17A-245 (8) 86 LAKE ST BP-2016-1037
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-245 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-2016-1037
Project# JS-2016-001756
Est. Cost: $9842.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sq. ft.): 16988.40 Owner: WANNER JOHN&MIRIAM PARIS
Zoning: URB(100)/ Applicant: KEITER BUILDERS
AT. 86 LAKE ST
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 () WC
FLORENCEMA01062 ISSUED ON:2/23/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 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 Sivature:
FeeType• Date Paid: Amount:
Building 2/23/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
{ 1 City of Northampton Status of Permit.
Building Department Curb,Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
- f3 %Qls i Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Pians
',spho a 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
Map Lot Unit
86 Lake Street Florence, MA 01062
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Miriam Paris &John Wanner 86 Lake Street Florence, MA 01062
Name(Print) Current Mailing Address: 267_210_9272
S t �(LtitX C-1 `I� l Telephone
Signature
2.2 Authorized Agent:
Name( 'nt) Current Mailing 8.8
Address:
SAU8C-C)
i a re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 9,841.74 (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
e77 APO
6. Total= 0 +2+3+4 +5) Check Number --
This Section For Official Use Only
Building Permit Number: Date
issued:
Signature:
Building Commissioner/Inspector of Buildings 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 O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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? YEE O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all age]l cable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors M
Accessory Bldg. ❑ Demolition ❑ New Signs rj] Decks Siding❑] Other[p]
Brief DKec0PaFS&nTWj1tec�Ows
Work:
Alteration of existing bedroom Yes X No Adding new bedroom Yes X
Attached Narrative Renovating unfinished basement Yes �o _No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing,complete the followlnoL.
a. Use of building : One Family Two Family Other window
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, John Wanner as Owner of the subject
property
hereby authorize Keiter Builders. Inc
to act on my behalf, in all matters relative to work authorized by this building permit application.
Please see attached signed contract 02 22 16
Signature of Owner Date
I, Keiter Builders. Inc 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.
Scott Keiter
Print Name
-a I,--_ 02.22.16
Sign r Agen - Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:Scott Keiter CS-102457
License Number
51 A Hatfield St Northampton, MA 01060 6.20.16
;Addre4ss4 Expiration Date
413.586.8600
Telephone
9.Registered Home Imurovement Contractor. Not Applicable ❑
Keiter Builders Inc 175168
Comoany Name Registration Number
35 Main Street Florence, MA 01062 4.29.17
Address Expiration Date
Telephone 413.586.8600
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....... 0 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 108.35.1.
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
The Commonwealth of Massachusetts
Department of Industrial Accidents
t 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): Keiter Builders, Inc
Address:35 Main Street
City/State/Zip: Florence, MA 01062 Phone #:413.586.8600
Are you an employer? Check the appropriate box:
Type of project(required):
1.10 1 am a employer with 15 4. 0 I am a general contractor and 1 6. ® New construction
employees (full and/or part-time).* have hired the sub-contractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g, ® Demolition
workingfor me in an capacity. employees and have workers'
y9. � Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their I I.CJ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.CJ Roof repairs
insurance required.] t c. 152, §1(4),and we have no windows
employees. [No workers' 13.6 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.
tContractors 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:Arbella
Policy# or Self-ins. Lic. #:9127440615 Expiration Date:6.11.16
86 Lake St Florence, ma
Job Site Address: City/State/Zip:
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 der the pains and penalties of perjury that the information provided above is true and correct.
02.22.16
Signature: fit' (
-XDate:
Phone#: 4 .586.8600
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#:
Williamsburg, MA
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: 86Lake St Florence MA 01062
The debris will be transported by: Kelter Builders. Inc
The debris will be received by: valley Recycling
Building permit number:
Name of Permit Applicant Keiter Builders. Inc
02,22.16
zl�
Date Signature of Permit Applicant
KE(TERBUILDERS, INC. 0WN[Q
/
43N, Scott Keiter, President Date Date
uoic
�rO7ICE:
lHESK)NQi}K[SDFT||EP,\KU[S ,\B()V[ /\PPLY0K(} T0TH[ ,\GK[EK1ENT0[ ll|[ P/\KT|E6
|\) /\iTLRN,ATI VI: |)|S!/[T[ S[[[iE\,I TlKlTl/\ D BY lUEC0NTR6O'oK. TD[ OVVN[K MAY
|NUl6[[ ,\IAT-KN,\]1V[ U/SPUT[ K[S0i0l0N FIVEy4 VVH[R[ TUlS SECllON IS NOT
S[P4K/\TLiT 5lONLU 8Y TU[ PARll[S. [H[ K|GHT TO ALTERNATIVE DJBPUT[
K[0OiOT|0N S|l&ii [NDTWY} YEARS /\F[ERT8E DATE OFT8l8 AGR[[K42NT.
N0T7CE:
ll|[ S|GN/\TUK[8 0F TH[ P/\Kll[8 /\B()V[ /\PPLY 0NLY TOl'HE AGR[[\1L"MTOF THE P&R[|[S
Tl) 4[[EkNAllV[ DISPUTE 9[lTiENFNT /N[D0l�D BY T8[ CONTK/\[TOR. DUEO\VNER MAY
|NIll/\T[ D|SPOlI RESOLUTION EVEN VVH[KE THi3 9[CT|0N IS NOT
SB\\R/\TB,Y SIGNED BY lli[ PARTIES. [UE RIGHT TO |N[il/\]I AiTEDNJUVE DISPUTE
R[SUL[llOKSH/\LL [NDl'YV0Y[/\DS /\Hl]< ll|[ DAT[ O|� ll]l8 /VGK[|:\1[NT.
MIS[ELlAAIEOU',�:
l'hisagnemen\ is N'lusxuhuscUscoo{ruci contains the coiireu�ruunen( he\ocen us. unv rcporsentkionuor
»unaniics not cxyoya|y contained in it are not u part ofdic /\grermcnL and it is binding upon our heirs.
CXeco|vn. succcssory and assigns. ]hiu �grcomcm may be modified only by un inmnumcnI. in writing signed h\
butho[us.
l.his u�mcmcu( is subject to and is intended to comply with (hc pnmisiooy o/' Chapter 142/\ of the
>|uyymchunsiS6encru| Laws and its corresponding regulations.
U\�nurUnderstands and acknowledges that KcitcrBui\dco, Inc. muy use an,,. photos taken during the course o[
work- k`r pronx`|ionx) por|xoycx. This may inc|udc, but is not limited /o, the k`Unving: VVch*i1c. nonspopcm,
� �o d
]ourou|s. mugazmcs. pos . xn flyers.
RIGHTRlC+-VCEL. CN\A7RAC7.
YOU KJ/\Y [AN[B, TH|S |F [[ ||/\S 13FEN8lL]N[|) 8Y /\ PARTY TUEKETUBY
F(}K\Y&&D|NG YOUR INTENT TO IN \VR[UNG BY ORDINARY MAIL POSTED, BY
[H.E0R/\K1 S[KT OR UT DD]V|�KY. NV|' L&llLKllI/\�� MIDNIGHT OF ll|[ THIRD BUSINESS
DAY FOLLOWING T||FSK6N|N6OFTH|S /\6K[[h1[NT.
�
faN signing this AV_reemellt. Vou acknowlcdge that you ha,c receiVed a complete and original signed copy 4the
entire Agreement and attached Lxhibits. Kciter Builders. Inc. may not start work until after this agreement has
been signed.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY
BINDING AGREEME'NT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND,
YOU SHOULD CONSUL T WI TH AN A T"TORNEY BEFORE SIGNING.
KEITER BUILDERS, INC. OWNER
i
ilk,, Scott Keiter, President Date uj Date
Date
6
PARIS (02.08.16) February 8, 2016
Scott Keiter ,
ORKeiter Builders, Inc. � "OPE F r r a
35 Main Street
Florence, MA 01062 KESTER
Office 413.586.8600
Fax 413.280.0124 BUILDERS
scottkeiter@gmail.com
www.KeiterBuilders.com
License #: 102457
Project Customer
PARIS (02.08.16) Emmy Paris & John Wanner Mobile 267-210-9272
86 Lake Street 86 Lake Street miriamsparis@gmail.com
Florence, MA 01062 Florence, MA 01062
WINDOWS
Description
--- Cost
Windows
See r k Miles quote x CJKI XPX
Windows(Installation and Misc.Materials)
Mudding Permit
Demolition&debris removal
-Staging e.Ladders
Site set-up&breakdown
i 1,New construction unit in-ming R(x�:n
(I)New construction unit:n downstairs bathroow,
-l I)New construction unit in stairwell Includes fixed lite cnd above filed n7ull
I I,New construction unit in front morn
Intal 1,11 existing window in,front room Install zip srieathir-y,tape to existing,remove pcnannei.piece lit metal siding(owner to provide siding),air
sea:,fiberglass insulation,drywall.tape aria finish,no painting f primer
(1;New construction unit i:,,Upstairs Bathroom Modify upstairs bathroom window training to accommodate new,shorter window Field mull fixed
transom
-All windows will include the roilowing
Hough opening prep
Flan flashing
--Inslallatian of new windows 10 all manufacturer spocificaoons
lashing tape at nailing fins
F:Xlenor casing and drip Cap to match recently installed umis(Boral Trim and whit?.alurritrium)
Low expansion win%-YDw foam insulation
-Imenor casirx,;,stool apron installed by others.NIC
Painting and i or Staining by others. NIC
Project Total $9,841.74
We appreciate your business and look forward to working with you.
Approved By: Date 6-,2 . -2 Date:Date: �o�d�
Contractor
Customer
Keiter Builders. Inc, License N ',02457 t