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23B-030 (8)
I I HATFIELD ST-DIAL SELF BP-2018-1346 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map-.Block:23B-030 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeon-NEWCOMMERCIALBUILDING BUILDING PERMIT Permit 9 BP-2018-1348 Project# JS-2018-002396 Est Cost $725000.00 Fee: $4712.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Grouo� KEITER BUILDERS 102457 Lot Size(sa.ft.): 5793.48 Owner: RINGWOOD PHILLIP Zoning: URB(100)/ Applicant. KEITER BUILDERS AT. 11 HATFIELD ST - DIAL SELF Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.4/5/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.NEW 2600 SQ FT 2 STORY BUILDING WITH 4 SRD UNITS -APPROVED FULL PERMIT ON 4/4/2019 POST THIS CARD SO IT IS VISIBLE FROM THE STREET Iuspectorof 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: 91 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 4/5/2019 0:00:00 $4712.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 11 HATFIELD ST-DIAL SELF BP-2018-1348 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-030 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv' NEW COMMERCIAL BUILDING BUILDING PERMIT Permit# BP-2018-1348 Proiect# JS-2018-002396 Est.Cost:$725000.00 Fee:$4712.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sg.ft.): 5793.48 Owner: RINGWOOD PHILLIP Zoning,URB(100)/ Applicant: KEITER BUILDERS AT. 11 HATFIELD ST - DIAL SELF Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON. TO PERFORM THE FOLLOWING WORK:NEVVA� T" 26/0�0�SgQQ FT 2 STORY BUILDING WITH 4 SRO UNITS - FOUNDATION ONLY 'Arr10R+vtj, fk&W,tx 'fji�k9 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: FeeTvpe: Date Paid: Amount: Budding $4712.00 212 Main Sheet,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner N�pS FP n�-TtnC File#BP-2018-1348 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESSTHONE 35 MAIN ST FLORENCE (413)586-8600 O PROPERTY LOCATION I1 HATFIELD ST 1vCy�(MJ MAP 23B PARCEL 030 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY. PERMIT APPLICATION CHECKLIST REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out I Fee Paid TypeofConstruction NEW 2600 SOFT 2 STORY BJTtHM5G WITH 4 SRD UNITS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans I cl de& Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 G �J 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 fficial 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. RECEIVED If Version1.7 Commercial Building Pcnnit .Mu 13,2000 Department use only 158 City of Northampton Status of Permit: - Building Department Curb CutlOrriveway Permit 212 Main Street Sewer/Septic Availability. DEPT OF OUNDlklO WgpEDnpY NORTHAMPTON.MAOt0B0 Room 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site 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 W 1 1.1 Prooertv Address: This section to be completed by office I I Hatfield StreetMap o�3 Lot unit �t� s� Q6 T ira Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Phillip Ringwood, Executive Director l FJ r Name(Print) Current Mailing Address'. Signature ~NTS Telephone — 2.2 Authorized Anent: Keifer Builders, Inc. 35 Main Street Florence, MA 01062 Name(Print) Current Mw in Address. 413-58�-8600 Signature — Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building �/ �y GOD (a)Building Permit Fee $0 2. Electrical W (b)Estimated Total Cost of Construction from 6 3. Plumbing 2S Building Permit Fee 4. Mechanical(HVAC) �� -71A 5. Fire Protection jt eh7J 6. Total-(1 +2+3+4+5) S Check Number u This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissionerllnspeclor of Buildings Dale V crsiun 1.7 Comnmmlal Build ins Permit May 1.5,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition 1-1 Repairs❑ Additions Accessory Building El Exterior Aftersiien ❑ Existing Ground Sign❑ New Signs❑ RoofingLI Chainge o1 Use❑ Oilier W' Brief Description {1& r}16eo s(l P4- 2 3 bu.:�Q�e�-- i-( Soto Of Proposed Work: CA N r i J SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A.t j0] A-2 A-3 1A A4 O AA IS Ell B Business 2A [(—]j E Educational � 28 I (L)f F Factory F-i n F-2 ® 2C H Huh Hazard G 3A Lo 1 Institutional i-1 iM I2 R mercantile 0 ®i ....-3 R,i Ll R_z R3esentl O ❑ 5A S storage s-t n s-2 ft] sB �l U Utility 0 Specify. M Mixed Use Specify. S Special Use 0 Specify. COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGF IN USE Existing Use Group: Praposed Use Group: Existing Hazard Index 780 CMR 34)'. Pro osed 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) In in 2. 2" 31, 3ra 4u, 4 Total Area(sB Total Proposed New Construction(at) Total Height(R) Total Height it 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private i Zone Outside Flood Zone❑ Municipaln On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 &. NORTHAMPTON ZONING Existing proposed Required by Zoning This colmnn tube tilled in by Hnildine Depumnent .t Stye Fronmtic Setbacks Front Side L: R: L:_ R:__ Rear 13 ding Height Bldg.Square Footage % Open Space Footage 7 11-bi they minus Her&pwN akin-1 H otparking Spaces Fill: Isolwne&Inrs�ionl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONTKNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 lulling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required Version L7 Commencial Building Permit May IS,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 G.F.OF ENCLOSED SPACE) 9.1 Reglstered Archltact: . . ..._._......_ _ _. _____.. , ,..... _._„ .>....._._. Not Applicable ❑ Dome A. Brooks .— ._.__ _.._.._.._...__. ....__ .__ 50961 Name Begistrant): 188 Federal Street Florence,MA 01062 Registration Number _ -- __...__... .. . _...._._...__ ._._.. 08/31/2018 Address _../" 5 (413) 773-55.51 Expiration Date Signature Tekphone 9.2 Registered Professional Engineer(s): Name Area of Respons b lity Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Regstrater Number Signature Telephone Expiration Date Name Area of Responsibility Andress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Regiscmhon Number Signature Telephone Expiration Date 9.3 General Contractor '�.. _._._._ ._.. ___.-_ _ _ -.._ Not Applicable E3 Company Name'. Responsible In Charge of Construction Address Signature Telephone Version1.7 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 Archileel: Dome A.Brooks _._. _. . Not Applicable ❑ _. .. ....___.. . , .... 150961. . Name(Registrant) -- 188 Federal Street, Florence, MA 01062 Regulation Number ... . . . __..... 08/31/2018 Address r ................. (413) 773-5551 Expiration Date_ Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Respons tility Address Registration Number Signature Telephone Emiction Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor .._. ...._. .. _.. _.... Not Applicable [3 Company Name'. Responsible In Charge of ConslruIX on Address Signature Telephone Vcrsiim 1.7 Commcrciel 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 Ell Name(Registrant)'. Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiation Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Data Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Kciter Builders, Inc Not Applicable Company Name: Scott Keifer Responsible In Charge of Construction St Main St. Horence, MA 01062 AJq ess 413-586-3600 ms do Kt Signature Telephone Vcrsion1.7 Commercial Briding Penolt May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I Phillip Ringwood, Executive Director, Franklin County DIAUSELF Ino., as Owner of the subject property hereby authorize Keifer BUIdlers, Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. VY Signature of Owner Date Keifer Builders, Inc 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. SeoH Keifer print e 4.24.18 Sighblure of OvmeoAgent Date SECTION 12-CONSTRUCTION SERVICES 101 Licensed Construction Supervisor: Not Applicable ❑ Scott Keifer CS-102457 Name of License Holder. License Number S I A Hatfield Strecl 6/20/18 Aogr�ss Expiration Date 413-586-8600 nature ' Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2SC(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 Q No Q 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: I I ❑fidd St The debris will be transported by: Keiter Builders, Inc. The debris will be received by: valley Recycling Building permit number: Name of Permit Applicant Kelter Builder Inc d111B At ["'W m. ICal Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of IndustrialAceidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 US www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Keifer Builders, Inc. Marne (Business/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): 1.2 1 am a employer with 20 4. ® 1 am a general contractor and I 6. New construction employees (full and/or part-time).' have hired the sub-contractors 2,0 1 am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have R. ® Demolition working for me in any capacity. employees and have workers' 9 ® Building addition [No workers comp. insurance comp. insurances 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 MGI. 12.0 Roof repairs insurance required.] c. 152. §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Am'applicant that checks Km#1 must also up oto the section Maow shoving their workers'wmpen,alion polio inlimnalinn_ 'Ilan _ who salmi(Iisotfidavaiadtnmingtheyare doingall work and Nen hirc outside comramorsmust suhmit a new a Ind"a indicating such. rComractnr that check this bus must aaached an additional sheet shoving the name of the sub-contractor and state whether or not those entities hove employees_ If the sub-contractors have employees,they nose provide their nvrkers'comp policy number_ I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. AIM MUTUAL Insurance Company Name:_ Policy k or Self-ins. Lic. !?: MCC20020005382018A _ Fxpnation Date:6/11/19 11 Hatfield St Northampton, 01060 Job Site Address: City/SlatdZip: 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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that if copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rtify tinder the pains and penalties of perjury that the information provided above is true and correct. 6.13.18 nature. Yresidenr.ABI _--,_ Dale. Phone n: 413-586-860C Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License N Issuing Authority (circle one): I.Board of Health 2.Building Department 3.City/town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: ACi ® CERTIFICATE OF LIABILITY INSURANCE °A t.MA°A"1"1 11 1 0511/12018 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: It the certificate holder is an ADDITIONAL INSURED,Ne PolicyUes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 WAIVED,Subject to the terms and conditions of the policy,terrain Policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement's). aouCEBE^¢T Cyni Henderson DISK Elite Webber&Grinnell PHEND r (413)586 0111 (013)506.6481 8 NOM King Street Ao0XEs5. ORRUNIasOR�Lr¢I41elandgrinnell.com INSURENTMAFFOR°INGCOVERAGE NAIO_X_ Northern n MA MUST Selective Go olSCdrOlina _ _ IrvsuneRn. msuxFU INSURER O: AM.Mal.I M. Keller Builders,Inc INSURER C: Ann.Scott Keiter - - --� _- -� 'INSURER° -_ 35 Main Street INSURER E: Florence MA 01062 INSURERS. COVERAGES CERTIFICATE NUMBER: Master Exp 2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMEN f TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMEN r 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 MSR MEN POLICY EFF PIXACY EXP MnS ITS _ 1YPEWINWRANCE RED MD _ VOLICY NUMBER to Di MMNOryY X COMMERCIAL GENERAL LIABILITY F CH°CCURRENOE_--Fs-,000.000 DANA ET PER ED CLAIMSMA°E ®OGNR PREMISES _ea E 500000 _ MED EXP sill am msml 5 15,000 A 52265567 06/0112018 06"01/2019 PERGENAL a ADM INJURY 5 1000,000 GEN'L AGGREGATE LIMnLIES PER GENERAL AGGREGATE 8 2000000 POLICY DlRRc&7 El AN, PRODUCTS-COMP"OPAGG E ROOO,Op OTHER AUIDMORILE LABILITY CEQM BmIr"NGLE LIMIT S 1000,000 ANY AUTO BOO LY NNRY(Per cenon) S A OWNED x sLHEDULED A9105217 08"01"2018 06/0112019 eODILYINJURV(Peraocmno $ AURiOPoS°rvLv NON�OWNED PROPERTY DAMAGE S — x AVT°SONLV x ALTOS ONLY N,acacem ,- Medical payments s 5,000 uxBwuA wB OCGLR EACH on:LRRErAE s 5,000,000 A PXCE55 LIAB CLAIMSMADE 52265567 0610112018 05101/2019 AGGREGATE y 5000.000__ DED RETENTIONS 10000 WORHERS COMPENSATION AND EMPLOYERS LIABILITY X STAT T x OqR B AN Y Per""T"NUARTNEWffiV6 ECUT YIN LEACHACCIOENT S 1000000 — oFFlCFwMEnfBBRPACT LU, O NIA MCC20020005382018A 06/11/2018 06/1112019 HHl IMaI —,. L DEFACE-EA EMPLOYEE $ 1.000,000 Ine:.dewlo=�ma, g' loop apo DECUN PTI ON OF OPERATIONS Mr. EL DISEASE POLICY LIMIT E DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES IACORD IOL AJJIBPnaI Berri SJR..'-,met'EeanmM1ed II more spam ir myth 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. AUTHOEVED REPRESENTATIVE Jp ©1988-1015 ACORD CORPORATION. All rights reserved. ADDED 26(201SI03) The ACORD new and logo are Registered marks of ACORD `L Initial Construction Control Document Ulf C CTo be submitted with the building permit application by a Registered Design Professional for work per the edition C the Massachusetts State Building Code,780 MR, Section 107 Project Title: Northampton Teen Housing Date: 06/14/2018 Property Address: 11B Hatfield Street, Northampton,MA Project: Check one or both as applicable: N New construction i7 Existing Construction Project description New 2600 SF 2 Storey building with 4 SRO units and a program space. The intent of the project is to provide affordable supportive housing for Vounq adults between 18&24 p �j _ye`rr_atrys old who are experiencing homelessness or are at risk of becomi=g_ho rm�atess. a I yyb l[i, Sf�13{may MA Registration Number Expiration date: 6 3 I )0 ,in,a registered design pro(essionel, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [X] Architectural [ ] Structural [ ] Mechanical � [ ] Fire Protection [ ] 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 perforin the necessary professional services and be present on the construction site on a regular and periodic basis to: I. Review, for conformance to this code and the design concept,shop drawing's',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. Be 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 7.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to t i ial a`Final Construction Control Document'. y�EPEp NJ Enter in the space to the right a"wet"or Sc' efi n. m electronic signature and seal: o� 0 YC� AIdPtON W MA Phone number: ht7•1IJ 'S SSI q Mr`' mail: O1V\ Bui d n flwlal Usc Only Building Official Name. Permit No,'._ Dote: Version 06_11_2013 Forance Integrated Systems 100 County Road Southampton, MA 01073 413-530-0622 Fire Alarm Narrative: 05-29-2018 Location: Dial-Self Teen Housing 11 Hatfield Street Northampton, MA 01060 Building: Usage Group B &R2, Two story Commercial building. Construction Type VB Protected Installing Company: George E. Forance III [Linc#288C] dba/Fomnce Integrated Systems 100 County Road Southampton, MA 01073 Fire Alarm System: The Fire Alarm System is a Silent Knight 5808 Addressable UL Commercial Fire Alarm Panel . The initiating devices [smoke detectors,heat detectors,pull stations, and flow switch] are addressable and each has a discrete address for communication to the Central Station. The smoke detectors are photoelectric with built in heat detectors fixed at 1350. The Silent Knight Fire Alarm Panel is located inside at exit space to the left of the Laundry room entry. (Code in Knox box to right of exit door to enable operation). The procedure to silence an alarm is to Press Silence, and then enters a valid code(1111). The procedure to reset an alarm is to Press Reset, and then enter a valid code(I 111). The building is a fully sprinkled wet system with water flow and two tamper switches. They are connected to the fire alarm via addressable monitor modules located on the east side 1" floor mechanical room. Fire Alarm Monitoring: The Fire Alarm System will be monitored at Rapid Response Monitoring {800-932-3822) in NY. Forance Integrated Systems shall program all alarms, troubles and supervisory. It shall dial thru the built in digital dialer to the central station. Proper notifications to the Fire Dept. and responsible parties shall be made upon receiving the signals. Fire Alarm Equipment: 1 —Silent Knight 5808 Addressable Fire Alarm Panel 5 - Silent Knight