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DRAWN BY, SP
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NOTE: EXISTING 5/8"T&G BD.
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MIN.TOTAL LENGTH OF BRACED WALL SHEATHING,ADD 13"
PANEL FOR 100 MPH WIND=11' HIGH-R ZIP SHEATHING
NAILED DIRECTLY TO
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STUDS
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WITH A 38'-0"
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FRONT ELEVATION _
CITY OF NORTHAMPTON
BUILDING DEPARTMENT 1 ` -�
These plans have been reviewed
And approved. /el_s M ref .K I\J ;I I, I ,
Date 7;7/3 Iv, he
///
Signature % (
By signing this Agreement, you acknowledge that you have received a complete and original signed copy of the
entire Agreement and attached Exhibits. Keiter Builders, Inc. 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. OWNER
-t3
,e� —�C
J3
by ott Keiter,President Date Date
Date
6
of conservation commissions,are required to be obtained before Keiter Builders, Inc. can obtain their permits, it
is your obligation to satisfy such requirements and you shall meet those requirements at your cost.
STARTING AND ENDING DATES:
Keiter Builders, Inc. will apply for the permits within 30 day(s) of signing this Agreement or your satisfying
any conditions required to be met prior to the permits being used, whichever date is later. Keiter Builders, Inc.
will start work within 60 day(s) of obtaining the necessary permits and expects to have the work substantially
completed within 90 day (s)of starting.
If Keiter Builders, Inc. is delayed at any time, in the progress of completing the work, due to acts of God, war,
civil commotion, accident, government regulations or policies, any act or neglect of yours, or by any separate
contractor, or by change orders, or by labor disputes, fire, delay in transportation, unavailability of materials,
adverse weather conditions, unavoidable casualties, difficulty in obtaining fuel, electricity, services or supplies
from the sources from which they are normally obtained, or other causes reasonably beyond my control, then
Keiter Builders, Inc. may reasonably extend the date for substantial completion. If the work is not substantially
complete by the ending date, as extended, Keiter Builders, Inc. will not be liable to you for any incidental or
consequential damages you may incur due to such delay.
If you are supplying any materials or equipment to be used in the work, you shall have such materials and
equipment delivered to the work site not less than 5 days before they are needed for the work. If they are not
delivered on a timely basis, Keiter Builders, Inc. will not be able to schedule work dependent upon them and the
date of substantial completion will be extended due to such delay_
TOTAL PRICE AND PAYMENT SCHEDULE:
The total price for performing the work and supplying the materials under this Agreement is
Ninety_Eight Thousand .Eighty Dollars and Thirty Nine Cents ($98,080.39) DOLLARS. Payments against
work completed and materials delivered will be made within 2 days from when Keiter Builders, Inc. notifies
you that they have reached different completion stages. Payments will be made in the amounts as set forth in
the attached payment schedule.
1/3 of Project Cost due with signed contract(Includes Special Order Materials) ($32,693.46)
Payment due prior to initiating work
($24,520.10)
Payment due at approximately 80% Completion ($24,520.10)
Final payment due at Substantial Completion. ($16,346.73)
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
rate of Eighteen (18%) percent or at the maximum legal rate whichever is less. In the event that Keiter
Builders, Inc. incurs costs or expenses in collecting any payments due and unpaid under this Agreement, you
shall pay such costs and expenses including reasonable attorney's fees.
If you fail to make any payments when they are due, then Keiter Builders, Inc. may immediately stop work.
Keiter Builders, Inc. may choose to not start work again until you are current with the payments and Keiter
Builders, Inc. feels secure in obtaining the remaining payments. If there is any stoppage in work due to your
2
CONSTRUCTION AGREEMENT
Keiter Builders, Inc., of Northampton, MA whose Federal Tax Identification Number is 27-2518846,
Contractor's Registration Number 175168 (Exp. 04-29-2015), and License #102457 (Exp. 06-20-2014), is
entering into this Agreement with you Ronald Malmquist.a 200 Crescent Street, NorthamptonLMA.
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:
Keiter Builders, Inc. will perform the work set forth in the attached Scope of Work on your home, or the
property located at 200 Crescent 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. Keiter Builders, Inc. reserves the right to make minor changes in any plans and to substitute
materials of equal or better quality.
