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32A-143 (6) City of Northampton t Massachusetts DEPARTMENT OF BUILDING INSPECTIONSy. 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: , Lk �' * L CAA-76'&.L4 Date: If Project Location: 3� �'� ��' S+ Map: Parcel: Zone: Scope of Project: (..1'KyVQ' ~O V\ In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: Mass. Registration # Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] ENTIRE PROJECT For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 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, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. �E�RED ARCy T H M0 Signature Signature and Seal of Registered Professional 1 • n No.50175 cn SHELBURNE FALLS, � a�QQ �o MA J� MDay of 0_I2 F P q�TN of: MP`'S (seal) 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: �L ACAAn L,+ The debris will be transported by: Vu ��kv-�s The debris will be received by: ojz�� ttt�A Building permit number: Name of Permit Applicant &A\LA.(s , �� C' Date Signature of Permit Applicant r ® DATE(MM/DDNYYY) A�° CERTIFICATE OF LIABILITY INSURANCE F 7/10/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT C nthia Henderson, CISR NAME: y _ --- Webber & Grinnell PHONE (413)586-0111 1 No):(413)586-6481 (A/C. E-MAIL chenderson @webberandgrinnell.com 8 North King Street ADDRESS: --- INSURER(S AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER AArbel_la Insurance Group 17000_.__ INSURED INSURER B: Keiter Builders, Inc. INSURER C: Attn: Scott Keiter INSURER D: 35 Main Street INSURER E: _. Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBERktaster Exp 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _ -INSR' ADDL SUBR ' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M D YYY M D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 A _ CLAIMS-MADE t X l OCCUR PREMISES(Ea occurrence $ 8500064396 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 J X POLICY L jE L—J LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I�__. OTHER: $ AUTOMOBILE LIABILITY EO aBINEDiSINGLE LIMIT $ 1,000,000 I ANY AUTO BODILY INJURY(Per person) $ _ _ -- A ALL OWNED X SCHEDULED 1020039381 6/1/2015 6/1/2016 BODILY INJURY(Per accident) $ AUTOS _ AUTOS -- X HIRED AUTOS X NON-OWNED PROaccident)S Y DAMAGE $ - AUTOS Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 4600064399 6/1/2015 6/1/2016 $ WORKERS COMPENSATION X I R OTH- STPEATUTE ER _ AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? L"J N/A A (Mandatory in NH) 912 7440615 6/11/2015 6/11/2016 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION (508)665-8449 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tradesmen International, LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ron 10 Mercer Road Natick, MA 01760 AUTHORIZED REPRESENTATIVE +r Rai tidl�l C Henderson, CISR/CIN .- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS119,9;r qn l nm i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print U ibl Name (Business/Organization/Individual): t.A IV,-C, Addre,ss;: City/State/Zip: OW4A,&Ce YVV'� 006-x- Phone# Are you an employer? Check the appropriate box: Type of project(required): A 6. ❑ New construction 1. �I am an employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 2 Ek<oemodeling listed on the attached sheet. 2. ❑ 1 am a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition ship and have no employees employees and have workers' 9. ❑ Building addition working for me in any capacity. comp. insurance.]: [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their 11.11 Plumbing repairs or additions 3. ❑ I am a homeownerSeattle8 doing right of exemption per MGL c. 12.❑ Roof repairs all work myself. [No workers' 152, §1(4),and we have no comp. insurance required.] i employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box tt I 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 suds. $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. 1 am an employer that is providing workers'compensation insurance for mmy' employees. Below is the policy and job site information. Insurance Company'Name: Y / ' 1 �Policy#or'Self-ins.Lic.#: 671 0*� (0 6� � Expiration Date: - Job Site'Address`. All Locations `"� City/State/Zip: A!/Y� 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature- AtA 1 104 t44 416w 6D ate: s 1/ 1 4 6 f Phone#: V �t3 6 T 6 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#: Z:\Workers Comp Aff-Highlited.doc LUCENTINI & LUCENTINI 08.18.15 August 18, 2015 Description Cost Doors&Hardware ALLOWANCE:$1500+Tax Drywall nightway Drywall. Proposal dated 07.16.15. Flooring Mercier Carpet. Proposal dated 08.10.15. Furnish and install Mannington Boulce carpet color Quartz. Broadloom Paint Jerry Bannister Painting. Proposal dated 07.23.15. Price does riot include stripping brick. Includes Adder for Gear coating rnaple trim vtrn .r.. ,. a. �� �g3.< .�; ...� � Ca ..'ae ,.,�.,< NONE r „.. N -wN �,' �t NONE :, a ", , a , v .. .. �e HVAC John Thomas Plumbing&Heating. Proposal dated 07.22.15 ELECTRICAL ALLOWANCE: $8,175.00 Project Total $59,067.52 We appreciate your bus jr>es and look forward to working with you. Approved By: % Date: l5 �/ 3 Date: Contractor Customer 1 i Keiter Builders, Inc., License#: 102457 3 LUCENTINI & LUCENTINI 08.18.15 August 18, 2015 Description Cost Misc.Patchwork Levelastic/Floor Patch 'rz�€Y tk -, n F a a. � fa. . tom° s,: .�'�, .•, ` �a ..,t � � . x�r * ... . Baseboard 1 x 4 flat stock. Maple Conference Room Storage Closet-Shelves Cutting& Patching Drywall. Misc.locations for electrical,HVAC,other. Door Casing 1 x 4 flat stock Maple. Framing Layout New partition walls Steel Studs(Includes double walls as drawn) Framing to accomodate sound proofing above ceiling elevation General Carpentry Microwave Area MPME Plyood Platform for Custom Sofa (1)location. CDX Plyood Plywood Shelf Work Surface(Reception Area) Finished,maple plywood banded with maple. Maple box below(2)locations Conceal all concrete tooting locations with finished maple plywood Work Table-Back Hallway Enclose footing into maple box. Install maple table top at approximately 36"above floor height. GLAZED PARTITION $3,526.19 Glass Supply and Install. Glass Allowance: $1,200.00(Pending Smith Glass). Trimwork Per plan A5.1.Clear coated Maple 3 C`v. .s k C B Y ] a d f Y3= ". _ . pax. ax�..a, d._- � 4,ar'. ,•,. .,Y_, .e-� � .x RK.v I Accoustical Sealant -Misc.Locations Sound Proofing See document named"Acoustical Recommendations". Options Taken: 1 Partition between Conference and Reception=a.i.,b,and c 2.Partition between Office&Reception=a ii.,b(oft set boxes),c,and d 3.Partition between Office&Wall=a,b.i&ii 4.All connections to existing beam=a. 5 All connections to existing brick wall=a 6.Light Fixtures=Add metal back boxes 7.None-In place,add horizontal strapping with rockwool insulation between strapping. Add second layer of 518 drywall. 8 Ductwork=a.i. Keiter Builders, Inc., License#: 102457 2 LUCENTINI & LUCENTINI 08.18.15 August 18, 2015 Scott Keiter � . Keiter Builders, Inc. WO 35 Main Street =lorence, MA 01062 KEITER Jffice 413.586.8600 pax 413.280.0124 B U , L D E R S cottkeiter @gmail.com www.KeiterBuilders.com License #: 102457 Project j Customer LUCENTINI & LUCENTINI 08.18.15 r Lucentini & Lucentini, LLP Office 413-585-8300 36 Main Street, Unit A 36 Main Street, Unit A Mobile 917-770-9185 Northampton, MA 01060 Northampton, MA 01060 e.lucentini @rllattorneys.com OFFICE RENOVATION - SCOPE OF WORK Notes: PLANS NAMED "LUCENTINI OFFICE" BY MORGAN STUDIO DATED 07-10-15. PAGES A1.1, A5.1, AND A 7.1 Description Cost Building Permit Demolition&Debris Removal Existing Floor System including glue Misc.ceiling locations Misc.walls Book Shelves Dust Protection Negative Pressure Air Sealing Floor Protection Stairs Hallway New Finishes General Administration Materials Running Parking Meter Bags Site Set-Up&Breakdown Waste Removal Dump Truck&Driver rt s Cut/Jack Hammer Granite Piece(Existing Foundation) (1)location at back hallway Electrical Trench Saw cut trench for electrical and low voltage wiring to run sub slab in conference room. Feed table location Keiter Builders, Inc., License#: 102457 1 *k' I SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BLSINNESS LOWING THE SIGNING OF "1'IIIS AGREEMENT. gning this Agreement, you acknowledge that you have received a complete and original signed copy of the ire Agreement and attached Exhibits. Keiter Builders, Inc. may not start work until after this Agreement has been signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING AGREEMENT, IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD CONSULT WITH AN ATTORNEY BE,EFORE SIGNING. KEITER BUILD RS, INC, OWNER by, Scott Keit �rcsid t Date Date 9 r D to 6 y HAS BEEN APPROVIF,D BY THE SECRETARY UMER AFFAIRS AND BUSINESS REGULATIONS AOND T HF CONSUMER OFFICE OF SQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN SHALL BE .142A. MASS. GENERAL LAWS, KEITER BU DES, INC. OWNER By Scott iter, P A ent Date G ate NOTICE: Da e THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE, ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT. AOTICF,: THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. "THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE "THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO INITIATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO YEARS AFTER THE DATE OF THIS AGREEMENT. ,>-IISCELLANEOUS: This agreement is a Massachusetts contract. contains the entire agreement between us, any representations or %\arranties not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs, .xecutors, successors and assigns. This Agreement may be modified only by an instrument in writing signed by )th of us. This agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Iassachusetts General Laws and its corresponding regulations. Owner understands and acknowledges that Keiter Builders, Inc. may use any photos taken during the course of .�ork for promotional purposes. This may include, but is not limited to, the following: Website, newspapers, ournals, magazines, posters, and flyers. RIGHT TO CANCEL CONTRACT: >I MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO BY :ORWARDING YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTED, BY 5 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 O No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Eric Lucentinj 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. Sicfature of Owner Date 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 ofgerj.ury. Scott Keiter, President, Keiter Builders, Inc Print Na agLa Z�"' n ure o Owner/A nt Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Scott Keiter CS-102457 Name of License Holder: License Number 51 A Hatfield St Northampton, MA 01062 06.20.2016 Addre 413-586-8600 Expiration Date Si t 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 Q No O Version 1.7 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 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: PLEASE SEE ATTACHED Not Applicable ❑ 50175 Name(Registrant): PLEASE SEE ATTACHED Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor �=��v &��, U�, , � �6=( , Not Applicable ❑ Company Name: �1 Responsible In Charge of Construction zu rl_ -51k OAw� J�,w Addres 4 C i lure T lephone 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 % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version l.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 ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[:] Change of Use❑ Other❑ Brief Description Renovate existing space into legal offices Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE PLEASE SEE ATTACHED CONSTRUCTION CONTROL DOC USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ 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 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(so 1 St 1 St 2nd 2nd 3rd 3rd 4th 4th Total Area (so 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: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[] Versionl.7 Commercial Buildin.- Permit May 15,2000 Department"use only City of Northampton Status of Permit: Ouilding Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability i AUG Room 100 Water/Well Availability Li N rthampton, MA 01060 Two Sets of Structural Plans , ph6n6 41 -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 SECTION 1 -SITE INFORMATION 1.1 ProRerty Address: This section to be completed by office 36 Main Street Unit A Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Eric Lucentini 20 Hampton Ave Suite 160 Northampton,MA Name(Print) Current Mailing Address: 917-7 770-9185 Signature gz-6" '7 i /,,,� eIT ephone 2.2 Authorized Agent: Keiter Builders, Inc 35 Main Street Florence, MA 01062 Name(Print) Current Mailing Address: � ®®"�,,�, 413-586-8600 Signature V�^'� 'Telephone SECTI N -ESTIMATED CONSTRUCTION ST Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �0\ ?;'�( a (a) Building Permit Fee 2. Electrical G� y (b) Estimated Total Cost of ` l Construction from 6 3. Plumbing /' Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =.(l +2+ +4+ 5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0210 APPLICANT/CONTACT PERSON SCOTT KEITER ADDRESS/PHONE 51A HATFIELD ST NORTHAMPTON01060(413)586-8600 Q PROPERTY LOCATION 36 MAIN ST-UNIT A MAP 32A PARCEL 143 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid flQ M-7 Building Permit Filled out Fee Paid Typeof Construction: RENOVATE INTO LEGAL OFFICES 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 ° I lO( / c C"&,V/ C THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 Delay 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. 36 MAIN ST-UNIT A BP-2016-0210 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 143 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0210 Project# JS-2016-000212 Est. Cost: Fee: $413.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): Owner: LUCENTINI ERIC& SANDRA zoninp-: CB Applicant: SCOTT KEITER AT: 36 MAIN ST - UNIT A Applicant Address: Phone: Insurance: 5 1 A HATFIELD ST (413) 586-8600 O WC NORTHAMPTON MAO 1060 ISSUED ON.91812015 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE INTO LEGAL OFFICES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED 13Y THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Date Paid: Amount: Building 9/8/2015 0:00:00 $413.00 212 Main Street,Phone(413)587-1240, Fax: (4 1'))587-1272 Louis Hasbrouck—Building Commissioner