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23A-061 (6)
63 MAPLE ST-APT 2 BP-2019-0929 GIS# _ COMMONWEALTH OF MASSACHUSETTS Map-.Block:23A-061 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category GAS BUILDING PERMIT Permit# BP-2019-0929 Project# JS-2019-001441 Est Cost: $8000.00 Fee' $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa. ft.): 12456.16 Owner: 63 MAPLE ST LLC tonin¢ GB[100)/ Applicant: KEITER BUILDERS AT. 63 MAPLE ST -APT 2 Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 0 WC FLORENCEMA01062 ISSUED ON:3/6/2019 0:00:00 TO PERFORM THE FOLLOWING WORK BATH RENO 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 3/6/20190:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File 4 BP-2019-0929 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (4 13)586-8600 Q PROPERTY LOCATION 63 MAPLE ST-APT 2 MAP 23A PARCEL 061 001 ZONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: BATH RENO 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 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 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 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. Version1.7 Coinmemnil Ruildino Permit Mac 15.2000 Department use only City of Northampton Status of Permit - Building Department Curb CuMDdveway Permit) 212 Main Street SewdylSeptic Availability Room 100 WatarANell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Sde Plans 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 63 Maple St Florence -Apt 2 Map 1?-3,4 Lot 0CtI Unit Zone Overlay District Elm St,District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 63 Maple St LLQ C/O Scott Keller 35 Main St FLorence Name(Print) Current Mailing Address. p 413-586-8600 Signature I i Telephone 2.2 Authorized Anent: Keller Builders, Inc. 35 Main Street Horence, MA 01062 Name(Print) Current Mailin Address'. 413-586'-8600 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only cum letetlby permitapplicant 1. Building CTYA (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of (�d Construction from 6 3. Plumbing UIT� Building Permit Fee 4. Mechanical(HVAC) 1� �� 5. Fire Protection y� 6. Total=(1 +2+3+4+ 5) Check Number This Section For Official Use Only Building Permit Number Dale Issued Signature: Building Commissioner/Inspector of Buildings Data Version 1.7 Commcrdal Building Permit Ma) 15,2000 SECTION4,CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations W✓ Existing Wall Signs ❑ Demolition Lj Rapalrs❑ Additions ❑ Accessory Building[/ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[A Change of Use Other ❑ Brief Description Renovatation of exi siti ng bathroom Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE Sea attached _ USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly LI] A-1 ® A-2 ITT A-3 T11 1A 0 A-4 A-5 1B B Business 0 2A E Educational 0 2B 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A 0 Institutional 0 1-1 0 1-2 0 1-3 [7-11 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 I0 R-2 0 R-3 L7 5A 0 S Storage © S-1 0 S-2 1011 5B U Utility 0 Specify. M Mixed Use 0 Specify. S Special Use lull 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(at) st a 2�a 3" 3ra 41, 4m Total Area(at) Total Proposed New Construction(sq Total Height(ft) Total Height It 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 04 Private L7 Zone Outside Flood Zone[] Municipal 0 On site disposal system[] 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 Depenment Lot Sae I mil Setbacks Front side 1,:—R:--- L: R: Rear Building Height Bldg.Square Footage 14 Open Space Footage °k. lot area minus bldg&paved ra rg) d or Parking Spaces EII: U'okrre&L—iioi0 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O 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 O 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 O IF YES, describe size, type and location: E Will the construction activity disturb(clearing,grading,excavation,or filing)over 1 acre or is it part of a common plan that will disturb over l acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required Versioul.7 Commercial Building Pennil Ma} 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 U Name(Registrant)'. Registration Number Address Expiration Data Signature Telephone 9.2 Registered Professional Englneer(s): Mechanical Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Atltlress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration NUTber Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Keiter Builders, Inc Not Applicable DI Company Name'. Scott Keifer Responsible In Charge of Construction 37 Main St. laorcncc, MA 01062 A ess — 413-586-8600 Signature Telephone Version 1 Commercial Bolding Permit May I i,2000 SECTION 10.STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 63 Mapl St I.LC,CIO Scott Keiter 1, as Owner of the subject property Keifer Builders, Inc. hereby authorize to act9y lbelba5,in I maattters relative to work authorized by this building permit application. 