Loading...
32A-058 (29) DATE(MM/DD/YYYY) °® CERTIFICATE OF LIABILITY INSURANCE 7/10/2015 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 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 Cynthia Henderson, CISR NAME: y ___---- Webber & Grinnell PHONE (413)586-0111 F No:(413)586-6481 8 North Kin g Street E-MAIL ADDRESS: g chenderson @webberand rinnell.com INSURERS AFFORDING COVERAGE NAIC A__ Northampton MA 01060 _ INSURER A Arbella Insurance Group 17000 INSURED INSURER B: 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 2016 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD/YYYY POLICY/YYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - DAMAGE TO RENTED A CLAIMS-MADE OCCUR PREMISES Ea occurrence $ - 300,000 8500064396 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY JECT E] PRO [::] LOC PRODUCTS-COMP/OPAGG $ 2,000,000 _ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _. _ ANY AUTO BODILY INJURY(Per person) $ A ! ALL OWNED yJ SCHEDULED 1020039381 6/1/2015 6/1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS --- NON-OWNED PROPERTY accident)Y DAMAGE $ X HIRED AUTOS X AUTOS Medical Payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 4600064399 6/1/2015 6/1/2016 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100.1.000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) 9127440615 6/11/2015 6/11/2016 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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. AUTHORIZED REPRESENTATIVE C Henderson, CISR/CIN °d' � �OrLj ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS095 i gn i em i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): &A_ Address: 3s- K.Q, Ai,_ & City/State/Zip: r"CX Phone #: f Are an employer? Check the appropriate box: Type of project(required): I. I am a employer with 4. E] I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working or me in an capacity. employees and have workers' g Y P Y• 9. E] Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] + c. 152, §1(4), and we have no 1n^Q employees. [No workers' 13.[[ ther S comp. 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 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 Company Name: Policy#or Self-ins. Lic. #: a �' ��17 C Expiration Date: �( Job Site Address: S-b Upt�rv, 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 certify der the pain and penalties of perjury that the information provided above is true and correct. Si nature: ULAA Date: 16 b It 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#: 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: The debris will be transported by: RCN-S The debris will be received by: Building permit number: Name of Permit Applicant d ) Date Signature of Permit Applicant i Boston Bay Architects,Inc. r Planning urc r 'j interiors Construction- a _ o_ Management E 214 Lincoln Street �'FC 4•- Unit 3115 ■ r:�., ,�„ r- _ '� Boston,MA 02134 A / -`; .�,.n Tel.:611.782A255 l Fax:617 782,0277 •7 W o@ wb db Sit,:wwbbacom F 1 i I �`•., '`Fa,. �- t Ate"'�{SSE�-a�� P1 ?7v...„,,.�.n, _ P1 °,..a n.� - P7 .�,� r�° R I ( Wall Column Deterioration Detail of Deteriorated Steel Deteriorated Steel Column Column on stair capstone on stair capstone �_P 9/F .ncxirecrs sE>4. (o f Y\yl OOµ N VO Y il,q�¢�j,TYIN L.�4VGK Pti- I I I � �f T H Or _HF.vICiJNS/SUnr;I5510N �q NT> I __ _C � Mq�-•� I� \ LIJENT: sO DCE PARK CONDW1141- Nu ORUHOUPip.'CEU1 01060 �IiiCR CrvPRESERVATIOH.IrvNH VAIR REP—S C I RL — ) - _ ICI D4AnIKC TRLE:_� P;WUS.DETAILS 0% - v"11W 6-pit,If&-E'pN it Si41R AT Urv;pN STREET VNOEa��DO I�,_ - I CN[CKtD P. -- _�1J iCS�Y2aL7_k4-EotYx_-..!.. It�u Y-K1PN/�' � Isc.fr. P.A ' q.. 2,2 IM. coL .. o.TEE oT.zs.aors o nn: NOTE: I t�,rERi F�6au(J(,i E+cx,cIN4AVD T}'JM GN SHEET rvD: ZZ-+slug•. °Ry*eF� See Structural Engineering Column Repair -- - "11244f'50L.0 Drawings Attached ^ GOl(i*1N`�=•GdtO:J PT F�35E A L4 I SHEET. I RECEIVED tit L 1 9 201 --- -- Y�Yi Y'�•(:S'�°i'YthTr'.srmnT2.Y1L%9F:'�. gay Architects, Inc. R �aCt�so�� Orj 1 S ' el C e�O / Coauvn 6 LED S i'o . i . y . C w Kt v -07 0�1 i.5 n K a7 07 1 S' L.- R.J. Farah Engineering, Inc. Structural and Building Envelope Engineers lunch rur.VIA 021!18 PROJI-X"T'NAN111": rage jr/l /'A '-�6-A-3 Z 5--- • P..k! At L I A V A O;L New fell gx Phl -T L ost Cz AX -I A'r P- N —P, A -x! 4 C. M'lL A IT ui C" C.4 uj f4 C4 Cm Union Street Repair 09.21.15 September 21, 2015 Description _Quantity Hours Labor Other _Subcontract cost Paint(4)posts 1 Ea 0 $0.00 $0.00 $0.00 $1,610.00 $1,610.00 Prepare(hand scrape),prime,paint,and caulk entire post(top to bottom) Project Total 60 $1,160.78 $3,841.00 $431.25 $1,610.00 $7,043.03 We appreciate your business and look forward to working with you. Approved By: Date: Date: Contractor Customer Keiter Builders, Inc., License#: 102457 Union Street Repair 09.21.15 September 21, 2015 Scott Keiter SCOPE Keiter Builders, Inc. Main Street r,vrence, MA 01062 KEITER Office 413.586.8600 Fax 413.280.0124 11B UlLDERS� scottkeiter@gmaii.com www.KeiterBuilders.com License #: 102457 Project Customer Union Street Repair 09.21.15 Coolidge Park Condominiums 50 Union Street 50 Union Street Northampton, MA 01060 j Northampton, MA 01060 STEEL COLUMN REPAIRS Notes: PLANS: COOLIDGE PARK CONDOMINIUM BY BOSTON BAY ARCHITECTS DATED 07.25.15. PAGES A1.2, A1.3, &Al A Description Ouantity Hours Material Labor Other Subcontract Cost s emolition&Debris Removal 1 Ea 4 $0.00 $253.00 $57.50 $0.00 $310.50 Cut post base and remove material Permit 1 Ea 2 $0.00 $172.50 $230.00 $0,00 $402.50 Portable Toilet 1 Ea 0 $0.00 $0.00 $143.75 $0.00 $143.75 Site Safety&Management 1 Ea 8 $61.09 $506.00 $0.00 $0.00 $567.09 PP n Steel Fabrication 1 Ea 0 $610.94 $0.00 $0.00 $0.00 $610.94 Campbell Iron Works proposal E532 dated 08.18.15. Brackets,epoxy,TC bolts,Galy. Thread rods Steel installation 1 Ea 10 $61.09 $632.50 $0.00 $0.00 $693.59 Drilling,bracket installation,construction grout Carpentry(2 Back Piers) 2 Ea 16 $183.28 $1,012.00 $0.00 $0.00 $1,195.28 Cut open post bases. Sand I brush rust away $91.641Ea $506.00/Ea $597 641Ea from steel. Prime in place. Install pressure treated blocking. Install trim to match two front Piers. Carpentry(2 Front Piers) 1 Ea 20 $244.38 $1,265.00 $0.00 $0.00 $1,509.38 Install pressure treated blocking,install base trim per plans Kofrnr Ai rilriArS Inc.. License#: 102457 1 Construction Control Affidavit THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety Date: October 2, 2015 To: Inspectional Services Commissioner-City of Northampton 212 Main Street, Northampton, MA 01060 Proiect: Coolidge Park Condominium 50 Union Street Northampton, MA 01060 Scope of Project: Entrance Stair Repairs, Historic Preservation, Drawings dated 7/25/2015 In accordance with the Eighth Edition Massachusetts State Building Code, 780 CMR Section 116.2: I, Ronald J. Alex, Registered Architect MASS Registration Number 5494 being a registered professional architect, hereby CERTFY that I have prepared or directly supervised the preparation of all architectural design plans, computations, and specifications for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, 8th Edition, all acceptable architectural practices and all applicable laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned design of the work proceed in accordance with the documents approved for this building permit. Upon completion of the work, I shall submit a final report as to the satisfactory completion of the above mentioned project. REGISTERED ARCHITECT Boston Bay Architects, Inc. Ronald J. Alex,AIA Name ignature Mass Reg. No.5494 Date DAR JOHN FCJ 4°No.5494 O BOSTON: 3 MA J� (seal) �FqC TH OF MASS Construction Control Affidavit/Projects/Coolidge Park Condominium/50 Union Street 1 I I AC L,c ed a cy,yine and Q.&I Agned sit 13) I I C. lt)aN I I ot "I'ill AAoIk u I It I! al'Icr this At,,�rce In ell I ha; I)o .SOT Sl(;,\ THIS CONT&ACT it' THERE BLANW SVICES. THIS IS A LEGALLY BINDING AGREEMENT. IF THERE A RE,,I,*\Y PRO IISIONS WHICH J'OUDOADT UADERST4.-ND, KIATUIR 131ALDERS, INC. 71 V R Cr 3C,/Date 1)�, Scott kcite I., President Rut ty, DwC KEUVER 1131, ILDER4 IM 0 SN VR f � Scutt ietter, President 2 NOW, -T) Date AL 7a��17 AD M'E': ! ill Sli;A_A1 i, RI S 1 it I 111 1 10 Wit RNYVA DINK I 1 A 1 1 1 PNIM i\11 l:\7 V pi Fly I I it (,()I\ 11v1 \(' J()1-1. I VIL ()\VNLR MAY 1\1 I 1A i 1: AI I l' k\A I&I Sol I 11O\ I \,I \, \\ I HRl: 11115 1L-,'F('I1()\, IS NOI I III S. OH: 816111 W ENIII-MI AIAI-R\AIIVE I)ISPtTT SIP \RA I LEI III PAR RI So [ [- 11()\ SHALL I NJ) I \M YEARS AFTER IHFDAFL (* OHS A(TIENHAT. A'0 TICE� 11, S10\A I t R ()I-, I I IT: i"Al", 1 1 E.,� ABOVI: APPLY ()\I Y I() 1-11L ,\(jJZEJ NIIAA 0I FI H-, PAR 1-11-S At I FRN-\ I 1\1 DISM-1 I St. I I LKIp,j 1\11 JA I EJ) 1j)' 11 IF o-04FRACI OR). 'I lH--. MAY INi 1 1,\ \1 1 I-j" MIERI-- VIIIS 1-11-V1,10\ Is \()'I .\.;\ I'jVE DI�Pl, I I RKSOEA IMN IAK\ S&NI-A) MY IIH PAR IFS. 1111, RK111 11) INIIIAIL AITIANAML IASPITI jI( c\ sjl \Ij 1m) 1 \\ () Yl :W :AI 1 M i M. DAMY I I ITS MAMIN 1 . WISCELL 1A'F01 1-hi, a CCCnlelll is t11" 1cl-ircsClit"Itiow, or not C\Pl'esslV it xc 1,,�1 a p'll-I of 111", 'And it is binJint" upon our licirs. �LICCCL,"11'� ,Md AM,, I \,rcanum nw, he nwdiflcd 01113 h, m, in,itimient in "Wing signcd b� Ih, is quitecl u) aid 6 imunded k, ctmiQ itli, (TwI)m t42A of the �js�: ajj� photos taken durin.,-, the course ol' Inc. 111, m undcl-stand, and ackmmwdg-,�> that K�:itcl littildcl kilkminy websin wwspapem. \\01'k loo rn)111060nal purpo'c' I Ids IU:q WOW hilt 6 Mq 111"d jouinal'. posicl,. and RIWIT TO CAA CL'L CONTR,ICI: Y()1 MAY (-AV'Clj 11115 A(M 1 \11 \1 11 1"1 it "S'16NI 1) I3y A J'ARITY IIIEREIC) BY FORWARIAN(I ) ()t R V`. I I N ' I" ( \\( 1:1 1\ \\ 1\6 BY ()RIDE\ \1-\))' NIAH, P()SILD. M, It I I oRAM SEN 1 01? H) DI I M 11) . %M 1 M I,R IIL\N MID\1611 I ()l I Ili- I IIIRD lit SINESS I)_\) F(1.1DWINK 11" NMINki (q IAII N I 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 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ' (,,a�- ,o ".'-ee` R`�"-C I, 1 6 10(a Z— CWI1'�` >��✓ ( ' as Owner of the subject property hereby authorize / to act on my behalf, in all matters relative to work authorized by this building permit application. LJ Signature ff Owner Date ilm 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 pain and 0enalties of perjury. Q Print Na / N�f aCv `GL..G G g at a of O ge Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Y,� ,,�j� Not/Applicable/❑t (,/ Name of License Holder: C S"4 hCtAa C--S G 6g 4 License N ber / ` /LtA 1 � l &-:' ;nature res Expiration Date �d 6 r6 w Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affida it must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buiofng permit. Signed Affidavit Attached Yes No 0 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: 1- ,?\o-A A OL WV\ Not Applicable ❑ Name(Registrant): Registration Number Address C A 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 CC 1 �.J Not Applicable ❑ Company Name: Responsible In Charge of Construction Addres atu Telephone Version 1.7 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 % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ver been issued for/on the site? NO 0 DON'T KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Regi of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained l Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES I NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,er fillin g)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 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❑ Cha ge of Use❑ Other ❑ Brief Description Enter a brief description he, re.,, Of Proposed Work: C``D�� CA'( It— SECTION 5-USE GROUP AND CONSTRUCTION TYPE `'XIS \ cz&t 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 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 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) 1St 151 2nd 2nd 3`d 3rd 4tn 4tn 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 ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] Version 1.7 Commercial Building Permit May 15,2000 Department use only OCT 8 2015 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - ic,Plumbing&Gas tnspeckWA 212 Main Street Sewer/Septic Availability Northampton,MA 01060 Room 100 1lVaterMlell Availability Northampton, MA 01060 Two Sets of Structural Plans" phone 413-587-1240 Fax 413-587-1272 PiotrSite Flans 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 Property Address: This section to be completed by office 5 U1i 1 "r Map Lot Unit ✓A Zone Overlay District wElm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: lft4 4y- Name(Print) Current Mailing Address: Signature ]w ��+Tell hone SECTION I-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (x(13 (a)Building Permit Fee 2. Electrical 1 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) , (s 5. Fire Protection 6. Total = (1 +2+3+4 +5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0478 APPLICANT/CONTACT PERSON SCOTT KEITER ADDRESS/PHONE 51A HATFIELD ST NORTHAMPTON01060(413)586-8600 Q PROPERTY LOCATION 50 UNION ST MAP 32A PARCEL 058 000 ZONE URC000Z THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: STRUCTURAL COLUMN REPAIR New Construction r, Non Structural interior renovations U4 12d!!!( 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 INF ATION PRESENTED: Approved 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 D lay Sign o ui in ficial 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. 50 UNION ST BP-2016-0478 cis#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-058 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2016-0478 Project# JS-2016-000806 Est. Cost: $7043.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): Owner: HUMBERT-DROZ MARGARET Zoning: URC(100) Applicant: KEITER BUILDERS AT. 50 UNION ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 WC FLORENCEMA01062 ISSUED ON.10/1412 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRUCTURAL COLUMN REPAIR 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 10/14/2015 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner