Loading...
41-046 (2) 1260 WESTHAMPTON RD BP-2019-1023 GIS u: COMMONWEALTH OF MASSACHUSETTS Map:Block:41 -046 CITY OF NORTHAMPTON Lor -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Remit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catcgorv:REPAIR BUILDING PERMIT Remit g BP-2019-1023 Proiect4 JS-2019-001679 Est.Cost: $81674.00 Fee $530.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: KEITER BUILDERS 102457 Lot siee(so.It.): 44866.80 Owner: SMITH DONALD RAYMOND&LISA A Zoning; Applicant: KEITER BUILDERS AT: 1260 WESTHAMPTON RD Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON:3127/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIRS TO HOUSE CAUSED BY FALLEN TREES 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 sianamre: FeeType: Date Paid: Amount: Building 3/2720190:00:00 $530.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-1023 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600() PROPERTY LOCATION 1260 WESTHAMPTON RD MAP 41 PARCEL 046 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvoeofConstruction: REPAIRS TO HOUS BY FALLEN TREES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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 No am us of admit: ,r Building De artEnt Cu Cu Driveway Permit 212 Main we �pR 1 9 X019 se ed ¢C Ayatlabllly Room 00 We er/W Il Availability Northampton, A 106 Sets f Structural Plans phone 413-587-1240 ax 49 �9 �t,1,9, ij� l r,'�rn t/Site ans 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 0Cty Unit 1260 Westhampton Rd Zone Overlay Disiricl Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Donald Smith 1260 Westhampton Rd Name(Print) Current Mailing Address: See attached signed contract Telephone Signature 2.2 Authorized Adel Kelter Builders Inc, 35 Mein Street Florence, MA 01062 Nem dint) Current Mailing Address. & p r,`,{ di 413-586-8600 Sigrature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Dollars)to be Official Use Only completed bermita licant 1. Building �1 S"' 8� I (a)Building Permit Fee T I 2. Electrical (b)Estimated Total Cost of Construction from fi 3 Plumbing Building Permit Fee {(��� 4. Mechanical(HVAC) �-\3 '✓ 5. Fire Protection 6. Total=(1 +2+3+4 +5) Check Number This Section For Official Use Only Date Building Permit Number: Issued. Signature: Building Commissioner/Inspector of Buildings Date BGrant @ KeiterBuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Requirod by Zoning Ih'rs column m he 1.11kb Iu h} hmlc iu,D uor ul IAt SiLe Frontage Sclbacks Front Side L: R: L: R: I Building Height Bldg.Square Iotuage 'b Open Space Footage nal arca minus bldg M pa-d ark n W of Parking S aces Fill: fvolwnrM L�uno A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW O YES Q IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q 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 O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearinggrading excavation,or filling)over 1 acre or is it part of a common plan that will disturb over l acre? YES NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoollcablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E:]Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding[0] Other[©] Brief Description of Proposed Werk) Repairs to houw,damage caused by fallen Ives Alteration of existing bedroom_Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement =Yes No Plans Attached Roll -Sheet Sa. If New house and or addition to existina houshra 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 attachetl? 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? in Type of construction Is construction within 100 it of wetlands?_Yes _Nc. Is construction within 100 yr. floodplain_Yes No I. Depth of basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulations? Yes No 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 Donald Smith as Owner of the subject property hereby authorize K tar Bit'II Inc to act on my behalf, in all matters relative to work authorized by this building permit application. See attached signed contract 3 15,19 Signature of Owner Date I, Ke ter 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. ScollK t Print N/y/� �/ j.,_ee& P rta /- - 31519 Sign eo(Ouner/A nl Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoendsor. Not Applicable ❑ Name of License Holder Scott Keifer CS-102457 License Number 51 A Hatfield St Northampton MA 01062 6.20.20 Addre Expiration Dale G� _, xb 413-586-8600 Signature Telephone 9. Replstered Home Improvement Contractor: Not Applicable ❑ Keifer Builders, Inc. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.19 Address Expiration Date Ske'fer@KeiterBuilders.Com Telephone413-586-8600 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. C.15$§26C(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.._.. ❑ City of Northampton Massachusetts i. �,. I DEPARTMENT OF HpILDING INSPECTIONS 212 Main Street •Municipal Building Qs ig Northampton, M 01060 bN:yjP Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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. The debris from construction work being performed at 1260 Westampton Rd (Please print house number and street name) is to be disposed of at: Valley Recycling (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Duseau Truckinq (Company Name and Address) '&// P d kms_ 03.15.19 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Vs I Congress Street, Suite 100 Boston,MA 0211 4-2 01 7 www.niass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Keiter Builders, Inc Nana (Business/Organization/Individual): _ Address:35 Main Street Ci /State/Zi : Florence, MA 01062 Phone #: 413.586.8600 Are you an employer? Check the appropriate box: Type of project(required): 1.9 1 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. ® Remodeling ship and have no employees These sub-contractors have g, ® Demolition working for me in any capacity. employees and have workers' 9 ® guilding addition [No workers' comp. insurance comp. Insurance.t required.] 5. 0 We are a corporation and its 1o.® Electrical repairs or additions officers have exercised their 11. Plumbing airs or additionsre 3.0 I am a homeowner doing all work fiP 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.S Otht.� -� _ comp. insurance required.] Any mp1,cart Nal checks box N 1 matt also fill on thcxecvi ,,helom showing their workers armpensation policy Inernnmion- r Ilon cs,u,r'oimsubmit this affidavit indicating they are doing all amk mrd then bin outside wnmaclors must submit a new alfideva indentingsud, tContractors that check this box must attached an additional sheet shoeing the name ofthe sub-cunuactors and state whether or nut those critics,hacc employees. If the sub-contractors have employees,they must provide their workerscomp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. AIM MUYUeI Insurance Company Name: _ Policy# or Self-ins. Lic. N: MCC20020005382018A Expiration Date: 6.11.2019 1260 Westhampton Rd Northampton Job Site Address: City/State/Gip: 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 ofNIGI,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 forst of 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 rhfy, under the pains andpenaldes of perjury that the information provided above is true and correct. 3.15.19 Signature' � ['resident, Keiter Builders, Inc. Date' Phone p: 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 N 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 8: ® ACOKO CERTIFICATE OF LIABILITY INSURANCEIli OPTEIMMNOIVYWI 05117/20/8 THIS CERTIFICATE IS ISSUED ASA 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 HOME°BT Cynthia Henderson DISK Ellie WebDerMGdnnell PRouEer, (01 31 556 0111 P2 Na- (a1L1556E481 8 NOdh King Steel aoDA[ss mendeUASOEvreaRrandgrinnell cam INSVRERISIPFFOn01NG COVERPGE NAIC9 NONhanni MA 01060 INSURER A. Selective ins Co of S Carolina INSURED ASCRER a-. A"I.M MCWRIA I.M. None,BWIdes In.. NSVRER C AtN:SOLD Keller INSURER D-. 95 Main Street IN6VHER E FlOmnce MA 01062 INSURER F'. COVERAGES CERTIFICATE NUMBER: Master EPP 2019 REVISION NUMBER: THIS 15 TO CERTIFY THAT TME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED. NOTCOURSTANDINGANY REQUIREMENT TERM OR CONDITION OF MY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WTCH 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. /NOR TYPE OF INSURANCE POLICY NUMBER ..oMPc NY CY EFF MMAOYM'xVY LIMn6 FOR x CO MM ERCIAL GENERAL LIPBILITY EACH OCCURRENCE E 1'�' AMP E REry 500.000 CWMSMADE O DCCVR PREMIS 6 Eeo a ED EXP wm ane Parsom 5 'S 000 A 52265667 0501/2015 06101,12019 WNLaa0v AJuflY 51,000,000 GEN"L AGGREGATE LIMIT APPLIES PER AGGREGATE 5 2,000,000 pIT DIET FLOC $-COMIOP AGG 52000.000 I OTHER AUTOMOBILE LIPBILITV a. O aM G LE LIMI T E 1000.000v AUTO meV IP.,Pe,." sAAUTOS oxIsL A9105217 06/012018 06101/2019 N.msYIP...�meoB sx HD TY1 AMAGE sAUTO6ONClepeymenls 5 5000x Le. ELLA lCVRRENCE 5 5,000000 A ExCE55 LIARE 52265567O6/Ot/2010 06/01/2019 55000,0U0 Lw X s WORKERS COMPENSATION AxD EMPLOYERS LIABILITYE PROPETOPARTNYIN EL CAD n AccmENT b IF-000 B ANY E"MREMewOn ExauERIExEODT1VE DED+ ❑N NIA MCC20020005382018A 0611112018 0641/2019 IMlarla.Yln NFL L DISFASE EA EMPLOYEE 51,000.00o IoescalvTiON of 0PFRATION1 n.- 1 000.000 Ei. DI6G4-POL'CYLIMT 5 DESCRIPTON OF OPERATICN51 LOCA90NS I VEHICLES IA60xD 101,Avdirl I Rem.Ms eabeaux,PvI In an.cNeC a mon spam b RAN'Aal 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. AUTHORQED REPRESENTATIVE ©1986-2015 ACORD CORPORATION. All rights reserved. ACORD 25(201 MIS) The ACORD name and logo are registered marks of ACORD