31D-010 (36) Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
Z for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College.Vivarium AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new.
I Keith D. Prata, MA Registration Number: 47397 Expiration date: 26110L20
, am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural X 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 Contr ment'.
\,�N OF U4
Enter in the space to the right a"wet" or Illy Cy
electronic signature and seal: KEITH
pRATA
3
MECHANICAL
No.47397
ASO&G/s T elk
6SIONAIL
Phone number:617-254-0016 Email:KPrata@brplusa.com
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 01 01 2018
Initial Construction Control Document
u To be submitted with the building permit application by a
a
d Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall 44 College Lane Northampton MA 01063
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new
I Keith D. Prata, MA Registration Number: 47397 Expiration date: 06/30/20 am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning,':
Architectural Structural X 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 (F1 OF 414Ss
electronic signature and seal:
KEITH D. tp
p PRATA 4
MECHANICAL
0
&N o.47397
9O,c C'/S T
NA
Phone
ANG\
e
Phone number:617-254-0016 Email: KPrata@brplusa.comy
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a
description.
Version 010l 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
< for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium,AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new..
I Keith D. Prata, MA Registration Number: 47397 Expiration date: 06Z30/20, am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural X 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 H OF
electronic signature and seal:
KEITHD. t P-
PRA,T A
MECHANICAL
o No.47397
Fit STe
FS�/ONAL
/Z
, -� (z-,
Email:KPrata@brplusa.com
Phone number:617-254-0016 6/
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 01 01 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement — Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new,
I Reza Ghayspoor,MA Registration Number:47758 Expiration date: 06/30/20 am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection Electrical X Other:Fire Alarm
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 OF t4,4,_
electronic signature and seal:
REZA
14AYSPOO
No.477
106—
ON
Phone number:617-2540016 Email:RGhayspoor@brplusa.com V
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 01 01 2018
�.� a� � ,` „A.,..A
t', �
.� ,~.��
� .y ii
t �,��4�,.+,.�,,�'.
f
Initial Construction Control Document
Z To be submitted with the building permit application by a
W
R d Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College Vivarium AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall 44 College Lane Northampton MA 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new.
I Reza GhaysRoor, MA Registration Number: 47758 Expiration date: 06/30/20 am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection Electrical X Other: Fire Alarm
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 signature and seal: X 50 OFl1/q
REZA
No.477
T
Phone number:617-254-0016 Email:RGhayspoor@brplusa.com
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 01 01 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,.Vivarium AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Upgrade of existing air handling units and exhaust fans with new.
I Reza Ghaysl2oor,MA Registration Number:47758 Expiration date: 06/30/2 ,am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection Electrical X Other:Fire Alarm
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 ayZN OF 44,
electronic signature and seal:
REZA
Q14AYSPOOR
No.477 A
T
60A
Phone number:617-254-0016 Email:RGhayspoor@brplusa.com
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 01 01 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
4 for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement — Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new..
I Reza Ghaysl2oor,MA Registration Number:47758 Expiration date: 06/30/20 am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection X 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 signature and seal:
OF 44
4
REZA
GHAYSPO
Phone number:617-254-0016 Email: RGhayspoor@brplusa.com (U
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 01 01 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement — Date:November 1_6 2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA. 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new,
I Reza Ghayspoor, MA Registration Number:47758 Expiration date: 06/30/20,am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning :
Architectural Structural Mechanical
Fire Protection X 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 signature and seal: c`PLSNOF
A-4 RE
Cc GHAYSPOO Cn
Flo.477P8
IST
Phone number:617-254-0016 Email:RGhayspoor@brplusa.com
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 01 01 2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement — Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane Northampton,MA.01063
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description:U12grade of existing air handling units and exhaust fans with new.
