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31B-225 (9) DAWES HOUSE- 8 BEDFORD TER BP-2016-1367 GIS#: COMMONWEALTH OF MASSACHUSETTS MU:Block: 3 1 B-225 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-2016-1367 Project# JS-2016-002348 Est. Cost: $468385.00 Fee: $3278.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 9583.20 Owner: SMITH COLLEGE OFFICE OF THE TREASURER zoning: EU(100)iURC(100) Applicant: KEITER BUILDERS AT. DAWES HOUSE - 8 BEDFORD TER Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.5/20/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.INTERIOR & EXTERIOR RENOVATIONS & NEW PORCH 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 5/20/2016 0:00:00 $3278.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1367 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE01062(413)586-8600 Q PROPERTY LOCATION DAWES HOUSE-8 BEDFORD TER MAP 3 1 B PARCEL 225 001 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: INTERIOR&EXTERIOR RENOVATIONS&NEW PORCH 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 INFQRMATION 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 /kr�4�( S-6/9 /14. 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. Version 13 Commercial Building Permit May 15,2000 Department use only Ci iof Northampton Status of Permit, Bu(ding Department Curti CutlDdveway Permit _.v 12 Main Street Sawer/SeP Aviallablilty Room 100 Water'tWeit Avatlabiiity DEPT OF BUILDING INSPE Wrogn r,o� ort ampton, MA 01060 Two Sets'of,Stniclurai Plans phone - 7-1240 Fax 413-587-1272 Pkititite E�ians tither:Specify 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: This section to be completed by office ��'�. SMITH COLLEGE - DAWES HOUSE Map Lot )�!5' Unit 8 BEDFORD TERRACE Zane Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT:::] 2.1 Owner of Record: The Trustees of Smith College C/O Facilit� 126 West Street, Northampton MA Name(Print) i' '"" y 1 V � tZ-eurrent Mailing Address: J5'w. 5 R..s�...7,, Q' - Signature * Telephone #1 3 5 2.2 Authorized/Agent,• Keiter Builders, Inc 35 Main St Florence, MA Name(Print) Current Mailing Address: 413-586-8600 Signature President,kelter Builders,Inc. Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leled by permit applicant 1. Building $342,696.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of $61,510,00 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 4. $49,701 5. $14,478 5.Fire Protection 6. Tolai=(1 +2+3+4+5) 68,385.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature Building Commissioner/Inspector 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 Existing Wall Signs ❑ Demolition❑ Repairs[:] Additions ❑ Accessory Building❑ Exterior Alteration Existing Ground Sign[] New Signs❑ Roofing❑1Change of Use❑ Other[:] Brief Description JI�Qh dY ►�d1/ /lt�OVcc 1'+-t--) Of Proposed Work: VQ Pc^rlz_\� SECTION 5-USE GROUP AND CONSTRUCTION TYPE see attached Control DOCS 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 ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3g M Mercantile ❑ q El 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 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) 1 St 15t 2nd 2nd 3rd 3rd 4th 4th 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: F7,"3 Sewage Disposal System: Public Private ElZone Outside Flood Zone nicipal❑ On site disposal system Versionl.7 Commercial Building Permit May 15,2000 N 8. NORTHAMPTOZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bids&paved parkins) #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. 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: iZ H 1 r Not Applicable E]Name(Registrant): P/ —4S ( � � Registration Number Address t 'elVl 1�'C b- 0 CLC 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 A ess 4135868600 President, keiter BuildvrG, Int. 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 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED I WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Gary J. Hartwell, c/o Faciliteis Management as Owner of the subject property hereby authorize Keiter Builders, Inc. to act on my beha in 11 matters relative to work authorized by this building permit application. '11,X�4 Signature of 01r D to 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 Kelter Print N ;?� ('resident,Keiter Builders,Inc. 055.16.16 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 51A Hatfield St 06/20/16 A cess Expiration Date 4ePresident,Kelter 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 © No❑ 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: 8 Bedford Terrace The debris will be transported by: Duseau Trucking The debris will be received by: Val'ley Recycling Building permit number: Name of Permit Applicant Keiter Builders, Inc 05.16.16 t'resident,leiter Builders.inc. Date Signature of Permit Applicant The Commonwealth of Massachusetts _ Department of Industrial Accidents W Office of;investigations I Congress Street,Suite 100 Boston,NIA 02114-2017 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaalicant Information Please Print Le0bly Hanle (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): I.IN I am a employer with 16 4. 0 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. jrRemodeling shipand have no em to ees These sub-contractors have � p Y 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 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 13.� Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 must also 1111 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. tContractors 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:Arbella Insurance Policy# or Self-ins. L 9127440615 ic. #• Expiration Date:6/11/2016 8 Bedford Terrace Northampton,Job Site Address:_.--_--------_-------_____-__-- -----------------;_-__- City/State/Zip: p On, 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 hereby rtify under tl pains and penalties of perjury that the information provided above is true and correct. 04.25.16 Si nature: _ Date: 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#: City o ',"orthampton 'r�� Mass ,::huse tts 8w "^ DEPARTIXNT OF ,.:,'XLDTNG INSPSCTZQNS 212 blain Stree - i`Municigal Building Nortkam�t; r}, MA 01060 Louis Pax '- 3-587-1272 Chuck Miller Building C_. nmissioner Phom :: 1i3-587-1240 Assistant Commissioner CONSTRUCTION f. NTROL DOCUMENT (For professional EngineersIA,., Itectts responsible for Entire Project) Project Ti:, . ;)Ag4i CoL-LE6;E --DAWN HbV>c HA�;-E IL Date: 'rte �l � � '-7-0 t Project Lo. - Map: Parcel; Zone; Scope of F : cut: R.EN OVATI ON t0N<:.,7(LVZ_7(01Q Cr 'POPCH In accordu: r th the Eighth ed tion Massachusetts ate Building Code, 780 CMR Section 107.6: I t,k rs T H C)P— A-TJ Mass. Registration# 5,01 Being a re creel professional ;-ngineer/Archite hr _,,)y CERTIFIES that i have prepared or directly supervised the prepat- :gin of all design plat-s, computations anc: ecifications concerning: ` `4` PROJECT' For the ab r,arned project and that to the best of knowledge, such plans, computations and specifications meet the z provisions of the Massachusetts '_ .ite Building Code, all acceptable engineering practices and all ap �!e Laws for the proposed project Furthermor_ ; -Inderstand ands REE that 1 shall p,_ )rm the necessary professional services to determine that the above oned portions of 'he work proca �r% ;;ordance with the documents approved for the building permit and responsible for the following �ified in Section 10.7.6.2.2: 1. :e,,y of shop drawings, samples sfnd c ,,r submittals of the contractor as required by the >t uction documents as submitted for building permit, and approval for the conformance is des'gn concept. 2, and approvui of the quality n ar; rccedures f5 r all code-required controlled materials. 3. nr:sent at intervals appropriate f,. `` ( ape of construction to become generally familiar with r-),-+cess and qw,�lity of the wor` t erm!ne, in general, if the work is being performed ,"ter conslsterz with the consu yl.,"- documents. I shall subs in a forrn accept-able ding official, a progress report together with pertinent comments �_r�rpletion of Lire work, I sha: _�ubi to the building d�icial a final report as to the satisfactory completion actin,=ss of the r c,Ject for occ,:° nc Signature <.i of Registerec Professional �,,�,RED ARcl,,,� No.5, Qay _t'E ij 2.s 1 SHELBI ' ,L Fi;LLS,