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22B-109 (7) 199 PINE ST-PIONEER VALLEY BOOKS BP-2020-0686 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B- 109 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2020-0686 Proiect# JS-2020-00116 Est.Cost: $22000.00 Fee:$154.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa. ft.): 203425.20 Owner: MATT&NICK LLC Zonin : SI 92 /WP 73 /URA 19 /U 2 / Applicant. KEITER BUILDERS AT. 199 PINE ST - PIONEER VALLEY BOOKS Applicant Address: Phone: Insurance: 35 MAIN ST 413 586-8600 WC FLORENCEMA01062 ISSUED ON.121312019 0:00:00 TO PERFORM THE FOLLOWING WORK.ADD NEW CMU WALL TO LOADING DOCK & REVISE EXIT LANDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspec or 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: Smok : Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND ILEGULATIONS. Certificate of Occupancy si nature: FeeType: Date Paid: Amount: Building 12/3/2019 0:00:00 $154.00 12 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner 199 PINE ST-PIONEER VALLEY 130OKS BP-2020-0686 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B- 109 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2020-0686 Proiect# JS-2020-00116 Est.Cost: $22000.00 Fee:$154.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa.ft.): 203425.20 Owner: MATT&NICK LLC Zoning: SI 92 /WP 73 /URA 19 /UR 2 / Applicant: KEITER BUILDERS AT: 199 PINE ST- PIONEER VALLEY BOOKS Applicant Address: Phone: Insurance: 35 MAIN ST 413 586-8600 0 WC FLORENCEMA01062 ISSUED ON.121312019 0:00:00 TO PERFORM THE:1SISIBLE LOWING WORK.•ADD NEW CMU WALL TO LOADING DOCK & REVISE EXIT LANDING POST THIS CARD SO IT 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 D artment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke Final: THIS PERMIT MAY BE RE OKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND GULATIONS. Certificate of Occupancy si¢nature: FeeTvpe: Date Paid: Amount: Building 12/3/ 019 0:00:00 $154.00 12 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE;OR� N DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAM'LY D l: �= ' SECTION 1 -SITE INFORMATION I NOV 2 6 1.1 Property Address: This section to be completed by office 199 Pine Street 1 lorenceMap���j DEPT OF Sul t,1� Unit NORTHANfF�TpN.'' Zone Overlay District Elm St. District CB District I SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: )) ! L Name(Print) �• iC'�� l.-/ Current Mailing Address: `b J 1 G�^�S\ e j Signature � � � Telephone 2.2 Authorized Agent: Keiter builders,Inc. 35 Main Street Horence, MA U1062 Name(Print) Current Mailing Address: 413-586-8600 Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building d ism (a) Building Permit Fee 2. Electrical /. (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee (� 00 4. Mechanical (HVAC) /5 /• vV 5. Fire Protection / 6. Total=0 +2 +3 +4+ 5) Check Number This Section For Official Use Only Building Permit Number Date 6 96, Issued Signnatuture: 111-2-6112 6/ 9 Building Commissioner/Inspector of Buildings Date Version 1.7 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 21 Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Add new CMU wall to existing loading dock. Revise exit landing from existing loading dock Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE See attached USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly a A-1 ® A-2 ® A-3 ® 1A A-4 ® A-5 ❑❑ 1B ❑❑ B Business 2A E Educational 2B F Factory ❑❑ F-1 ❑❑ F-2 ❑❑ 2C H High Hazard 0 3A Institutional ❑❑ 1-1 071 1-2 ❑❑ 1-3 [] 3B M Mercantile R3 4 R Residential R-1 R-2 ® R-3 Q 5A S Storage ® S-1 ❑❑ S-2 ❑❑ 5B U Utility Specify: M Mixed Use ® Specify: S Special Use FE�l 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(sf) 15 St 2nd 2nd 3 rd 3rd 4 4t th Total Area (sf) 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 q Private [Co I Zone Outside Flood Zoned FMunicipal ® On site disposal system[7] Versionl.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 90 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 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 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 1.7 Conu7iercial 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: NA Not Applicable Ell Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): David Vreeland Civil Name Area of Responsibility 46317 Address Registration Number 6/30/20 See attached 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 Keiter Builders, Inc _ Not Applicable 12 Company Name: Scott Keiter Responsible In Charge of Construction 35 Main St. Florence, MA 01062 A ess� '-Z 413-586-8600 413-586-8600 �ZfPresident.KBI Signature __ Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN • OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Keiter Builders, Inc. hereby authorize to act on my bepalf, in all m ers relative t k author'-ed by this building permit application. Signaturof 044r V 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 of perjury. Scott Keiter Print e P, J.A4 Sign ure of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Scott Keiter CS-102457 Name of License Holder: License Number 5 1 A Hatneld Street 6/20/20 Ad ss Expiration Date 413-586-8600 &Z4 �,,,2Z7 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 O No 0 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: 199 Pine St Florence 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 11.21.19 ie� President, 101 Date Signature of Permit Applicant c � i ne t ommonweatan of ivrassacnuserts Department of Industrial Accidents =6 Office of Investigations 0 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 Legibly Name (Business/Organization/Individual): Keiter Builders, Inc. Address: 35 Main Street City/State/lip: Phone #: Florence MA 01062 413-586-8600 Are you an employer? Check the appropriate box: Type of project (required): 1.2 I am a employer with 22 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ® New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8. ® Demolition working for me in any capacity. employees and have workers' 9. ® Building addition [No workers' comp. insurance comp, insurance.: required.] 