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23D-185 39 WINSLOW AVE BP-2019-1211 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:23D- 185 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Cateaorv: REPAIR BUILDING PERMIT Permit# BP-2019-1211 Project# JS-2019-001962 Est Cost, $16000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const C as : Contractor: License: Use Group KEITER BUILDERS 102457 Lot Slze(sn.It.): 16117.20 Owner, NORTON JOHN F&SUSAN F&ANDREW M&E PRATON&1 PRATON Zoninz URB(100)/ Applicant: KEITER BUILDERS AT.- 39 WINSLOW AVE Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.-41304019 0:00:00 TO PERFORMTHE FOLLOWING WORK:replace roof caused by wind damage and mist house repairs 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 DeparSment Fireplace/Chimney: Rough: Oil: Insulation: Final: make: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 4/30/20190:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck- Building Commissioner File#BP-2019-1211 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 p PROPERTY LOCATION 39 WINSLOW AVE MAP 23D PARCEL 185 001 ZONE URBI I00V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST USED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construct ow replace roof caused by wind dama mist h use re airs New Construction Non Structuralinterior re o ations Addition to Fxisting 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 INF9RMATION 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 4-19- 2019 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 -,;,-0— City of Northampton Status of Permit: ,�)1` Building Department Curb Cut/Driveway Permit 16"-'A 212 Main Street Sewer/Septic Availability l Room 100 WaterlWell 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 OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address. This section to be completed by office Map �'� D Lot r+� Unit 39 Winslow Ave Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 Owner of Record: Susan&John Norton 39 Winslow Ave _ Name(Print) Current Meiling Address- See attached alerted contract Telephone Signature 2,2 Authorbed Agent: Keifer Builders, Inc. 35 Main Street Florence, MA 01062 Nem riot) Current Mailing Address. 413-586-8600 S.,Ham e Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant _ 1. Building (a) Building Permit Fee 16,000 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) '" U 5. Fire Protection 6 Total=(1 + 2 +3+4+5) 16.000 Check Number 7 This Section For Official Use Onl Date Building PerjNumr. Issued: �J 42 Signature: Building Commissionerlinspector of Buildings Date BGrant CO Keitel-Builders.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 Propo+cd Rcyuircd by Znning Inu ullobe 011e]mbn Building x,"numm.. Lot Siad FrOnraoe Setbacks Frond Side I R: Ran, 13 dung Haight Bldg. Square Footage Open Space footage QUI mire mina,blue&pnved mrklnnl 0 ,1 l"h ine Saeccz Fill: irolwne&I'xu int A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 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 OX DONT 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 OX 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 0 IF YES, describe size, type and location: E Will the construction activity disturb(clearing,gradingexcavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO O IF YES,then a Nodhampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK Iche k all I'c bl 1 New House ❑ Addition ❑ Replacement Windows At eration(s) ❑ Roofing 0 Or Doors ❑ Accessory Bldg. E:] Demolition ❑ New Signs [01 Decks [q Siding(01 Other(01 Brief Description of Proposed Work Replace root caused by damage from wind storm,miac house repairs 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 existing housing complete the followina- 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? I,. Type of construction I. Is construction within 100 ffof wetlanO,?_Yes No. 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 John&Susan No as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. See attached signed contract 4 29 19 Signature of Owner Date I Keifer 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. SCOlf Ke,ter Print Ns 'l r - 429 19 Signaltbreol OvmerlAgent Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Nam,of License H Ian - Scott Keiter CS-102457 License Number 51 A Hatfield St Northampton MA 01062 6.20.20 Addre Expiration Date _ �.,.4 e.� 413-586-8600 Signature Telephone 9 Rea'stered Home Improvement Contractor Not Applicable ❑ Keifer Builders Inc. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.21 Address Expiration Date Skeiter@KeiterBuilders.Com Telephone413-586-8600 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.._.. ❑ trn.:ay�- City of Northampton ' ((� Massachusetts ( DEPARTMENT OF BUILDING INSPECTIONS 212 Mein Street •Municipal Bui Id-9 Northampton, aR 01060 Debris 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. The debris from construction work being performed at. 39 Winslow Ave (Please print house number and street name) Is to be disposed of at: Valley Recyclinq (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Duseau Trucking (Company Name and Address) gnature 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'Massachuseus Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print legibly Keiter Builders, Inc Nanle (Business/organization/Individual): Addiess:35 Main Street City/State/Zip; Florence, MA 01062 Phone 4: 413.586.8600 Are you an employer? Check the appropriate box: 'type of project (required): 1.R I out a employer with 20 4. 0 1 am a general contractor and I employees (full and/or part-time).* hi have re(1 lltesub-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 8. 0 Demolition working for me in any capacity. employees and have workers9. 0 Building addition [No workers' clmp. insurance comp. msurance.t required.J 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself tNo workers' comp. right of exemption per MGL 121T Root repair insurance required.] ' c. 152, $1(4),and we have no employees. JNa worker' 13.0 Other comp. insurance requlreT 'An, uppllcam Ihat chuck hu.cb musenlun till nutthenemioahoboshomi ag richrmrkcrs'eumpcn otiuu PuGry inlbnnauon. iIluteor ehuxhnt'nhi:ufhduvll indicar lthyaedi'ntull rrtrkWne l tn'dc wtt ew . mststh titre c 11 durh' I' aCv td . t((Alk] l0.1ry t hat e bu.k this h)xnust umched uiaddaik....l Ii,,l sh,k.t'..the the ot the sth cottociorrandstakete 0 oi )t dk)zc ciailu. tmc emplgoe_ If nc 41h-co iroukkrH have empin}ocs,they must pnnide Ihtfr oarhws comppoliC� numbar. 1 on an emplorer that is providing corkers'compensation insurance,/or nor enrp egrees. Belory is ibe policy and job.vile information. Insurance Company m Name: AIM Mutual Policy Y, or Self-ins. Lie. h: MCC20020005382018A Ifxpira(ion Date'._6.11 .2019 7 Beaver Brook Loop Florence .lob 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 foe up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDP.R and a line of up to$250.00 a day against the violator. Be advised that a copy of IhiS statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do herebify under the pains and penalties of perjury that the information provided above is rive and correct. dim tw'e' 1'r�iden6 licher l3nildersJnc 4.29.19 Date:_ .. _ Phone a: 413.586.8600 Official use only. Do not write in this area,to be completer(by city or town official. City or Town: Permit/License It Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.CityTown Clerk 4. k1ectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone It:_ A`OR& CERTIFICATE OF LIABILITY INSURANCE GFTEIrAM.Gn,YYYY' l 1 05"L¢01 S 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 ORA LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU RERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Emlicy(,Ii must have ADDITIONAL INSURED provisions or be reacted. If SUBROGATION IS WAIVED,I ub(ect 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 certificale,holder in lieu of such endorsemengs). JR."ECORE LUAN1Ag1 Cynthia Henderson CISR Ellie Webber A Grinnell 11OxE (413)586-0111FnrC NP[ 4'3)5866401 e North hng Street PIPE . cn,rdEXUAWebbemnogrinnerrom IN511RER141AEFOROING COVERAGE NA. Northampton MA 01060 IrvsVx[a n-. Selective ln4Co,HSCamlina wSUR[O ANSULTURE A.I M.MWuaVA.l M. Keiter Builo6rs.Inc INSURER C All Scott Reiter INEUPLAm 35 Main Street NSUNERE _ Florence MAY 01062 COVERAGES CERTIFICATE NUMBER: Master E%p 2019 REVISION REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUGO TO THF HELPED NAMCO ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT'.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCLMENT WI➢I RESPECT TO VJr11CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN DEDUCED BY PAIR CLAIMS. I Niq TYPE OF INSURANCE POLCYNOMENT _ _ Mwv1 FJMMlDI LLIMITS _ XCOMMERCIAL GENERAL LIABILITY ETOL I OCCURRENCE 11CJ000D CLAr ADP 19 OCCUR PFENISEs'Fz omEnnenooi S 500.000 15 000 A 52265587 06/01/2018 06,01I2019 ^I PAULA pHY 5 1 000.000 GEN'L ALVARGATE LIMITLIMITAHALES PER GE11TALAGGREOm E 5 2000.000 pOLCv jELO'! LOG PRODUCTS 20DO.ODD COMpgP nOG 5 _ OTryBH AUTOMOBILE LIAa1Lm EOMBni�m BINGLE UMn g 1,000,000 ,UTO aomcv INJURY Evi A �WNFLOS ONs X pUTLCE,ULED A9105217 05/012018 O5N12019 0001_nrvmRY rPY.amdml NIELF N NTri ]A�IIEA17E RTVOAMA�E X R"CHFNTY X BUFFS ONLY al payments 4 5,000 UMBRELLA LIAO OOCLR FACE WOUHREVCE 4 5.000.TOO A EXCESS LIAO LAIMB,MAOE S2265567 06/01/2018 06101/2019 5.000000X R NUON s 10.00' _WORKERS COMPENSATION Tni T' X O�tl- ANN OY ANVPJ T0 ; E%LCUTVE y1000000 B FEEc - HE E Lu eIo'+ Nrn MCG20020005382018A OBrt 112016 06rt V2010 tPre o 5 _ y 1000000 'n EI :n'IOrEE _ Il res.oosuiea unee —1 ODD,OOD OEsc=IPnoN OF GPEHAnousPrLW, IF wsFtw.poawumn s _ DESCRIPTION OF OPERAONS a0CATIONS r VEHICLES IACORO 1m,Aemtlonzi m—lat Smmme.'O be nmrnea T—M are"A cqu BA) 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. AUMORIZEU HETHESENTX IVE ©19882015 ACORD CORPORATION. All rights reserved, ADDING 25(2016103) The ACCEDE name and logo are registered marks of ACORD Keiter Builders. Inc. 35 %1 Street �+ - o,e eMA 01062 / r 73 388 2600 Fax tet„ 22G , 2a B U I L D E R S zKgr 'ke;terbutloes cpm Kei(erBc.ders.ccm Customer COST ESTIMATE "d Susar 0,:c u r AUc. oe f .,,e ._ ree Oaroag- at s ,ble3ct n sGer?y Item �p Amount Al . x 'ta¢,,... 01-5000-General Requirements 00 )V " ; '7 ''Pi, x . {{ in', .',s}tl• ' 06-0500 Deck and Fence $13.SUC.00 t dock. 07-5000 - Root Demolition and Reconstruction S13 2,2 00 ,.-----COST--ESTIMATE--- Item OSTESTIMATEItem Amount w efi n� " {w `}{'r} yns�- yak 08-1600- Doors & Frames 5-1.0OO.00 _. S ON OWNER SIGNATURE 1. DATE _ -- .. .. .^sit:.