31D-065 (15) 43 WEST ST BP-2021-1517
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31D-065 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Stair BUILDING PERMIT
Permit# BP-2021-1517
Project# J S-2021-002526
Est.Cost: $8000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEITER BUILDERS 102457
Lot Size(sq. ft.): 9844.56 Owner: Smith College-Trustess of Smith College
Zoning: EU(100)/URC(100)/ Applicant: KEITER BUILDERS
AT: 43 WEST ST
Applicant Address: Phone: Insurance:
35 MAIN ST (413) 586-8600 O WC
FLORENCEMA01062 ISSUED ON:6/21/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR & REPLACE FRONT STAIRS IN SAME
FOOTPRINT
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: Howe# 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 CIIL'Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
3—
Certificate of Occupancy Signature: ( • • ' ,�, 1
1 •
I
FeeType: Date Paid: Amount:
Building 6/21/2021 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
••
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The Commonwealth of Massachusetts
Office of Public Safety and Inspections
a% Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Bul(diitg Permit Number:BP-2O21-1.517 Date Applied:(0I21 Ito 2. 1 Building Official:
SECTION 1:LOCATION
43 West Street
No.and Street City/Town Zip Code Name of Building(if applicable)
31D-ors
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair IX Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Description of Proposed Work:
Repair and replace front stairs in same footprint
SECTION 3:COMPLETE THIS SE(_LION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) NA
Total Area(sq.ft.)and Total Height(ft.) NA
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub ❑ A-3 ❑ A-4❑ A-5 0 B: Business 0 E: Educational 0
F: Factory F-I 0 F2❑ H: High Hazard H-1❑ H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 1-2❑ 1-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4❑
S: Storage S-1❑ S-2 0 U: Utility❑ Special Use 0 and please describe below:
Special.Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ HA IIB ❑ IIIA ❑ IIIB ❑ IV VA VB ❑
SECTION 7:Su.b INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit Debris Removal:
Public DiCheck if outside Flood Zone® Indicate municipal❑ A trench will not be Licensed Disposal Site n
Private 0 or indentify Zone: or on site system 0 required El or trench or specify:
permit is enclosed 0 USA Waste
Railroad right-of-way: Hazards to Air Navigation: 11A Historic Commission Review Process:
Not Applicable IZ9 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes 0 or No 6 Yes 0 No ❑C
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 4: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
The Trustees of The Smith College 126 West Street, Northampton 01063
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Karl Kowitz on behalf of The Trustees of The Smith College 413-531-2525 kkowitz@smith.edu
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Keiter Builders, Inc 35 Main Florence, MA 01062 Florence, MA 01062
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here ).
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) •
NA- See control waiver
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Keiter Corporation
Company Name
Scott Keiter CS-102457
Name of Person Responsible for Construction License No. and Type if Applicable
35 Main Street Florence, MA 01062
Street Address City/Town State Zip
_41-3-5.86 8600 4_1-3 320. 9035 skeiter@keiterbuilders.com
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes ZI No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$ 8,000
1.Building $ 8,000 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$ 100 .
3.Plumbing $ o0
4.Mechanical (HVAC) $ Note:Minimum fee=$I C)— (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 8,000 (contact municipality)and write check number here 11 3 2'7
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
applicatiorXfs)true an accurate to the best of my knowledge and understanding.
J. Scott Keiter, President 413_586 8600 6/16/2021
Please p ' t and sign name Title Telephone No. Date
35 Main Street. Forence, MA. 01062 skeiter@keiterbuilders.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: 1 I ; , sl' . - i d�,�
Name ,� Date
h m ,, The City of Northampton
4i"-k,.-1
+�Y=-N.,..„,
- e Building Department
0„,-), _ ,
212 Main Street
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OR"'ED'il"o� Northampton,Massachusetts 01060
Phone (4413) 587-1240
Fax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVAT ION PROJECTS)
In accordance with the provisions of MGL c40, s54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111. s150A.
The debris will be disposed of in: Valley Recycling
Location of Facility Easthampton St Northampton, MA
The debris will be transported by: USA Waste
Name of Hauler USA Waste
Signature of Applicant: Date: 6/16/2021
The Commonwealth of Massachusetts
_. Department of Industrial Accidents
1 Congress Street,Suite 100
'fl= Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Keiter Corporation
Address: 35 Main St
CIty/State/Zip: Florence,MA01062 Phone#: 413-586-8600
Are you an employer?Check the appropriate box: Type of project(required):
LEI I am a employer with 35 employees(full andlor pan-time).* 7. 0 New construction
2.1:1 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'camp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]f 9. ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.E I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,*1(4),and we have no employees.[No workers'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.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AIM Mutual
Policy#or Self-ins.Lic.#:MCC20020005382020 Expiration Date: 6/11/2022
Job Site Address: 43 West Street City/State/Zip: Northampton. MA
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce under e
ins and penalties of perjury that the information provided above is true and correct.
Signature: � �f.� pi�•s,�-E �B� Date: 6/16/2021
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#:
KEITER
35 Main Street•Florence•MA•01062•Phone:413-586-8600•Fax:413-280-0124•keiterbuilders.com
Commissioner Flagg 6/16/2021
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the Stair Repair Project at
41 West Street 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"
N` (0/PJ/D,,/K
Respectfully, ,
p4.2,
Scott Keiter
Keiter Corporation
35 Main St
Florence, MA 01062