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31D-020 (59) SCOTT GYM.COLLEGE LN-STRIDE LAB BP-2019.1199 GIs#: COMMONWEALTH OF MASSACHUSETTS Mep Block: 3 1 D-020 CITY OF NORTHAMPTON L t • 01 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorvrenovation BUILDING PERMIT rtnit4 BP-2019-1199 Project# JAS-2019-001947 Est cosi:$6600000 Fee: $46200 PERMISSION IS HEREBY GRANTED TO: Const,Class, Contractor: License: Use Group KEITER BUILDERS 102457 Lot Sizdw.ft.): 479160.00 Owner: SMITH COLLEGE OFFICE OF TREASURER oning:EU(98)/URC(85)/RR(28)NWR27)/FFR(16)// Apph'cank KEITER BUILDERS AT: SCOTT GYM - COLLEGE LN - STRIDE LAB Apeiicant Address: Phone: Insurance: 35 MAIN ST (413) 5,86-8600 0 WC FLORENCEMA01062 ISSUED ON44/2612019 0:00:00 TO PERFORM THE FOLLOWING WORK INTERIOR LAB RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footingin Rough: Rough: House# Foundation: Drlveway Final: Final: Final: Rough Frames Gas: Fire Deeartmeht Fireploco/Chimney: Rough: M Insulation: Final: Smoke; Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Cgrtificate of Occupancy $1evaturet FggTYnei Datg Paid: Arnot t: Building 4/26/20190:00:00 $462.00 212 Main Street,Phone(413)587.1240,Fax:(413)587.1272 Louis Hasbrouck—Building Commissioner File#BP-2019-1199 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 O PROPERTY LOCATION SCOTT GYM-COLLEGE LN-STRIDE LAB MAP31DPARCEL020 001 ZONE EU(98)/URC(85)/RR(28)/WP(27)/FFR(16)' THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CH CKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstruction: INTERIOR LAB RENO New Construction Non Stniccural' tenor 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 INFOJiMATION 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 Permii ­ 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 Sturm Water Management Demolition Delay (/ /s-t'-'e 4 2 s 1 -- Signal=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 BP- If-1 f Version l]Commemid Building Permit May 15,2000 Department use only City of Northampton Stains of Permit Building Department cum CudDdvewey Permit 212 Main Street Sewer/Seplic Availabillty Room 100 Water/Well Availebllity Northampton, MA 01060 Two Sees of Stuctural Plans phone 413-587-1240 Fa 3-582.1272-- E v pec APPLICATION TO CONSTRUCT,REPAIR,RE IOVAfE,CHANGE THE USE OR 0CUP NCV OF,OR DEMOLISH ANY BUILDING OTHE THAN A ONE OR TWO FAMILY O ELLI G APF P 5 9019 SECTION 1-BRE INFORMATION ' 1.1 Flew r r : _ se on IF be completed by oNks Sint o ege- tride Lab-Scott Gym n -rr�rs _. - -- Ma Let Unit Zone Overlay District EIm St Uletic( CS W.Vlct SECTION 2-PROPERTY OWNERSHIP/AUTHORI2E0 AGENT 2.1 Owner of Record! CoIIE�.G �( ZD7 LI.,s (A&A Nem " e(Pont) BUSfacs 5s'Taf7sT l.-eCunt Melhg Address', _C ne ,L1 A-- Signature - bill 3 • 5-85- 23G 2.2 Authorized Agent: Kerter blunders,Inc. 35 Main Street Nlorence,MA U1062 Name(Print) Comic Mallin Address', 413-586-8600 Signatory Toleehena SECTION 3-ESTIMATED CONSTRUCTION COSTS Item EsIlmaled rest(Dollars)to be Official Use Only completed bermilapplicant 1. Building 42,400 (a)Building Permit Fee 2. Elec tical 23,600 (tel Esdmatad Total Cost of ConsWctlon from 6 3. Plumbing 0 Building Parmh Fee 4, Mechanical(HVAC) 0 V q&a 5.Fire Protection 6. Total=(1 +2+3+4+5) 66,000 1 Check Number Thus Secdon For Of6clal Use Only Building Peemtt Number Date r undo d Signature: Bustling C.ryrnnI.rWIneneF1e,of buildings Date Vers1onl.7 Commercial Building Pemdt May 15,2000 5E91ION 0.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Aitera0ona �jj ExlstIng Well Signe ❑ Demolition L] Repalra0 Additions ❑ Accessory Building❑ Exterior Alteration Existing Ground Sign[I NewSigns[] RonOng❑ Changeol Use❑ Other❑ Brierpilon 01 Proposed Work: Interior lab renovation-see plans lG(AJ VCt/ILW c. 4:A1 Lx-W ob 2 SECTION 5-USE GROUP AND CONSTRUCTION TYPE Sea attached USE GROUP(Chock as applicable) CONSTRUCTION TYPE A Assembly ® A-1 Tj A-2 ® A-3 ® 1A A4 ® A-5 ® in B Business ® 2A E Educational ® 28 03 F Factory ® F-1 ® F-2 02 2C ED H High Hazard ® 3A 03 1 InsOlutional ® 1.1 1.2 ® 1-3 ® 3B M Morcentlle ® 4 R Residential R-1 ® R-2 ® R-3 ® 5A 13 S Store, � S-1 � S-2 ® SB U Utility Specify: M Mixed Use ® Specify. S Special Use 93 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/Oft CHANGE IN USE EA.arg Use Gmup: Proposed Use Gmup', Existing Ha>AN IMex]80 CMR 34 : Proposed HaraN Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Are.par Floor(sQ 1e 1e 2- 2- 3m 3' 4. 4- Total Are.(so Total Proposed New Construction hf) Total Height(II) Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ® private P Zone Outside Flood Zone❑ Municipal g On site disposal system Versionl?Commercial Building Permit May IS,2000 8 NOR11UNIPTON ZONING Existing Proposed Required by Zoning Thio column lu M filled in by 6uilJing mepenmem Lor Sire Fmnau e Sclbwks EEQnl Side L. .....R _..__ L R: _.. Re. Ag Height Bldg.Square Foulage Open Space Footage % (tui w minor bWg B PrvN akin 1 #of Parkung Si Fill'. volumearrcnJon 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: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter Book Page and/or Document# 8. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES,describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q IF YES, describe size, type and location: E. Will the comeouction activity disturb(clearing,goading,excavallon,or filling)over i acre of Is it pan of a common plan Nal will disturb avert etre? YES O NO O IF YES,then a Northampton Bloom Water Management Permit fmm the DPW Is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 8-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMP 416(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.t fleglmered ArehltaeF. Not Applicable ❑ Neme lReg suan0. Regizpovan Number Ad&oss EeDbatlon Data 319neture Telephone 9.2 Raglaterad Prof asetonel Engloeerta): MeRlcal Neme Pma of of Responsibility Address Ragi a alion Number SgnoWm TelopMna Exomfoo Dale Neme Ana,of ResDanslbillty Addrese Ra9lelr U.Numtwr S 6nature TelepMne Fsldmtion Dale Neme Ata of Resppmlbllily Adana, Ragisbellon Numbor Signature TelepMne Evlrallon Date Nemo Areas Responelbllity And— Regiabe on Numbor S'riaum Telephone Erplratloo Date 9.3 General Contractor _ Keifer Builders,Inc Not Applicable m Company No,., Scott Keller Re.,roble In CMge of ComtNtllon 35 Main St.Morence,NIA UIUW Ayyees ii//(('//``��� 413-58fi-8600 vm�amr.cet Signature Telephone Vcrsionl 7 Comtcarcial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Pear Review Required Yes O No O SECTION II -OWNER AUTHORIZATION-TO BECOMPLETEO WHEN OWNERS AGENT OR CONTL TRACTOR APPLIES FOR SUIL,DIING PERMITfRRM � 1, A)1151nT APIA YP-� . � ��'ASI�SDU p"'r"IN �fl'�-- ,as Ovmor of the subject property Keller Builders,Inc. hereby eul to act j4y�behalf to work authpdzed by this building pamtil application. 04.15.19 Keifer Builders,Inc 1, as Overer/Ault u ized Agent hereby declare Nal lire statements and Information on the foregoing application are We and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Scott Keifer Pdnl e �/ 04.15.19 Sigodi of OmwrlAgenl Dale SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Connrectlon Supervise,r. Nat Appilcable ❑ Scott Keiter CS-102457 Name or License Halder'. License Number IA Katheld Street 6/20/20 Ad Erp ration Data ,7&14 L_ r.— 413-566-8'600 teary tun ' TelePlvne SECTION/3-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this appilcolion.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: 104 Lm rcuueaetaxa 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 04.15.19 .x{ � Prnlden4 KBI Date vvv Signature of Permit Applicant The Commonwealth of Massachusetts " Department of IndustrialAecidents Office of Investigations { FI- I Congress Street,Suite 100 & Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricions/Plumbers Applicant Information Please Print Legibly Keller Builders, Inc. Noma (Business/OrganiratiaMndividual): Address:35 Main Street Ci /State/Zi :Florence, MA 01062 Phone#:413-586-8600 Are you anemployer? Check the appropriate box: L m Q I aa employer with 20 4. ❑ 1 am a general contractor and I Typo of project(required): employees(full and/or pan-time).- have hired the sub-contractors 6. []New comwetion 2.❑ I em a sole proprietor or partner- listed on the attached ahecL 7. Remodeling ship and have no employees These sub-contractors have g, ®Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance camp. insurmce.i 9. [3 Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12❑Roof repairs insurance required.]t c. 152,§I(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] •Any epplicwi that checks ban al must aka fill our the section below showing their work.'wmpemetion policy infommtion. t H....who submit this dridavit i,Mics inp they arc doing 01 work and then hire outride contrvemrs most sub.!,.new smdovit indwtingsuch. IConuocmn Net cbmk Nis box mmt meshed rn additional ahcet showing the none of the subsomrecton and sum whether or not Nose void.have .or.,.. If the sub<ontmcmrs have employm,Nry mon provide their xerk. comp.polity ambo. I am an employer that is provlding workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name:AIM MUTUAL Policy H orSelf-ins.Lie. MOC20020005382018A k. Expiration Date:6/11/19 Job Site Address: 102 Lower College Lane City/State/Zip:Northampton Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to see=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 farm 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 herebyAerrify under the pains and penaldes of perjury that the information provided above is hue and correct. 511, President,KBI 04.15.19 o � P _ . Date Phone q: 413-586-860C Offralal 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 or Health 2.Building Department 3.Citylfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACOR& CERTIFICATE OF LIABILITY INSURANCE '"""-0I a n12o16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMAMELY 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 INSURERISI,AUTHORUVED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If Me c muScala holder Is an ADDITIONAL INSURED,the palltygee)IWMI hese ADDITIONAL INSURED poYlsbin er M md.mmd. It SUBROGATION IS WAIVED,suhlwd to the terms and conditions of the policy,certain p9111 may require an endorsement A stolement on thl.ae III dee.net on%,tl9tda to Us cInufon.held.,In II..of auah mdmaement(s). PRODucFN C,um.HPndawn EVER Eine WEh5er 6 Gnnnad Pt]ISBBA1n >, (All1506M51 5 Nam Nrl Shah yN dreMmY 1® .r mM,II ran e....q....DE xuc e NOMBmobn MA SHOW " Sel%Na Ne CO O15 Ca2Ym eEy museRe AIM MUWWALM. Palle BuEden.mc. IxaUeenc. Ann Smn NESUr Wee..D ]SMein SDwl ImortsE Flaws. MA OICB3 NPUELEF, COVERAGES CERTIFICATE NUMBER: Motor E.P 2019 REVISION NUMBER: THIS IS TO OERTIFY7HAT THE POLICES OF INSURANCE LETEO BELOW YAVE BEEN ISSUED TO THE INSURED NAMEOAROVE FOR THE PCUCY PERfOD INDICATED NOTW9 HSTMDINGAHY REOUREMENT,TERM OR CONDITION OFA.WCONIIUCTOR OTHER DOCUMENTWRH RESPECT TO WHICH THIS CERNFKATEMAYBE ISSUEDORNAVPER IN,THE INSUMNCEPFFOROEO BY RIE POLICIES DESCRIBED HEREIN5SUBIEC!iOALLTNETERMS, ESCLUSIONSANO CONWICNS OF SUCH POLICIES.LIMITS SHOWN NAV HAVE BEEN REDUCED BY PAD"MS. EMIap UYna VLDE MLIYIIUIY '4fy.eLCWRENCE a 1' '� ..484MEa®OUTA MEN 9 • a SD],0.'G MED em xxr=m s 15.000 A 5326556] CBN12018 0 N012019 PEmeNML.CVxwm a 1.WO,WD wre UHT...L DPAEwL.Dpaene. 12.oeD,Da0 Im0❑ ❑P�Da mPADD I 2.060,000 COM I m ER ILELwILms LDOD.ODD .m'.UfD aCM11mAmrtapmnl f AaWLv ailCRNpa D A910531] 06]12018 06,1112019 BWILY INron(F.e I I oOOr NaNmeED I MCI®I paymeme s END U"° PCCLA MI UICUUMN., s SA00.I100 A FxFaaune CWHB,xwF 5226555) 0"Ino1B GNO12019 wpNNwre a S.MD.OW o . 10000 Won forcoNPENI ^" UO ENHUWE1EaO LlAMrm R TaeD.ItOD B 'Ltt cmw4nKIL2vEwRrF MCC3W20OJ5Y201Bp 0&112018 ON112D19 E .H.DCIOFM I DFn4ENNE4 PFR ElCLUCBOP 1.000.0]] lanJwerFFNn EL D6E45E.EAFMM1OYEE { DE.DnaNnepI DFOP MTM9 Fkw EL 03FA1E PWKY LWn 1 1.OJ0.000 DFdCYRpM OF.,NA oxallDC.LTOx.IVEMCW HCMD,II.IIItlbnl a— -n M en.EM IlmnrpaY MMrM CERTIFICATE HOLDER CANCELLATION SHOULOANYOF TNEASOVE DESCRAIM POUC1E9 BE CANCELLED BEFORE THE E%PIMTON DAM THEREOF NOTICE KILL Be DELIVERED IN ACCORDANCE WITH ME POLICY PROVISIONS. AlrlxaPmpeeneuxuTrre O 1931 ACORD CORPORATION. An rights Co erNed. ACORD 26(20HUCH The ACCUSED more end logo are resulted mrI a ACORD KENTER BUILDERS35Man Street Flo'ence•MA•01062•Phone 4135868600•Fax [ders.com Commissioner Hasbrouck 4.15.19 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Smith College Stride Lab Project at 102 Lower College Lane in Northampton because the work is of a minor nature, will not 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" Resp ctfully, low d i cott Keiter Keiter Builders, Inc. 35 Main St