38D-081 /entire ing this Agreement, you acknowledge that you have received a complete and original signed copy of the
greement and attached Exhibits. Keiter Builders, Inc. may not start work until after this Agreement has
been signed.
DO NOT SIGN THIS CONTRACT IF THERE
P ARE ANY BLANK SPACES- THIS IS A LEGALLY
BINDING AGREEMENT. IF THERE ARE ANY WHICH YOU DO NOT UNDERSTAND,
YOU SHOULD CONSULT WITH AN ATTORNEY BEFORE SIGNING.
KEITER BUILDERS, INC. OWNER
4V
to
b Scott eiter,President Date
Date
Initial Here
Initial Her 6 �� _
DOLGOFF August 20, 2014
scription Cos
De t
OUALIFICATIONS
Exclusions
Owner to remove and reinstall drapes
Nail hole filling,painting,or other finishes
Project Total 12,303.21
16-z2--Z0lJ
Approved By: Date: 8/20/14 Date:
Contractor Customer
Initia Initial Here
Keiter Builders, Inc., License#: 102457 2
DOLGOFF August 20, 2014
Keiter Builders, Inc.
35 Main St.
Florence, MA 01062
Office 413.586.8600 E I T E R"
Fax 413.280.0124
scottkeiter@gmail.com B U I L D E RS(-'
www.KeiterBuilders.com
License#: 102457
Project_ L Customer
DOLGOFF { Cindy Dolgoff Mobile 413-244-4814
15 HAMPDEN STREET 15 Hampden Street gnilrets55 @aol.com
Northampton, MA 01060 ! I Northampton, MA 01060
3 SLIDERS&6 INTERIOR DOOR SLABS WITH LOCKSETS
Description _ — — cost
Fol. GENERAL AEGUIREME114 TS
Demolition&Debris Removal
Remove,and dispose of,three sliders
Remove and dispose of six interior doors
Permits
t
Interior Doors
Labor and misc materials
Modify slab to fit opening
Mortise slab to tit existing hinges
Bore slab for new locksets
Modify jamb to except new strike plate
Interior Doors
SEE RK MILES QUOTE DATED 10.04.14($817.94)
RK Miles Quote SOAD000129-1 (S4,629.18)
Sliding Glass Door
All labor and misc.materials:
Vycor pan flashing
install new doors to manufacturer
specifications
Low expansion foam insulation
PVC exterior trim-Brickmould
2 112 inch pre-primed colonial casing
i
Notes
Existing sliders are pella
Painted wood claps. 5 inch exposure
May need to cut back hardwood flooring
Bring red oak 1x4 for possible transition
Drip cap not required on top-under soffit
Kick plate to remain as is
2x4 wall
No lead paint _ ,„tee initial Here
Keiter Builders, Inc., License#: 102457 1
/, nservation commissions, are required to be obtained before Keiter Builders, Inc. can obtain their permits, it
gation 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 45 day(s) of obtaining the necessary permits and expects to have the work substantially
completed within 7 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
TWELVE THOUSAND, THREE HUNDRED AND THREE ($12,303.00) 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 due with signed contract
($3,472.00)
40% of window cost+ 1/3 labor & misc. material due prior to initiating work ($4,366.00)
Final payment due at Substantial Completion.
All sums not paid before substantial completion of the work will be due and payable upon substantial
completion. annual
Payments due and unpaid under this Agreement shall bear interest from the is lespsayme the is d enttth e Keiter
rate of Eighteen (18%) percent or at the maximum legal rate
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
Keiter Builders, Inc. may choose to not start work again until you If there crrent with the
toppagep n worksduedto your
Builders, Inc. feels secure in obtaining the remaining paym ent
failure to pay on time, or to make Keiter Builders, Inc. feel insecure that the remaining payments will be made,
such delay shall automatically extend the date of substantial completion. Initial Here
Initial He a 2
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: ( s �trm-Q6&n 5 4l�
The debris will be transported by: cIeY 64x4"
The debris will be received by: Vot4y
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
v Office of Investigations
R a I Congress Street,Suite 100
a
.` Boston,MA 02114-2017
M www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1 ,, / n,, Please Print Legibly
Name (Business/Organization/Individual): Y.e�'C�/`( '�l�.�l emirs IK L
Address: 65 AUK A 1S
Cit /State/Zi e1 61062- Phone #: ql3
Are you an employer? Check the appropriate box: Type of project(required):
1. 1 am a with employer 4. E] I am a general contractor and 1
—� 6. F1 New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.]
5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name Q[S II'1,S1.GM rt.Ct —
Policy #or Self-ins. Lic. 4:IFUAo-LA 5-07-'$c), I H Expiration Date: Cm to
Job Site Address: C/..H.t ��PiYI City/State/Zip:/(�(JY7uw.*f n 1 of
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: /W • Date: U • - YI
Phone# �j(?i %CD
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1 Not Applicable ❑ l'
Name of License Holder: VC U�'�' ` �e CIS J 10 dal�[s�
License Number
Address Expiration Date
A2:::�
�l l3 ,5�6 86f
SigrAkure Telephone
9.Reaistered Home Improvement Contractor: Not Applicable ❑
kefW Al't /Pt r- ! S16$
Company Name Registration Number
,5:1 )9 KIM vlo 60 qh�-R f!�-
Address p!l�,l Expiration Date
Telephone y/3AA 0 6v
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 build!22 permit.
Signed Affidavit Attached Yes....... No...... ❑
11 - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occunied 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 Deriod 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 ❑ Replacement�dows Alteration(s) El Roofing El Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding[lam] Other[O]
Brief Description of Proposed
Work: 'Z)cKS�- R e-Q, l ceVAQ4'1i:
Alteration of existing bedroom Yes �X No Adding new bedroom Yes �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 onm y behalf, in all matters relative to work authorized by this building permit application.
Signatu a of Owner V Date
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 me
Si ure of Owner gent 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
Frontave
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 er 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 Reg' ry 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 0 DON'T KNOW qt:�l YES Q
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 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, excav Att6n, 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` .
City of Northampton Status of Permit:,,
Building Department Curb Cut/Driyeway Permit
u
212 Main Street Sewer/Septic AvailabtI'
gas tns
lions Room 100 1Uater/UUell Ava iability
Electric,p umb
orthamP on MA 01060 rthampton, MA 01060 Two Sets of Structural Plans
tJ
phone 413-587-1240 Fax 413-587-1272 Plct/Sita 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 Prooerty Address: r
V 5 4GI.Y�9c71-ey-1 S- -YQe-4- Map Lot Unit
A)oy- too(,µ *YA t AAA Zone Overlay District
01060 Elm St.District CS District
SECTION 2'-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailipg�ddreALM u s/Lf
Telephone ` -1
Signature
2.2 Authorized Agent: 1
SCD�� l't C 3 S GI�Y` S 10�f2 y�G2 YVI I� OL06
Name(Print) Current Mailing Address:
lure Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 2 U3 a\ (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) �'� O�J 01 \ Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
15 HAMPDEN ST BP-2015-0565
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 38D-081 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPLACEMENT DOOR BUILDING PERMIT
Permit# BP-2015-0565
Project# JS-2015-001079
Est. Cost: $12303.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT KEITER 102457
Lot Size(sq. 1): 7492.32 Owner: DOLGOFF GARY D&CYNTHIA TAYLOR DOLGOFF
Zoning. URB(100)/ Applicant: SCOTT KEITER
AT. 15 HAMPDEN ST
Applicant Address: Phone: Insurance:
5 1 A HATFIELD ST (413) 586-8600 O WC
NORTHAMPTON MAO 1060 ISSUED ON.11/14/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT DOOR
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 11/14/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner