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32C lY of Louis Hasbrouck<Ihasbrouck@northamptonma.gov> r _ . .. 351 Pleasant St 1 message Louis Hasbrouck<Iasbrouck@northamptonma.gov> Tue, Nov 27, 2018 at 6:28 PM To:Scott Keiter<skeiter@keiterbuilders.com> Scott, I signed the permit for the work at 351 Pleasant St. If it turns into a bigger job,send us an amended scope of work. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax KEITER BUILDERS35 Main Street•Florence•MA•01062•Phone:413-586-8600•Fax:413-280-0124•keiterbuilders com Commissioner Hasbrouck 11.21.18 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the UPS Store Rot Repair Project at 351 Pleasant St in Northampton 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, eott Keiter Keiter Builders, Inc. 35 Main St Florence, MA 01062 AC® US//17/2018® CERTIFICATE OF LIABILITY INSURANCE DATE 17/20118 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 CONTACT Cynthia Henderson CISR Elite NAME: Webber&GrinnellAHCONE No E=t: (413)586-0111 FA/c,No: (413)586-6481 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC d Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina INSURED INSURER 8: A.I.M.Mutual/A,I.M. Keifer Builders,Inc. INSURER C: Attn:Scott Keifer INSURER D: 35 Main Street INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2019 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 POLICY EFFPOLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMMDIYYYY MMIDO/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence) $ 500,000 MED EXP(Any one person) S 15,000 A S2265567 06/01/2018 06/01/2019 PERSONAL&ADV INJURY $ 1`000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 r'OLICY E JECPRO ❑ fd2,000,000 T LOC PRODUCTS-COPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED XSCHEDULED A9105217 06/01/2018 06101/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY X AUTOS ONLY Per accldem Medical payments s 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-f+IAOE 52265567 06101/2018 06/01/2019 AGGREGATE S 5'000'000 DED I X RETENTION $ 10,000 S WORKERS COMPENSATIONX STATUTE X OT"_ AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s B OFFICERIMEMBEREXCLUE F NIA MCC20020005382018A 06!11!2018 06!11/2019 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 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) City of Northampton is listed as Additional Insured with respects to General Liability as per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS, 210 Main Street AUTHORIZED REPRESENTATIVE '1 Northampton MA 01060 —L) T, � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD The Commonwealth of 1'llassachusetts s• Departnnent of IndustrialAccitlents Office of Investigations 1'•1 — li� I Congress Sti-eet,Suite 100 v �, t = •, Bostoiz,MA 02114-2017 1 i www.tnass.gov1diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Keiter Builders, Inc. Name (BLIS i1)CSS/Organization/Individual): 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 am a employer with 20 4. 0 1 am a general contractor and 1 6. ®New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for me in an capacity. employees and have workers' 5 Y9. Q Building addition [No workers' comp. insurance comp. instuance.* 5. its 10.Q Electrical repairs or additions required.] We are a corporation and ;.Q I am a homeowner doing all work officers have exercised their I LF-1Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.n P P 12.Q Roof re airs insurance required.] t c. 152, §1(4),and we have no 13.Q Other f of Repair employees. [No workers' C01111), insurance required.] *Any applicant that checks box it I mist also fill out the section below showing Ihcir workers'compensation policy information. t I Iomeowners who submit this aff idavit indicating they am doing all work and that hire outside contractors must submit anew afiidnvit indicating sucli. tContractcrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whctheror not those auitics have employees. 11'the sub-contractors have employees,they must provide their workers'comp.policy number. I(Int an employer that is providing livorliers'contpensation htsuraneeJbr my entploYees. .Beloit,is the polis}'and job site lnfortnation, AIM MUTUAL 111SUranCe Company Name: Policy#or Self-ins. Lie. #: MCC20020005382018A Expiration Date:6/11/19 Amherst College Northampton, 01066 .hob Site Address: City/State/Zip: p 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 tine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fire of up to x;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 erti(y under the pains and penalties of pctjury that the information provided above is true and correct. 11.21.18 Si<znature:ir ' ""` Date: Phone#: 413-586-8600 Official rtse only. fro 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.Buildino Department 3.City/To%vii Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Parson: 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: 1�.