I Reza Ghaysl2oor,MA Registration Number:47758 Expiration date:Q6/30 20 am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection X 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 I
F 4f,4A,5�1
electronic signature and seal: �A O
REZA
GHAYSPO R
No.477
/ST
Phone number:617-254-0016 Email: RGhayspoor@brplusa.co
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 01 01 2018
Initial Construction Control Document
H To be submitted with the building permit application by a
Registered Design Professional
for work per the 91h edition of'the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Sabin Reed Vivarium - Smith College Date: 16 Nov 2018
Property Address: 44 College Lane, Northampton, MA 01063
Project: Check(x)one or both as applicable: New eonstruet X Existing Construction
Project description: Renovation of Existing Building
1, Ryan S. Hellwig PE, MA Registration Number: 37300-ST Expiration date: 6-30-2020 , am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
^rehtel X Structural Mee-haffieat
Fixe Pfeteetien Eleetrieal 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 shall perform the necessary professional
services and be present on the construction site on a regular and periodic basis to:
I. 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 -,N OF uas
electronic signature and seal: RYAN S,
tiFLLwlc
STRUCTURAL.
No, 37300
Cts
Phone number: (413)774-7444 Email: rshpe@crocker.com st0
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.
Initial Construction Control Document
P17ifj*' To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Smith College,Vivarium AHU Replacement Date:November 16,2018
Property Address: Smith College,Sabin-Reed Hall,44 College Lane,Northampton,MA 01063
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description:Upgrade of existing air handling units and exhaust fans with new.
1, Charles Roberts, MA Registration Number: 10107 Expiration date: 8/31/2019, am a registered design
professional, and I 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 in accordance with the Professional Standard of
Care,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.Such
review shall not diminish or relieve the Contractor of its submittal and other responsibilities.
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.The contractor shall be
responsible for performing the work in accordance with the contract documents and shall be
exclusively responsible for its construction means,methods,sequences and procedures,and for
construction safety.
4. The performance of the services shall not require any special testing or inspections unless specifically
stated in the 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 Construe Document'.
Enter in the space to the right a"wet" or
electronic signature and seal: 0 10io?
Phone number: 413.259.1630 Email:croberts@kuhnriddle.com n AMH
Building Official Use Only o
Ni OF WOO
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 01 01 2018
III
ACCMV CERTIFICATE OF LIABILITY INSURANCE ""eIm"wyYyy)
a5trrnols
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* M the certificate,holder Is an ADDITIONAL INSURED,the poilcy(les)must have ADDITIONAL INSURED provistons or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an
this Certificate does not confer rights to the certificate holder in lieu of such endo mement(s.
PRODUCER NCONTACT AME: Cynthia Henderson CISR Elite
Webber 3 GrinnellW PHONE (473)586 0111 No: (413)586 6481
8 North King Street Ao0 chenderson®webberandgrinnelt.Com
INSURER(S)AFFORDING COVERAGE NAIC E
Northampton MA 01060 INSURERA: Setecttve Ins Co of S Carolina
INSURED INSURER 11. A.I.M.MutuailA.l M.
Kelter Builders.Inc. INSURER C:
Ann:Scott Keller INSURER 0'.
35 Main Stresl INSURER E:
Florence MA 01062 INSURER F
COVERAGES CERTIFICATE NUMBER: Maslen Exp 2019 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 CONTRACTOR 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 AOUI.IRISH POLICY EFF POLICY a"
LTIt TYPE OF INSURANCE POUCYNUMZKR MMAoh-nm imumem UNITS
COMMERCUILGENGRALUAIII(Ln'Y EACH OCCURRENCE i 11000'400
CLAUM34AADE ®OCCUR PREMISES(b i 500•
ODD
MED M Ww ant 1 15,000
rA 52265567 06101/2018 08/0112019 PERSONAL A ADV INJURY S 1,000,000
OM AGGREGATE LIMIT APPLIES PER: GENERALAGGRECATE S 2,000,000
POLICY F�PR D LGC PRODUCTS•CDMPIOPAGO S 2,040,000
OTHER. i
AUTOMOBILE LHABILr1Yi 1,000,000
ANY AUTO BODILY INJURY(Pw aanon) S
A oviNED SCHEDULED A9105217 06/0112018 08/01/2019 eoo LY IPUURY(Pa wcwvr4 i
AU1103 ONLY ALMS
HIRED NON�GWHED + i
AUTO$ONLY AUTOS ONLY
Medical payments i 5,000
UMBRELLALJAS OCCUR EACH OCCURRENCE i 51000,004
AEXCESS LJAIN %6 ME-MAOE S2266567 08101/2018 06/0112019 AGGREGATE i 5,040_Ot10
DED I X RETENTION i 10,400 i
MTORROERS COMPENSATION
AM EMPLOYERS'LIAMILITY
ANY PROPR�KIRMARINERIEXECUTNE YIN EL EACH ACCIDENT 11,000,004
s OFFICEIVMEIMSER EXCLUDED? 0 NIA MCC24D24D05382D18A 08111/2015 08/11/2019 —
PA
yy-41"aryin"N) E.LDISEASE-EA EMPLOYEE i 1,ODO.000
DESCR"IPTI'ONCPOPERATIONSbelow EL DISEASE-POLICY LIMIT S 1,004,000
DESCRIPTWN OF OPERAAONB I LOCATIONS I VEISCLES(ACORD tat,Addl0a"Romarks Schadule.maybe arlaoMd N mora aPaat Is requi-4
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
0 1958.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' p I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Kei#er Builders, Inc.
