Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
36-370
167 EMERSON WAY BP-2021-0068 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-370 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING P E RM I T Permit# BP-2021-0068 Proiect# JS-2021-000097 Est.Cost: $923649.00 Fee: $2242.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sa.ft.): 40946.40 Owner: MCDONOUGH AMY zoning: Applicant. KEITER BUILDERS AT. 167 EMERSON WAY Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 0 WC' FLORENCEMA01062 ISSUED ON.7/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW SINGLE FAM I LY HOUSE 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: Building 7/21/2020 0:00:00 $2242.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID: D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD Department use only Fir City of Northampton Status of Permit: Building Department Curb CuUDriveway 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, 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 _ Lot 3 7 D Unit 167 Emerson Way Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Amy McDonou011 183 Madison Ave Holyoke N L�dnr'�e'aby: Current Mailing Address: t�t11 ,�'U,�DUbu U Telephone 413-214-4762 WC6781AM4DF. 2.2 Authorized Agent: Keiter Corporation 35 Main St Florence Name r t) Current Mailing Address: 41 P,s, �a� 413-586-8600 Sign re 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 760,169 2. Electrical (b) Estimated Total Cost of 53,810 Construction from 6 3. Plumbing Building Permit Fee 50,000 4. Mechanical (HVAC) 59,670 5. Fire Protection 6. Total = 0 + 2 + 3+4 +5) 923,649 Check Number This Section For Official Use Only Building Permit Number: bp-, a2 l — 01,.� 1 DateIssued: Signature: d� Building Commissioner/Inspector of Buildings Date Bgrant p@ Keiterbuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD 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 41,000 41,000 Frontage Per condo bylaws Setbacks Front 30 30 Side L:24 R: 30 L:'30 R: Rear 30 120 Building Height 26' Bldg.Square Footage % 3,500' Open Space Footage "Ir, (Lot area minus bldg&paved 35,500 parking) 3 #of Parking Spaces 0 Fill: NA (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 0 NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. DocuSign Envelope ID:D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House © Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[O] Brief Description of Proposed Work: Construction of new home Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit:12 Number of Bathrooms5 c. Is there a garage attached?Yes d. Proposed Square footage of new construction. 3,500 Dimensions 110'x 48' e. Number of stories? 2 f. Method of heating? Natural Gas furnace-forced air Fireplaces or Woodstoves Gas f.b. Number of each 1 g. Energy Conservation Compliance. Yes-HERS Masscheck Energy Compliance form attached?Yes h. Type of construction Stick frame i. Is construction within 100 ft. of wetlands? Yes X No. Is construction within 100 yr. floodplain Yes X No j. Depth of basement or cellar floor below finished grade 7'10" k. Will building conform to the Building and Zoning regulations? X Yes No. I. Septic Tank City Sewer X Private well City water Supply X SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Amy McDonough as Owner of the subject property hereby authorize Keiter Corporation t QGbJPY V.half, in all matters relative to work authorized by this building permit application. 7/12/2020 l� a Date I, Keiter Corporation 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 PN &,9t 7.10.20 Sign re of Owner/Agent Date DocuSign Envelope ID:D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Scott Keiter CS-102457 License Number 51 A Hatfield St Northampton MA 01062 6.20.22 Addre Expiration Date P,•G E mar 413-586-8600 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Keiter Builders. 175168 Company Name Registration Number 35 Main St Florence MA 01062 4.28.21 Address Expiration Date Skeiter@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....... IN No...... ❑ DocuSign Envelope ID.D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD City of Northampton Massachusetts �- DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building jb 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: 167 Emerson Way (Please print house number and street name) Is to be disposed of at: Valley Recycling (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) 7.10.20 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. 'i'` Massachusetts DocuSign Envelope ID: D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD f Department of Industrial Accidents Office of Investigations a 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 Name (Business/Organization/Individual): Address:35 Main Street Ci /State/Zip: Florence, MA 01062 Phone #:413.586.8600 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with 35 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have g, ® 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 10.® Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.® 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#I 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. tContractors 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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Policy#or Self-ins. Lic. #: MCC20020005382020 Expiration Date:6.11 .2021 167 Emerson Way Northampton 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 rtify under the pains and penalties of perjury that the information provided above is true and correct. 7.10.20 Signa ,President 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: Pern-it/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#: DocuSign Envelope ID:D99EBE53-4C7B-4E37-A2B6-E6CC37D13DOD ACo® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DDYYYY) `„� " 05/29/2020 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&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (AIC, IC No Ext): AIC,No): 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Selective Ins Cc of S Carolina 19259 INSURED INSURER B: A.I.M.Mutual/A.I.M. Keiter Corporation INSURER C: Attn:Scott Keifer INSURER D: 35 Main Street INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 2021 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 AUUL ZSUt3K POLICY EFFPOLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500'000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2020 06/01/2021 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $POLICY ❑PRO 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A9105217 06/01/2020 06/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY tDAMAGE $ AUTOS ONLY AUTOS ONLY Per acciden r I I Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S2265567 06/01/2020 06/01/2021 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 0 $ WORKERS COMPENSATION SPER TATUTE xi ORTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? NIA MCC20020005382020 06/11/2020 06/11/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD