Loading...
38B-006 (112) 126 WEST ST-CAMPUS POLICE BP-2020-0806 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-006 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-2020-0806 Proiect# JS-2020-001394 Est.Cost: $450000.00 Fee:$3150.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa.ft.): 9365.40 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: SI(100)/WP(6)/ Applicant. KEITER BUILDERS AT. 126 WEST ST - CAMPUS POLICE Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.111512020 0:00:00 TO PERFORM THE FOLLOWING WORK:RENO EXISTING SPACE TO CREATE POLICE DISPATCH AND OFFICES, RELOCATE BUILDING SERVICES INTO THE CENTRAL STORE 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# Fou ndat ion: 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: FeeType: Date Paid: Amount: Building 1/15/2020 0:00:00 $3150.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial-Bujlding pomiLMay 15,2000 Department use only City of NorthamptonStfttrs-vf# mit: Building Departmen Curb Cut1D 'veway Permit 212 Main Street �aN Sa+N@OSep c Av Iilability __ Room 100 >< Water/Wel Avail bility,,. _ Northampton, MA 01060 r'"T of SUILDIN Stru ral Plans '�`"" A1 phone 413-587-1240 Fax 413-587-� 1n�0 � FC710 Ptt9tlt�dt>a PlSans 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 Pr er Address: This section to be completedby office i26 est t- Campus Police '30-L-' /}� Map '3� Lot `� Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 wner of Record: �J Name(Print) Xl`" .C�aJ -r'v ^1 f Current Mailing Address: a t z // ,,r G ,r,,,#�� �Y C,JaC•7N/� .�J`� C7 t t?(0 3 Signature !� a Telephone All 3 " 5-8 6 —z-V v 2.2 Authorized Agent: M Ketter Iiwlders,Inc. J.) Main Street rlorence,MA UIU02 Name(Print) Current Mailing Address: 413-586-8600 Signature _1 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only ____.completed by permit applicant 1. Building O'ma", Cw (a)Building Permit Fee / 2. Electrical tel (b)Estimated Total Cost of �1 (UD r OOo Construction from(6) �� X T 3. Plumbing [U r C;&10 Building Permit Fee 4. Mechanical(HVAC) loot ovv 3t 6. Fire Protection o1D C�cJD 6. Total= (1 +2+ 3 +4 +6) Check Number This Section For Official Use Only Building Permit Number Date O/ „ Issued Signature: f 6A LI� d Build) Commissioner/Inspector of Build) 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 ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Renovate existing space to create Police Dispatch and offices. Relocate Building Services into Brief Description the Central Store. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly © A-1 © A-2 © A-3 © 1A 93 A-4 © A-5 © 1B IB Business 93 2A 'E Educational © 213 F Factory © F-1 0j F-2 © 2C 93 H Hi h Hazard ® 3A I institutional M 11 © 1-2 ® 1-3 ® 3B M Mercantile © 4 R Residential © R-1 © R-2 ® R-3 © 5A S Storage © S-1 S-2 93 5B U Utility 93 Specify: M Mixed Use ® Specify: S Special Use 03 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.t 1.t 2nd 2 d 3W 3rd 4'" 4a, Total Area (so Total Proposed New Construction (so Total Height(ft) Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: F7.3 Sewage Disposal System: Public R Private g2 Zone Outside Flood Zone❑ unicipal [q On site disposal system[] 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: Thomas Hartman Not Applicable E3 10448 Name(Registrant): Registration Number 8/31/2020 Address See attached control doc 413-549-3616 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 Keiter Builders,Inc Not Applicable m Company Name: Scott Keiter Responsible In Charge of Construction 35 Main St. Florence,MA 01062 Ad*es pt- gi 413-586-8600 Praidrat,tCBI Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 ,SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,_ ��� ' '� c9►.t 3E�1'►�� C�C= c rte -t(L�5 r t~-x 1 5K I z N ,as Owner of the subject property hereby authorizet'� ' Q- k�a U 1,!.&6 G.- to act on my behalf, in all matters relative to work authorized by this building permit application. o ,) _�:)E taA L F 01IFF -'c taG --c tl,taSTE'eS b 1: -r WE- Signature of Owne Date Keiter Builders,Inc 1,_______ , 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 h t'r.tL.f 01.14.2020 SIgnbiure of Owner/Agent Dale SECTION 12-CONSTRUCTION SERVICES 10.1—Li rensqd Construction Supervisor: Not Applicable ❑ Scott Keiter CS-102457 Name of License Holder License Number 51 A Hatheld Street 6/20/20 Ad ss Expiration Date P 413-586-8600 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 (�) 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: 126 west sc 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 01-142020 Lt �� President,KBI Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 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/Organi(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): I.® I am a employer with 22 4. 0 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors b. ® New construction .0 I am a sole proprietor or partner- listed on the attached sheet. 7. ®i Remodeling ship and have no employees These sub-contractors have g, ® Demolition working for me in any capacity. employees and have workers' 9 ® Building addition [No workers' comp. insurance comp, insurance.# required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions .0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. tight of exemption per MGL 12.® Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other camp. 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 art 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'camp 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 Dater 6/11/2020 23 West ST Northampton 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 S1,500.00 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. 1 do herebyrtify�the pains and penalties of perjury that the information provided above is true and correct. i nature.Zt- President, KBIDate:01 .14.2020 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 AC O CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDbrwrY) 06103/2019 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(les)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 NAMe. Cynd a Henderson CISR,CPIA Webber 8 Grinnell PHONE (413)58"111 (A/C,No): (413)586-6481 8 North King Street LAWLs chenderson(2twebberandgrinnell.com ADDRE INSURER(S AFFORDINO COVERAGE NAJC 0 orthampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 SURER INSURER B: A I M MUtuaUA.I.M, Keller Builders,Inc. INSURER c Attn Scott Keiter INSURER G: 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 MAYBE 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 LTR TYPE OF INSURANCE IN5D WYD POLICY NUMBER MMIDD M LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000,000 CLAIMS-MADE a OCCUR PREMISES Es ocmmenae S 500,000 MED EXP(Arty one person) S 15,000 52265567 06101/2019 06/01/2020 PERSONAL a ADV INJURY S 1,000,000 GENIAGGREGATELIMIT APPLIES PER GEN ERALAGGREGATE $ 2,000,000 ]POLICY ❑Pf6 F—]LOC PRODUCTS.COMPIOPAGO S 2,000,000 OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea sccSdanl) ANYAL70 BODILY INJURY(Par parson) $ A OWNED AUTOS ONLY SCHEDULED A9105217 06/01/2019 0610112020 sootLY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PR s AUTOS ONLY AUTOS ONLY Per accident Medical payments S 5,000 UMBRELLA LLAB OCCUR EACIA OCCURRENCE _ S 5,000,000 A EXCESS LL"" CLAIM S2265567 06/01/2019 06!0112020 AGGREGATE $ 5,000,000 DED X RETENTION S 10,000 $ ..._ WORKERS COMPENIATJON PER DTH• AND EJAPLOYERS'LJABILJTY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNEPtO7 ECLJTIVE E L.EACH ACCIDENT S 1,000,000 B OFICERR.IEMBEREXCLUDED9 FN NIA MCC20020DO5382019A 06/11/2019 06111/2020 (Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 H yea,describe under DESCRIPTION OF OPERATIONS beton E.L.DISEASE-POLICY LJMrT S 1,000,000 1 DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD 101,AddNianal RamaNu Schedule,may be attact»d H more span Is mquir•d) ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Initial Construction Control Document 4 To be submitted with the building permit application by a d Registered Design Professional r for work per the 91" edition of the �•'•y Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Smith College- Campus Police Date: 13 Jan 2020 Property Address: 126 West Street,Northampton, MA Project: Check(x)one or both as applicable: X Existing Construction Project description: Renovate existing space to create Police Dispatch and offices. Relocate Building Services into the Central Store. I, Thomas RC Hartman, AIA, MA Registration Number: 10448 Expiration date: 8/31/20, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X Architectural 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. I 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(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a`Final Construction Control Document'. Enter in the space to the right a"wet"or �. electronic signature and seal: ►���ED AtIR? cc AMH.tECRST Phone number: 413-549-3616 Email: Tom@CandHArchitects.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013