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31B-069 (2) 85 PROSPECT ST BP-2020-0319 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B-069 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2020-0319 Project# JS-2020-000534 Est. Cost: $60000.00 Fee: $390.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 7492.32 Owner: SIMMONS RACHEL Zoning: URC(100)/ Applicant: KEITER BUILDERS AT. 85 PROSPECT ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O WC FLORENCEMA01062 ISSUED ON.9/17/2019 0:00:00 TO PERFORM THE FOLLOWING WORK KITCHEN AND 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 9/17/2019 0:00:00 $390.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0319 APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q PROPERTY LOCATION 85 PROSPECT ST MAP 3 1 B PARCEL 069 001 ZONE URC000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: KITCHEN AND BATH RENO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 102457 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 9/17M Sig Lure of Building Official UV Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. i f artment use only City of Northampton 1� Status oTr3er Building Department SEPC(�rb Cut/Drive ay P rmit 212 Main Street SC 20$gptic vaila ility Room 100 SFR WaterMell A ailabi ity Northampton, MA 0106 A) 0 nr?Tngrrtr)r truct al Plans phone 413-587-1240 Fax 413-587-T ' �1a>t�S, Other pe APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office Map .316 _ Lot 0 0q Unit 85 Prospect Street Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Rachel Simmons 85 Prospect St Name(Print) Current Mailing Address: See attached signed contract telephone Signature 2.2 Authorized Agent: Keiter Builders, Inc. 35 Main Street Florence, MA 01062 Nam rint) Current Mailing Address: PN,, &B{ 413-586-8600 Sigyature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /. (a) Building Permit Fee r _l % [ C 2. Electrical (b) Estimated Total Cost of O �jJv 6 OD Construction from 6) 3. Plumbing f D Building Permit Fee G 4. Mechanical(HVAC) D 5. Fire Protection / 6. Total =0 +2 +3+4 + 5) 000 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date BGrant @ KeiterBuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 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 `Io (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 O DON'T KNOW O YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW Q YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q Date Issued: C. Do any signs exist on the property? YES O NO OX IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) © Roofing ❑ Or Doors r_1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [O] Other[01 Brief Description of Proposed Kitchen and bathroom remodel Work. Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes X _No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr floodplain Yes__No I Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? \ Yes No . I. Septic Tank City Sewer\ Private well City water Supply\ SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Rachel Simmons as Owner of the subject property hereby authorize K .iter Ruild .rs Inc to act on my behalf, in all matters relative to work authorized by this building permit application. See attached signed contract 9.9.19 Signature of Owner Date 1, Keiter 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 Scott Keiter Print N P' - e< 9.9.19 Sign re of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Kelter CS-102457 License Number 51 A Hatfield St Northampton, MA 01062 6.20.20 Addre Expiration Date /Z 413-586-8600 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Keiter Builders, Inc. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.21 Address Expiration Date SkeiterC4)KeiterBuilders.Com Telephone413-586-8600 SECTION 10-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....... M No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS = 212 Main Street •Municipal Building Northampton, MA 01060 Debris 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. The debris from construction work being performed at: 85 Prospect Street (Please print house number and street name) Is to be disposed of at: Valley Recyclinq (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: USA Waste_ (Company Name and Address) �+ E—&e= 9.9.19 -- — gnature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents u 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 Legibly Keiter Builders, Inc Name (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.[9 1 am a employer with 25 4. 0 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 g, ® Demolition workingfor me in an capacity. employees and have workers' Y p Y• 9. ® Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their I I.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.® Other comp. insurance required.] *Any applicant that checks box#1 must also 1-ill out the section below showing their workers'compensation policy intonnation. 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 emplo%ecs. they must provide their corkers'comp.policy number. I am an employer that is providing workers'compensation insurance./or n?v emplovees. Below is the policy and job site information. AIM Mutual Insurance Company Name: Policy # or Self-ins. Lic. #: MCC20020005382019A Expiration Date:6.11.2020 85 Prospect St Northampton, MA 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 tinder 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 rtify�the pains and penalties of perjury that the information provided above is true and correct. 9.9.19 President, Keiter Builders. Inc. Si nature: _ _ Date: Phone #: 413.586.8600 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#: _ 1 DATE(MMIDDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 06/03/2019 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 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 NAME CT Cyndie Henderson CISR.CPIA Webber&Grinnell P';CNE xu (413)586-0111 FAX Np (413)586-6481 8 North King Street E-MAIL chenderson@webberandgrinnell.Com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC M Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER 8: A.I.M.Mutual/A.I.M. Kelter Builders,Inc. INSURER C Attn:Scott Keiter INSURER D: 35 Main Street INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2020 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 ADDLSUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVO POLICY NUMBER MMIDDIYYYY MMIDD/VYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500.000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Anv one Person) $ 15,000 A S2265567 06/01/2019 06/01/2020 PERSONAL BADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2.000,000 JECT POLICY PRO F LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _ ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED A9105217 06/01/2019 06/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per a."ent Medical payments s 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESSLIIAB HCLAIMS-MADE S2265567 06/01/2019 06/01/2020 AGGREGATE $ 5'000'000 X DED RETENTION $ 10'000 $ WORKERS COMPENSATION X1 PTAT TE X OTH _ AND EMPLOYERS'LIABILITY YIN 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA MCC20020005382019A 06/11/2019 06/11/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yesdescribe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD where the project is located. The arbitrator shall be either a licensed attorney or retired judge who is familiar with construction law.If the parties can not mutually agree on an arbitrator within thirty(30)days of written demand for arbitration,then either of the parties shall submit the dispute to binding arbitration before the American Arbitration Association in accordance with the Construction Industry Rules of the American Arbitration Association then in effect. Judgment upon the award may be entered in any Court having jurisdiction thereof. The prevailing party in any legal proceeding related to this Agreement shall be entitled to payment of reasonable attorney's fees, costs, and post judgment interest at the legal rate. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION This Agreement represents and contains the entire agreement and understanding between the parties. Prior discussions or verbal representations by Contractor or Owner that are not contained in this Agreement are not a part of this Agreement. In the event that any provision of this Agreement is at any time held by a Court to be invalid or unenforceable,the parties agree that all other provisions of this Agreement will remain in full force and effect.Any future modification of this Agreement should be made in writing and executed by Owner and Contractor. MISCELLANEOUS This Agreement is a Massachusetts contract, contains the entire agreement between us, any representations or warranties not expressly contained in it are not a part of the Agreement, and it is binding upon our heirs, executors, successors and assigns. This Agreement may be modified only by an instrument in writing signed by both of us. This Agreement is subject to and is intended to comply with the provisions of Chapter 142A of the Massachusetts General Laws and its corresponding regulations. YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO BY FORWARDING YOUR INTENT TO CANCEL IN WRITING BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. By signing this Agreement, you acknowledge that you have received a complete and original signed copy of the entire Agreement and attached Addenda. Contractor may not start work until after this Agreement has been signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD CONSULT WITHANATTORNEYBEFORE SIGNING KEITER BUILDERS,INC. (CONTRACTOR) OWNER by, Scott Keiter, President Date tate Date ADDENDA 11 Contractor Owner i CS Beam 2018.9.0.16 85 Prospect ST 8-2-19 kmBeamEngine 2018.9.0.1 Materials Database 1572 Northampton 4:46 looff I Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: 0.00 Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: L/360 live, U240 total Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 12.0 PLF Filename: 12 Beam1.KYB Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform(PSF) Top 0' 0.00" 12' 0,00" 5' 0.00" 40 10 Live Replacement Uniform(PSF) Top 0' 0.00" 8' 0.00" 6' 0.00" 30 10 Live Point(LBS) Top 8' 0.00" 547 209 Live Additional Uniform PLF Top 0' 0.00" 12' 0.00" 120 56 Live X O 1200 1200 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) 3.500" 1.766" 4019# 2 12' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) 3.500" 1.613" 3669# Maximum Load Case Reactions Used for applying point loads(or line loads)to carrying members Live Dead 1 2958# 1060# 2 2689# 980# Design spans 11' 6.750" Product: 1-3/4x11-7/8 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Connect members with 2 rows of 16d common nails at 12.0"oc Design assumes continuous lateral bracing along the top chord. Design assumes maximum unbraced length of 0.00'along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 11902.'# 21275.'# 55% 6' Total Load D+L Shear 3348.# 78971 421/6 0.23' Total Load D+L Max.Reaction 40194 79621 50% 0' Total Load D+L TL Deflection 0.2918" 0.5781" L/475 6' Total Load D+L LL Deflection 0.2144" 0.3854" U647 6' Total Load L Control: Positive Moment DOLs: Live=1001/. Snow=115% Roof=1251/6 Wind=160°/ All product names are trademarks of their respective owners Copyright(C)2018 by Simpson Strong-Tie Company Inc.ALL RIGHTS RESERVED. "Passing is defined aswhen the member,floor joist,beam or girder,shown on this drawing meets applicable design criteria for Loads,Loading Conditions,and Spans listed on this sheet The design must be reviewed by a qualified designer or design professional as required for approval.This design assumes product installation accordino to the manufacturer's specifications.