SK-Acclimate Smoke Detector 4— Silent Knight SK-Heat Detector 2 - Silent Knight SK-Pull-DA Pull Station 5—Silent Knight Monitor Module 7— System Sensor Horn/Strobe Low Frequency 2— System Sensor Strobe 1 — System Sensor Outdoor Strobe Page 1 Zone Listing: 01 -Front Exit Pull Station - 1"Floor 1 t ot.J 02-Main Office CO Detector- 1"Floor ` 03-Meeting Area CO Detector- 1"Floor 04-Main Entry Pull Station- 1"Floor'.. f 05 -Meeting Room Smoke Detector- 1"Floor ';i rr 06-Main Entry Smoke Detector by FACP - 1"Floor I t ir, 07-Electrical Room Smoke Detector- 1"Floor Fir.' O8-Apartment 1 Smoke/Co Detector w/Sounder Base- 1Floor I i 09-Apartment I Heat Detector- I"Floor I I in'.. 10-Apartment 2 Smoke/Co Detector w/Sounder Base- 1s' Floor f i I1 -Apartment 2 Heat Detector- 1"Floor II i,, 12 - Water Flow Switch WET Sprinkler System- I"Floor -❑r� 13 -Tamper Switch WET Sprinkler System Primary- I"Floor . ..i , 14 -Tamper Switch WET Sprinkler System Secondary- 1"Floor 15-Apartment 3 Smoke/Co Detector w/Sounder Base- 1" Floor I i . 16-Apartment 3 Heat Detector- 1"Floor I 1 i:, 17-Apartment 4 Smoke/Co Detector w/Sounder Base 1"Floor 1 18 -Apartment 4 Heat Detector- 1"Floor I u.; 19-Hallway Smoke Detector-2"d Floor f I'uz 20-Mechanical Room Smoke Detector-2"d Floor (4 Page 2 Fire Sprinkler System Protection Narrative Report DIAL-SELF - NORTHAMPTON TEEN HOUSING 11 HATFIELD STREET/ LOCUST STREET NORTHAMPTON, MA. 01060 Prepared By: Fire Service Group LLC 1010 Thorndike Street Palmer, ma. 01069 Section-I Basis of Design Lla This Residential housing building to be Polly sprinklered with a New wet pipe residential sprinkler systems. The New systems to be designed In accordance with NFPA 13R, 2013 Edition. 1.1 b This is a new building being constructed. l.lc The building will have(2) story's above grade. 1.1 d There is no basement in this building. 1.1 e The construction of the building is to be wood framing and wood construction. 1.1 f There appears to be no hazardous material usage or storage at this time. L Ig There is no high piled storage. l.l h There is site access arrangement for emergency response vehicles. The front of the building is on Northampton Street. 1.2 Applicable Laws, Regulations, and Standards NFPA 13R, 2013 Installation of Sprinkler Systems Ninth Edition of the Massachusetts Building Code 1.3 Design Responsibility for the Fire Sprinkler System The design responsibility of the fire sprinkler system is the installing contractor of the project. 1.4 Fire Protection System to be Installed a) Water Supply and Hydrants There is a new 4"Ductile Iron pipe underground being brought into this new building. b) There will be 2 %9 single inlet Fire Department Connection installed at the main Sprinkler riser room location. c) Automatic Fire Sprinkler System The new fire sprinkler system will be hydraulically calculated based on NFPAI3R, 2013. There will be 100 gpm for outside hose stream allowances. Section 2- Sequence of Operation 2.1 Fire Sprinkler System Water Flow a) Upon sprinkler system water flow,the following functions shall be performed: • Indicate condition at Fire Alarm Panel • Initiate building evacuation through building alarm system • Transmit alarm signal to central stations 2.2 Control Valve Signal The fire sprinkler system control valves are equipped with tamper switches to indicate either partial or complete closure. The tamper switches shall send a signal to the Fire Alarm Panel. Section 3—Testing Criteria 3.1 Personnel a) The installing contractor shall notify the owner and the local fire department of the testing schedule for the installation of the fire sprinkler system so that each may be represented at the time of testing. b) Testing shall be in compliance with the requirements of NFPA 13, 2013. A hydrostatic test of the fire sprinkler piping shall be performed at 200 psi for 2 hours. 3.2 Testing Equipment and Tools As-built drawings Notification Announcement Manufacturer's installation instructions,maintenance manuals, portable test pump and gauges, hoses and connections for piping hydrostatic test.