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KEITER BUILDERSCN PROPOSAL March 13, 2014 CUSTOMER NAME: Smith College,Attn: Karla Youngblood PROJECT ADDRESS: Campus Center ESTIMATED START DATE: Spring Break ESTIMATED PROJECT RUN TIME: 3 Days PLANS: Analogue Studio SKA# 1, 2, E-1 dated 03-10-14 DOOR RELOCATION ■ This proposal includes the following: • All demolition and debris removal • Removal of existing doors and frame • Re-frame wall at new door location • Installation of existing door frame, slabs, and hardware • New jack studs at either side of door • New drywall around sides of door • Frame-in opening • Rock wool insulation if required • All sheetrock, taping, and finishing • New vinyl cove base at hallway side • New tile base in kitchen area • Prime and paint approximately 240 square feet of wall • All electrical work as specified in E-1 • Note: The contractor would like to create a 1' x P hole in the wall 1-week prior to work to verify interior wall conditions. This hole would be concealed with a small piece of plywood TOTAL PRICE FOR LABOR AND MATERIAL $3,641.00 Initial Construction Control Document To be subtnitted with the building permit application by a Registered Design Profcssionid for work per the$`edition of the Massachusetts State Building Code,780 CMR,Section 107 Project Title: t rii► o l *1A 10—0. 1,.-'y 6e . &2 Property Address: ]QQ ��,y S � &A da im l MA a l Q&A' Project: Check one or both as applicable: ^New construction iWtxisting Construction Project descripdon: k� #r. Ir 1 r—* �l MA Registration Number. 'LUSH b Expiration date: 'sl 1�1' _,am a registered design professkmd,-and I have prepared or directly supervised the preposition of all design plans, computations and specifications concerning: j4*'Areh tectwal [ j Structural [ j Mechanical [ j Fire Protection ( j Electrical [ j 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. I understand And agree that I(or my designee)shall perform the necessary professional services and be present on the conswction site on a regular and periodic basis to: I. 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. He 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,1 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 Documen'. CEO A / Enter in the space to the right a"wet"or electronic signature and seal: w` a OU Phonenumber: &J'7•440•'1S-69 Email Ntb�1S eost Aa Building Off'W i Use Only LN ALIN OF Bonding Official N une• Permit No.- Date Version 06112013 C, f 1 CITY OF NORTHAMPTON ON :r Construction DDebris Affidavit In accordance with the provisions of MG.L. c. 40_§ 54, all debris resulting from any work -cwered-by-a-- -uildipg-Perm'ii shall be disposed-of.in a�p-opedy licensed disposal facility, as defined by M.G.L. c..I11' § 150A, Address of Work: /60 2GMA S-�• / 0 — The-debris-Ml.be-transported by: The debris.wili 6e.receive '--t:. '�--� _ - -lam G� `� L//L( SfgnaWm of Permit-40kint Vl .'Mate 3— - l `-y-' Bundling Permit Number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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 Le ibl nIri aie t 1 y`✓z . City/State/Zip: k D rod-W 10 7U� MA- 0 M!r 0 Phone*' 415 -.5Y6-B &coo Arid,yob am employer?:Check'the'appropriate box: Type ot'pr6pect(regalred)t I. I am an employer with 8 4. 111 am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling listed on the attached sheet. 2. ❑ 1 am a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition ship and have no employees employees and have workers' 9. ❑ Building addition working for me in any capacity. comp. insurance.* [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We area corporation and its officers have exercised their 11.❑ Plumbing repairs or additions 3. ❑ I am a homeownerSeattle8 doing right of exemption per MGL c. 12.❑ Roof repairs all work myself. [No workers' 152,§1(4),and we have no comp. insurance required.] f employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 an 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'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 Compati�Tame T►�Gl V�Y-Z 2 Stit V-"G--2_ Policy#or Self-iris.Lie.#: - E-145 :;)Lf rJ&5 7f.-,743 Expiration Date: (P Jo Site'A dress All Locations City/State/Zip: Q l' Gt v�c�0 M.,4 6 t6 6 a 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#` 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#: ZAWorkers Comp Aff-Highlited.doc Venim1.7 CommueW Bnitding Permit May 15.2000 AddrM �iu � der a uG o Lveroa oat T •.2 P►ahwiorsrllE s n!" Asasu Ruon aun�ber f- a.rtH Area of RespmMkOity Address _ _ . __ nwrrbar T Daie Flsnw Arm of Rnpan bi" AftM Repistrepon M~ T on Dage 1�w Ares of Respa»billy AORM R40"aw Nunew B Tale Data 0.3 Gomall Conb*CW Wt Appk*Ns Cl Raponelblrtn mor of Gay"Ckn a:. 4 �t'C -� rT.._ OR _ T- 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: ..�T7i((�i 0 Not Applicable ❑ Name(Registrant): / /VJ"ltjA- to"K DRIVEr /�{� rinoP- gbSTD/J MA Registration Number Address O22/0 617-17410 75b8 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): L//VDral2L��0� �Sl-1Pi Rf��-FS.� 1�• G• Name Area of Responsibility -1135 GoT'TAC-r ST MA, 0I 10 Address Registration Number yl✓ -732 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 KE 1 T&KZ N 1 1. `� I K.1 C . Not Applicable ❑ Company Name: Responsible In Charge of Construction �l ��pp q , Add ss �J `1' i•IF11\ ( 4 2014,�0- K 3 5�b-a fro S' n ure v 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 0 No 0 SECTION 11''-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR C NTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize TT rte=lT�/L �t'CS. 7 - / C • to act on my b,p4ia , in tters relative t work authorized by this building permit application. � igna u f er Date 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 u d r}fie p i_ an penalties of perjury. Print N e _ S G OT'T 14-14 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: `'GOT`C� IL l: I T G 2 C S ^ I Q 2- S� License Number ST_ H WT' ,1 PThty MN 0-10(00 x , 2 0 2 o I <f- Adqfess Expiration Date -1- /415. 5,9->c_- -LD.L,00 S' n ture 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 I NWR 14 2C i 4 a i Ltect actions 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 Brief Description Enter a brief description here. Of Proposed Work: ��� �T• h� �/QD SECTION 5-'USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ 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 Hi h Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 1 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ 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(sf) St _.. _. _.... 1sc 2nd 2nd 3rd 3rd 4m 4tn Total Area(so 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 ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 & 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 % 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 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Page and/or Document#' tla\ B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exravation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit ft 15,2000 060" rfirnent use erriy ity of Northampton Status of I'erml ilding Department Burkautltrlvway Pe�ttt V 12 Main Street Sevverl5epic'�4vatlaili x Room 100 ulaterNVll Auallablhty NpWiampton, MA 01060 T of Structural Plans"- phone 413-587-1240 Fax 413-587-1272 PtOtS>tet�ians c C7ther cif y 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 Property Address: ,,, This section to be co�m�pl/e�ted by office Map Lot pqT 7 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n opt' ,l` Name(Print) Current Mailing Address: Sin © Telephone " 9 p 2.2 Au hori Acien : cTr IGE tZ�tZ t �� .KEITt72 AI t,plr125) 1.lc• 5t i+i'c> �t Ego S r I�io�re t,�utwra c Name(Print) Current Mailing Address: 43-586-8r�o Signature Telephone SECTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building a d D a e (a)Building Permit Fee 2. Electrical 1 6e) (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) J Cv��. Check Number This Section For Official Use Only Building Permit Number Date' Issued Signature: Building Commissioner/inspector of Buildings Date File#BP-2014-0951 APPLICANT/CONTACT PERSON SCOTT KEITER ADDRESS/PHONE 51A HATFIELD ST NORTHAMPTON (413)320-9035 PROPERTY LOCATION 100 ELM ST-CAMPUS CENTER MAP 31B PARCEL 249 001 ZONE EU(100)/URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out aa Fee Paid Typeof Construction: RELOCATE DOOR 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 IMATION PRESENTED: 7Approved 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 f 3 f7 C Signature of Building Official Date 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. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 100 ELM ST-CAMPUS CENTER BP-2014-0951 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B-249 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-2014-0951 Project# JS-2014-001649 Est. Cost: $3641.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sq. ft.): 15855.84 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: EU(100)/URC(100)/ Applicant: SCOTT KEITER AT: 100 ELM ST - CAMPUS CENTER Applicant Address: Phone: Insurance: 5 1 A HATFIELD ST (413) 320-9035 WC NORTHAMPTONMAO1060 ISSUED ON:311712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-RELOCATE DOOR 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: FeeType• Date Paid: Amount: Building 3/17/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner