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(1 �-`.,.^�; ¢ ��n��' ,�-. '� �o' i ¢,, � ' f e ' � �s �': � IIs 11 � A -_ a^s r� tti f ••, f r i j Z a- N, t . 1YN TMH3 if $ zj �x o I y N z 1 4 2 0 d� x k i { 3;9 Z z � z . M......: a Z 41 Smith College Q a , ' m o a y n 43 West St, Apartment #2 & #4c D 0)� os c&h architects M D �� Coldham and hartman.com amherst,ma "M Renovation \sh �a 43 West St,Northampton MA m 43 WEST ST BP-2016-1191 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.-Block: 3 1 D-065 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-2016-1191 Project# JS-2016-001990 Est. Cost: $134175.00 Fee: $939.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 9844.56 Owner: STANDICK TRUST&RICHARD RESCIA&STANLEY ZEWSKI TRUSTEES Zoning: EU(100)/URC(100)/ Applicant: KEITER BUILDERS AT. 43 WEST ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 WC FLORENCEMA01062 ISSUED ON:4/19/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE APTS 2 & 4 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 4/19/2016 0:00:00 $939.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1191 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE01062(413)586-8600 Q PROPERTY LOCATION 43 WEST ST MAP 31D PARCEL 065 001 ZONE EU(100)/URC(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: RENOVATE APTS 2&4 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 7INF 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 re of Building�Officiar 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. APR i Version 1.7 Commercial Building Permit May 15,2000 QeparUrtent use only City of Northampton Status of Permik �� a 4= Building Department Curb`CuUDrhfway�Pemit ,7 212 Main Street S' mr(Septtc;AvatlablUty 4 Room 100 Water/Utte€I AvailabiNty `^ Northampton, MA 01060 Two Sets o#StrucWral Pas phone 413-587-1240 Fax 413-587-1272 PlQuSlte Plans APPLICATION 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: Map � j� Lot (/�� Unit This section to be completed by office /i 43 West Street Apartments 2&4 and Common Area Zane Overlay Dlstrici Northampton,MA 01060 Elm St.District CS District' SECTION 2-PROPERTY OWNERSHIPIAUTHORtZED AGENT 2.1 Owner of Record:-,.+r Trustees o Smith College CO/Facilties 0V 126 West Street,Northampton MA Name(Print) Current Mailing Address: 413-584--3�"�� Signature Telephone 2.2 Authorized Agent: Keiter Builders,Inc 35 Main St Florence,MA Name(Print) Current Mailing Address: 4135868600 Signature IjCA4 President,Keiter Builders,Inc. Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 90,813.00 (a)Building Permit Fee 2. Electrical 26,652 00 (b)Estimated Total Cost of Construction from 6 3. Plumbing 16,710.00 Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1+2+3+4+5) $134,175.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissionerlinspector of Buildings Date 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 0 Existing Wall Signs El Demolition El Repairs D Additions [I Accessory Building 171 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing[] Change of Use C3 Other El Brief Description Of Proposed Work: Renovate kitchens,bathrooms,electrical upgrades,window replacement and improvements to ---- - SECTION 5-USE GROUP AND CONSTRUCTION TYPE Please see attached control Docs USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 r-1 A-2 0 A-3 171 1A 11 A-4 ❑ A-5 0 1B El B Business ❑ 2A ❑ E Educational 0 2B ❑ F Factory 0 F-1 El F-2 El 2C 0 H High Hazard 0 3A El I Institutional 1:1 1-1 ❑ 1-2 E3 1-3 [1 3B 0 M Mercantile 1:1 4 El R Residential 13 R-1 El R-2 El R-3 El 5A 171 S Storage 0 S-1 Fl S-2 El 513 C3 U Utility n Specify: M Mixed Use 171 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN 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) ist i M 2 nd 2 nd 3rd 41h 4 Total Area(so Total Proposed New Construction(sf) Total Height(ft) Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private C-] Zone Outside Flood Zone[3 Municipal [:] On site disposal system 0 8: NORTHAMPTON ZONING Version 1.7 Commercial Building Permit May 15,2000 ' 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 arca minus bldg&paved parking) k of Parking Spaces Fill: (volume&Locution) 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/t B. Does the site contain a brook, body of water or wetlands? NO O 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 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. Version).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: a C _ Not Applicable ❑ Name(Registrant): _/iyef Q Registration Number Address '031#6 5" it AA SN3611P Expiration Date 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. Company Name: Not Applicable❑ Scott Keiter Responsible In Charge of Construction 35 Main Street Northampton MA As PresidcnG Kei[cr Builders,inc. 4135868600 Signature Telephone Version 1.7 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 O SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT %i,/ (?c?_4L 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. Signature of Owner .__J Date 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 N e '-Y--,/ �CSLC President,Keiter Builders,Inc. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Keiter CS-102457 License Number 5 1 A Hatfield St 06/20/16 X`C_1VK_ Expiration Date President,Keiter Builders,Inc. 4135868600 Signature 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 Q No O City ofNorthampton 2l2Main Street,Northampton, M& 0l06O Solid Waste Disposal Affidavit |naccordance ofthe provisions ofK8GLo4O. S54. \ acknowledge that oa m condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in e properly licensed solid vveote disposal faoi|ity, as defined by N1GL c 111, S 150\. Address ofthe work: 43 West Street The debris will betransported by: Duseau Trucking The debris will bareceived by: Valley Recycling Building permit number: Name of Permit Applicant Keiter Builders, Inc Inc.At ;e�President,Keiter Builders, Date Signature ofPermit Applicant The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 M www.naass.govldia. Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Keiter Builders, Inc. Address:35 Main St City/State/Zip:Florence, MA 01062 Phone#:413-586-8600 Are you an employer?Check the appropriate box: Type of project(required): 1.R I am a employer with 15 _ 4• ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 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 ❑Building addition [No workers' camp.insurance comp.insurance.l ❑ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] c. 152,§x'1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 91 mus(also till out the section below showing their workers'compensation policy information. t homeowners who submit this anidavit 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 a»t art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Arbella Insurance Policy#or Self-ins.Lie.#:9127440615 Expiration Date:6/11/2016 Job Site Address: 43 West Street City/State/Zip:Northampton, MA 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 herebyrttfy under dy pains and penalties of perjury that the information provided above is true and correct. Signal Date: 04.06.16 Phone#• 4135868600 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#: ACo CERTIFICATE OF LIABILITY INSURANCE FDAT/10/20E(0/20 5 � 715 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(les) 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). PRODUCER CONTACT Cynthia Henderson CISR NAME: Y r Webber & Grinnell PHONE (413)586-0111 FAX N :(413)586-6481 8 North King Street AD'DRESS,chenderson@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# _ 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 Ex 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP R POLICY NUMBER D/Y YY) (MM/DD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 1XI OCCUR DAMAGE TO RENTED PREMISES Ea occurrence300,000$ 8500064396 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT PRODUCTS $ 2,000,000 ❑ LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OS AUTOS Ix SCHEDULED AU1020039381 6/1/2015 6/1/2016 BODILYINJURY(Peraccident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ 5,000 X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR_J� CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION 10,000 4600064399 6/1/2015 6/1/2016 $ WORKERS COMPENSATIONX PER OT AND EMPLOYERS'LIABILITY Y/N STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ _ 100,000 OFFICER/MEMBER EXCLUDED? ❑N N/A A (Mandatory In NH) 9127440615 6/11/2015 6/11/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INR095 r9mann Initial Construction Control Document 14— To be submitted with the building permit application by a Registered Design Professional r for work per the 8th edition of the " Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Smith College, 43 West Street-Apt#2, 4 and Common Area Date: 08 April 2016 Property Address: 43 West Street,Northampton, MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: In apartments#2 and#4 the scope includes the renovate kitchens and bathrooms, electrical upgrades, a replacement window in each, and improvement of the emergency lighting and exit signs in the common areas. 1, Thomas RC Hartman, AIA, MA Registration Number: 10448 Expiration date: 8/31/16, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural 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. 4. 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 �y+ electronic signature and seal: (14 A' A Alti'i ;j Phone number: 413-549-3616 Email: tom@coldhamandhartman.com r 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, nrovide a description.