Should Keiter Builders, Inc. 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 Keiter
Builders, Inc. 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, Keiter Builders, Inc., or subcontractors hired by Keiter Builders, Inc_, will obtain, on
your behalf,the following permits(if required):
Building Permit Electrical Permit Smoke Certificate
Plumbing Permit Demolition Permit Certificate of Occupancy
IT IS THE OBLIGATION OF KEITER BUILDERS, INC. TO OBTAIN THESE PERMITS AS YOUR
AGENT. IN THE EVENT THAT KEITER BUILDERS,INC.DOES NOT OBTAIN THESE PERMITS,
AND YOU OBTAIN THEM, OR IF KEITER BUILDERS, INC. IS 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.
Keiter Builders, Inc. obligation to obtain permits is limited to those permits directly related to performing the
work Keiter Builders, Inc. 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
,Comm CERTIFICATE OF LIABILITY INSURANCE 6/11/2013YY)
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 Cynthia Henderson, CISR
Webber S. Grinnell !
PHONE . (413)586-0111 1 ra No.(413)586-6481
A
8 North King Street ( ;chenderson@webberandgrinnell.com
INSURER(S)AFFORDING COVERAGE NAIL
Northampton MA 01060 INSURER A:Travelers Companies, Inc.
INSURED
INSURER a:citation 40274
Reiter Builders, Inc. INSURERC:Travelers Indemn. Co. CT 25682
51A Hatfield Street INSURER D-
INSURER E
Northampton MA 01060 .INSURER VI _
COVERAGES CERTIFICATE NUMBER raster Exp 12/13 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE JON WV,., POUGY NUMBER POLICY E� (( POLICY
RMMfDGYYYYYu 0WMlODlYYYY) LIMITS
GENERAL UABIUTY EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE i0 RENTED
PREMISES(Ea occurrencel S 300,000
A t CLAIMS-MADE n OCCUR 680631956611342 6/1/2013 4/1/2014 MED EXP(Any one pe on) _ S 5,000
PERSONAL&ADVINJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
GEM.L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AEG 5 2,000,000
` ii POLICY t ( n LOC 5
AUTOMOBILE UABIUTY COMBINED S 4GL.E URarr
ea accident) S 1,000,000
!3 , ANY AUTO BODILY IN,TJRY(Per pence) S
ALL OWNED x SCHEDULED 121003CDRO7 12/21/201212/21/2013 -
AUTOS AUTOS BODILY IPi.gJRY(Per acddem 5
X HIRED AUTOS x qOS ED PROPERTY DAMAGE S
(Per accident)
Medical troments $ 5,000
UMBRELLA UAB — OCCUR EACH OCCURRENCE _ S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
D'ID ( I RETENTIONS
C WORKERS COMPENSATION S
AND EMPLOYERS'LIAHIUT Y
�T RY LIMITS I 10TH-
AND
ANY PROPRIETORIPARTNERJEXECUTiVE Y/N 100,000
OFHCERJMEMBER EXCLUDED? ( j
E.L.N/A EACH ACCWJEN? $
(Mandatory In NH) `15UB2156578213 6/11/2013 411/2016 E.L.DISE/4. -EA EMPLOYEE 5 100,000
L yes,describe under
DESCRIPTION OF OPERATIONS below _ _ EL DISEASE-POLICY LIMIT 5 500,000,
1 I 1
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It mote 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
***** For Information Only ***** ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C Henderson, CISR/CIN ''Sow.e4N.ci
ACORD 25(2010105) (0 1988-2010 ACORD CORPORATION- All rights reserved.
IttROOS mmnnss nt TH Arnan nen.cs,r.rl I,.,.. -arcs rcsnietasneR....rt..,.f ernan
,
-f/
BUILDER . ',: i:
SIDING Vii. EXTERIOR TRIM
SCOPE OF WORK
August 18,2013
CUSTOMER NAME: Ronald Malmquist
ADDRESS: 200 Crescent Street,Northampton,MA 01060
ESTIMATED START DATE: Fall 2013
This contract includes the following:
• Permit application, fees, and inspections
• Portable toilet
• Staging delivery, set-up,and break-down
• Coordinate utility to install protective boot on service to home
• Daily site cleanup
• Demolition and debris removal. This includes:
o Following EPA RRP Lead-Safe demolition practices
o Rip all siding, backing board, and any exterior trim to wall sheathing
o Demolish and remove all back porch debris. Leave concrete slab in tact
o Preparation of sheathing to accept new siding(i.e.removing nails,nailing off loose pieces, etc.)
o Inspection of all sheathing—report to Owner
o At this time, any blown-in insulation from the exterior would occur
o 30 Yard Dumpster
• Furnish and install the following items to all manufacturer specifications:
o 6 '/d" (5" exposure)pre-primed smooth hardiplank lap siding
o New 5/4" x 6"Boral Trim exterior corners—Proper membrane flashing at joints
o New 5/4" x 4"frieze trim below all soffits
o New flat casing(Boral)at garage door and(3)exterior doors
o Boral flat casing at all window locations not in this proposal(See Window Proposal)
o Install Elastomeric caulking at all siding/trim junctions, and at all butt joints in field
o Install aluminum flashing behind all butt joints in field
o Install Boral mounting blocks at any wall penetrations—properly flash
o Flash junction between siding and chimney
TOTAL SIDING AND EXTERIOR TRIM PROJECT:
14450.00
,
JBUILRS' l
WALL SYSTEM AND ROOF MODIFICATON
SCOPE OF WORK
AUGUST 18,2013
CUSTOMER NAME: Ronald Malmquist
ADDRESS: 200 Crescent Street,Northampton,MA 01060
ESTIMATED START DATE: Fall 2013
This contract includes the following:
• Permit application, fees, and inspections
• Daily site cleanup
• Furnish and install the following items to all manufacturer specifications:
o Cut horizontal troughs to allow access to existing fiberglass insulation. Remove insulation from
wall cavities from the exterior and reinstall sheathing
o Facilitate blowing of cellulose insulation into wall cavities from exterior
o Install 1 '/" High-R Zip sheathing around home
o Seal all joints using Zip Tape
o Install 1 x 3"vertical strapping(pine furring)at all stud locations to create air barrier and drainage
plane
o Zip Sheathing to act as drainage plane
o Countersink and fasten strapping using 4 '12"Headlok Lags every 24"
o Custom bend and install appropriate aluminum flashing details at all fenestration heads
o Install Core Vent at bottom and top of all channels
o Custom bend and install appropriate aluminum flashing detail at bottom of wall to encapsulate foam
for weather and insect protection
o Bump fascia and rake trim out to allow for air escape at top of wall plane—moisture control
o Remove all existing gable end trim
o Cut back roof sheathing to 2nd rafter and install new roof sheathing to carry out to new edge
o Install new rake framing to accommodate new wall plane and additional overhang
o Install new rake trim and soffit using Boral trim. Proposal assumes an approximate 7" overhang
o Leave roof in watertight condition until roofing contractor arrives
o Cut back eave fascia and soffit and Dutchman in new trim to extend to new rake
o Bump out flat roof fascia in similar manner on garage North and South Side
TOTAL PRICE FOR LABOR AND MATERIAL: $24,750.00
({it 1v44
EXTERIOR DOORS
SCOPE OF WORK
AUGUST 18,2013
CUSTOMER NAME: Ronald Malmquist
ADDRESS: 200 Crescent Street,Northampton,MA 01060
ESTIMATED START DATE: Fall 2013
This contract includes the following:
■ ALLOWANCE FOR DOORS AND HARDWARE=$2,200.00
■ LABOR AND MISC. MATERIALS INCLUDING:
o Demolition and Debris Removal
o Opening preparation including pan flashing
o Installation of new door units to manufacturer specifications
o All weather and air sealing
o Exterior trim is covered under estimate named"Siding and Exterior Trim"
o Interior extension jambs and casing
TOTAL PRICE FOR LABOR AND MATERIAL: $4,150.00
8 ere
WINDOWS
SCOPE OF WORK
August 18,2013
WINDOWS (Please see attached r.k.Miles quote#3Y7K53X for window specifications& pricing)
This contract includes the following:
• Permit application,fees,and inspections.
• Waste disposal.
• Daily site cleanup.
• All construction will be isolated and contained using portable tent enclosures.
