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32A-121 (14)
71 KING ST-WHALEN BP-2019-0971 GIS ft: COMMONWEALTH OF MASSACHUSETTS Man.Block: 32A- 121 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Categ_orv' renovation BUILDING PERMIT Permit# BP-2019-0971 Project# JS-2019-001603 Est.Cost:$128560.00 Fee: $899.0 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa ft): Owner: J W INC C/O WHALEN INSURANCE Zoning CB(100)/ Applicant: KEITER BUILDERS AT: 71 KING ST -WHALEN Applicant Address: Phone: Insurance: 35 MAIN ST (4131586-8600 0 WC FLORENCEMA01062 ISSUED ON.-31712019 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW SHED ROOF DORMER„ RECONFIGURE INTERIOR PARTITION WALLS, NEW BATHROOM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 3/7/2019 0:00:00 $899.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0971 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 O PROPERTY LOCATION 71 KING ST-WHALEN ,MAP 32A PARCEL 121 000 ZONE CB(I00V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out I ID CLUI I/ Fee Paid Typeof Construction: NEW SHED ROOF DOR ME REC IGURE INTERIOR PARTITION WALLS.NEW BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 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 � 3L-7 Signature of Building Official Uate 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. r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Version l.7 Commercial Burning Permit May 15,2000 Department use only City of Northampton Status of Fermi: Building Department Curb CutlDdveway Permit - 212 Main Street Sewer/Septic Avallabllliy Room 100 WatenWell Availability Northampton, MA 01060 Two Sets of Structural:Plans _ phone 413-587-1240 Fax 413-587-1272 Plousite.Plans Other Specify ' APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER TTHAANSA ONE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION ECE�VEQ 1.1 Progerg Adi rr as: This section to be completed by office 71 mK g St Northampton MAR 7 2019&lap ZA Lm 101 Unit Zen Overlay District DEPT OF BUILDING MSPECTIORS trim AMPTOKMA011811l cl CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Pring �W e, Curren)MaillnB Atldrasa', ',]�(�_- n.yr /j� WLU 16vo Signature V Telephone .2 Authorized A a : i. Keller Buddem,Inc. 35 Main Street Florence,MA UIU62 Nerve(Pring Curren(MaiOn Address: 413-586d-8600 Signature Telephone I SECTION a-ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Goners)to be Official Use Only wm leted by permitapplicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of s L T Construction from 6 3. Plumbing �50- Building Permit Fee OD 4. Mechanical(HVAC) Il.I f J D (J I I 5.Fire Protection T 6, Total=(1 +2.3+4t5) 1 Check Number This Section For Oflicisl Use Only Building Permit Number Data Issued Signature: Building 71— ngs Date i i Veision1 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 Well Signs ❑ Demolition Repairs Additions ❑ Accessory Building LI Exterior Alteration © Existing Ground Sign❑ New Signs❑ Roofing C_] Change of Use L] Other❑ Brief Description New shred roof dormer to provide more ceiling height. Reconfigure interior partition Of Proposed Work: walls to provide 5 units of professional office Space. New toilet room SECTION 5-USE GROUP AND CONSTRUCTION TYPE Be.attached USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 A-2 9 A-3 IAI A-4 ® A-5 113 B Business 2A E Educational 213 F Factory © F-1 © F-2 0 2C H High Hazard ® 3A I Institutional I-1 1-2 © 1-3 LaJ 313 M Mercantile ® 4 93 R Residential R-1 R-2 ® R-3 01 5A rp] S Storage S-1 S-2 © 5B U Utility U 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(at) P to 2nd 2. 3 3'd 4. 41n Total Area(sU Total Proposed New Construction(at) Total Height(ft) Total Height N 7.Water Supply(M.G.L.C.40,§54) 7.1 Flood Zona Information: 7.3 Sewage Disposal System: Public Private ® Zone Outside Flood Zoneo Municipal EL On site disposal systema Versionl.7 Canter al Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Inning 'ous column m be filled in by BuildingMpanmem Lot Size Fr nla e Setbacks Front Side L:_R_. _ Li — Rear Building Height Bldg.Square portage % j Open Space Foolage % (W men minus bldg&pevW #of Posing Spaces Fill: valumc&Inmtion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Q YES Q 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 O Obtained O , Date Issued: C. Do any signs exist on the property? YES O 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 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 pad 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. VoNnon l7 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 Archltect: Emily Estes Baillergeon Not Applicable Ell Nem-(Reglsiranp: 50838 Reglslration Number AJdresa .— . .--- . —_ 8/31/19 Expiration Date Seeatlachetl confro/doc _ 41Telephone Signature Telephone 9.2 Registered Professional Engineer(s): i Mechanical Name Area of Responsibility Address Regislratlon Number 31gneWre Telephone Expiration Dale 'I Name Area of Responsibility Address Regislralion Number Signaler- Telephone Expiration Dela Name Area or Responefluilly Address Registration Number I Signature Telephone Explration Dale Name Area of Responsibility Address Registration Number Signalore Telephone Expiralion Out. 9.3 General Contractor Keifer Builders,Inc Not Applicable m Company Name: Scott Keifer Responsible In Charge of Construction 35 Main St.Morence,MA 01062 413-S8G-8G00 P,aidcnl,Kin Signature TaleDhone Version l.7 C.ner ial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(760 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,-Pu . , � . .IC as Owner of the subject property Keiter Builders,Inc. hereby authorize to act an my by Imo rk authorized by this building permit application 03.07.2019 Signetu wnar _. —. Data Keiter Builders,Inc I, es 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 Keifer Print e 03.07.2019 Sign uraof OvmerlAgent Dale SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Scott Kciter CS-102457 Name of License Holder'.____ License Number S 1 A Hatnelct Street 6120120 Ad ss -- Expiration Date 413-586-8600 nature T.Ii SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(6)) Workers Compensatlon Insurance affidavit must be completed and submitted with this application. Failure to provide this affil will result in the denial of the Issuance of the building permit. Signed Affidavit Attached Yes Q No O City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavitii 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: n Kma street 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 03.072019 K01 Date Signature of Permit Applicant The Commonwealth of Massachusetts ulDepartment of Industrial Accidents Cone of Investigations 1 Congress Street,Suite 100 Roston,MA 02114-2017 waimmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Keiter Builders, Inc. Address:35 Main Street City/State/Zip: Florence, MA 01062 Phone##:413-586-8600 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 20 4. ® 1 am a general contractor and I h ®New construction (full and/or part-timet.• have hired the sub-contractors 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have S, ®Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance) ® Building addition required.] 5. ® We are a corporation and its 10.0 Electrical repairs or additions 3,® 1 am a homeowner doing all work officers have exercised their 11,0 Plumbing repairs or additions workers No myself. ' coin right of exemption per MGL Y [ P 12.® Aoaf repairs insurance required.] t c. 152,§l(4),and we have no employees. [No workers' 13.0 Other comp, insurance required,] •Any applicant that checks box qi must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this eiridi vit indicating they aro doing all work and then him outside com amote must submit a new off idavit indicating such. lConnreemrs that check this hos..at attached ea additional short showing the name of the sub-eonrcaetms and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their wa losia'camppolicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the pohcv rsnd job slle information, Insurance Company Name:AIM MUTUAL Policy#or Self-ins, Lic.#: MCC20020005382018A _ _ Expiration Date:6/11/19 71 King St Northampton Job Site Address:__ _ _City/StateYZ.ip: _ Attach a copy of the workers' compensation policy declaration page(showing lire 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 tine 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 tins statement may be forwarded to the Office of '.. Investigations of the DIA for insurance coverage verification. I do/tereb nfy underthe pains andpenalties of perjury than the inforusation provided above is hue and correct. 3.7.19 Siena(u[e: Presidenh KBI Date: _ t Phone#. 413-586-8600 Official use only. Do trot write in this area,to be completed by city mlawn official. City or Town: Permit/Licrose# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector fi.Other Contact Person: Phone#: I ACO CERTIFICATE OF LIABILITY INSURANCE DATE I" DDAY 111 0511112018 THIS CERTIFICATE IS ISSUED ASA 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. l IMPORTANT: If the cerliflca a holder Is an ADDITIONAL INSURED,END policy(Iee)muel have ADDITIONAL INSURED p...Alme,or be and praeSit 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 cardfilmoe holder In Sam of END Dndonamenti eflwucsa PONTER Cynthia Henderson CISR Elite Webber B Grinnell "Emspred N1,DO (x13)580-0111 4K Nc: (61 j jl 8 North Seen AY,'DON, Lhendimmmifriahberand,rne0.wm I..M8I allmo IN°COVEMnf NAICX Northampton MA 01060 INSIANNA SBLESN'e ire Co of 5 Cemllne INSURED RELPER4 1 M,M°WPBA.LIA Reller Builders,Ins, INsuNBRc AIN:SEGH Kate, flummen O 35 Main Street ..in.E: FICmnLe MA JOBS BRUNEI,,, l COVERAGES CERTIFICATE NUMBER: MandEr E%G20I9 REVISION NUMBER: I). THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOW FCA THE POLICY PERIOD INDICATED. NOIWITHSTANDINGAWMQNREMENT,TERM OR CONDITION DEANY 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 ALLTHE TERMS, E%CLUSIDNSAND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS 1 mas OR TYPE OF INSURANCE And. FOUDY NUMRSR POUMMI°CY MEirl MI00 LIM12 r MY Xj COMMERCIAL GENERAL MMt1N EgCH COULD ENCS 3 1,000,000 IMSMgUE ❑X OLCUR PP MIS Fam m 3 6W`000 MEOExP f 15.000 A 52265561 O6I01R01tl 06101/2019 PORGONA-Ii INJURY 3 1.000,000 GENLAGOREGATE LIMITAPPLIES PER; GENEMLAGGREGATE $ 2,000,000 l POUCY❑JERLT ❑mC PROOISae-CCMProPnOG a SWISWo OTHER: _ $ AUTOMOBILE WDWN ...INM.neING PUNT —$ 1,00,M0 "I ANYAUIC BOOBY INJURY Are rensi) 5 A numsGxty X ACTULD LEO A9105217 BLANDON LEIOV2019 INJURY(PI,scre e 8 IRREJUNV"EARED. °nOPERN nAM X g11TOa ONLY X AUIDSO.VLY pyx til M 5 Medical payments 3—5060— U 060 X UMBRELLA Use C' UR EARN OCCURRENCE $ 500'000 A E%cESS UAB MARRE S2265567 06'0112018 LACTE2019 AGGREGATEV 0 Des X RFIEMILW 8 10,000 AND NERB°OMPBN9A l X iA TE4H0 EMPLOYERe'LWallrNBMrr PROPRIETORNAmHEwFxscmrvE YO NIA MCC20020op5392010A O6H1Q01R 068112018 EL EAG'ACCIDEOFPYERMEMW EXUUDEUP 0(Nmder'. N) EL DISEASE-EAESCRIPINOFFnESCRIPTICX pFOPEMTICN54obw °E9CWPTIOX OF UPEPgIIOXe ILOWTION81 VEXILIFB(ACOP°IBL ANEUSU A.—UR DIPRIe,maY as ae+eaetl Irmon apeu N,e{ubaC) 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. AUTNOP6EO REPRESENTATIVE old - o 0 198 0-201 5 ACCORD CORPORATION. All rights resmsed. ACCORD 25(2016103) The ACCORD name and logo are registered marks of ACO RD Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per tire ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: professional office suites Date: 315119 Property Address: 71 King Street, Northampton, MA Project: Check (x) one or both as applicable. New construction x Existing Construction Project description: New shed roof dormer to provide more ceiling height. Reconfigure interior partition walls to provide 5 units of professional office space. New toilet room. 1, l,mily I'.stes Baillargeon, MA Registration Number: 50888 Expiration date: 8/31/19 , 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. 1 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 (sec item 3.) together with pertinent comments, inn form acceptable to the building official. Open completion of the work, 1 shall submit to the building official a'Final Constructs r 'lAirdfl)lI ent'. Enter in the space to the right a "wet" or electronic signaturcond seal: 1 m,ij 1 Ml.UC111.F "r�M Phone number: (413)320.6199 Email:emily«estesarchiectcom ru OF yr s looldiog Official Lfsv Oalp Building Official Name: Permit No.: Date: Note 1. h+dicate with an'a' project dosign plans,rompulations and spedfiralions that you prepamd or directly supary isad. If'nlher' is ohnsen,provide a description. Vcrsinn 01 01 2018