�� �A-e' The debris will be received by: Building permit number: Name of Permit Applicant g�'tj\ O f3 �OLC- Date Signature of Permit Applicant 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 O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT OA ! � � as Owner of the subject property Keiter Builders, Inc. hereby authorize__ to act on my behalf, in all atters to k uthorized by this building permit applicati n. Signature of Owner 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 D A Sign ure of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Scott Keiter CS-102457 Name of License Holder: License Number 51 A Hatfield Street Cl 6/20/20 Add ss Expiration Date -�n 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 O No 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: Not Applicable 0 Name(Registrant): Registration Number Address 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 Company Name: Scott Keiter Responsible In Charge of Construction 35 Main St. Florence, MA 01062 IM A!dress 413-586-8600 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 W 8. NORT.IiAMPTON LONG Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Sidc L: _R: L: R:- Rear :Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&pawed orkim,g) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW YES IF YES: enter Book Page and/or Document #i B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O 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 El Change of Use❑ Other❑ Misc. Kot Kepau�, Brief Description 'tti� to % sTVN.0 r 'Me nne �3 Rarrt6N St'DrN6,'rRt,tvt%j Ar r9"eve �rh 460-+r o p Of Proposed Work: StkE+��tNVBr & &-p-OKS. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ® A-1 0 A-2 92 A-3 1A �■ A-4 ❑❑ A-5 ❑E 1B ❑� B Business © 2A 0 E Educational 1 I 2B I 0 F Factory ® F-1 ❑❑ F-2 ® 2C a H High Hazard 0 3A I Institutional 0 1-1 Pi 1-2 0 1-3 0 36 LD M Mercantile ® 4 0 R Residential ® R-1 ® R-2 ❑O R-3 0 5A F■ S Storage 0 S-1 S-2 ® 5B �■ U Utility ® Specify: IN Mixed Use Specify: S Special Use 0 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) 1 sr 1 sl 2r�tl 2ntl 3 3rd 4th 4'n 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 92 Zone Outside Flood Zone❑ Municipal On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability_ Northampton, MA 01060 Two Sets of Structural Pians__ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Othe.( peCi y __..w.._ APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHAN E THE U(5' .,,ORD MOLISH ANY BUILDING OTHER THAN A ONE 0 TW FAMILY DWELLING SECTION 1 -SITE INFORMATION NOV 2 1 2018 i c 7 c,l 1.1 Property Address: This section to be competed by office 351 Pleasant St- UPN Store MAEPT OF BUILDING INSP TTIONS Unit NORTHAMPTON.MA )60 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record- /I PCrren�M7ailiName( rddess:mAA y4-16�1 /� Signature 1Telephone �C 2.2 Authorize gent: Kciter Builders, Inc. ® 35 Main Street Florence, MA 01062 Name(Print) Current MailingAddress: 413-58 -5600 Signature _ iF P_., meg, Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildings ov O (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 _ 3. Plumbing Building Permit Fee CM 4. Mechanical(HVAC) / 5. Fire Protection 6. Total = (1 + 2+3 +4 +5) S 000 Check Number This Section For Official Use Only Building Permit Number Date Issued Sianature: Building Commissioner/Inspector of Buildings V Date File#BP-2019-0623 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q PROPERTY LOCATION 351 PLEASANT ST-UPS MAP 32C PARCEL 140 000 ZONE GB(93)/TJRC(7)/WP(1)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHE„_,!KLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: SELECTIVE ROT REPAIR ON FRONT OF UP O New Construction Non Structural interior renovations Addition to Existing I Ilk 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 RMATION 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 TWater 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 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. 351 PLEASANT ST-UPS BP-2019-0623 GIs#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 32C- 140 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:REPAIR BUILDING PERMIT Permit# BP-2019-0623 Proigct# JS-2019-001022 §J.Cost: $5090.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: nst. ass: Contractor. License: Use Groug: KEITER BUILDERS 102457 Lot Size(sq. ft.): Owner: MILLBAM PLACE ONE CONDO Zoning: GB(93)/URC(7)/WP(1) Annlicant. KEITER BUILDERS AT. 351 PLEASANT ST - UPS Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 WC FLORENCEMA01062 ISSUED ON:11/28/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-SELECTIVE ROT REPAIR ON FRONT OF UPS 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# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deaartlnept Fireplace/Chimney: Rough: Oil: Insulation: Final: moke: 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 11/28/2018 0:00:00 $100,00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner