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31B-179 (19)
�II i III i i I Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8t" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Capen Annex Interior Renovations Date:11/6/2015 Property Address: Smith College, Northampton, MA Project: Check(x) one or both as applicable: x New construction x Existing Construction Project description: Lobby, Classroom, Corridor, and Misc. Renovations I, Laura Fitch, MA Registration Number: 8835 Expiration date: 8/16, am a registered design professional, and have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet" or electronic j signature and seal: 1 AMMIST Phone number: 413-549-5799 OF Email: lfitch @krausfitch.com , rya, Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, provide a description. Version 06 11 2013 i �I I I �� I i' I �' li �I I' I 7 ® DATE(MM/DD/YYYY) A�Ro CERTIFICATE OF LIABILITY INSURANCE 7/10/2015 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 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). CONTACT C nthia Henderson, CISR PRODUCER NAME: y _ — - - PHONE (413)586-0111 FAX (413)586-6481 Webber & Grinnell Fxt)�_ 8 North King Street E-MAIL DRESS chenderson @webberandgrinnell.com AD : .. - INSURER(S)AFFORDING COVERAGE NAIC;r-. Northampton MA 01060 INSURER A Arbella_Insurance Group __ 17000 INSURED INSURER B ____ _--.- -- - Keiter Builders, Inc. INSURER C: Attn: Scott Keiter INSURER D: - 35 Main Street INSURER E _ ___ _ Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER:Master Exp 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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. INSFI ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/Y YY X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 300,000 }Il _ CLAIMS-MADE OCCUR PREMISES(Ea occurrence)_ 8500064396 6/1/2015 6/1/2016 M_ED EXP(Anyoneperson) $ -- 5,000 —_ PERSONAL 8,ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X JECT OTHER: COMBINED SINGLE LIMIT 1 $ 1,000,000 AUTOMOBILE LIABILITY (Ea accident)_ _ A ANY AUTO BODILY INJURY(Per person) $ '� ALL OWNED -XI's SCHEDULED 1020039381 6/1/2015 6/1/2016 BODILYINJURY(Peraccident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per_PERTntl $ X_ HIRED AUTOS X AUTOS $ 5,000 Medical a menls X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 11000,000 DED X RETENTION 10 000 4600064399 6/1/2015 6/1/2016 $ WORKERS COMPENSATION X PER 0TH- STAT TE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT _ $ 100,00.0 OFFICER/MEMBER EXCLUDED? C N/A A (Mandatory in NH) 9127440615 6/11/2015 6/11/2016 E.LDISEASE-EAEMPLOYE $ 100 000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/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 {{,�,, C Henderson, CISR/CIN AJIII " ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Nc;nPv;,nm dm� i �� �I 'I �� I' II �'I ',I �I�� �� �� �wwoh The Commonwealth of Massachusetts Department of Industrial Accidents 9-3 W Office of Investigations a 1 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 Keiter Builders, Inc Name (Business/Organization/Individual): _ 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): 1.11 1 am a employer with 15 4. 0 I am a general contractor and I 6. 0 New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 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 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.® Other comp. insurance required.] *Any applicant that checks box#1 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. Insurance Company Name:ACIJeIIa — Policy# or Self-ins. Lic. #:9127440615 Expiration Date:6.11.16 Job Site Address: 25 Henshaw Ave City/State/Zip: Northampton, MA 0- 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 th ains and penalties of perjury that the information provided above is true and correct. 11 .3.15 Si nature: r�� Date: 4 Phone#: 13 86.8600 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#: 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 o HenshawAve The debris will be transported by: Duseau Trucking The debris will be received by: valley Recvlcing Building permit number: Name of Permit Applicant Kenter Bu*i erc one t &2 1,-,/ Date Signature of Permit Applicant Iii i Version l 3 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Gary 1, Hartwell as Owner of the subject property hereby authorize Keiter Builders, Inc to act on my behalf,in all att rs relative to work authorized by this building permit application. 10/19/15 Signature of Owner Date Keiter Builders, Inc w._ _ �� ® ® _ w _m ,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 eiter Print Na } n dAg nt Date JB�TION 12.CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder Scott Keiter CS-102457 License Number 51 A Hatfield, Street Northampton,MA 01060 06.20.16 Address Expiration Date 413.586.8600 S Telephone SECTION 13-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 0 II it i Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Laura Fitch Not Applicable ❑ 8835 Name(Registrant): Laura Fitch Registration Number 8.16 Address 413.549.5799 Expiration Date Please see attached Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Keiter Builders, Inc Not Applicable❑ Company Name: Scott Keiter Responsible In Charge of Construction 35 Main Street Florence, MA 01060 Addr s 413.586.8600 ig e Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING 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 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: Filed 10.7.15 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 0 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. ii i Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition[—] Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign F] New Signs[:] Roofing❑ Change of Use❑ Other❑✓ Brief Description Lobby,classroom,corridor and misc renovations Of Proposed Work: SECTION 5 USE GROUP AND CONSTRUCTION TYPE Please see the attached plans and control documents USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 p 3B M Mercantile ❑ 4 R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify. M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE 1N USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 151 St 2nd 2nd 3rd 3rd 4 4 m th Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private❑ Zone Outside Flood Zonen Municipal❑ On site disposal system �i �,�.: .. Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability ... Room 100 Waterr'4a11 Availability -. NOV orthampton, MA 01060 Two Sets of Structural Plans pho e 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans DE+ :c lr:, l -�rcroNS Other Specify_ ON TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Capen Annex zone Overlay District ')5A Wi-nchaiv A vP Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record; ,riQ The Trustees of The Smith College 4o � ld West St.,Northampton, MA 01063 Name(Print) 6y4A1 7vuk,-- Current Mailing Address, 585-2441 Signature Telephone 2.2 Authorited Aaent: Keiter Builders, Inc 35 Main Street Florence,MA 01062 p Name(Print) Current Mailing Address,. 413.586.8600 Signature Telephone SECTI -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only corm feted by ermit applicant 1. Building (,/ (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) j qV CW Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/ins clor of SuHdin s Date I i File#BP-2016-0649 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE01062(413)586-8600 Q PROPERTY LOCATION CAPEN HOUSE ANNEX-25A HENSHAW AVE MAP 31B PARCEL 179 001 ZONE URC(100)/EU(92)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Zty r3 "o Fee Paid Building Permit Filled out Fee Paid Tyneof Construction:_RENOVATE LOBBY,CLASS ROOM,CORRIDOR&MISC RENOVATIONS 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: _L,AYpproved 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 iti Delay Si re o Bui ding 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. CAPEN HOUSE ANNEX-25A HENSHAW AVE BP-2016-0649 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B - 179 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0649 Project# JS-2016-001037 Est. Cost: $140000.00 Fee: $980.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): Owner: SMITH COLLEGE OFFICE OF THE TREASURER Zoning: URC(100)/EU(92)/ Applicant: KEITER BUILDERS AT. CAPEN HOUSE ANNEX - 25A HENSHAW AVE Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.11/17/2015 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE LOBBY, CLASS ROOM, CORRIDOR & MISC RENOVATIONS 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 11/17/2015 0:00:00 $980.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner