31D-067 (9) 30 BELMONT AVE BP-2017-0474
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 31D-067 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:HANDICAP RAMP BUILDING PERMIT
Permit# BP-2017-0474
Project# JS-2017-000787
Est.Cost:$26000.00
Fe91$182A0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use rou ;_ KEITER BUILDERS 102457
Lot Size(se.ft.): 3746.16 Owner: SMITH COLLEGE
Zoning: URC Applicant: KEITER BUILDERS
AT: 30 BELMONT AVE
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 1) WC
FLORENCEMA01062 ISSUED ON::10/28/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW HANDICAP RAMP
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 10/28/2016 0:00:00 $182.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File F BP-2017-0474
APPLICANT/CONTACT PERSON KEITER BUILDERS
ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-860)0
PROPERTY LOCATION 30 BELMONT AVE
MAP 3 ID PARCEL 067 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid C e.1S 550'7 'Y 1 go\
Building Permit Filled out
Fee Paid
TypeofConstruction: CONSTRUCT NEW HANDLCA_ P.I AMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owney/Statement or License l0 457 .} ./{ .t
3 sets of Plans/Plot Plan Oji 'tt O' EG7;eO/Pr/JC
THE FOL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I ATION 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 frorn Elm Street Commission Permit DPW Storm Water Management
r t- o• r
Signa - of Build ng 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.
r Versionl.7 Commercial Buildin€Permit May 15,2000
ADepartment use only
' City of Northampton StahuofPernt
/ Building Department Curb CubOrlveway Pandit —.._
212 Main Street Sewer/SepucAvailability,__
Room 100 Water/Welt Availability
/�o._ Northampton, MA 01060 Two Sets of Structural Plans __
.d' cone 413-5871240 Fax 413-587-1272 Plot/Site Plans
Other 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
36 6 — - +f3 . Map Lot Unit
s_trc/r r I r f�^-� Zone Overlay OisWct
Elm St.District CB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
2.1 Owner of Record:
The Trusiess of The Smith Cm.s,
Name(Print) Ct0 Facilites Management, . .rtwgii Current Mailing Address. 126 West St,Northampton,MA 01063
Signature _ _ _ Telephone 585.2441
24 Authorized Meat: Asn, ,[7 ,, n/ c �1
mama(Pha)y(7� IY 6k -ter $ Current Wading Addresss. 3r /It' I& �+( - -F(�/((,t4 c,,..c
Suture ¢ President,1(01 Telephone 636 ale, G'Lt
SECTION 3•ESTIMATED CONSTRUCTION COST
`Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building < r i r/1 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from IS)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection41
��� r ,�'y ry
6. Total•(i +2+3+4+5) .24i Ct/ Check Number 657-) 7 /
^_ 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 13,2!X10
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 Change of Use Other ,i,Q- i
Brief Description Construct new handicap ramp - _ -S2t-(,Z-12
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 to 0
k4 0 A-5 0 18 ❑
8 Business Q ~..—. _ 2A .—... 0 .—._
E Educational ❑ 2B i ❑
F Factory ❑ F-1 0 F-2 0 2C 0
H High Hazard 0 _ i 3A 0
I Institutional 0 I-t 0 1-2 0 1-3 0 3B 0
M Mercantile 0 ..—.— ,_.. 4 0
R Residential ❑ R-t 0 R-2 0 R-3 0 5A 0
S Storage 0 Sit ❑ S-2 0 513 0
U Utility ❑ i Specify:
M Mixed Use ❑ Spedfy:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existin; 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)
let
2" 2e
3 a
4th
4"
Total Area(sf) Total Proposed New Construction(s0
Total Height(ft)
Total Height ft
71 Water Supply(MAL.A 40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone Municipal ❑ On site disposal system
Version l.7 Commercial Building Permit May /5,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Pay, L: R:
Rear
Building Height --��
Bldg_Square Footage
Open Space Footage
lot
area minus bldg&paved
narking)
it of Parking Spaces
Pig:
{volume&Ideation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document,7
B. Does the site contain a brook, body of water or wetlands? NO Q 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
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 Uj
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it pad of a common plan
that witl disturb over 1 acre? YES O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versions 7 Commercial Building Permit May U.2000
SECTION B 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:
Not Applicable O
Name(Registranty.
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Englneer(s)
Name Area of Responsibility
Address Registration Number
SS•nature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature lelephon¢ Expiration Date
Name Area ot Responsibildy
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 0
Company Name:
Scott Keiter
Responsible In Charge of Construction
35 Main St. Florence,MA 01062
¢ss
president.KIR413-586-8600
Signature Telephone
Version l.7 Commercial Building Permit May 15.2O(
SECTION ID-STRUCTURAL PEER REVIEW(780 CMR 110.11) -- I
atdependem Shut-twat Engineering Structural Peer Review Required Yes 0 <,ei&e
SECTION 11.OWNER AUTHORIZATION-TO SE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t Gary Hartwell
.__.__....�A_ .y as Owner of thesubject property
hereby authorize Jamy2l! JC.40 92ft , to
act on my behalf, in all hers relative to work authorized by this building permit application.
iall0;le
Signature of Owner Date
Et A." __1ei44-LPk..^SC....-S )'C'e .as OwnertAuttodzad
Agent hereby declare that the statements and information en the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Sc 1CeAw
rice
President,RBI
1uhc.0A G2__.
Signetwe of Owner/Agent pale_SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed ConstructionSUnecvtwrG Not Applicable Applicable
Name of License HoMet -SC0 4T -t Vet. _t �- J(Jc}
License Number
_.- a f .__
Apipass Expireikn Date
-I/^ • President KM S'?6 <t
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 Me issuance of the building permit.