• Installation of(18)new construction windows. This includes the following:
o Full tear-outs. Removal of existing interior trim,jambs_frames,windows,and exterior trim. This proposal
assumes that siding will be removed prior to window installation
o This proposal assumes that all windows and doors will require a custom milled and installed extension jamb
o Rough opening preparation including pan flashings
o Installation of new window units to all manufacturer specifications
o All weather and air sealing
o Installation of new,5/4"x 4"Boral Trim(or equivalent)_ To be constructed as a surround on worktables
using hidden fastening system(pocket screws and glue). Installed a single unit
o Installation of new aluminum drip caps at headpiece
o Installation of new interior casing(2'/2"colonial),window stools(Poplar);and aprons
• The following openings arc to be modified per Owner's request. All carpentry(structural/framing,siding,drywall,
insulation,flashing,etc.)is included:
o (#3) South Wall Left Side: Increase opening size from 25"x 41"to 60-x 60"
o (#8) Kitchen North Temp: Change from exterior door to window-34"x 51"
o (#12) Master Bedroom: Increase opening size from 25"x 41"to 120"x 41"
o (#14) Office North: Increase opening size from 34"x 39 to 34"x 44W'
o (#15) Office East: Increase opening size from 34-x 39%"to 34"x 44 2'
o (#17) Guest East: Increase opening size from 34"x 40"to 34"x 44%"
o (#18) Guest South: Increase opening size from 31"x 40I I"to 31"x 44 %"
• Per review with Architect, the large window located in"Rome's Room"needs to be structurally modified. This
includes the following:
o Remove existing header and replace with(2)9 %"LVLs
o Verify continuous posting(jacks)to wall plate
o Temporary support of ceiling joists during project
o Re-installation of sheathing and insulation
• Please note that the following are not included in this contract:
o Any engineering or architectural plans that may be required by the Building Dept.
o Any electrical or plumbing work—if required
o Any painting,nail hole filling,stain,polyurethane,or other finishes.
INTEGRITY WINDOWS(including Tax): 81.7,246.39
PRICE FOR MISCELLANEOUS MATERIALS,AND LABOR: $16,600.00
TOTAL WINDOW COST: $33 846.39
8_.
CITY P NORTHAMPTON
• Construction Debris Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work
co-ver-ed by-a-Building Permii shalt be disposed of in a-properly licensed.disposal facility,
as defined by M.G.L. c. 111 § 150A.
•
•
• Address of Work: 200 CR€ ems. �
4 -f!a� Ma DIOG0
__The-debris_will.be-transported by: e-etiti!. .5-iddider r t4'l C •
The debris.will be received:at:. � � PiG7G-i/‘149
— _ Signature of Permit Applicant - '
u-- Date S ' Z 7. 3
- Building Permit Number:
•
•
•
•
•
•
•
•
•
•
•
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
• 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information {{ / Please Print Legibly
Name(Business/Organization/Individual): re r417 5a/ w-e r5i 4C.
Address: 5/ A--
City/State/Zip: /t/OVfa.imp 1 /IAA— 011)&0 Phone#: 4413. 58 6 86O
Are you an employer? Check the appropriate box: Type of project(required):
1. I am an employer with - 4. ❑I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling
listed on the attached sheet.
2. ❑ I am a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition
ship and have no employees employees and have workers'
working for me in any capacity. comp.insurance.$ 9. ❑ Building addition
[No workers'comp.insurance 10.❑ Electrical repairs or additions
required.] 5. ❑ We are a corporation and its
officers have exercised their 11.❑ Plumbing repairs or additions
3. ❑ I am a homeownerSeattle8 doing right of exemption per MGL c. 12.❑ Roof repairs
all work myself. [No workers' 152,§1(4),and we have no
comp.insurance required.]t employees. [No workers' 13.❑ Other
comp.insurance required.]
*My 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.
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. 'j� �
Insurance Company Name: 1 �a ✓ 'Q V j / uvanc-e..-
Policy#or Self-ins.Lic.#: E 013.9 5'5 7g;1 a Expiration Date: 6, ' 1/•.2 b/3
Job Site Address:All Locations BOO Gre SC-e £WeQ k City/State/Zip: NO V-44.444 p# MA- D 10 ben
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 rtify u r the pains and penalties of perjury that the information provided above is true and
correct. t/ I
Signature: $4 f I�tiW OI Ide✓f) IMC, Date: B• 27. 13
Phone#: 11-/3 -5236 —866
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#:
Z:\Workers Comp Aff-Highlited.doc
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ n 2 /�
Name of License Holder: S COT T- ��1"c�— ( 3 - /6 ` / 5 7
License Number
51 A N a-f-Ci d sf. NOV-I-ka frwein IAA- 01b6,0 to - 20 • /+
Ad 4 ess Expiration Date
I 1 v VA,r/N-:--___ 14(5.51 - $600
4:ture Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
1<eP+-ev Bu ./d-eve, Go c . / 75/ (01S
Com an Name Registration Number
51 A af1.("mod 9f 44. 27- /5
Adclress �/� � Expiration Date
r�G�avv� ►"` 616 6 Teleplio'ne5�L. .S Wild
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 4 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 ❑ Replacemegt Wjndows Alteration(s) Roofing D
Or Doors
Accessory Bldg. ❑ Demolition El New Signs [DI Decks [q Siding[0] Other[
Brief Description of Proposed
Work: YepIa Ce en.4- 1 'in of ow cliKoors �fGLin r pc-fev.'or- ri roal mod,CtGGc�e-r�
Alteration of existing bedroom Yes g 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 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
, 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
eo Pr
I, Kt �
, ate Intl e -� i`'eV �� A`1kV5 1 `�"'G' , 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.
Si, ed n•z the pains and penalties of perjury.
... / CoTr K r
' N.mei
nature•f r er/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 DON'T KNOW ® YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES II NO ®
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.
r,. Department use only
\( City of Northampton Status of Permit:
�('�(� ��� `'� Building Department Curb Cut/Driveway Permit
v �^ 1 i 212 Main Street Sewer/Septic Availability
,�-� 20`3 Room 100 Water/Well Availability
,` orthampton, MA 01060 Two Sets of Structural Plans
t =Vin-` - -587-1240 Fax 413-587-1272 Plot/Site Plans
�r`9°Mp,O i;.
Qwn`m.�On, Other Specify
syeAdtt‘'14,30 0.
PPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: L
�x0 CiKe SG� S"�►e--L Map Lot Unit
Nos' ti P f 6Y_ MA- 010(v0 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ill
/44V�,4 (47;51-
Name(Print) o Current Mailing Address:
v Telephone
Signature
2.2 Authorized Agent: � �`
Ke►=eV .tf'id-er�, hnc . dzi- -eel'-ter 5! A Oa-f-g 24-1(64- Aforiinawi,o1n 4
Nam- (Print) Current Mailing Address: b IOW
Pic______ 4-15 -5' -gt-,aa
Si.1.ture Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 9B/ D So 39 (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) 98,o8O , 31 Check Number 02 7
This Section For Official Use Only
Building Permit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0237
APPLICANT/CONTACT PERSON SCOTT KEITER
ADDRESS/PHONE 51A HATFIELD ST NORTHAMPTON (413)320-9035
PROPERTY LOCATION 200 CRESCENT ST
MAP 24C PARCEL 184 001 ZONE URB(54)/URA(46)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out t 7t7 f5 r3
Fee Paid J
Typeof Construction: INSTALL REPLACEMENT WINDOWS/DOORS,SIDING,ROOF,EXT TRIM&ROOF
MODIFICATIONS
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
INF9RMATION 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 Delay
/
Sit ture of Bui ding - icial 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.
200 CRESCENT ST BP-2014-0237
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 184 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-2014-0237
Project# JS-2014-000391
Est. Cost: $98080.00
Fee: $588.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. ft.): 12806.64 Owner: MALMQUIST RONALD
Zoning:URB(54)/URA(46)/ Applicant: SCOTT KEITER
AT: 200 CRESCENT ST
Applicant Address: Phone: Insurance:
51A HATFIELD ST (413) 320-9035 WC
NORTHAMPTONMA01060 ISSUED ON:8/29/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS/DOORS,
SIDING,ROOF, EXT TRIM & ROOF MODIFICATIONS
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 8/29/2013 0:00:00 $588.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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