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23A-291 (19)
190 NONOTUCK ST BP-2021-1407 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-291 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2021-1407 Project# JS-2021-002346 Est.Cost: $50000.00 Fee: $350.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KEITER BUILDERS 102457 Lot Size(sq.ft.): Owner: FRITZ NICOLE Zoning: GI(100)/ Applicant: KEITER BUILDERS AT: 190 NONOTUCK ST Applicant Address: Phone: Insurance: 35 MAIN ST FLORENCE ISSUED ON:5/28/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD EXTERIOR CANOPY AND ENTRY MODIFICATIONS 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. 6 >9 • Certificate of Occupancy Signatur FeeType: Date Paid: Amount: Building 5/28/20210:00:00 $350.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Z,-a k File#BP-2021-1407 -P(a'SEfin, '� APPLICANT/CONTACT PERSON KEITER BUILDERS ADDRESS/PHONE 35 MAIN ST FLORENCE (413)586-8600 Q L✓ I(�. PROPERTY LOCATION 190 NONOTUCK ST MAP 23A PARCEL 291 000 ZONE GI(100)/ 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: ADD EXTERIOR CANOPY AND ENTRY IFICATIONS 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: X 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 •-t ,g .1,11 /d,'Sit I Sig .ture of Building Official 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. rha�-e- Fo--Q` LA. - F tor e_ C�.. MAY 2 5 20 fl 2 7 The Commonwealth of Massachusetts oppUii Office of Public Safety and Inspections � ++ ATHgtigr-, M1 1SPF^T�pN Massachusetts State Building Code(780 CMR) "-Buildittgftrmit Application for any Building other than a One-or Two-Family Dwelling D (This Section For Official Use Only) Building Permit Numbe:6 /Date Applied: Building Official: SECTION 1:LOCATION 190 Nonotuck Street Florence Hearing No.and Street City/Town Zip Code Name of Building(if applicable) Q-q I Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration EX Addition❑ Demolition ❑ (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: Add exterior canopy and entry modifications SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)S Area Per Floor(sq.ft.) NA Total Area(sq.ft.)and Total Height(ft.) NA SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business ❑ E: Educational 0 F: Factory F-1 ❑ F2❑ H: High Hazard H-1 0 H-2 0 H-3 ❑ H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R-4 Cl S: Storage S-1❑ S-2 0 U: Utility❑ Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) LA ❑ IB ❑ IIA ❑ LIB DIA ❑ IIIB ❑ IV VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) WaterTrench Permit: Debris Removal: Supply: Flood Zone Information: Sewage Disposal: Public® Check if outside Flood Zone El Indicate municipal CHA trench will not be Licensed Disposal Site M required In or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed 0 USA Waste Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable® Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No L Yes❑ No ❑C SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Florence Hearing C/0 Nicole Fritz Name(Print) No.and Street City/Town Zip Property Owner Contact Information: See the attached signed contract - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here g Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Tom Hartman - - , tomC�canh rcitects corn 10448 Name(Registrant) Telephone No. e-mail address Registration Number Amherst, rr°hitPrttlra( /1 3/21 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Keiter Corporation Company Name • Scott Keiter CS-102457 Name of Person Responsible for Construction License No. and Type if Applicable 35 Main Street Florence, MA 01062 Street Address City/Town State Zip �1,3�86 8600 41-3 320. 9035 skeiter@keiterbuilders.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes XI No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 50,() 0 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 47,000 Building Permit Fee=Total Construction st x Insert here 2.Electrical $ 3,000 appropriate municipal factor -S 350 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (c nicipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 50,000 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT /3 '703 By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information contained in this applicatio,. e and,A�accurate to the best of my knowledge and understanding. Scott Keiter, President 413-586 8600 5/18/2021 Please p 4!t and sign name Title Telephone No. Date 35 Main Street. Forence, MA. 01062 skeiter@keiterbuilders.com Street Address City/Town State Zip Email Address l� Municipal Inspector to fill out this section upon application approval: (i C • ` p ► : —J ( Name Da 4 The City of Northampton �:irr---, , Building Department BYr�rk. � ' ,y� � i , 212 Main Street �4"0,16I£p pie' h Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 5g7-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, s150A. The debris will be disposed of in: Valley Recycling Location of Facility Easthampton St Northampton, MA The debris will be transported by: USA Waste Name of Hauler USA Waste Signature of Applicant: \ �Q Date: 5/20/2021 • ' The Commonwealth of Massachusetts fr, •- Department of Industrial Accidents 1 Congress Street,Suite 100 V, Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Keiter Corporation Address: 35 Main St City/State/Zip: Florence,MA 01062 Phone#: 413-586-8600 Are you an employer?Check the appropriate box: Type of project(required): l.®I am a employer with 35 employees(full and/or pan-time).* 7. ❑New construction 2.❑I am a sole proprietor or parmership and have no employees working for me in 8. J Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14•El Other 152,§1(4),and we have no employees.[No workers'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 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: 6/11/21 Job Site Address: 53 West Street City/State/Zip: Northampton, MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under e ins and penalties of perjury that the information provided above is true and correct. Signature: r..t.lt.-E IBZ 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 b.Other Contact Person: Phone#: ACC:WEI DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 CONTACTME: Cyndie Henderson CISR,CPIA NA Webber&Grinnell PHOO.EN Extt: (413)586-0111 FAX,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 Keiter 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD wVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE i RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 500,000 _ MED EXP(Any one person) $ 15'000 A S2265567 06/01/2020 06/01/2021 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JECT n LOC 2,000,000 PRODUCTS-COMP/OP AGO $ 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 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 X RETENTION$ 0 WORKERS COMPENSATION X STATUTE X 02H AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE I— E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? I I N/A 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 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 ILL ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:67EEE3C2-372A-4733-8DC3-0C2447FC2225 KEITER CORPORATION OWNER (CORPORATION) ,—Docu L Siyned by:' �— t, D"o"c�uSigned by: Soft 5/20/2021 t(coU. rvtf# 5/19/2021 `-701'3A1FAR7d4AC1 —47ADD33B0A9F4A1 by,Scott Keiter, President Date Date • Date ADDENDA The following have been attached to this Agreement: 1. Scope of Work"FLORENCE HEARING REV 1"dated May 5, 2021 2. Drawings titled"For Permit"dated March 11,2021 prepared by Coldham&Hartman Architects,LLC 3. Evidence of Insurance r—DS ,. DS CONTRACTOR` OWNER` 11