4. Mechanical (HVAC) 31, 5. Fire Protection r . o o 6. Total= (1 +2 +3 +4 +5) ) � e).° Check Number 0Z3 qf i/) 04 7 i This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0276 APPLICANT /CONTACT PERSON SCOTT KEITER ADDRESS /PHONE 51A HATFIELD ST NORTHAMPTON (413) 320 -9035 PROPERTY LOCATION 441 KENNEDY RD MAP 10 PARCEL 023 001 ZONE RR(100)/WSP(100)/WP(13)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /J oil Fee Paid f l / Typeof Construction: RENOVATE COMPLETE INTERIOR, FINISH BASEMENTWERCISE RM,BATH,STORAGE) 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 INFO ATION PRESENTED: 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 Demolition - lay 9 /c , 011 Signature of Building Official 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. 441 KENNEDY RD BP- 2013 -0276 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 10 - 023 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP-2013-0276 Project # JS- 2013- 000448 Est. Cost: $181560.00 Fee: $1089.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): 375443.64 Owner: SMITH HOWARD Zoning: RR(100)/WSP(100)/WP(13)/ Applicant: SCOTT KEITER AT: 441 KENNEDY RD Applicant Address: Phone: Insurance: 51A HATFIELD ST (413) 320 -9035 WC NORTHAMPTONMA01060 ISSUED ON:9/13/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: RENOVATE COMPLETE INTERIOR, FINISH BASEMENT (XERCISE RM,BATH,STORAGE) 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 9/13/2012 0:00:00 $1089.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner