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31A-324 8 PARADISE RD BP-2021-1109 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31A-324 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2021-1109 Project# JS-2021-001869 Est.Cost: $175000.00 Fee: $1225.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: EU(I06)/URC(85)/RR(21)/WP(2I)/ Applicant: KEITER BUILDERS AT: 8 PARADISE RD Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O W(' FLORENCEMA01062 ISSUED ON:4/5/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RENO KITCHEN 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: Las: 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. • f • >2 iC% Certificate of Occupancy signature: ' FeeType: Date Paid: Amount: Building 4/5/2021 0:00:00 $1225.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED APR - 22021 I)EPT OF ',U41."r;;-1,,.Ct'F_,TIGid3 NORTHAM!'' i lr,IR060, The Commonwealth of Massachusetts Office of Public Safety and Inspections 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) Building Permit Nux nbettik P.1•l l C/Date Applied: Building Official: SECTION 1:LOCATION 8 Paradise Road. Northampton, MA 01062 President's House No.and Street City j'/4 3a'L Zip Code Name of Building(if applicable) ' Assessors Map N Block N hand/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 Cl Repair❑ Alteration CX Addition❑ Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy Cl Other 0 Specify: Are building plans and/or construction documents being supplied as pert of this permit application? Yes lI No Cl Is an Independent Structural Engineering Peer Review required? Yes 0 No 1!t Brief Description of Proposed Work Rennvate existing kitchen with new cabinets, lighting and flooring SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE LN USE OR OCCUPANCY _ Check here if en Existing Building Investigation and Evaluation is enclosed(Sec 780 CMR 34) Cl Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEItiH t 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 NA -NA SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 Cl A-2 0 Nightclub ❑ A-3 © A-4 0 A-5❑ B: Business Cl I E: Educational CI F: Factory F-I 0 F2© H: High Hazard H-1 Cl H-2 0 H-3 Cl H4❑ H-5 0 I: Institutional I-I❑ 1-2© 1-3© 1-4 0 M: Mercantile❑ R: Residential R-1D R-2 0 R-3❑ Rio D 5: Storage S-1 0 5-2❑ U: Utility Cl Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) lA O IB O HA O IIB © IIIA O 1Il11 0 IV ❑ VA C] VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 fox details on each item) Water Supply. Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public CS Check if outside Flood Zone El Indicate municipal ES A trench will not be Licensed Disposal Site 73 Privets❑ or indentify Zone: or on site system 0 required in or trench or specify: permit is enclosed 0 USA Waste Railroad right-of-way: Hazards to Air Navigation: Le Historic Commission Review Pructsl Not Applicable la Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes Cl or No ti Yes❑ No DC 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 CYO 77//. T-yL.IA'jYN'.4r fir'I/r7-1 -Co64.6 F. Rein 6A6,00,0 /a 644csr Sr /,J©2nil741,12)n 0/0 63 Name(Print) No.and Street City/Town Zip Pro_perty Owner Contact Information: / .. ef4RTim!"Paco. -5"5),S cS-ao cy _ f 6116'. 0A}e(01 i iN-6,,4e Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: • l<./ K /2b/rcatr,t 36"/27A/v Jr �Yo/(T7-/A,ePrciyi %14( 0/06 2 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 AU 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 XI. Otherwise provide construction cmtrol forms see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control lthe professional coordinating document submittals) • Thomas Douglas 411 5850641 douglascPtdouglasarchitects.com 8944 Name(Registrant) Telephone No. e-mail address Registration Number Pleasant Street Northampton,MA 01060 Arcitectural 8/21 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 _413586 8600 41.3329.9035 skelter@keiterbuitders com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 1L•WOR3 COMPENSATION It ANCE AFFtOAVrr(M G.L.a 362 §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 RI No 13 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated t lasts:(Labor and Materials) Total Construction Cost(from Item 6)=S L 75.000 1.Building S 84,524 Building Permit Fee Na Total Construction . ert here 2 Electrical 5 34,387 appropriate municipal . e 3.Plumbing S 41,089 4.Mechanical (HVAC) S 15,000 Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 175,000 (contact municipality)and write check number here 1� Yl SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By P. ring my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this ap.F e•lion•is d accurate to the best of my knowledge and understanding. / i— Pn's„—4 e8i • 413-586 8600 3/26/21 ' ease print and sign name Title Telephone No. Date 35 Main Street Florence, MA 01062 skeiter@keiterbuilders.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: ��u(lI,►Vg .. ,.. d"�Pji/ o�I Name I 0 D tt TheCit y _''-_p--__ Bufldlmg Department 2l3 Main 3tnee ^�n Northampton,yAussachu-seus01OGO Phone(4}3)587'l24U Fus (4}3) 587'1272 CONSTRUCTION DEBRIS A.FFMANrfT (FOR ALL MIOUIlON AND RENO\/AT ION PROJECTS) In accordance with the provisions of MGL c4O, s54, a condition of Building Permft Number Is that all debris nsau|Ung from this work shall be disposed of in a properly licensed waste disposal facility ao defined byN1GLo111. s15OA. The debris will be disposed of in: Valley Recycling Location ofFacility Easthampton St Norlhamp1nn. K0A The debris will be transported by: U8AVVashe Name of Hauler USA Waste - Signature ofApplicant: Date: 3/26/21 '' �� _-' The Commonwealth of Massachusetts t ^. Department of Industrial Accidents 11-Wit u MIK 1 Congress Street Suite 100 vox _ sat ;t $ , X i IF; F Boston,MA 02114-2017 ' ,40 www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMVMIT't'ING AUTHORITY. Applicant Information Please Print Legibly, Name(Business/Organization/Individual): ICeiter Corporation Address:35 Mann St City/State/Zip: Florence,MA 01062 Phone#: 413-586-8600 Are you an employer?Check the appropriate but: Type of project(required): I.®I am a employer with 35 employees(full and/or part-tilts).' 7. ❑New construction 2.0 em a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.(No workers'comp.insurance requited.) 7 3. I am a homeowner doing all work myself. 9. ❑Demolition (No workers'comp_insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will I 0 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 5.0 I am a general contractor and I have hired the subcontractors listed on the attached sheet 13.0 Roof repairs These subcontractors have employees and have workers'comp.insurance? 6.0 We are a corporation and its offices have exercised their right of exemption per MGL c. 14•El Other 152,§l(4),and we have no employed.[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 wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Cantraetars that check this box Must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. !Stitt subcontractors 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 i or Self-ins.Lic.b':Mcc20020005382020 Expiration Date: 8111121 lob Site Address: 8 Paradise Rd 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby cc it wider e ins and penalties of perjury that the information provided above is true and correct. Signature: / 4't.41,.&.4. eta-- Date: 3/26/21 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone tt: ACCI©* CERTIFICATE OF LIABILITY INSURANCE DATE(MWDONYYY) `.._. 05129)7020 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 en ADDITIONAL INSURED,the pollcy(Ias)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 won Webber(1 Grinnell �P�NO�N�E (413)586-0111 FAX (413)588.6481 Mtn.Ertl, (MC,No): 8 North King Street ADDRESS; c 1endatsonQyyebberendgrinnetm co INSURERIS)AFFORDING COVERAGE NAIC Northampton MA 01080 INSURER A.. Selective Ina Co of S Carolina 19259 INSURED INJURER B A.I.M Mutual/A.I.M, Keller COIpore(ion INSURER c Attn:Scott Keller INSURER D 35 Main Street INSURER E Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2021 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED WANED 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 SE ISSUED OR MAY PERTAIN, INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES Limas SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. 1NSR - POLICY OFF - POUCYEXP LTR TYPE OF INSURANCE MD_ma POLICY NUMBER (MWDDITYY'r) (MMIOOIYYYT) LIMITS COMME cacti(serum L SILITY EACH OCCURRENCES 1,000,000 DAM REM 000 1 CLAMS-AIALIE X OCCUR PA E TO RENTEDRE►�ISES Ms oeeurmece) S ' SM MED EXP(Any we person) S 15,000 A S2265567 06/01/2020 06/01Q021 PERSONAL AADVINJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY C JECCT' i I Loc PRODUCTS-COMPIOP AGG s 2.000,000 OTHER _ s AUTOMOSILE LIABILITY C66I(}T iED SINGLE LIMIT $ 1.000,000 (Ea appdanli X ANY AUTO ROILY INJURY(Per omen) $ A OWNED SCHEDULED A9105217 06101(2020 06/01/2021 BODILY INJURY Per ectIdem) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE T Awns ONLY —AUTOS ONLY (Per accident) Medical payments s 5,000 X UMBREW►LUa X OCCUR _ EACH OCCURRENCE $ 5,000,000 A excessLua ~ CLAIMS-MADE 52265567 06/01/2020 06/01/2021 AGGREGATE s 5,000,000 _ DEO XI RETENTION$ 0 S WORKERS COMPENSATION XI PER X1 OTH- AND EMPLOYERS'LIABILITY Y/N XI STAM1• /`•t ER 6 ANYPROPRIiTOR/PARTNER/EXECUTTVE NIA MCC20020005382020 08/11/2020 Dt3111(2021 EL.EACH ACCIDENT S 1,900,000 OF ICERfMEMBEREXCLUOED't 1 '� (Mande/xi In RH) EL DISF&SF-EA EMPLOYEE S 1,000,000 If yes,descibe under 1.000,00o DESCRIPTION OF OPERATIONS below _ EL DtSFASF-POLICY LIMIT s DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remafta Schedule,may be attached N 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 Evidence al Insurance"" ACCORDANCE WITH THE POLICY PROV)B1ON8. AUTHORIZED REPRESENTATIVE 0 1988-201S ACORD CORPORATION. All rights reserved. ACORD 2S(2016103) The ACORD name and tupu ere registered manta of ACORD