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32C-056 (4) I I 1 PLEASANT ST SYLVESTER'S BP-2020-0745 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2020-0745 Project# JS-2020-001285 Est.Cost: $64924.00 Fee: $455.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa.ft.): 4922.28_ Owner: ST MARTIN PETER A&MAUREEN F MCGUINNESS Zoning:CB(100)/ Applicant: KEITER BUILDERS AT. 111 PLEASANT ST SYLVESTER'S Applicant Address: Phone: Insurance: 35_MAIN ST (413) 586-8600 0 WC FLORENCEMA01062 ISSUED ON:12/20/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-INTERIOR DINING ROOM RENOVATIONS, REPAIRS TO HVAC DUCTS AND ENTRY 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: FeeTyim Date Paid: Amount: Building 12/20/2019 0:00:00 $455.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 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 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 1.1 Property Address: This section to be completed by office I I 1 Plesant St - Sylvester's Map 2�a G Lot d�3(/ Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Peter St. Martin & Maureen McGuinness / Lyman St hasthampton, MA Name(Print) Current Mailing Address: 413-262-2021 See attached signed contract Signature Telephone 2.2 Authorized Agent: Keiter Builders, Inc. 35 Main Street Florence, MA 01062 Name(Print) Current Mail in Address: 413-586-8600 Signature — Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building 51 �( O (a) Building Permit Fees 2. Electrical C�1T 1�p (b) Estimated Total Cost of f' x U` Construction from 6 J 3. Plumbing / Building Permit Fee 4. Mechanical(HVAC) tea- `1 - 5. Fire Protection 6. Total=0 +2 +3+4 +5) Check Number This Section For Official Use Only Building Permit Number Date �- —7 q Issued Signat re: a�vz i" Buildinj Commissioner/Inspector of Buildings I U Date 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❑ Change of Use❑ Other 71 Brief Description Interior renovations to dining room of existing restaurant. The project includes: new flooring,new Of Proposed Work: light fixtures,repairs to existing HVAC ducts and repairs to existing exterior masonry entry SECTION 5-USE GROUP AND CONSTRUCTION TYPE See attached USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 © A-2 0 A-3 © 1A A-4 0 A-5 0 1B B Business 2A E Educational 2B F Factory F-1 F-2 2C H High Hazard © 3A Institutional ❑❑ 1-1 1-2 ❑❑ 1-3 3B M Mercantile 0 4 R Residential 0 R-1 R-2 R-3 5A S Storage ® S-1 ❑❑ S-2 ❑❑ 5B 0 U Utility 0 Specify: M Mixed Use 0 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 st 1 5t 2nd 2nd 3rd 3rd 4th 4�h 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❑ Vcrsion1.7 Commercial Building Permit Map 15.2000 8. NORTHAMPTON ZONIKG7 F..xisting Proposed Required hp Zoning This column to he filled in he Building Department Lot Size Fronta«e Setbacks Front Side L: R: I.: R: Rear Building Height Bldg.Square Footage `7r Open Space Footage (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 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 filling)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 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: Emily Estes Baillargeon Not Applicable M Name(Registrant): 50838 17 Allison St Northampton, MA Registration Number 8/20 Address 413-320-6199 Expiration Date See attached control doc 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 10 Company Name: Scott Keiter Responsible In Charge of Construction 35 Main St. Florence, MA 01062 A ess� , 413-586-8600 President,KBI Signature Telephone N/ersion1.7 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 O SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Peter St. Martin & Maureen McGuinness as Owner of the subject property Keiter Builders, Inc. hereby authorize to act on my behalf, in all matters relative to work 2uthorized by this building permit application. 12.17.19 See attached signed contract Signature of Owner Date Keiter Buildc,s, Inc 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 pains and penalties of perjury. Scott Keiter Print e 12.17.19 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 6/20/20 Ad ss 413-586-8600 Expiration Date P 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 Atta:.hed Yes 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: 111 Pleasant 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 Keiter Builder, Inc 12.17.19 zt �� President. 1131 Date Signature of Permit Applicant < The Commonwealth of Massachusetts Department of Industrial Accidents k r Office of Investigations 1 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): 1.2 1 am a employer with 22 4. ® I am a general contractor and 1 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 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ® Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ® We are a corporation and its I0.® Electrical repairs or additions 3.® 1 am a homeowner doing all work officers have exercised their 1 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' 13.0 Other 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 empl ver that is providing workers'compensation insurance for my employees. Below is the policy and job site information. AIM MUTUAL Insurance Company Name: Policy#or Self-ins. Lic. #: MCC20020005382019A Expiration Date:6/11/20 111 Pleasant St FLORENCE 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 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 rttfy under the pains and penalties of perjury that the information provided above is true and correct. 12.17.19 Signature:_ President, KBI Dat : Phone#: 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 # 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 #: DATE(MMIDD/YYYY) ,�Cor2o� 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 CONTACT Cyndie Henderson CISR.CPIA NAME: Webber 8 Grinnell PHONE . (413)586-0111 AAC No): (413)586-8481 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC k Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: A.I.M.Mutual/A.I.M. 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 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 /NSR AUUL�it.l POLICY EFF TYPE OF INSURANCE POLICY NUMBER MM/DDIYYri MMILDI CY EXP LTR D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGE N 500,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S2265567 06/01/2019 06/01/2020 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY ❑JECT F LOC PRODUCTS-COMPIOP AGG $ 2,000.000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT CE. cciden $ 1,000,000 at ANY AUTO BODILY INJURY(Per person) s 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 accident Medical payments s 5,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 5'000'000 A EXCESS UAB HCLAIMS-MADE S2265567 06/01/2019 06/01/2020 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 10,000 X $ WORKERS COMPENSATION X STATUTE /� ERH AND EMPLOYERS'LIABILITY YIN 1.000.000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBEREXCLUC � NIA MCC20020005382019A 06/11/2019 06/11/2020 (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ 1,000,000 tt yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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 orwarranties 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. You may cancel this Agreement if it has been signed by a party thereto by forwarding your intent to cancel in writing no 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 ISA LEGALLY BINDING AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND, YOU SHOULD CONSULT WITH AN ATTORNEY BEFORE SIGNING. KEITER BUILDERS, INC. (CONTRACTOR) OWNER by,Scott Keiter, President Date Date Date 10 Contractor Owner Initial Construction Control Document Vff.) Z To be submitted with the building permit application by a W d Registered Design Professional V for work per the ninth edition of the Y Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Sylvester's Restaurant Renovations Date:11/20/19 Property Address: 111 Pleasant Street,Northampton,MA 01060 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description:Interior renovations to dining room of existing restaurant. The project includes: new flooring,new light fixtures,repairs to existing HVAC ducts and repairs to existing exterior masonry entry. I, Emily Estes Baillargeon, MA Registration Number: 50838 Expiration date: 08/20 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical 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 perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, 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, I shall submit field/progress reports (see item 3.) together with pertinent comments,in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a"wet' or electronic signature and seal: cjE c, a�.oar V i w Phone number: (413) 320-6199 Email: emily@estesarchitect.com Building Official Use Only Building Official Name: Permit No.: Date: