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24B-089 (6) 261 KING ST BP-2021-0066 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24B-089 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT. Permit# BP-2021-0066 Proiect# JS-2020-002026 Est.Cost: Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq. ft.): 25003.44 Owner: Y&B REALTY INC Zoning: HB(100)/ Applicant. KEITER BUILDERS AT. 261 KING ST Applicant Address: Phone: Insurance: 35 MAIN ST (413) 586-8600 O _ WC FLORENCEMA01062 ISSUED ON.7/20/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:SELECTIVE DEMO TO OPEN WALLS FOR ENGINEERS 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 7/20/2020 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner EiV ( la v - C_ Te C lnihionwealth of Massachusetts (! O ice of Public Safety and Inspections 1 t DFPT.OF SUl I !NG IPISPECTIONS NORTHAMP?ON.MA 01050 N1 sa6lusetts State bu iding Code , ?Cmi") ' n for any Building other than a One-or T°wo.Pamily Dwelling {T pis Src*I -t For Official USO Ont r Building Fermit cb��7. _____ ate Applxerl RuildjAg Official: s SECTION L LOCATION _ i Na and Steet C y/Town lip tx�rfs Narne of Building(if applicable) Assess= ap airsck fl anti or .:ot # SECTION 2:PROPOSEL)V,,;jKK Edition of MIA State Code used_ ... If New f.onstmiction cherl.hese 0 sit deck)all that apply in the °n row, loan• . ._ _ Existing building C Repair L-3 ; Alteration QN ease fill out and subretit Appendix r) lasgoJrpaalcv.hange of Use G Other 13 Specify: Are building plarts and;"m construction dorwn"ts being supplied as part of this perfnit applicatio a? Yes C.3e L"3 is an independent Structural Enngineerin ,,Peer Rev( re aired? Yes G No CY' Brief E ption of 3'rop d Crory. C� 11,416.11 . -All A � , .. 3 " SEC'1710N 3.COMPLETE THIS SE MON IF FJCISTING BUILDING UN IDER60114,ItFIZVATI—ADDITION,OR CHANCE IN USE OR OCCIsPANTCY Cbecs hese if an Existing Building Iynvesfxgation and Evaluation is enclosed(See 780 C IAA34) 0 .__. _ Existing Use Group(s): ' �l�crsed Use Croup sl. _ SECTION 4 BI�I"LDING HEIGHT AND-AREA --' E'Xisting Proposed 1 No.cal Floors/Stories(inciude be-semean levels)S Area Der Hoar(sq,ft.) �l q Total Area(xqft)and Total Height(#'t.) SECTION 3:USE GROUP(Check as applicable) A A � 4 �seuxbly A- =Nil 7 tclub^0 A-3 © A-4 0 A-a D i B: Business u F: Educatianaa 0 F: Factory F-1 Q F2 Co Hz Ia Tlaaazd H i 0 11-20 F-v C( I44*0 1-I-4[2 I. Insfitaxtiona 1-1 I-?0 N-i FN }4 L I: Ntfiercaniile i =tt-?F] l? M Storage S-I C 5-213 i U. Utility© Special Use l?an please de the�+e;ox _......__ _._ _._.. pecial Use Descriptions _ SECTION,f CONSTRUCTION'TYPE(Check as a i eabie) SECT Oh 7:SITE INFORMATION{refer to 780 CMR 305.3 for details on each item] Watier SUPPI Flood Zone Information- ' Sewage Disposal: 'rench Permit. Debris Removal: A trench willf pal ee ' :tensed Dispose Site Public Q' j cc i£ezax slue P3oou Zosle L:d.isate rn,rnsci ""W required h i or specify:: US A Private 0 cr inclendf} €cine: or on site system 0 i pernut Lsenc oseci 0 d .A I ; RaihvW right-ref-way.- Hazards to Air Navigation: MA his, s Cs:nmissi€an Rei ie e Process: Not Applicable M-''� Is Structure 1*:iihin airmrt approach area? l their review rompleted' car Cc rise t to Build$eaa osed fa Yep.0 x No i�' "res 0 NO 43� sEcrioNv s;coN T Nr of CERTIFICATE OF OCCLT.aNCY E&tivn of Code: � Ls>Group(s). __ Type cf Constr€zction:_.__._._.-.._.. 1 Does the bWlding contain an SprirLtJer System?:�_.._..._ _ Special Stipulations: Design Occupant Loud per Floor atA Assernbly space;_ �_ Fill out section 9 & sign where it says name . .._S MO? 4: PROPERTY OWNER Al i�Ol l7ATI[31' �*dMe and,Address sof Prop"t?�ner � �a 'varve I'rirst) Na.and Stmt Cies=J Tawe ' ape s°C3xr er Con act Ixrfnzaztatlt�n: TurningLeafCenterSC 1 Q)3 Noho Properties, LLC _ 732-406.1000ltlall.Cott? Title Telephone Na (business) Tele horse No. `cell If applicable,the property ot+ner hereby authorizes: p ` ) e znait address -Saj Khan 261 King Street Northampton MA 01060 Name Street Address � City/T o!aA n S;a�hZip j to for and act on the prt3 ,-t}r-swner's behalf,to all rnatterw relative to s,ark.authorized by this build prranit a licat.,sx SECTION 10.CONS'TR CT oCON �I'lease fill out 4lapendix 1) Lz a buLding is len than 35,G)D cu ft.of ertclasrd space a es14"Or 'under Constzuctl0r Con--ol thai check here 0. t}therr�nse zavat#e : ctic�tz ctntrai Fc rens(sre sc tizan m'J7 z t L4e ewe;as required. •a ' tI Professional R onsible for Co_ntruction Control ithe professioaul eoordinatiag do, ezcaent submittals) Rianat��Zegistrant} Telephc�rae Nc, r,-mail adorers i Registration.*3tarnber Street Ac dress City/Town State Zip Discipline _F_<Piratsa Date i 'M General Contracrar 3 _ Company Name 1 Name o:`Pier{-on Responsible for Construction Ucensse No. -rad Type 1 AppiicaHe " ll .Ce w trees Address City/Town State Zi 1�l lacsne Na. *usiness } Telephone No.(cell) e-mail address 3 SECTION ZX:YVURKERS COMi'ISATIGIv fVSd &',NCElam}Ii3� "IT -�" _.i'tii. L Lfi .g 25C{ 3l csrkers'C ,pensation busurance Affidavit from the MA Departnien-of Industrial Aef�ide is xrust be completed and subuutted%%"th d s am lication. Failure t;r provide this affidavit will result is the dextral of the��� rCe Of the building permit Is a iii n =umatted witia this a €scatian? Yest�' No C7 SECTION 32:C cL7CTTON COSTS AND PERMIT FEE .( tern Estimated Costs:(l Hibor a _. Fuhd:Materials, i otal Constructure Cast tfrom Item tit lining Buil ing Vernet Fee-Total Construction Gest x { l ere " trica3 5 appropriate muiucipal factor)-5 .itambing $ ( 4.s echariral {T i 'AC S NNOte:Minimum fee=S-log, ,i:vntart anti ticapalit�r} ' 5, Mechanical �Gtlser) 4 S e Enclose cheek payable to -- (contact municipality)an�write check number here.._._ ON 13.SIC`NATI CE OF 13UMDING PERMIT AppLICANT ' e'ltcririg any name below,I liezaby attest under the pains end pe.�Ities of pc: ury that all of t ie tnforma#wn contai�aeci in�sss r -cation,is the and accurate to tate best of any knowledge and understanding. Owner 732-406-1000 )000 ew61a1CrnpS trees _ 1VcrthatnptrnA 0)0fi0 __ - Telephone No. Date Stere: Acidze s Turn nal a nters e .. Cih=f'1`awYn State Zip # Municipal Inspector to fill out this secdon upon application approval; _....._ ^n D to `.11-te City of Northampton Ufawilding Department t4 212 Main Street NorthamPtou,Massachusetts 0 c 060 Pane(413) 529-1402. Fax (413) 529-14313 CONSTRUCTION DEBPJS FF DA►"T (1-'OR ALL DEMOLITION AND RENOVATION PR.OJEC I s) Ira aGCOrdance with the provisions of MGL c40, s54, a condition of 3u;lding Permit Number is that all debris resulting from this worli shall be disposer. of In a properly licensed waste disposal facility as defined by tAGl..c;111, S 1500 The debris wil: be disposed of in. Location of Facility_ The debris gal€1 be transported by: Name of Hauler—U, Signature of Applicant`� Dov:_ Tile Coninwriu'eaNt of Afassachusetts K vA--. Department Of Industrial Accidents ' , I Congress,Street,suite.100 Basion,MA 02II4-201 7 +nurrittss bmv/dia Workers, Co peasat on Insurance Afftdaidt:BuiltlersiContractors/Electriciansipiumiscrs. AlicantTO B FILED MOTH THF.P��NUT`TJNG,AUTIat}RI 1'`Y. lufarati n Please Print Laeibh Name iBusin�s�a a:szariots� xacl<viduall: Y AA- Phone re you an antployer?Clxetkthe egprzspriate hoz: Type ofpro71required7, i a^z a e zzflaver eviti5 rgrotnvess{full snid or part-time;.* ""j am a soli prapzieresr ar paMership and^ave no etnployets`aveti ing for znc in 7- '�^-�New tapacstgNO worms'c°arrp.inauran, mquirad.)am a harz)raw�r dcircg all work myself.its ue3r)mss"sinsurance required.)r 9- DIi a.•r,a rox=ow"r curd vnll be hiriM,eortuactgrs to conduct all work on my property. 1 will I fl Building addition Caesar;beat all Bort-z uirs either have work=s,cuxnpcassnan insurance ra are solo _ propnc on with res a Electrical rea$irs o:additions tnp icyazs. I ass scare al csrtactar and''r, vc zircd 1.l a sub:: r acta:s fisted or i to a sac lied s:ceez. 12. Plumbing repairs or additions Ystse S t CorLactazs'a c em,—Yscs and¢cave worhrrs'corny:.insur%u1. .1 13. 7^ Roofrepairs d. +4e arc x c ssi r arr 1St ofrl have ratslcises chair r�ht of xexr-A n pct>YlCs1 c. 14,L t b� � 152, 7€'t rrni we lssve ao employees to wnrzcr ca�rtp,instuance required.] 1 l ;*Any alpficarthan Homeowners s chack5 hax� aru,s-sz assncrts'xabars:c�azddtl;tiux al idshccc iaca x+ire a arric of the s,_1.contra x m p"Iic�at, cont—actors ci rusarhhsru a new affdavitndiccat. and state wlcc�,ts.r nat;.Ease e^ziroasvec: ars rg}uys s 11."ti c s E z au2arY hair ?oyaes,zYu Y m ttt av#tSe tt:lr w tasEtcrs":o, lie numbs;, ., t"tp.i3tr y t am an ernplryer llalzt is prat=idin raraT kers'cartzpetrsttti0lt irtsitrrzrtee for mac otnptoyecs Betuw is the police andjob site ilzf0rmatirarr. : arz,-t:e Company Nadu, Polixy 9 or Selz ius.L•ic.#• '{.{ ._ � _. z`� _ Expiration Hats: (c �. rob Site Address: -' C. l Attacb a copy Of the wvor�Wam�p ��y declaration Mage(s;hoNvin the ptpo y number aasd �expiration ate). Failure to Sert:zc cov:rat=e as squired under MGL c- 152,�25A is a critninrl violation punishable by a fine up to$1 'I char taxlc.v; i ar.'srtnttacat,as a e l as civil Penalties in the form of a STOP WORD.ORDER and a fire of lip to 250.40 a ay agaiarst the violator_A copy of tris s terns t:nay ice forwarded to the Qf�ce of iavastigatiers of tiro LsIA f r ur utance overa e verifca ix_ !der hereby"ce, strider the�pg*a penaltfrs of per,jury that dw h1forntr 40A prVWded above is true and correct .. ----- j date: official use only. Do 1101.write in this area,to be ce nsplered by ciq or totvtt official City or Town; _ Perrait/License# Issuing Authority(circle ane): �mm 1-Board Of Health 1 Building.Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: __ Phone#: �® DATE(MM/DD/YYYY) A C CERTIFICATE OF LIABILITY INSURANCE 05/29/2020 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 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 q cNo Ext): (413)586-0111I (FAX C,No): (413)586-6481 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: A.I.M.Mutual/A.I.M. Keiter Corporation INSURER C Attn:Scott Kelter 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 51JUK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ A 500,000 CLAIMS-MADE /� OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,000 A S2265567 06/01/2020 06/01/2021 PERSONAL a 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 DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S2265567 06/01/2020 06/01/2021 AGGREGATE $ 5,000,000 OED X RETENTION$ 0 $ WORKERS COMPENSATION PER/� STATUTE --N EORH AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? a NIA MCC20020005382020 06/11/2020 06/11/2021 (Mandatory in NH) I 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 KEITER V U ' LD E R ✓ 35 Main Street*Florence-MA•01062•Phone:413-586-8600•Fax:413-280-0124•keiterbuilders.com Commissioner Flagg 07.16.2020 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Selective Demolition to aide the designer professionals at 261 King St in Northampton 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,. o 1Z /aa Potiter Keiter Corporation 35 Main St Florence, MA 01062