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23A-004 (5) 25 MEADOW ST BP-2019-0344 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-004 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2019-0344 Proiect# JS-2019-000557 Est.Cost: $292000.00 Fee: $1898.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq.ft.): 8973.36 Owner: STARR DANIEL&JULIE Zoning: URB(100)/ Applicant: KEITER BUILDERS AT: 25 MEADOW ST Applicant Address: Phone: Insurance: 35 MAINT ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.9/24/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL EXISTING 1400 SQ FT HOUSE AND ADDING NEW SECOND STORY MASTER BED/BATH 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 Sienature: FeeTyoe: Date Paid: Amount: Building 9/24/2018 0:00:00 $1898.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0344 (Joh C-5 APPLICANT/CONTACT PERSON KEITER BUILDERS S ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q PROPERTY LOCATION 25 MEADOW ST MAP 23A PARCEL 004 001 ZONE URB000) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLIC ECKLIST ENC OS REQUIRED DATE ZONING FORM FILLED OUT Fee Paid qM Li Building Permit Filled out Fee Paid !ypeof Construction: REMODEL EXISTING 1 T HOUSE AND ADDING NEW SECOND STORY MASTER BED/BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay CZ-0,?/V, Is Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OOR/TWO FAMILY DWELLING C SECTION 1 -SITE INFORMATION &C/ 1.1 Property Address: This section to be completed by office Map az 3/4 Lot 00c� Unit 25 Meadow St Florence, MA Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Julie & David Starr 25 Meadow St Name(Print) Current Mailing Address: 09/1712018 f)(.yu/ os:oo PM EDT Telephone Signature 2.2 Authorized Agent: Keiter Builders, Inc 35 Hain St Florence., MA Nam rint) Current Mailing Address: j"A 4 P, President, KBI 413-586-8600 SiMature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building cRok-i (a) Building Permit Fee 2. Electrical ) (b) Estimated Total Cost of ` Construction from 6 3. Plumbing j GOD Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection (--J 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 I i 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 °k Open Space Footage °k1 (Lot area minus bldg&paved irking) #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? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 1 a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement_Windows Alteration(s) ��/� Roofing Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [E-1] Decks Siding [E=]] Other[D] Brief WorkDR;&0 fl11PJMTFlg 1400 SQ 1't house and adding new second story master bedroom / bath X X Alteration of existing bedroom Yes No Adding new bedroom Yes �o Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll - Sheet sa. 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 x 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 Julie and David Starr as Owner of the subject property hereby authorize Keiter Builders Inc to act w my behalf. in all matters relative to work authorized by this building permit a��lication. n - l 09/17/2018 J 0 / //2018 J l t- p_ �TCv.YY 09:00 PM EDT 1Owct. Starr 08:59 PM EDT 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 PName President, Keiter guilders, Inc. 01 <1 (LA Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Keiter CS-102457 License Number �fy 51 A Hatfield St Northampton, MA 01060 6.20.20 Addreso ---- - Expiration Date - President, Keiter Builders, lite 413.586.8600 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Keiter Builders, Inc 175168 Company Name Registration Number 35 Main Street Florence, MA 01062 04/28/19 Address Expiration Date SKeiter@KeitcrBuilders.com __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....... ® No...... 17 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 10835.1. 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 s r i 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: 25 Meadow St The debris will be transported by: Keiter Builders, Inc The debris will be received by: Duseau Trucking Building permit number: Name of Permit Applicant Keiter Builders, Inc 09.1$.18 X� President, Keifer Builders, 1ne Date Signature of Permit Applicant 4 I I 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 Aaulicant Information Please Print Legibly Name (Business/Organization/Individual): Keifer 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.EN I am a employer with 20 4. 0 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ® New construction 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' y P ty• + 9. ® Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions officers have exercised their 11. Plumbing airs or additions 1 am a homeowner doing all work g re P myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] + c. 152, §1(4), and we have no employees. [No workers' 13.® Other comp. insurance required.] *Any applicant that checks box#I must also till 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. AIM Mutual Insurance Company Name: Policy# or Self-ins. Lic. #: MCC20020005382018A Expiration Date: 6.11 .2019 25 Meadow St Northampton, 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 rtifyu�e the pains and penalties of perjure that the information provided above is true and correct. President Keiter Builders,Inc. 09.18.18 Si nat re. ' _ Date: _ Phone#: 413.586.8600 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#: _ 9 a I ACoR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/17/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT Cynthia Henderson CISR Elite NAME: Webber&Grinnell PHONE , (413)586-0111 AIX No): (413)586-6481 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p Northampton MA 01060 INSURERA: Selective Ins CO Of S Carolina INSURED INSURER B: A.I.M.Mutual/A.I.M. Keiter Builders,Inc. INSURER C: Attn:Scott Keiter INSURER 0: 35 Main Street INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS TIED 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 ADDLSUBR TYPE OF INSURANCE POLICY NUMBER MM/DD EFF MMIDD EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE I"I OCCUR PREMISES EaENTE occur ence $ 500,000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2018 06/01/2019 -PERSONAL SADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER_ GENERAL AGGREGATE $ 2.000,000 POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: _ _ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED rx SCHEDULED A9105217 06/01/2018 06/01/2019 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB HCLAIMS-MADE 52265567 06/01/2.018 06/01/2019 AGGREGATE $ 5,000,000 _ DED I X RETENTION$ 101000 $ WORKERS COMPENSATION X PER X OTH- YIN AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUIlVE E.L.EACH ACCIDENT $ 1.000,000 B OFFICER/MEMBER EXCLUDED? N I NIA MCC20020005382018A 06/11/2018 06/11/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MY Ofi /Fon Louis Hasbrouck<Iasbrouck@northamptonma.gov> Re: 25 Meadow St 1 message Louis Hasbrouck<Iasbrouck@northamptonma.gov> Thu, Sep 20,2018 at 11:19 AM To: Brynn Grant<bgrant@keiterbuilders.com> Hi, We need setbacks,especially on the left side rear corner of the house.The required side setback is 10'provided the 2nd story addition doesn't go past the existing footprint. From the map I have,it's really close but it will likely make it. Can you get somebody to measure? Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax On Tue, Sep 18, 2018 at 10:12 AM, Brynn Grant<bgrant@keiterbuilders.com>wrote: Hi Lou. Please find the attached digital copy. I will be filing this application today. Thanks Brynn Grant Office Manager Keiter Builders, Inc. 35 Main Street Florence, MA 01062 413-586-8600 Ext 100 413-280-0124 Fax www.keiterbuilders.com MORTGAGE LOAN INSPECTION 5452}/� VG POOL AREA GARAGE N t � ! E 2 STY t WIF I I 65.6 S1RV�' LOCUS REFERENCE: BOOK 3973 PAGE 237 TO: AND: FIRST AMERICAN TITLE INS CO OWNER. JOHN E.MODESTOW NANNETTE B.MODESTOW 1 hcreb)report that the premises shown on this plan arc LOCATION: 25 MEADOW STREET not located within a Flood Hazard Arca as shown on the NORTHAMPTON,MASSACHUSETTS Federal Emergcnc)Management Agency's Flood Insurance Rate Map, Community No.250167-0001A HOLMBERG & HOWE, INC. Effective Datc APRIL 3, 1978 PROFESSIONAL LAND SURVEYORS 87 UNION STREET,EASTHAMPTON MA 01027-0945 1 also report,to the best of my knowledge,information 37 DAMON POND ROAD,CHESTERFSELD MA 01012-0176 and belief,that this inspection plan shows the improvement or imprvvemems as located on the premises described,that the improvements arc entirely within lot SCALE: lines,and that there are no encroachments upon the HOF 4se 1"=30' premises described bf the improvement or improvements o of un)-adjoining prcmiscs,except as noted.1 further FMILY , report that there are no easement%of record affecting the �" H 6' DATE: OLMf3 tract shown hereon except as noted. 140,Z"'3011 2' JULY 6,2018 TE IV44JLAta5�4 JOB NUMBER: 18-095 TMS PLAN IS rOR IllENTmF ATION fl)RI'OSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY. AND IS NOT TO 013 USED FOR CONSTRUCTION PLANNING OR LAYOUT.