Signed Affidavit Attached Yes O 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: aeBelm rn Ave
The debris will be transported by: Keifer Builders, Inc.
The debris will be received by: Valley Recycling
Building permit number:
Name of Permit Applicant Keifer Builder, Inc
0927.16
GR_ rr..a. nm
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
,'t� L
se. Office of Investigations
t mica 1 Congress Street,Suite 100
"1.
£ y Boston,MA 02114-2017
�- www.nzass.govldia
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 bog:
Type of project(required):
I.0 I am a employer with 18 4. ® I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors fi. ®New construction
2.0 i 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 workers'
9 0 Building addition
[No workers' comp. insurance comp. insurance.,
� We are a corporation
required.]
5. and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 1 in Plumbing repairs or additions
myself, [No workers' comp. right of exemption per MOL 12.0 Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
_ comp.insurance required.] _
"Any applicant that checksbox 4I must also all 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,
t?C'ontrnctoa that check this box must attached an addition&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 fru my employees. Below is the policy and fob site
information.
Insurance Company Name:Arbella Protection
Policy#or Self-ins. Lie, #:9127440615 Expiration Date: 6/1/17
39 Belmont Ave Northampton
Job 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
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the Corm of a STOP WORK ORDER and a tine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DR for insurance coverage verification.
I do Date:
hereby�rrtify under the pains and penalties of perjury that the information provided above is true and correct.
(j . �: / 09.27.16
Signature-
^"'�- President,Kiat
Pttoneu_413586-8600
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: _Permit/License 4 — -_ •
-
Issuing Authority (circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Aa M
CERTIFICATE OF LIABILITY INSURANCE DATE`MDD" Y'
°Y
6/}4/2016 _
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. N SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s). „_,__
PRODUCER CONTACT Cynthia Bendereona CIE
Webber c Grinnell PHONE. (413) 6-0111 _. LEAN. 1,3164u
PHONE..EW_ —58on —.—--.. _. I1A6,NSL—.. .506-_._ ._ _...
S North King Street laths_chendersonewebberandgrineell,coon_
. — ..
__HSVREfry$lAFFORDING COVERAGE _ _ _ NAIC/
Northampton RA 01060 INSURER AA Arbel la Protection __. _ _41360._
INSURED k1SVP_EA B,__ _ _ _ _ _ i
getter Builders, Inc. jsungsc:.—
Attn: Scott Bolter NsusteD_
35 Main Street
Florence MA 01062 INSURER F'
COVERAGE CERTIFICATE NUMBER:Haster Exp 2017 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.i - 'AlMACY EFS MACYY EIPT- - -
LTRL TYPEOF INSURANCE SO WPOLICY ICY NUMaER IMMDDMYYYI I I MMTLIMITS
U/YYYYI
X I COMMERCIAL GENERALUABILITY I I I EACH OCCURRENCE• pAM GE t() ENiED _IE_ 1,000,000
A CLAMS-MADE .,ADE EOCCUR I vEM LSESIE_IWaGIJ b 100,000
T 8500064396 4/U1016 6/1/2021 :L RED ERR ANNy o_rymw H.5 5,000
. — .... aERSONu8?AW INJURY TS-.... ',ODD,000
_6E L AGGREGATE LIMITLIIPPLIES PER: 1 GENERAL AGGREGATE 16 2,000,000
'X POLICY inc I PRODUCT, C /OP (GI5 _ 2,000,000
OTHER 4
AUTOMOBILE IJABRITY I DOMONFO SINGLE GNP 13 1,000,000
AILOWNED rR. SCHEDULEDIB001LBODILY+ 'M"Tt1`ax ) I$ -
A : X i` K 1102003938101 I 6/1/2016 611/1027 INJURY( MsrCP ) 5
ANY AUTO
IAUTOS — — —
IIREtlAUT06 MON-OWNED PROPER VO MAGE
AUTOS I I r109 9199A01
1 I ANTANAWIFFNA i5 5,000
X 'UMBREttAUAB I I OCCUREEAC OCCURRFNOE_ S. 5,000,000
A INCEa6t1A0 ICLNMSMAO)6 : AGGREGATE __ _ _$_ _B 000 Opo
I QEDk X ,RETCm19N$ 10 009 I I.4600064399 6/1/1016 6/1f103T I
—III X 6
:WORKERS COMPENSATION X
ANOEMPLOYERS LABILITY SIATYi£, . ..:1R _. _..
• „NNY PROPRETORPARTNERrex£CVTVE I _EL EACH ACCIDENT S 1,000,000
`OFFCERVEMBER EX449DEO? I N I'N1A1 11
AytantlMory In NH/ 931T440615 6/l1/2016 6/11/2017 'L EL DSEASE EA EMPOEd 5_ 1,0110 000
Ice/ mweeNI
DESCRIPTION OF OPERATIONS Wow 1 EL O1SEAgE-POLIMLIMrti6 },000,00Q
IIS I
II I I I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES INROAD Itit Additional Rnngrks Schedule.may be atbciRd it more Apace is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
FOr Informational Purposes THE EXPIRATION RATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
C Henderson, CISR/CIN II f
t
®19882014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014m1) The ACORD name and logo are registered marks of ACORD
INR09S mn,enn
II
BUILDERS35 Main St. Florence,MA 01062 { oprtcE:(413)586-8600 I F42:(413)280-0124
Commissioner Hasbrouck 10.10.16
Subject:Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the College
Administration Ramp at 30 Belmont Ave in Northampton because the work is of a minor nature,will riot
affect health,accessibility, life and fire safety,or structural requirements and is impractical in that the
cost of control construction is considerable when compared to the cost of the proposed work. All work
will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
4 fully,
Scott Keit
Keiter Builders, Inc
35 Main Street
Northampton, NA 01060