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31A-067 JORDAN HOUSE BP-2023-1334 PARADISE RD- COMMONWEALTH OF MASSACHUSETTS JORDAN HOUSE Map:Block:Lot: CITY OF NORTHAMPTON 31 A-067-001 Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1334 PERMISSION IS HEREBY GRANTED TO: Project# JORDAN HOUSE 2023 Contractor: License: Est. Cost: 10000 KEITER CORPORATION 102457 Const.Class: Exp.Date: 06/20/2024 Use Group: Owner: COLLEGE SMITH Lot Size (sq.ft.) Zoning: EU/URC Applicant: KEITER CORPORATION Applicant Address Phone: Insurance: 35 MAIN ST,2ND FLOOR (413)586-8600 MCC20020005382022 FLORENCE, MA 01062 ISSUED ON: 09/25/2023 TO PERFORM THE FOLLOWING WORK: CEILING REPAIRS AT JORDAN HOUSE 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: • THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: al • 1 . w2 Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner • [ ' 177 The Commonwealth of Mass ch a seffs 2 5 2023 I^',,1 Office of Public Safety and Insp ctio t� Massachusetts State Building Code(7 0 CIstir OF cup Nr Building Permit Application for any Building other than a On - q ;� g • °logo (This Section For Official Use Only) Building Permit Number:4,73 33( Date Applied: Building Official: SECTION 1:LOCATION 1 Paradise Road Northampton 01063 Smith College Jordan House No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/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 0 Repair O Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑✓ Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work:Repair of a failed plaster ceiling to 1/2 of the ceiling (apor. 600 so. ft) in an open sitting room at Jordan House at Smith College (ground floor access from a ramp to the far left of the building). We will remove damaged plaster and replace it with GWB. The entire ceiling will then be repainted. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) NA NA NA NA Total Area(sq.ft.)and Total Height(ft.) NA NA NA NA SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB 0 IV 0 VA 0 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public B Check if outside Flood Zone IIIndicate municipal® A trench will not be Licensed Disposal Site El Private 0 or indentify Zone: or on site system 0 required O or trench or specify:USA Waste permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable O Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No O Yes 0 No O 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 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Trustees of Smith College 126 West Street Northampton 01063 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: J. Lucey, Project Mgr. 413.585 _2400 413.585 2412 jlucey@smith.edu Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Keiter Corporation 35 Main Street Florence MA 01062 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 fill 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 0. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) NA-See Control Waiver Name(Registrant) Telephone No. e-mail address Registration Number 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 413 586.8600 413 _320 9035 skeiter@keiter.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT" (M.G.L.c.152.§ 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 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item. and Materials) Total Construction Cost(from Item 6)_$ 10,000 1.Building $ 10,000 Building Permit Fee=Total Construction Cost x woo. here 2.Electrical $ appropriate municipal factor)=$.007 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$1 00 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost $ 10,000 (contact municipality)and write check number here 6011 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to e best of my knowledge and understanding. Scott Keiter t President 413.586 _ 8600 9/19/202 Please print and sign name Title Telephone No. Date 35 Main Street Florence MA 01062 skeiter@keiter.com Street Address City/Town State Zip Email Address ZMunicipal Inspector to fill out this section upon application approval: 01,1 q.Z6-Z4Z3 Name Date City of Northampton ,'- stis ""' src 7t Massachusetts �+ Ot, 1� ( ki G Ali-lS 1 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jkk c'.Northampton, MA 01060 � ,.' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Valley Recycling Location of Facility: 234 Easthampton Road, Northampton, MA 01060 The debris will be transported by: USA Waste Name of Hauler: USA Waste ____pSignature of Applicant: l - Date: 9/22/23 The Commonwealth of Massachusetts •—"' 7 '—'(i Department of Industrial Accidents • 1 Congress Street,Suite 100 Boston, MA 02114-2017 tcwlst ntass.gov/dla 11•utkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO RE FILED WITH TILE PE1L\tl•1-(LNG AUTHORITY. Applicant Information Please Print Leeihly Name(Mariners°Organiaotionlndr%iduat):Keiter Corporation Address: 35 Main Street City/Stateilip:Florence, MA 01062 phone##: 413-586-8600 Are you an midis)er?Check the appropristcb�a_ Type of project (required): 1.1:1 tam +cmplovar with 83 ,•„•.,,, employers Olin ardor part•tinte).• 7. El New construction 20 lam a sole AMINicWe or oaruershiv and have n•emolovei.‘s working for tne in K. o Remodeling any capacity (No workers'comp insurance sequined] 30 I am a hnesaowiier doing all work myself.(No workers'comp.imurJacr required]' 9. ® Demolition 4.Dmar-actors am a horaeowncr and will be hiringmar-actors to conduct all work on my property, I will 10❑Building addition mum;this:all corium-tors either have workers'. saiioeinauranxoraresole 1I n Electrical repass or additions pntprictora with no cn rtayeti,. 12,0 Plumbing repai,a or additions 50 I am a geresal contra:tor:uui 1 have hired the aub•contra:tor.listed on the attached sheet. l 3.0Roof repairs These subcontractors have employees and hatc workers'c*np insurance: 14.0Other 6❑W'c area corporation and its officers have exercised their right of excerption per MGL c. 152.i 1(4).and we have no employees. [No workers'comp.insurance required.) *Any applicant ilui cheeks box NI mint also MOW out the section below showing their workers compensation policy infer:nation. t Ftomeowne:s wto submit this affidavit indicating they are doing at work and then hire outside contractors mica submit a new affidavit irxiicaing such. :Contractors that check this box must sttaclred sn additional sheet showing the name of the sutrcontractors and state whether or not those entities have employees. if the sub-contractors have e c tIcyves.they neust provide their wotkcrs'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:MA Employers/AIM Policy#or Self-ins. Lic.#:MCC20020005382023A Expiration Date:6/11/2024 Job Site Address: 100 Green Street _City P State/Zip:Northampton, MA 01063 Attach a copy of the ssorkers' compensation policy declaration page (showing the policy number and expiration date). Failure to sects coverage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 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 S250.00 a day against the violator.A copy of this statement may be firwarded to the Office of Investigations of the DIA for insurance coverage seritication. l do hereby cert fy under he pains and penalties of that the information provided nary is true and correct. Sionanire: Date: 9/22/2023 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 a Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City(Cown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other A�RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/30/2023 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 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 NAME: y Alera Group,Inc. _--PHONE E Ext): (413)586-0111 FAX,No): (413)586-6481 Webber&Grinnell Division E-MAIL chenderson@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Selective Ins Co of S Carolina 19259 INSURED INSURER B: MA Employers/A.I.M. 12886 Keiter Corporation INSURER C: Attn:Scott Keiter INSURER D: 35 Main Street INSURER E Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2024 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. LTR TYPE OF INSURANCE INSD SWVD POLICY NUMBERUBR POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 1 0 RED CLAIMS-MADE n OCCUR PREMISES Ea occccu ence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2023 06/01/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRo 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A - OWNED SCHEDULED A9105217 06/01/2023 06/01/2024 BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A - EXCESS LIAB CLAIMS-MADE S2265567 06/01/2023 06/01/2024 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION �/ AND EMPLOYERS'LIABILITY X STATUTE ER Y/N 1 B OFFICER/MEMBER ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A MCC20020005382023A 06/11/2023 06/11/2024 E.L. ( EACH ACCIDENT $ , , 0 0 0 (Mandatory in n NER NH) EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1 0 00 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ' Waiver of Subrogation can be obtained should Insured win the bid for project. CERTIFICATE 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD KEITER 35 Main Street,Florence,MA 01062 o 413.586.8600 413.280.0124 w keiter.com Commissioner September 22, 2023 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Smith College Jordan House ceiling repair at 1 Paradise Road, Northampton, MA because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. All work will be completed within the prescriptive requirements of 780 CMR. Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, git4z, Scott Keiter Keiter Corporation 35 Main St Florence, MA 01062