Address:35 Main Street
City/State/Zip: Florence, MA 01062 Phone#:413-586-8600
Are you an employer?Check the appropriate box:
20 4. I am a general contractor and I Type of project(required):
1.M I am a employer with g 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. ?. 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' comp. insurance comp. insuranee.t
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.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill 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 shat 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:AIM MUTUAL
Policy#or Self-ins. Lic.#:MCC20020005382018A Expiration Date:6/11/19
Job Site Address:
Amherst College City/State/Zip:Northampton, 01 06C
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 S 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 herebyn*under the pains and penalties of perjury that the information provided above is true and correct.
� - C President,KBI 11.16.13
i e
Phone#: 413-586-8600
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: 44 College Lane
The debris will be transported by: Keiter Builders, inc.
The debris will be received by: Valley Recycling
Building permit number:
Name of Permit Applicant Keiter Builder, Inc
11,16.18 Lt 4� President,"I
Date Signature of Permit Applicant
Versionl 3 Commercial Building Permit May 15,2000
SECTION 10•STRUCTURAL PEER REVIEW V80 CMR 110.11)
Independent Structural Enginseft Structural Peer Review Required Yes 0 No
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, I'1 I ! ,as Owner of the subject proPertY
Keiter Builders,Inc.
hereby authorize to
act on my behalf,in all matters relative to work authorized by this building permit application.
8 of Owner ate
Keiter Builders,Inc
I, •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
Printe
t'r.uA4 .0'-'Z 11.18.18
Sign re of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable Cl
Scott Keiter CS-102457
Flame of Lieanaa Hotder
License Number
51A Hatfield Street 6120/20
AdcjWss
413-586-8600 Expiration Date
nature 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 (F) No 0
Versioal 3 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:
Charles Roberts Not Applicable 13
10107
Name(Registrant):
Amherst,MA Registration Number
8/31/2019
Address
413-259-1630 Expiration Date
See attached control doc
Signature Telephone
9.2 Registered Professional Engineer(s):
Keith Prate
Mechanical
Name Area of Responsibility
47397
Address Registration Number
617-254-0016 6/30/20
See attached control doc
Signature Telephom Expiration Date
lrlectrtcal/Nue Alarm
Reza Gihayspoor
Name Area of Responsibility
47758
Address RIstration Number
617-254-0016 6M
See attached control doc
Signature Telephone Expiration Date
Ryan Hellwig Structural
Name Area of Responsibility
Address Registration Numr
See attached control doc q1b 11LA-�i'( �;/20 71ao
Signature Telephone Expiratio Date
Name Area of Responsibility
Address Registration Number
Signature Tetephone Expiration Date
9.3 General Contractor
Keiter Builders,Inc
Not Applicable m
Company Name:
Scott Keiter
Responsible In Charge of Construction
35 Main St.Nlorence,MA 01062
A"ress
413-586-8600
PresideftL tit
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING—I
Existing Proposed Required by Zoning
'Ibis column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
I& L---R:— L:—R.—
Rear
Budding Height
Bldg.Square Footage %
Open Space Footage %
Ut area ndnw bldg&paved
parkin
Ing)
#of Parking Spaces
FBI:
(volume&Lavation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
(ft-1A
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document if
12N
B. Does the site contain a brook,body of water or wetlands? NO %�V� DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES NO
0
IF YES,describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES,describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I acre or Is It part of a common plan
that vAll disturb over I acre? YES NO
0
IF YES,then a Northampton Storm Water Management Permit from the DPW Is required,