1I Si afore of Owner v P` dl Date Keifer 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 Keifer Print e Sign ore of OwbbbAgenl Dale SECTION 12-CONSTRUCTION SERVICES 101 Licensed Construction Supervisor: Not Applicable ❑ Scott Keifer CS-102457 Name of License Holder:_,_ ___ License Number 5IA Hatheld Street 6/20/20 Ad ss E plration Date Z�&�D r 413-5868600 �ature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8)) 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 Q No 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: 63 Maple St Florence The debris will be transported by: Keiter Builders, Inc. The debris will be received by: valley Recycling Building permit number: Name of Permit Applicant Keiter Builder Inc 22629 A � 1.1"Wnl.IOU 1 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents p Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.niass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organieztion/Individual): Keiter Builders, Inc. Address:35 Main Street Cit /State//i : Florence, MA 01062 Phone 4:413-586-8600 Are you an employer? Check the appropriate box: Type of project (required): 1.2 1 am a employer with 204. ® 1 am a general contractor and I employees (full and/or part-lime).' have hired the sub-contractors 6. 0 New construction 10 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition for Incin workinS g an employees and have workers' Y capacity. 9. ® Building addition [No workers' comp. insurance comp. insurance.T required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.® 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.] c. 152, §I(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Ary upplicont that check-bnx 91 n ust also f ill out the section belay shaving their workerscompensation policy inforaoition. 'If..... ners.dosuhinit th6alLdavit i ndicatingthey aredoingall work and then hire outside eontramarsmust submitenew a ftidavn indicatng such. tContracnm that chock this Ma nhust attached ae additional sheet shoeing the name of the sub-contractors and state whetrer or not those entities have cmno,ccs. If the chromirr rshave employees,they nmst provide their workerscomp,policy numtxr. I am an employer that is providing workers'compensation insurance for my emplodees. Below is the poiicP and job site information. AIM MUTUAL Insurance Company Name: Policy 0or Self-ins. Lie. # MCC20020005382018A: Expiration Date:6/11/19 63 Maple St LLC Eastampton Job Site Address: 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 MCL a 152 can lead to the imposition of criminal penalties of a tine 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 line 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�nifyf lire pains and penalties of perjury that the information provided above is true andcorrect. 2.26.19 President. 6R1 Signature — ._.___. ...._— Dat c: Phone a: 413-586-860C Official use only. Do not write in this area,to be com pleted 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#: ACRO® CERTIFICATE OF LIABILITY INSURANCE 0511712018 THIS CERTIFICATE IS ISSUED ASA 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 IMSURER(S(,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyNesl 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 certHicaW holder in lieu of such endoreemengaf. oOUCm HAMEA°T Cynthia Henderson CISR Elite Werner B Grinnell PHOer (413)586 0111 CXKNb END, FAA (at 3)5066A01 _. B NDnr King Street g1IDFES5.. crendersonyttwebberandgri0nell LOm INSUREJENJ AFFORDING COY£RAGE NAICe Northampton MA 011160 IrvsuREa A: Selective ins CD:AS Carolina INSURER INsuxaa8, A.LM.MutuallA.I.M. Keifer Builders.Inn. INSURER C Ann.Spott Keller 35 Main Street --- — IHSUHFR F Florence MA 011162 INSUHERP COVERAGES CERTIFICATE NUMBER: Master Exp 2019 REMSION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR l'HE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR 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. Lm PEOFINSURANCE POLICYNUMBE0. MOMODYM/YYFF MMDDERN LIMITS R x COMMERCIALGENEMLUABIUTY EACH OCCURRENCE S 1,000,000 CIAIMSMADE 19OCCUR PREMISES Eeom ante S 500,000 MEOEAP(Amm—ii b 15,000 A 52265567 06/0112018 0610112019 PERION11 AAHNNICRY b 1000000 GENU AGGRICILL MMITAPPL155PER GFN5PAI.AGGREGATE $ 2,000,000 _ POLICY[::]ER. [:]LOC PRODUCTS-GOMPIOPAGG S 2000,000 AUTOMOBILE LIPXILITY myCOMBLNEmbYNGLE LIMIt S 1000,000 AUTO BODILY INJURY Per Mrw S ANY nl A O 'D Y x SCHOECI ED A9105211 0610112010 0610112019 ITCHY JV Per aweenl S HIRED O O ED ^ROPER/ 0 M GE S X OSON Y x OSO LY _.. Med<al payments S 5000 X OMflHF.IA LIPS R EACH OCCURRENCEg 5000000 A LA SSL OGC u MSMADE $2265567 06101/2018 06/01/2019 ASSCICATI E 5000000 XT RETENTION S t0,000 g NOR KERSCDMPEHSPTION x PER STATUTE x ER ANDS PLOYERS LIABILITY PrzovmETORmARTN RIEXEGU" YIN EL EACH ACCCENT s 1000000 B or`FIGERrvEMeER Excw°eD'+ ❑" NIA MCC20020005302010A 0611112018 O6I11I2019 IMABI.' mNHI EL DISEASE-EAEMPLOYEE S 1000000 ,enm Acer1 000 000 DECCHIPTION OF OPERATIONS Eine, .DISEASE.POLICY LIMIT 8 DESCRIPTION Of OPFPATIONS ILOCATIONS I VEHICLES(ACORN 101,Ree eoml RemaM1s ScnMule,evv be amcaeE If more ape¢le neusen 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. AUTHOR12EO HEPNESENTATIMF ©19084015AC0RD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD BUILDERS3 MM a in5treet-Florencu.MA•03062.Phone:4135868600•Fax 413 280 ter bulldervcom Commissioner Hasbrouck 02.26.19 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Apt 2 Bathroom Renovation Project at 63 Maple St in Florence 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, p/", 44 I cott Keiter Keiter Builders, Inc. 35 Main St Florence, MA 01062