5. 0 We are a corporation and its 10.® Electrical repairs or additions 3.® 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI.. 12.® Roof re airs insurance required.] t c. 152, §1(4),and we have no repairs employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers*compensation policy information. t I lomeowners 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 or 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. AIM MUTUAL Insurance Company Name:._ _............... ..... ..._.._ __..._..._...._._...._.._.__..._..— Policy # or Self-ins. Lic. #: MCC20020005382019A Expiration Date: 6/11/20 199 Pine St FLORENCE Job Site Address: _ City/State/Zip: 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 ,rtify snider the pains and penalties of perjury that the information provided above is true and correct. 11 .21 .19 Si mature. Z President, Kill Date: 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#: a DATE(MMIDD/YYYY) ACORO `... CERTIFICATE OF LIABILITY INSURANCE 06/03/2019 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 Cyndie Henderson CISR,CPIA PI10NE 413 586-0111 FAX (413)586-6481 Webber&Grinnell F,,,t. ( ) A/c NOI: 8 North King Street ADDRESS: chenderson@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC S Northampton MA 01060 INSURERA: Selective Ins Co of S Carolina 19259 INSURED INSURER 8: A.I.M.Mutual/A.I.M. Keiter Builders,Inc. INSURER C: Attn:Scott Keiter INSURER D: 35 Main Street INSURER E: Florence MA 01062 INSURER F COVERAGES CERTIFICATE NUMBER: Master Exp 2020 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 ADDL SUBRPOLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE I WVD POLICY NUMBER MMIDDIYYW MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1'000'000 DAMA E T RENTED 500,000 CLAIMS-MADE OCCUR PREMISES Eaoccurrence $ MED EXP(Anv one person) $ 15,000 A 52265567 06/01/2019 06/01/2020 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2.000,000 POLICY ❑PRO ❑ PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER JECT L� E — AUTOMOBILE LIABILITY EO accident nt)SINGLE LIMIT s 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED A9105217 06/01/2019 06/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acci en Medical payments $ 5,000 X UMBRELLA LIAc OCCUR EACH OCCURRENCE $ 5'000,000 A EXCESS LIAB HCLAIMS-MADE 52265567 06/01/2019 06/01/2020 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION X STAT TE X ORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVEFNI N A MCC20020005382019A 06/11/2019 06/11/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If ves,describe under1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. Evidence of Insurance AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Ini tial 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: Pioneer Valley Books-Loading Dock Enclosure Date: 11/20/19 Property Address: 199 Pine St, F orence, MA Project: Check (x) one or both a applicable: X New construction X Existing Construction Project description: Construction of a non-load bearing 8" CMU enclosure under an existing steel beam that supports the roof over the existing loading dock. I, David Vreeland, MA Registration Number: 46317, 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': Architectural X Structural Mechanical Fire Protection Electrical X Other: Construction Control for the above named project a d 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 engineer' practices for the proposed project. I understand and agree that I (or my designee) shall perform the nece sary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conforman e 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 re istered 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 oft e 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 o the building official. Upon completion of the work, I 3hall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a wet" or AN OF mss electronic signature and seal: 0 DAVID A. �cyc VREEL.AND CIVIL v-4 No.46317 �r c'/STEQ` AL G� Phone number:413-624-0126 Email: dvreeland@verizon.net euilding Official Use Only Building Official Name: Permit No.: Date: Version 01 01 2018 Vreeland Design Associates Date: 11/20/19 Sht. 1 of 1 An integrative approach to design, engineering and site planning Re: Pioneer Valley Books, 199 Pine St, Florence, MA: Proposed CMU wall enclosing existing loading dock. 39' --- -'11-11,11, 11'-9" 11'-8" 11'-8" 2' EXISTING STEEL I-BEAM EXISTING MASONRY END WALL AND CORNER SUPPORTING BEAM SEE PHOTO BELOW - 6' CUT BLOCK AND INSTALL DOOR FRAME- I t ' i NEW STEEL DOOR 9' I $. �) I I I 4"STEEL POST I 4"STEEL POST I _^ --- 4' EXISTING LOADING DOCK NEW PRECAST STAIRS CEMENT BLOCK WFILL WITH THREE OVERHEAD DOOR FRAMES NOTE: THE PROPOSED ENCLOSURE TO BE 8" FULLY GROUTED CMU WITH 2 - 3.5"x6"x3/8" STEEL ANGLE AS LINTELS OVER THE DOORS ji�OF o� DAVID VREELAtVD CIVIL y No.46317 .o.t� IstVVE Q Fgs� AL Gv 11/20/19 116 River Road, Leyden, MA 01337 Phone: (413) 624-0126 Email: dvreeland@verizon.net Fax: (413) 624-3282