Versions.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,400
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations; ❑ Existing Wall Signs ❑ Demolition❑ Repairs® Additions ❑ Accessory Building❑
Extortor Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[3 Change of Use❑ Other❑
Brief Description Upgrade of existing air handling units ans exhaust tans
Of Proposed Work:
SECTION 5-;.FSE GROUP AND CONSTRUCTION TYPE See attached
USE GROUP(Chock as applicable) CONSTRUCTION TYPE
A Assembly 03 A-1 ED A-2 ® A-3 ® 1A 13
A4 @) A-5 03 is 13
8 Business ® 2A 13
E Educational ® 2B 13
F Factory ® F-1 ® F-2 ® 2C 13
H High Hazard ® 3A 13
1 institutional ® 1-1 03 1-2 ® 1-3 ® 3B
M Mercantile ® 4
R Residential U R-1 ® R-2 93 R-3 ® 5A 13
S Storage ® S-1 ® S-2 ® 58
U Utility ® Specify:
M Mixed Use In 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 784 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1" 1't
2A 2nd
3'd 3rd
4t' 4'"
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height is
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: [T3goSewaDisposal System:
Public ® Private(2 Zone Outside Flood Zone[] MunidpaE ® On site disposal system[]
Version t.7 Commercial Building Permit May t5,2t00
p Department use only
°a 2 ity Northampton Status of Permit:
ding Department Curb Cut/Driveway Permit
`h,G�rz rPa� 212 Main Street Sawer/Septic Availability,
Room 100 WstetAVell Avallabllity
Northampton, MA 01060 Two Sets of Structural Pians
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 la fSECTION 1-SrM INFORMATION (' `j'�� f)
1.1 Property Address:
This section to be completed by office
44 college Lane Sabin Reed Map 3 t o Lot 0 /0 Unit
zone Overlay District;
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Pring (� I Y 1�'�tr �, - S, Current Malting Address:
—, S trot,-t•-� C a}t.ec,4- l b w zo�4 '*;ae t. Pie*"
0
Signature Telephone 00,'
2.2 Authorized Anent:
Ketter Builders,Inc. 35 Main Street Florence,MA UIU62
Name(Print) Current Mas Address:
413.5s'�-shoo
Signature Telephone
SEQTION 3-ESTIM&M CONSTRUCTION COST$
Item Estimated Cost(Dollars)to be Official Use Only
cam feted by,egrmit.Mlicant
1. Building g50I Oat> (a)Building Permit Fee
2. Electrical goo, cwa (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee �JJ
4. Mechanical(HVAC) I n(aourud o 4 l
5.Fire Protection l 1"116
6. Total=0 +2+3+4+5) 56f 0110 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Sulding Commissioner/inspector cr Bulklings Date
File#BP-2019-0614
APPLICANT/CONTACT PERSON KEITER BUILDERS
ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q
PROPERTY LOCATION 44 COLLEGE LN-SABIN REED
MAP 3 1 D PARCEL 010 001 ZONE EU(192)/RR(186)/WP(186)/URC(6)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
EN SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: UPGRADE OF EXISTING AIR HANDLING UNITS AND EXHAUST FAN
New Construction
Non Structural interior renovations
Addition to Existin
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
INF9RMATION PRESENTED:
V 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
it 7-.7L e
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.
44 COLLEGE LN-SABIN REED BP-2019-0614
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 D-010 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category:HVAC BUILDING PERMIT
Permit# BP-2019-0614
Project# JS-2019-001002
Est.Cost: $2365000.00
Fee:$16555.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sa.ft.) 30492.00 Owner. SMITH COLLEGE QFFICE OF TREASURER
Zoning: EU(192)/RR(186)/WP(186 /UZ RC(6)/ Applicant: KEITER BUILDERS
AT: 44 COLLEGE LN - SABIN REED
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 L WC
FLORENCEMA01062 ISSUED ON:11/28/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-UPGRADE OF EXISTING AIR HANDLING UNITS
AND EXHAUST FAN
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:te: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeTyae: Date Paid: Amount:
Building 11/28/2018 0:00:00 $16555.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner