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32A-035 (8) COLEBROOK December 27,2014 Keiter Builders, Inc. SCOPE 35 Main St. Florence, MA 01062 Office 413.586.8600 MAr Fax 413.280.0124 wEITERS scottkeiter @gmail.com B U l L � E R 5 www.KeiterBuilders.com License#: 102457 1 PrQj�'Ct ( CuStOt�?eC COLEBROOK t3inda Colebrook Mobile�917 213-7197 71 CHERRY STREET 71 Cherry Street appleseedbinda@verizon.net NORTHAMPTON, MA 01060 Northampton, MA 0 106 WINDOWS s: •P Windows RK Miles Quote to SOAD000268-1(51,736.01)+7ax Windows •Permit,application,and fees Daily waste removal Lead sate practices installation of(7)window,inserts including: - Remove and dispose existing sashes comity still as required to a=mmodate new insert --tnsutate window cavities using toergtass -Instan new insert to an manufacturer specifications insulate around new window using tow expansion foam supply and instan new interior wintlow stops(square edge) Apply caulking at interior --Install frame expander at exterior sin • NOTES Owner to move all furniture.Window treatments,wall hangings,and other%•longings prior to Starting project •Cauractor is rtor responsible for re-hanging window treatments Priming,painting,and nail hole tilling are excluded Project Total 4,434.14 Approved By: Date: M12/27/14 _ Date: Contractor Customer Keiter Builders, Inc.,License# 10245'7 1 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 riot start work until after this X- greement has Ix-en signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK Spat CES. THIS IS A LEGALLY BINDING AGREE, 1E?YT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT N.S UNDERSTAND, YOUSHOULDCOULT IVITIIAN.4TTORNEYBEFORESIGNIIYG. KEITER BUILDERS, INC. OWNER 3. b , ott Keiter,President Date i Date Date 6 ........................ KE11IR BU11 DE INC. OWNER By cott better, President Date D)*t S e 4L NOTICE: Date 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 DISP(jTE 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. 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: Websiti'2, newspapers, journals, magazines, posters. and 11yers. RIGHT.TQ-CAV E4,C0NT)0,C7'* 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 DFILIVERY. NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. 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: The debris will be transported by: �►�-� The debris will be received by: Ila& &Z-� Building permit number: Name of Permit Applicant r'e'44V &�t,�(st6 Date Signature of Permit Applicant 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/Electricianis/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �/ [�(�(I�1/•S Cie. Address: Ntzo I Ii S-' city/state/Zip: r(,e'l Cw ce d 106 a Phone #: y/3 6 6-6 G6 AWI an employer? Check the appropriate box: Type of project(required): 1. m a er with employer q 4. ❑ I am a general contractor and 1 p y T * have hired the sub-contractors 6. [:J New construction employees (full and/or part-time). 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. Buildin addition [No workers' comp. insurance comp. insurance.+ ❑ g required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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.[ ther W I tioQow comp. insurance required.] Ua­`,4 *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. Insurance Company Name: Policy #or Self-ins. Lic. #: f C4-Qr;ll, Expiration Date: Job Site Address: � ,/s-" City/State/Zip: t., xA+ d 1060 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 f Lt*1T Date: 3 tKf— Phone 4: ! 3 8"6 C. 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 Supe``rviisor\:� Not Applicable ❑ � Name of License Holder: `SG©�Y't F- T� -C -/It c� ` S License Number S 1 V�1 1�► e-Q-� S A)` AAA v uo(y 2a/( 6 Addres Expiration Date 1 / 5-66 E-8. lelafure Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 664 6L.(A l J-/-,S c. 1-7-�- l 6 Y Comoanv Name Registration Number Address�/�_rr Expiration Date ilk?. t Ce U l 6 a' _Telephone �5b $6CN 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. 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) 7 New House ❑ Addition ❑ Replacement W- dows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief Description of Pro osgd nn - Work: C4" Alteration of existing bedroom Yes o 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 e)-�* as Owner of the subject property ,o o I ,,, hereby authorize ,�"�' r LC to act on my behalf, in all matters relative to work authorized by this building permit application. e2 st 3- 3c). It Signature of Owner 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. S"-4 Print Nam �'- Si 6n ur of Owner/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 ` J YES 0 IF YES, date issued:' f 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 0 DON'T KNOW YES 0 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,excavation, 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. u�y Department use only ' x:h City of Northampton Status of Permit: Building Department Curb C4t/t3riveway Permit a= 212 Main Street Sewer/Septic availability �\ o� Room 100 Water/Well Adailabillty oQ Northampton, MA 01060 Two Sets of Structurat Plans ?° phone 413-587-1240 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 -:�k ('��" S-� Map Lot Unit J(tkGtA,,f ivy-\_ VIA-A Zone Overlay District' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 6'14.0- czu- - t✓(tie AAM s4 ,o qm m1d o to&D Name(Print) Current Mailing Address: Lut TelephoneRl� Signature 2.2 Authorized Anent: �w ( ;��dl�r S, 1 ?, S ykGt.t`v` IFUtct t ce KkA- d caisa- Name Print) Current Mailing Address: Si ure I V- "K Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building g0,3o, C0 (a)Building Permit Fee 2. Electrical clJ` (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) jO Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings bate 71 CHERRY ST BP-2015-0923 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.-Block: 32A-035 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-2015-0923 Project# JS-2015-001785 Est. Cost: $4030.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq.ft.): 4660.92 Owner: COLEBROOK BINDA Zoning URC(100) Applicant. SCOTT KEITER AT: 71 CHERRY ST Applicant Address: Phone: Insurance: 5 1 A HATFIELD ST (413) 586-8600 O WC NORTHAMPTON MAO 1060 ISSUED ON:41212015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 7 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 4/2/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner