24D-195 (7) DATE CERTIFICATE OF LIABILITY INSURANCE � Ar� ��.�Q.� Yy �
,... 1 611612014
THIS CERTIFICATE IS ISSUED AS A "BATTER OF INFQRMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVE
flAGE 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 he endorsed. If SUBROGATION 15 WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate dots not confer rights to the
.certificate holder in lieu of such endorswment(s).
sroourER C DNTACT Cynthia Henderson, CTSR
3AVtEt. _ __...._�........
IDebber & Grinnell F'M�NE 413 5as-0121 __ _FAX..
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$ North Bing Street �naAI � ehenderson@webberand rinnell.com
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' Keiter Builders, Inc. ; ssuRFRcTravelers Indemn Co._CT � 25682
lAttn: Scott Keiter �
vsuRER p
i 51A Hatfield Street INSURER
Northampton -14A 01060 iNSUFIER F
COVERAGES CERTIFICATE NU'MBER:Master Exp 12114 REVISION?DUMBER:
HIS IS r(' FTRTIF'Y':!(>T THE POLICIES OF iNSURAN(:t us rt.D i-4 LOW H Fi- I, :, Q °-7 !L i ti5L)RE0 NAMED,10VE FOR i SF POCK'ili Me!)
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i DESCRIPTION OF OPERATIONS i LOCATN}NS I VEHICLES iAthiich ACOPO tpt,Adadional Rarear85 schadwo,it more space is requw”)
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
'ruE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Evidence Of Insurance ? ACCORDANCE WITH THE POLICY PROVISIONS.
AU0,10RVED RFPRESEN7ATIYE
C Henderson, CTSRICI;!r "' •* +ho�'e-sa. ._+
ACORD 25(2010105) f 1988-2010 ACORD CORPORATION, All rights reserved.
"7'3`10 Arson r,,`1.w,.a ant{.,n.. At`nOn
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CUSTOMER zNANIE: P.J. d'Terri Copeland
,MDRE:SS: 153 Prospect Street. Northampton. MA
ESTIMATED D START Deb"FE: tiuminer. 2014
FSTEMATE:D PROJECT RUNTIME:E: t DaY
WINDOW INSERTS
This proposal includes the following:
• Please sec attached document na nK Paradigm Quotation 5t1AD000041-1 for window specifications
• Permit application, tees, and inspci;tir±ns
• Site set-tip and breakdown
■ Remove, and dispose cif. t?t existing double-hung sashes w'indoNyS to prepare for new inserts
Remove, and dispose ot; any storm t;indow units
1Zenu>ve, and temporarily relocate,existing; interior vkindow:Mops
• Prepare opening to accept new win+_lcawa
• Install fiberglass insulation in existing weigtat pockets
• Install new window units to all maiAlfaCarer �PCCifjCations
hatall all weather sealing and low expansion xvindow ham insuiation around new window frame
Rob stail existing intcHo i'indow stops _ If new interior stops are vgt6red. Conumclor will hill client
S 35AU 1 k indo .
• Install head of caulking at exterior indow
• install beak of caulking at interior of nav window
• `supply (I) Air Condhioning :support for tiiaster 3edroona ( 3N.00)
• Please not that this conuuct does am include any finiAes, including: Point. polyurethane. nail hoie linen;g.
etc.
PRICE FOR WINDOWS (INCi.,I DING TAX): S1.200.00
PRICT FOR PERMIT, LABOR, A14D AMC MATERIALS: S1 3:+0A)
'r0TAL PRICE, L'OR LABOR AND :ti.VrERIAL. S115QMO
K E,H BVILDHIS, INC.
i
Z�
11 0 t t, 1W eiter, President ate
Date
0"
Date
W 7704:
I'l IE SK-jNA I I,RF,S OF f'I IL PAR I ILI; ABOVE API'LY ONLY IT) n IF AGREEMENT Or Tj jE PARK WS
10
A I A"F_RNA FIVE DISP1jJjj SFTTI LNIEN I' I NITIA rFD BY Ij I F R
CONW ACT0R. I'IIF`. 0WNI_-.RMAY
JNHTATF 11 lIMNA11VE DISM,! !-F, jZF,`,OU40N INEN WPERE 1144 SFCjI0>j IS ;.),I,
'�F'.IIARAILILY SHWED 13Y JIM PARTH5, IIIF RRHIT 11) IN111,1111 ALTFRIVAITAX DISPUTF,
RFSOLL140N SILALE L\�
APTICE: . 1) F'\k() YEARS AFTER I IF' DAJj-j)F, 1,111S
I "-,11GYNATURES OF THE 10TWI IFS ABOVE z\PPLY ONLY H) PARIII.-S
'0 I. kli,-'N'I' INITIATUI) H)' IIIFCI)YJTItA(:TOR. WOWWWAY
IN111TATE ALII-AZNAT1VF,' f)ISPUJT RFS011111001 l-.VIN WIlEIZI.:. THIS SF' LION IS NO ']'
SFPARATIFI_X SIGNED BY THE PAR,105V JIM MUG To INIVAIT, ALTERNATIVE DISPUT171
RLSOLU'110N SHALL END PV0 WARS AFTER HlF, IT, OF FlI I S A G R I,_'P,,1 I�NT
This agreement is a ;\Iassachus�:,tts contract, contains the entire 1grcenlent betWeen us, any representations or
ALIM antics not e\pressly contained in it are not a pan of' the Agreement. and it is binding upon our heirs,
cxecutors, successors and asign% Uhis A gmernunt tray he modified only b) an instrUjilclit in writing signed by
hoth of us.
As a9monou is subject to and is ijitendcd 10 Comply 'with the provisOns of Chapter 1422 of the
Klassachuscus general Laws and its corm ponding I`Csy U lati Oils.
Mvner understands and acknowledg,,cs that Kciter Builders, Inc. may use any photos taken during the course of
:% irk 'tor promotional purposcs. This may include, but is not firnited to, the 1"ollo"ing: Website, jjew,,spapcj-s.
�,xnnais, magazines. posters. and tllyers.
1?1 G11 T TO C I_VCEL CON T1?A C T:
)VU MAY CATICEL IIIIS F0-+,N SIW\j--
j) [3Y A PARTY VIIFR[.-1'0 BY
1`0R.WARDING YOUR INIENT TO (7ANUL IN %VRITIN(,i BY ORDINARY MAll. POSTFf), jjY
! HAVRAM SENT OR 13N' DFIAVFRY. NOT 6\11R, I HAN N11DIAGIfF (* JAE IIIIRD BUSINESS
11AY FOLLOWNG THF SIGNING OFTI HS AGREENIEN1
N I
conser"anon COTMIllisSions. are reqt-ired t- be obtAned Mae Keitcr
is YOUr o Builders. In, con Main wed p,,;, it
114-'ati011 to SUisry such requimments and vcyu shall ineci those rcqUNcrnenN at your Act.
DA TES:
KCitu Builders, jjjc. will apply tor the punliB etMin 7 dqjq or qrjijl�),
Ihii A�recmer)t or your sari,��ing ally
tart oyork ywithin 45 da,. er ate is later. Kciter BuiNer, Inc. JI
,:onditions required to be inet prior to 'Ile Punlits being used. ,01ichev d,
- (s) of ohtairthij.), tile necessary purnits and oxpecls to have the
c0m*wd "Win 2 day (s) ofjwMhlQ. -,vork substantialiv
if Keiter HuNcirs. Inc. is delayed at any time. in the PM9WM of cornpleving the Nwirk, due to acts of(1,1
cf`:ji cOMMOtion. accident. governmenz regulations or policies. any "I or neglect of yours, or by any separate
()laractor- or by chut=e Ore CM or by labor disputes, fire, delay in transportation. unavai lability ()I'materials.
Adverse wleather conditj(.)ns. unavoi(la*h!e casualt-ies. difficulty in'obtaining
clecu-icilv. sere-ices or supplies
�rolll the Sources frorn m)ich ffiew- are normajo (MUM W Awl- Causes reason"MY beyond nay control, then
blatcr Huilders. Inc. niay rcasorlabiy cxicnd the djjQ ior.7ubsrafltiai Completion, Iftlic work is riot
COMPlete by tile enflame data as extended. Keiter )lujiders, Inc. twill
'lot be lidhIC to ,0(1 tier any incidental or
,,onsLquential damages vou may incur due to such delay.
if' VOU are suppl ying, any materials or Oquipment to be used in the 1W, you shall have such materials and
equipment delivered to the \vork- site no'It less than 5 days bck)rc MY are needed Or the =k. If they are (u)t
delivered on a timely basis. Keiter Builders. Inc. not be able to schedule work dependent upon illeA and the
date of substantial coillpletion will be"CO&I due to Such delay.
P14 YJfFNT.SC1V---D(1j.E:
Ile Mal Price Ibr per-Anning the wurk and supplyMg Ow matcHals under this Agreernem is
I lulldmd 02,5it)-00) DOLLMS, Par-nents against %vork Completed
inawrials ddhered. yyill i)c Inade wwilhir, 2 ja s ,For P and
71 wher, Keiter Builders. [11C. 110(ifin you that they have
i-eached different completion stages, Payrnerils Will he 111,11de in the amounts as set forth in (fie attached p'
Achedule. ayrnera
(it)% of window cost due whh signed ornmet (MM)
-401/4 of window cost+ 113 labor & misty. material due prior to initiating work (S930.00)
Final payment due At �tjbStajjtial Corti pletion.
(S901100)
All still's ;lot paid hcfbre substanikil coulPietion of the %kork will he LIUC and payable upon Substantial
Lorrlplctioll.
I'aYruelas JUC and unpaid under this A�-,rcenicnt shall bur haunt from We date payinua A slue at We annual
rate of Fighteen (M`O) percent otr at -tile maximum rate vI,,hichcNer is less. In the event that Keiter
Builders, Inc. incurs c,osN or expenses in collecting any payments due and unpaid under this Agreement, yon
sliaH Pay such costs and expenses illcltldhl' reasonable attorney's ices.
if You W h) make any layr-twnis when My are dial; dicr) Keiter Builclus,
1,,,citer Builders. Inc. may chmse to noL ,tart %work ai- Inc- (11"Y inlulediately stop work.
,.ain undl You itre cowrent with the payments and Kciter
I'Wilders. Inc. f'ecls secure in obtaininu 1hL rcnlaillhlt! pay inerlts, If"'llcre is mly, itopj-vtge in kiork, due to vour
'ailure to Pay oil time. or to make Keiter Builders, Inc, thel insecure 101 the ranahring Payments will be made.
�uch delay shall autoruaticaily extend the tatecif sue-'st,111tial COMpIction.
CONSTRUCTION AGREEMENT
Reiter Builders, Inc., of Northallip,on. Vl`' "lloic I"ederal I'lix Identification Number is 27-2518946.
Conv,uclor'.s Rev
L 2014), is
gistration Number 17`;168 ihP. 04-29-M5). and License 4102457 (Exp. 06-10-
�Intering into this Agreement With you 'I" ,
er'n Otle"11 LK:J,J.,Copeland of 153 Prospect St., North 11109nAM,
ALL RESIDENTIAL CONTRACT(.)JtS AND SUBCONTRACTORS ARE REQUIRED TO BE
REGISTERED wrm THE NIASSACHUSETTs BOARD OF BUILDING REGULATION'S ,01)
sTANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES
CONCERNING REGISTRATION SfjOUI,j) BE DIRECTED TO: DIRECTOR, VIOME
IMPROVEMENT CONTRACTOR REGISTRATION, ONE ksIIBuwrON PLACE, ROONT 1301,
BOS-11"ON, NIA 02018 (617) 727-8598.
SC 01C OFIVORK:
Leiter Builders, Inc, will pert'Orm the ,\,oLk tIet i'or-111 in the attached Scope of Work on your home. or the
- I
property located at I 5 3-Prospect St,, Northaill
P1011,, XLV I F\OU �WU!d like to chanue any work to be pertornied
or materials used, `�e have to makcAlCh changes through a Change Work Or-tier. which may also chani�e
[fie total price and extend tile date l'or completion. Change Orders will be handled on a time and material bas-Is.
Kelter Builders, Inc. reserxes the right to make niflior changes In any plans and to substitute materials of equal
Art Netter duality.
Should Keiter Builders, Inc. encounter aiv unknown conditions below the surface of the ground. or concealed
Or Unknown conditions in 'Lnv CNISUM-1 Iructure, VOLI Will agree to make an equitable .adjustment with Keiter
Builders. Inc. Linder a Charige Work Order, which shall 'increase the total price rind extend the date for
substantial completion of the work.
3erlbrrn this work. Kelter Builders. Inc., or subcontractors hired by K,21ter Builders. Inc., will obtain, on
our behalf. the following r,c rinits
Perillit Hecirical Permit Smoke Certit'icate
Plumbing Permit I
DemolitiI
on Permit Cerilticate ofOccupanev
IT IS THE OBLIGATION OF KFITFR [WILDERS, INC. TO MITAIN THESE PERMYI'S AS WtJR
k(;EAT. IN THE EVENT THAT KEITER BUILDERS, INC. DOES NOT OBTAIN TIJESE PERMITS,
AND YOU ORTAIN THEM, Oil IF KEITER 14,111,I)ERS, INC, IS NOT REGISTERED wilTH THE
BOARD OF Bt'1ILDING RF'(JA_kyI10NS, YOU WILL NOT BE FaNTITLE0 TO OBTAIN ANY
BENEFITS FROM TIIE (JrARANTFE VUND ESTABLISHED UNDI,"R
GENERAL LAWS CIIAPTER 142A. MASSAciliusErrs
,\Lifer Builders, Inc. mflis jtwrl it) obtain permits is limited to those permits directly related to performtril" tile
Kciter Builders. Inc. 10 do tile t:.xt,:nt that ether perinits or 14LAcrinilental or regulatory all-enc\
i;�l royals. Such is, but not led to, Chan-es. ""L
Hill irmnccs, ipccial pci-nilts, site plan approvals, oi-appro%als
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
Tam M-1`6si ss,Q ga itzi tiq i/Ind v>dual); C—/ / D NG.
c1li ut p: Ft4 r vine MA- D/o&Z
Ar
1. ii� n>°ei>ipl ��r?thckthappropriate:6'ox: TYAfprojeej`�ifihed)
I am an employer with 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.,D Demolition
ship and have no employees employees and have workers' ❑ Building addition
working for me in any capacity. comp. insurance.$
[No workers' comp. insurance 10.❑ Electrical repairs or additions
required.] 5. ❑ We are a 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.❑ 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. G
It suranc comp n% airie' ✓GI V cif-2 1�� ��15 lit I�ou VI e-c_
Policy#,'or Selfxi is°Lic,'# S Et b 2 A 5(05 78,9 / Expiration Date;; 2 D 75
Y6VSitepd`Bess All Locations tatty/Sate/Zip:
A14 aI-1,tP� A4 A- Q 1p
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 n er the pains and penalties of perjury that the information provided above is true and
correct.
Sgnat `e? Date;
Phone# j 3 - 8 �to D O
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#:
ZAWorkers Comp Aff-Highlited.doc
CITY OF NORTHAMPTON
PTON
Construction Debris Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work
----
covered-by-a-3*fdipg-Permii shalt be disposed .f•in aAroperly licensed disposal facility,
_ as defined by M.G.L c.-I I I § 150A.
Address of Work: �--
�lae debris_MI.be-transported by
The debris.will bb.received:at:. G(
-= - Signature of Perm git/i�PGcant
Date
Building Permit Number:
• T
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder r o–(I e eA 4--e–r C3 — 102457
IV6 License Number
MA G - -2b ,
Addre s � ✓i�
Expiration Date
S-4J ture Telephone
Home hnprovement Contractor: Not Applicable ❑
Cbmpany Name Registration Number
2615
Add r ss � Expiration Date
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.......V 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 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the 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 ❑ Replacemer4-WWdows Alteration(s) ❑ Roofing ❑
Or Doors X
Accessory Bldg. ❑ Demolition ❑ New Signs [Oi Decks [Q Siding[O) Other[El
Brief Description of Proposed
Work: fyt G Yt�l-G11 G 6]t
Alteration of existing bedroom Yes_ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing comiglete 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
I 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
C 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.
Print N e
I '
S' a re of O er/Agent Date
1
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
arkin )
#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 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW k--)k 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 0 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 0 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,excav on, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO t�7
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
�i y of Northampton Status of Permit:
� i
l ilding Department Curb CuttDriueway Permit
.J 20 2014 12 Main Street Sewerl&eptic.Av�allabilir
Room 100 water/Well vailabiiity':
Electric,Plumbing&Gas Inspe a ampton, MA 01060 Two Sets Of StruGtUr 1 Plans
Northampton, 6 7-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION 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:
Map Lot Unit
1 / L Zone Overlay District
M A o r 0 n
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of RecorA
rf a # - I
Name(Print) V Current Mailing Address:
Telephone
Signature
1*44
2.2 Authorized A ent: /
co-{ �, le Plre5 -P.+14 y F W 9%er5� WlC- 35 ��� .�— �
Na (Print) Current Mailing Address:
/Il3 5$ 6 '�6U6
nature Telephone
E 1 -ESTIMATED N U TI N
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Buildin g o (a)Building'Permit Fee
� b
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)
Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
153 PROSPECT ST BP-2014-1365
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 195 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-2014-1365
Project# JS-2014-002299
Est.Cost: $2550.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sa. ft.): 7884.36 Owner: O'NEIL THERESA A&PAMELA J COPELAND
zoning: URC(100)/ Applicant: SCOTT KEITER
AT. 153 PROSPECT ST
Applicant Address: Phone: Insurance:
5 1 A HATFIELD ST (413) 320-9035 WC
NORTHAMPTON MAO 1060 ISSUED ON.612012014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 5 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 6/20/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner