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31D-054 (5) 41 WEST ST-APT 1 &2 BP-2017-1498 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31D-054 CITY OF NORTHAMPTON Lot: -00 I PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit BP-2017-1498 Project# JS-2017-002494 Est.Cost:$150000.00 Fee: $1050.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq.ft.): 4791.60 Owner SMITH COLLEGE TRUSTEES OF C/O HPMG Zoning: EU(100)/CB(99)/URC(1)/ Applicant: KEITER BUILDERS AT: 41 WEST ST - APT 1 & 2 Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 0 WC FLORENCEMA01062 ISSUED ON 6/23/20170:00:00 TO PERFORM THE FOLLOWING WORK:COMPLETE RENOVATION OF APTS 1 & 2, INCLUDING INSULTION, NEW KITCHEN & BATHROOM 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 74 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 6/23/2017 0:00:00 $1050.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1498 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 0 PROPERTY LOCATION 41 WEST ST-APT 1 &2 MAP 3 ID PARCEL 054 001 ZONE EU(100)/CB(99)/URC(I)/ \fttlj'IJ('_ �UYY THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT it C Fce Paid �� Building Permit Filled out Fee Paid TvoeofConstruction: COMPLETE RENOVATION OF APTS 1 &2,INCLUDING INSULTION,NEW KITCHEN&BATHROOM 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: r/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 !emolition Delay / ry Si: of f:to d g 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. JUiv 2 2 SII Version I.7 Commercial Building Permit May 15,2000 Department use only DEFT- '' City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well 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,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING /�I�,/r,'� �/�,r.� SECTION 1 -SITE INFORMATION (,.f) bwv` gams 1.1 P_roys Atltlress: This section to be completed by office 41 West St-Apt 1 &2 Map '3 l ID Lot 6- Unit Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 'trustees of of S� �/mith College 126 West St Northampton,MA U1U62 ‘ 44, ,,(-L,,-, Name(Print) Y4<c Y,�wir, �v✓ / -N/P[f �� Current Mailing Address: 7 2t r/rcS Gil,t.���°'th: 413- 585-2423 Signature "CLCc oc..5 L- ca7r_ Telephone 2.2 Authorized Agent: J Keiter Builders,Inc. 35 Main St Florence,MA U1062 Name(Print) Current Mailing Address: 413-586-8600 Signature President,KBI Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical p( (..ls� (b)Estimated Total Cost of 1 r Construction from(6) 3. Plumbing n _^ CA 22 Building Permit Fee 4. Mechanical(HVAC) M.) /0, OD 5. Fire Protection c. /25 6. Total=(1 +2+3+4+5) /,Dr ( Zi) Check Number (I g(QD 0S0 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/inspector of Buildings Date Versionl.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 0 Demolition Repairs Additions C Accessory Building Exterior Alteration C Existing Ground Sign❑ New Signs C Roofing nnChange of Use1❑ OtherJJ.,, 0 Brief Description CeµleIPM a If\_OV6c ' '- V l r'4>Aal2.J ( a' 9 . Of Proposed Work: I AGI 1 , \ns -t -k „s ( �W4 IVVVVu` -' r SECTION 5-USE GROUP AND CONSTRUCTION TYPE YasK USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ® A3 A-3 ® IA 101 A-4 ® A-5 ® is 13 B Business ® 2A E Educational ® 2B 03 F Factory F-1 ] F-2 M 2C 03 H High Hazard DI 3A I Institutional ® I-1 g I4 ® 1-3 ® 36 CO M Mercantile ® 4 03 R Residential nl R-1 El R-2 ® R-3 M 5A LO S Storage S-1 ® S-2 ® 5B U Utility Specify: M Mixed Use ® Specify: S Special Use n 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(al) 1st 2 2e 3rd Ob 4� 4e 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: 73 Sewage Disposal System: Public ® Private J Zone Outside Flood ZoneD Municipal ® On site disposal system Version 1.7 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 (4n area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Lacmion) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: W YES: Was the permit recorded at the Registry of Deeds? NO O DONT 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 DONT KNOW Q 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 t acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: 1 t ‘their I Not Applicable Name(Registrant): NLYTt-tx,\ /0'1 8 Registration umber Address & 3i be-4- C ' ^ p Expiration ate Signature J"x-( q�� Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiraton 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 ID Company Name: Scott Keiter Responsible In Charge of Construction 33 Main St.Florence,MA 01062 A ess XQ president,KB! 413-586-8600 Signature Telephone Version]7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No O SECTION 11 -OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, AA,ec gra oN ig,ussL% OF/SsR�� - dere= or"/A't- tri Ccucmc ,as Owner of the subject property Keiter Builders,Inc. hereby authorize to act on my behalf,in all matters relative to work authodzed by this building permit application. Signature of Owner Date Keiter Builders,Inc 1, ,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 PprF Nam ?y``r President,RBI 04.11.16 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Scott Keifer CS-102457 Name of License Holder License Number 51 A Hatheld Street Northampton,MA 01062 06/20/2018 President Kill 413-586-8600 Expiration Date SignatureTelephone 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 O No Q 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: 41 West Street The debris will be transported by: Keifer Builders, Inc. The debris will be received by: valley Recycling Building permit number: Name of Permit Applicant Keiser Builder, Inc 06.20.17 i President,Kal Date Signature of Permit Applicant The Commonwealth of Massachusetts Via— Department of Industrial Accidents G:l . G' Office of Investigations fit. =; f I Congress Street,Suite 100 t' Boston,MA02114-2017 %'' s-' 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. I am a employer with 18 4. IDI am a general contractor and I employees (full and/or part-time)." have hired the sub-contractors 6. 0 New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, 0 Demolition workingfor me in anycapacity. employees and have workers' P LY 9. 0 Building addition [No workers' comp.insurance comp. insurance.] required.] 5. 0 We are a corporation and its l0.0 Electrical repairs or additions 3.❑ I am a homeovmer 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' 13.0 Other comp. insurance required.] *Any applicant that checks box NI must also fill out the section below showing their worker:compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. tConttacton that check this box must attached an additional sheet showing the name of the sub-contractor and nate 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 Protection Policy#or Self-ins. Lic.#:9127440615 6/1/17 Expiration Date: - 41 West St 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 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 sr_ under the pains and penalties of perjury that the information provided above is true and correct. w0( President,KB! 06.12.17 Signature., Date: Phone#: 413586-8600 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License It 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#: A�Oa CERTIFICATE OF LIABILITY INSURANCE 06/ a/2�oYeYI 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(&), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder N an ADDITIONAL INSURED,the Pollcydes)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 C1CT Cynthia Henderson, CISR Webber 6 Grinnell PHONE . (413)586-0111 FAX e:p1313e6-6611 8 North Ring StreetApo IE55:chenflersonb,ebberandgrinnell.com I5UR(R(Sj AFFORDING COVERAGE NAI:e Northampton MA 01060 NSURER A Arbella Protection 41360 INSUMED NSHRER B: Reiter Builders, Inc. XSURERC'. Attu: Scott Reiter NSURERD: 35 Main Street NSURERE: Florence HA 01062 NSURER F COVERAGES CERTIFICATE NUMBERMaster Erg 2017REVISION 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. UMW b6LRUBR POLICY EFF I POIJCYEXP 1 LTRI TYPE OF INSURANCE IHSOIWVOI POLICY NUMBER IIMWONIYYY1 I INW9LYYVYYII LIMITS X COMMERCIAL GENERAL LIABILITY I I .EACH OCCURRENCE 1 1,000,000 A Ir CLUMS-MAOE X OCCUR DAMAGE TO RENTED 100.000 _ PREMISESIEe ocwneOs) 5 8500066M396 6/1/2016 6/1/2017 I,MEDDEXP Pew* 1 5,000 JPER50 AL a ADV INJURY 1 6 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATEI S 2,000,000 TI POLICY PRO- JECT LOC I I I PRODUCTS-COw,OP AGO I6 2,000,000 I OTHER I S • AUTOMOBILE WBILITYIICOM«WED SINGLE LIMIT i.1 LEO 1,000,000 A ANY AUTO I BODILY INJURY(Per person) S AI OWNEDI SCHEDULED TOS 2 TOS I10100391R101 6/1/2016 6/1/2017 BOOZY INJURY(Per=tent) S _2 RED AUTOS •B IAUTOSVMED I 'PROPERTY Per IDMUGE 1 ,. Medicalpresets 'S 5,000 UMBRELLA LMB IOCCUR ' EACH OCCURRENCE S 5,000,000 A I_ - 1EXCESS LIAR riCWMSMADE I i AGGREGATE 5 5,000,000 DED Z RETENTIONS 10,coo 460006(399 I',. 6/1/2016 6/1/2013 15 WORKERS COMPENSATOR A PER x OTH- AND EMPLOYERYWD3 BTY V/N 1 ER ANY PRQPRIETORWAATNERIEXECUTIVE . EL EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N ',N/A -- A (Mandatory In NH) 91274406/5 6/11/1016 611112017 IEL DISEASE-EA EMPLOYEE f 1,000,000 IHyerl�eON ONO POLICY LIMITS 1,000,000 �OEX0.IPTIDX OF OPERATIONS below IEL DISEASE- DESCRIPTION OF OPERATONS;LOCATIONS/VEHICLES pcORO 101.AaaIIanal Rmude Schedule,mew bentrched if mom.pec.II rnArN1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOr Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE OEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNOR ED REPRESENTATIVE C Henderson, CISR/CIN K'..e... 41)1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025mum 1 Initial Construction Control Document Az To be submitted with the building permit application by a Registered Design Professional � �l for work per the 8'h edition of the Massachusetts State Building Code,780 CMR, Section 107 Project Title: Smith College, 41 West Street—Apt#1&2 Date: 15 June 2017 Property Address: 41 West Street, Northampton, MA Project: Check (x)one or both as applicable: New construction X Existing Construction Project description: Complete renovation of apartments 41 &2 including insulation. new kitchen and bathrooms. I.Thomas RC Hartman, AIA, MA Registration Number: 10448 Expiration date: 8/31/17, 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 [(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"orZt,FED AHe* electronic signature and seal: ts; Nr= ' u r Phone number:413-549-3616 Email: tom@CandHArchitects.com Building Official Use Only Building Official Name'. Permit No.: Date: Note I. Indicate m ith an 'x' project design plans computations and specifications that you prepared or directly supervised.If'other' is chosen. provide a description.