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24A-104 (3) ,aco CERTIFICATE OF LIABILITY INS °/16 ,D° � INSURANCE 6, 6/,20114 4 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 CAM�ACT Cynthia Henderson, CISR Webber & Grinnell PHONE (413)586-0111 FAX (413)586-6481 AIC 8 North King Street EMAIL .chenderson @webberandgrinnell.com _____INSURER(S)AFFORDING COVERAGE NAIC N Northampton _ MA 01060 INSURERA:Travelers Casualty of America INSURED +NSURERB:Citation 40274 Keiter Builders, Inc. INSURERCMravelers Indemn. Co. CT 25682 _ Attn: Scott Keiter INSURER 0: 51A Hatfield Street wsURERE! _ Northampton MA 01060 1 INSURER F COVERAGES CERTIFICATE NUMBER14aster Exp 12/14 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 ADDL SUBR POLICY EFF POLICY EXP L.TR TYPE OF INSURANCE INRR WaL POLICY NUMBER M D 01Y YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X_ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED �� PR MIS S a occurrence $ 300,000 A _ CLAMS-MADE n l OCCUR 6806319N6611442 6/1/2014 6/1/2015 MEDEXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS•COMP/OP AGG $ 2,000,000 X POLICY PRO- I-OC $ AUTOMOBILE LIABILITY EO adBINED1SINGLE LIMIT _ 11000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BCDR07 12/21/201312/21/2014 BODILY $ AUTOS AUTOS _ X HIRED AUTOS X NON OWNED PROPERTY DAMAGE $ ._ - AUTO.. Per dent) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAMS-MADE AGGREGATE $ _ DED RETENTION g C WORKERS COMPENSATION X ]MY STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100 000 OFFICER/MEMBER EXCLUDED) N/A (Mandatory in NH) IEUB2A56578214 6/11/2014 6/11/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESGR7PTION OF OPERATIONS below �` E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Henderson, CISR/CIN =RD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved, GLASS September 3, 2014 Description Cost t insulation -Low expansion foam insulation around new window frames -Fiberglass insulation in existing weight cavities i ! Window(Half Round) ALL LABOR AND MISC MATERIALS Preparation of opening Installation of window to all manufacturer specifications Installation of new interior stops Windows SEE RK MILES QUOTE XRNIDBM Windows(inserts) ALL LABOR AND MISC.MATERIALS Preparation of opening to accept insert Installation of 25 inserts to all manufacturer specifications Furnish,and install,frame expander's at sill location 0 . Staging and ladders • Exclusions Any painting,nail hole filling,or other finishes Owner to remove,and reinstall,window treatments Project Total 26,481.17 r Approved By: Date: 9/3/14 ,°; ! Date: Contractor Customer i Keiter Builders, Inc., License#: 102457 2 GLASS September 3, 2014 Keiter Builders, Inc. SCOPE OF WORK 35 Main St. Florence, MA 01062 Office 413.586.8600 K"E I To"E R Fax 413.280.0124 scottkeiter @gmail.com NBUILDERS,,` www.KeiterBuilders.com License #: 102457 Project --- --- - Customer T GLASS Pablo Yglesias & Margot Glass Office 413.582.9282 409 Prospect St. PO Box 83 Mobile 413.218.8243 Northampton, MA 01060 Northampton, MA 01061 nonidesigns@comcast.net Description— _— — — _ -- ---— ---- Cost r a Demolition&Debris Removal Remove,and dispose of,existing sashes Remove,and dispose of,existing storm windows Remove,and dispose of,existing window weights General Administration Lead Safe Practices Materials Running Permits Site Set-Up&Breakdown Waste Removal Dump Truck Work Isolation Drop cloths Tent enclosure if required Vac clean Interior Trim Remove and reuse existing interior stops Remove screws from interior stops Use trim nailer to install existing stops Install secondary stops to bridge space between new window frame and old stop Secondary stop to be standard piece of molding ae t Caulking&Sealants Caulking between window frame and exterior blind stop Caulking beneath window frame -Caulking between new,secondary stop and window frame ` Keiter Builders, Inc., License#: 102457 1 f � ' KEITER BUILDERS, INC. OWNER By*'tt Keiter, President Date ! 1 ate Date NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE, THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT. NOTICE: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE, ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT. MISCELLANEOUS. This agreement is a Massachusetts contract, contains the entire agreement between us, any representations or warranties not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs, executors, successors and assigns. This Agreement may be modified only by an instrument in writing signed by both of us. This agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Massachusetts General Laws and its corresponding regulations. Owner understands and acknowledges that Keiter Builders, Inc. may use any photos taken during the course of work for promotional purposes. This may include, but is not limited to, the following: Website, newspapers, journals, magazines, posters, and flyers. RIGHT TO CANCEL CONTRACT. 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. 5 ?i� l . 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 DAT'F.S: Keiter Builders, Inc. will apply for the permits within 7 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 10 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 Twenty Si_x_ Thousand Four Hundred and Eighty One ($26,481.00) 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. 60% of window cost (i cl /r► mlikkr uo) due with signed contract ($10,495.00) 40% of window cost + 1/3 labor & misc. material due prior to initiating work ($6,997.00) Final payment due at Substantial Completion. ($8,989.00) 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 failure to pay on time, or to make Keiter Builders, Inc. feel insecure that the remaining paymen s will be made, such delay shall automatically extend the date of substantial completion. 2 1 °1-1 He4 re �, U 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 4102457 (Exp. 06-20-2016), is entering into this Agreement with you Pablo Yglesias & Marmot Glass of 409 Prospect St., Northampton. MA. 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 409 Prospect St., 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): —x--- 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 , f i CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting'from any work - -- ver-ed:.by-a-B-u-ilding Permit-shalt be disposed,of in a=properly licensed.disposal facility, as defined by M.G.L.- c.- f I T § 150A. Address of Work: b�4' AAA. .p4 zaVA - --T-h"ebris_wi11.be-transported by:_���'��K-- The debris.wiH be received i�t:. Q,L Rib t Y1 Signature of PennitA'Plicant 'Date !I; / ti 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 Legibly Name (Business/Organization/Individual): KC (TEfe- SUl1X>ele'5 INAC- Address: _ ma1 h s�re_.c,76 City/State/Zip: -Y C-e_ /11 A 0 IM- Phone ( " 8196 Are you an employer? Check the appropriate box: Type of project(required): 1. 1 am an employer with_1 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. ❑ 1 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 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.] j 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. -j' n' Insurance Company Name: (�a ��`'eYJ C—e- Policy#or Self--ins.Lic.#:374—k5aA-6&V_ 7 Expiration Date: Job Site Address: All Locations City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing therpolicy 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 e of and the pains and penalties of perjury that the information provided above is true and correct. / , / Signature. 4e4 U�1�.Date: � ' lo- / `/ Phone#: Ldv 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 —7 8.1 Licensed Construction Supervisor: Not Applicable ❑ '1 �7 Name of License Holder: S C D T T Ke TE� VS " 1 02`"C S / License Number [WE EL Q kkTAAMVnvS Ill Mao 0 G 2 0 , AM res Expiration Date l3 .5�6 8 r lure Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ I(, WC 1-7.5� I lv j Company Name Registration Number Address Expiration Date K(bQ_T41 r Tt.v` M N- C(0( b Telee hl�e� �O SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 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. 'rhe undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature__ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wdows Alteration(s) ❑ Roofing El Or Doors ,,d& Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[_] Siding[O] Other[0] Brief Description of Proposed pp Work: (4-0IA:G yi. of -2(e wrinAtsy-N--- Alteration of existing bedroom Yes Y No Adding new bedroom Yes _ e No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of 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 1•�t J!(AK� � 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. Signed under the{p-aaiins and penalties of perjury. IC.O� fvi Ic`T-- S, 5 c °I I I nature wner/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 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 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q 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, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. � Department.use only I L l r =-=-- - - - !i ity of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit S P 10 2014 ", 212 Main Street Sewer/>epticAvailability Room 100 WatedWell Availability Electric, 1,cN rthampton, MA 01060 Two Sets f Structural Plans s e 4�3-587-1240 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 1.1 Property Address: This section to be completed by office r 4M Pr o5p e_C Map Lot Unit OO v+1 xa m p4c,i Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: PftetA M R-RG-roT U L-&SS 11oa VroS pe ck Sk- Nor--t'As , +b- I Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Anent: ITE(2 W1 LDGi.6, 1 ML • 35 MAIM SI' T-Lo�'eIVL.r= MAC- 0(No Z me(Pri t) Current Mailing Address: I LQ Mf2 0 19C• "4 153, 5P,)6 -S oo gnat Telephone YECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (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 =0 +2+3+4+5) 2(0 ( . �� Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 409 PROSPECT ST BP-2015-0275 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A- 104 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2015-0275 Proiect# JS-2015-000520 Est. Cost: $26481.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): 22912.56 Owner: YGLESIAS PABLO&MARGOT GLASS Zoning URA(100)/ Applicant: SCOTT KEITER AT. 409 PROSPECT ST Applicant Address: Phone: Insurance: 5 1 A HATFIELD ST (413) 586-8600 O WC NORTHAMPTON MAO 1060 ISSUED ON:911012014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 26 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 9/10/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner