38A-045 (2) ,..
i
N K E,
BUILDERS
SCOVE OF WORK
I~ehruar\ 10, ?ill
i
i
CUSTOMER OMER NAME: Tom Cola
ADDRESS: i 175 Grove Street, Northampton—MA
I%STIMATED START DATE:: Winter r Spring
ESTIMATED PROJECT RUN TI�wIE: 1 Day
NVINDOWS (Please see attach 11 Paradigm quote# 021196390 for windoA specifications)
This contract includes the followio1j:
• Permit application, fee>. a�z !iiast>cctii it
• installation of,(8) yr indovti inl;crts. I'llis hlcludes the f2>Ho
U
Removal idisposal i;f Storm units, evistirlg,!Sash ullii-s, and 1111"<, c�?inporlent
Preparing the openinl
o to accept ncvv vv indovv units
Installation i)f ne\\ itjserts to all man u fact tire r specifications and guideline4
M1 caulking and vve.;),ther sealing
Installation of love e J)allSi011 loalll insulation arzlund llev� iw,ert unit
ins allation of ffbcrvylss insulation in am v,ill+"bizvv ov-6ollt poeka,
lie-lostallation of c\Sting,, interior \�indov, slops
• Please note that the tc)13pvv in!',are not inducled: An} painting,11,01 hole filling.stain_ pall urethalze.ol.oiller tul,llzet.
• O\Vile!" i,, responsible tCtr renlio1 ill and re-Installmion o l\lncioT1 treatnlent,� (blind" etc-)
PRICE. FOR 11,1 DO";S(lu,•luclrng Tax).` 52,150.00
PRICE FOR Pl'R:1111, AHS("ELL.I\'EOt S MATL;RLI LS,A \1) LIBOR: S1,6r.11).(1(r
TOTAL PRICE FOR LAj30R A,,VD AIATERI.,1/:
By signing this Agreement, }ou1acknowledge that you have received a complete and original signed cop,, ot'the
entire agreement and attached l�;xhibits. Keitcr B ildcts, Inc. may not start kvork until alter this Agreement has
been sinned.
DO NOT SIGN THIS C'ONTf?A(, IT THERM' ARE .tAT BLANK SPACI?S. THIS IS A LEGALLY
III, DI'S'G,4GREF t1LE,,1'?`: IF THERE ARE:1NY PROVISIO.,N,"S "III("II x'[11:` DO.' VT t .1`1)ERST�'VD.
YOU SHOULD C0:1'SULT WIllf11,tN ATTOR.,`VL*Y I L'FORE SIU I1'G.
KHTER BUILt)ERS, INC'. OWNER
i
f fV
tai, Sccyf Keiter,fresident Date l.)ate
[)rte
i
i
i
i
ii
i
i
I
I
*[cnnsc/no iunuouiminsions, u,c required (wbcobtained hc|brc KcikxBui|del'S` Inc, call obtain their punniis it
is your obligation satisfy 'reClUirenicrits at your cost.
appk
Keiter Builders, Inc. will for the permits widiin 30 dy1y of sQnlg Ods Agreemem or your MCA
any conditions requied to be &'1:t prior to the permits I)einl:,, Used. whiche\,er date is later. Keiter
will start work withn 30 dyQ 1 o olmaJining die necessary pent-Als and expeos to Me the wwrk subsumfiaily
conil-fleted within 2. day (s) ot'st:
I CKeiter fluilders, Inc. is dclaykld at any time, in the progress of conilActing the %wwk. due w acts of(jot %var-
contractor. or by change ordeN[ or by labor disputes. fire. dehi� in transportation, unavailability of'rriaterials,
t7rom the sources from \vhich t are nornially obwKed, or other causes reasollLibly beyond my control. then
Keiter Builders, Inc. may, reasoriably extend the date for substantial conliMetion. l[the w-ork is [lot SUbStantiLtik
complete bl � ,lie criding dlatc zi,� exicilded. Kciter l3uildcr," Inc. %,�ill not Inc liable lo �ou for inJdcnial or
COnSeClUential damages you nla��incur due to such delay,
equipiletit delivered U) Be "at-111 site not less than 5 daN s bebwe the) Luc needed Rn- the work. If they are im[
d6keired on a MY MY& Eli I PAIllrildas, Kc. wh1l. not be able to Schedule work dependent upon ithein and jh�.,
LUC of'substantial completion wl]l be extended due to such delay,
11C WWI Yoe AV perNmailing the work and supplying the MatCrials under this Agreement is
noterials delkeired will be macie within 2 days Crom ";hen Keiter 11tulders. Inc. notifies �(:)u that ,hey
60%, of window cost due Nvith s�igned contract (S1290MO)
40%) of window cost + 1/3 labo k dh misc. material due prior to initiating N%ork (S 1,393.00)
Final payment due at Substantlial Completion.
AH sums not paid beflorc subitantil completion of' the work 011 he due ami pajahle ulxln suhsiantial
Pa�nients due and Unpaid Under i Jhis yreement shall War bacrest frorn the date Inlynient is due at the anrimil
ratc of kighteen (I 81Y poventl or at the maxinIUM le,,Ial rate wh0heyer is OR In the event that Keita.
fiLlilders. Inc, incurs costs kit- c �
shall pay such costs mid expense, including reasonable attornefs Wes,
Ifyou fail to make Lilly pa�nie,s "hen they are due, then Keiter 111_ulder,, lm:, ma� ininiediatcil stop
fluilders. file. feels secure in obtlairling tile remaining, pa)nicnts. 11' 111k:'re i-' aul in Work dUe to ',k)UY
failurc to pay' on time, or to lnakl_ Kciier Builders. ]tic. tie! insecure diaL the renlaining, payments \\ill bc n0de.
�
�
CONSTRUCTION AGREEMENT
Koi»cr Buuuvrm, Inc.. of N Is 27'2518846.
Contracur's RcL is� � I � .
entering into this /\-ncemcn/ wihy*uTgm�('o|g of'i75 Grove 5ti-"1. N»rLh4m[ton-\1/\'
ALL RESIDENTIAL, CONTRACTOWS AND SUB(..'.ONTRACTORS ARE RE'QUIRED TO BF,
REGISTERED WITH THEI NIASSACHUSETTS BOARD OF BUILDING REGULATIONS AND
STANDARDS, UNLESS SPECIFICAL1.), EXEMPT FROM REGISTRATION. INQUIRIES
IMPROVENIENT CONTRA(I-TOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301.
BosTON, MA 02018 (617) 7217-8598.
SCOPE OF IVORK:
Kelter lluildcis, Inc. -Mll I)CI-1,61-m the %vork set forth in th, attaclwd Scope of Work on �;01.4r hoine, or th,�
property located at 1'175 Grove Sp-eet', NoTth.amptppNjA, lfV0U V\,(Alld Ilk(: to changcany woi-k to bc pcil'oniwd
ot, matemals used, we -will have lo makesuch changes through a Change Work Order. which ma� also ChanLk�
the total priceand extend the dalite 1'61, Completion. Chanoe 01i,der, will bc handle�l ona I time land matel,lal hamS'.
Should Kelter Bulldcis_ Inc. em!0UI11QI_ anV UnkA10'All condition, below mc SUII''10: ofilie gound. orcoliccaled
Builders. Inc. Undet- :I Chanoel %Voi-k Oi-dci% which sliall Increasc the total prkx and extend the ,hiic 1'67-
substantial completion of the \Ndi-k
[o per6onn this work. Kcbcr Udcn. Inc.. or yubconu-ac/urs hircJ bv Keiter 0uildery. Inc., xiU ohuin- m1
)ourhdhaL the following perm (i[rcquirel):
_x 8u }divaPcnnx Bmctricu\ Punm 8nukc [eniUcutt!
P|umNn� Ycnuk i [box�\i�unPunnh C/n\Gouuo[Uccupuoc7
----- | --'-- ---
IT IS THE OBLIGATION Olr' K F ITE R BUILDERS, INC. TO 01111 AIN TIIVSI` PERMITS AS Y01. R
ALDERS, INC. DOES NOTOBTAIN THESE 11U'.RNlITS,
AND YOU OBTAIN THEM,IOR IF KEITER BUILDERS, INC. IS NOT REIGISTERVI) NVIT11 Tua.l
BOARD OF BUILDING RVIGULATIONS, Y01.1- WILL NOT BE ENT ITL U-11) TO OBTAIN AN-Y
GENERAI... LAWS CTIAPTEII' 142A.
Keiter U Udc [tic. oblioMioll obtain i is \i teU to duwc pet-mi[a directly re}uted to pet-|boning, Lhc
work Keiter B kbxs Inc. du, ]o1hc extent that odcrycrn/iLuurpovenuncn10 orrcgyulaxn-yiwcxcy
upproru|x. such as. but not |irni/ uo` zunuchmnocs. ruriuucos. specia| pmnits. siLup|mnuppn`vu|a, uruppno'u|/
----- -----�-� |'
/
CITY OF NORTHAMPTON
Construction D*ebres Aff-idavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resuiting'from any work
averedby-a-Building Permit shalt be disposed of.in a-properly licensed disposal facility,
as defined by M.G.L. c.-I I T § 150A.
Address of Work: 75 - r a V.(__
?he.-debris_vdi.be_transpo-rted by:_
The debris will be.r6ceived-lat:. .
— ----=• - - Signature of Permit-.Al 0kiht
.'Date /to'/7"
Buiidirig Permit Number:
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Narr�e�t�s��s�i�lrga�n��atio�lr►a��iauat>: K-��� -� � ��' o�-Gr5 , L�t c -
City/State/Zip:/ a►-4a tm p M4 l)I D f,p 6 Phone W i 5-1(e- 9 6,U
Ar&ybtt'ab�employer?:Check fhe appropriate box: Type" f'jrSlecf(required)"
1.� I am an employer with 1�1 4. ❑ I am a general contractor and 1 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' 9. ❑ Building addition
working for me in any capacity, comp. insurance.$
[No workers' comp. insurance 10.❑ Electrical repairs or additions
required.] 5. ❑ We area corporation and its
officers have exercised their 11.0 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.V Other V01 nOL�
comp. insurance required.]
'Any applicant that checks box#I 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. -i-
Insurance Comp�nny I�aihe:
Policy#br Self-'iii .L%c.# ��Gc a A J�lo 5 7 a I Expiration Date:
JoV9'ite'''Ad8M All Locations City/Si40Zip
l 75�yro ve- &f-+'--"4 "b r�o`.w1P 4m titer o 'to tP d
Attach a c 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 rti and r the pains and penalties of perjury that the information provided above is true and
correct.
Signature: Date: -
tv
Phone : 3 5 to— �( 6-0
Of 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#:
ZAWorkers Comp Aff-Highlited.doc
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: GD�� %� Pi/ �'� ✓ (✓5 - 16 2857
License Number
Ad ess Expiration Date
- A z �/O
i ature Telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
&tL-eL Co pany Name Registration Number
A q - 2-4? • 90 /5
Addres zG G Expiration Date
A p I '` Q d Telephone
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 bt4ilding permit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Horne 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,Von 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 ❑ Replacemen ndows Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[O] Other[O]
Brief Description of Proposed
Work: Qf2f -ce-wCKt "t D ts.nd a•ws
Alteration of existing bedroom Yes \—V d_lo Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes - No
Plans Attached Roll -Sheet
6a. If New house and ot iliddition to existina housing, complete o' o '
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 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.
Signature of Owner Date
� � t rI ��
, as Owner/Authorized
Agent hereby declare that the statemen s 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.
S 0-FT KE ilt�
Print Oame
41-
n ture of Owfmgent Date
IQ
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
.Y,
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/Findin,g ever been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
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 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exc vation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
/'� Da�artrnertt use only
v ity of Northampton Status,,afAPermtt.: 3
uilding Department Curb Cut#Criveway Perm%
AN 1 7 2014 1 212 Main Street SewertseptrcAvailabrllty
Room 100 iNateiNVell Ariaiitbriity
EftiriC,Plumbing&Gas insoe ct Npithampton, MA 01060 Two Sets of StructurslyPidns
Northampton. ^ 413-687-1240 Fax 413-587-1272 Plot/Site Plans
C+ther 5peoify
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
�/
/7-5 0 r0 V 2 -L(.� Map Lot Unit
Zone Overlay District
lVD r- t2 wtP M�t O(0 to d
Elm St.District CIS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_--T-�>Y" C D lo
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized A ent:
e r s . r' e✓ r r< `5/ f� t t�-�+r' � f /ll o -y�t�oh
ame( dint) Current Mailing Address:
ui3 6-6
i nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applic ant
1. Building 2 oa (a) Building Permit Fee
2. Electrical `l (b)Estimated Total Cost of
Construction from' 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
dft
6. Total=(1 +2+3+4+5) 9J-7 Jr C) Check Number r
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
175 GROVE ST BP-2014-1073
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 38A-045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2014-1073
Project# JS-2014-001844
Est. Cost: $3750.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group SCOTT KEITER 102457
Lot Size(sq. ft.): 9365.40 Owner: COLO THOMAS
Zoning. URB(100)/ Applicant: SCOTT KEITER
AT. 175 GROVE ST
Applicant Address: Phone: Insurance:
5 1 A HATFIELD ST (413) 320-9035 WC
NORTHAMPTONMAO1060 ISSUED ON:411712014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 8 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 Siiinature:
FeeType• Date Paid: Amount:
Building 4/17/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner