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31B-170 (7) BP-2022-0553 AttIENSHAW AVE COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 3 I B-170-001 CITY OF NORTHAMP N Permit: Dem o PERSONS CONTRACTING WITH UNREGISTERE CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0553 PERMISSIONIS HEREBY GRANTED TO: Project# DEMO Contractor: License: Est. Cost: 110000 KEITER CORPORATION 102457 Const.Class: Exp.Date:06/20/2022 Use Group: Owner: SMITH COLLEGE XINH SPANGLER Lot Size (sq.ft.) Zoning: EU/URC Applicant: KEITER CORPORATION Applicant Address Phone: Insurance: 35 MAIN ST,2ND FLOOR (413)586-8600 MCC20020005382021A FLORENCE, MA 01062 ISSUED ON:05/18/2022 TO PERFORM THE FOLLO WING WORK: DEMO LOWER LEVEL FLOOR SYSTEM, I ST FLOOR DEMOLITIONS TO ENABLE FLOOR REMOVAL 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q XI . 5911 Fees Paid: $770.00 212 Main Street,Phone(413) 587-1240,Fax:(413)5:7-1272 Office of the Building Commissioner a n b w- Ems �g � � ��-. ,.�._'/�°�-- ,._- ; -------------,......t! ) -7 Amy , 8 . , The Commonwealth of Massachusetts 2022 f Office of Public Safety and Inslpectioris�T ! 1114. / Massachusetts State Building Code i780 CMR)^,'D AU1LnNc!Nsi, tf Building Permit Application for any Building other than One-or Two- 1 fig (This Section For Official Use Only) Building Permit Number:•23'SS3 Date Applied: BuildingOfficial: Parsons House SECTION 1:LOCATION 24 Henshaw Ave Northampton, MA 01063 No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK I Edition of MA State Code used 9th If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair 0 Alteration a Addition 0 Demolition ❑ (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy El Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No Cl Is an Independent Structural Engineering Peer Review required? Yes 0 No Ea Brief Description of Proposed Work: Make Safe MEP work and Demolition only— Lower Leve Floor system to access crawispace for renediation. Misc. First floor demotions to enable the floor removal, 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) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) NA I Total Area(sq.ft.)and Total Height(ft.) NA SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Businels 0 E: Educational 0 F: Factory F-1 El F2 0 H: High Hazard H-1 El H-a❑ H-3 0 H-4❑ H-5 0 I: Institutional I-1 0 I-2❑ 1-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2❑ R-3 0 R-4❑ S: Storage S-1 0 S-2 0 U: Utility❑ Special Use El and pie,describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ HA El IIB ❑ IIIA ❑ IIIB ❑ , IV VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public IICheck if outside Flood Zone® Indicate municipal ❑ A trench will not be Licensed Disposal Site ri required El or trench or specify: Private 0 or indentify Zone: or on site system 0 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 0 or No d I Yes 0 No Rl 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 Trustees of Smith College CIO Karl Kowitz 126 West Street Northampton, MA 01062 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Project Manager 413.585 2404 _ kkowitz@smith.edu _ Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Keiter Corporation 35 Main Street Florence, MA 01062 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 hereR. 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) • Laura Fitch 413—S49-;799 lfitch@facdarchitects.com 8835 Name(Registrant) Telephone No. e-mail address Registration Number 110 Pulpit Road St Amherst, MA 01002 Arch 8/3/122 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 ._4_1-15$6131220._ 41-3 320. 9035 skeiter@keiterbuilders.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IVLG.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes gl No I:I SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item 110.000 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 110,000 Building Permit Fee=Total Construction Cost x 7 (Insert here 2.Electrical $ appropriate m ••-...,... . .r)=$ • 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimu ' fee=$ 770 (co tact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 110.000 (contact municipality)and write check number here I -2S g(1 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this applicatio. • e and accurate to the best of my knowledge and understanding. or x Scott Keiter, President 413-586.8600 2121/22 Please p 4 t and sign name Title Telephone No. Date 35 Main Street. Forence, MA. 01062 skeiter@keiter.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: • Name Date .G The Cite of Northampton mow `` Building Department 3' ,''� Y 12 Main Street ��4andl£p Jot' Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECT) 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, s15C A. 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: Date: 05.17.22 The Commonwealth of Massachusetts Department of Industrial Accidents gsum ii ammo= 1 Congress Street, Suite 100 rf 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): 1.®I am a employer with 65 employees(full and/or part-time).* 7. New construction 2.0I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'camp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. X❑Demolition 10 Q Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.1=I 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.❑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.#:MCC20020005382021A Expiration Date: 6/11/22 Job Site Address: 24 Henshaw Ave City/State/Zip: Northampton 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: f.ts..it.-F LB2- Date: 5.17.22 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(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 06/16/2021 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 NAM Webber&Grinnell PHONE (413)586-0 11 FAl( (413)586-6481 (A/C.No,Extl: (A/C,No): 8 North King Street E-MAIL chenderson@ ebberandgrinnell.com ADDRESS: INSURE (S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins o of S Carolina 19259 INSURED INSURER B: MA Employer{;/A.I.M. 12886 Keiter Corporation INSURER C: Attn:Scott Keiter INSURER D: 35 Main Street INSURER E: Florence MA 01062 INSURER F COVERAGES CERTIFICATE NUMBER: Master Exp 2022 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 DOI);UMENT 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 CLAIM INSR ADDL SUER POLICY EFF PO ICY EXP W LTR TYPE OF INSURANCE INSD VD POLICY NUMBER (MM/DD/YYYY) (MM D/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2021 06/ 1/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000.000 POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A9105217 06/01/2021 06/01/2022 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 06/01/2021 06/01/2022 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 WORKERS COMPENSATION X STATUTE X ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA MCC20020005382021A 06/11/2021 06/11/2022 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? $ (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/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 HEREOF,NOTICE WILL BE DELIVERED IN ""Evidence of Insurance"" ACCORDANCE WITH TH POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©19$8-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of A4ORD Initial Construction Control ocument To be submitted with the building permit a.plication by a Registered Design Profession 1 • for work per the 9th edition of e Massachusetts State Building Code, 780 C u' , Section 107 Project Title: Demolition only—Lower Level Floor System Date:5/16/2022 Property Address: Parsons House,Henshaw Ave., Smith College Campus Project: Check(x)one or both as applicable: -New construction x Existing Co .truction Project description: Make Safe MEP work and Demolition only—Lower Lev. Floor system to access crawlspace for remediation. Misc.First floor demotions to enable the floor removal. I, Laura Fitch, MA Registration Number: 8835 Expiration date: 8/22,am a egistered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': x Architectural Structural Mech.nical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, . d 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 y designee) shall perform the necessary professional services and be present on the construction site on a regular and peri D dic basis to: 1. Review,for conformance to this code and the design concept, shop draw.' gs, samples and other submittals by the contractor in accordance with the requirements of the construction doc ents. 2. Perform the duties for registered design professionals in 780 CMR Chapt-r 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 anner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding th• provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see i em 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 Cons• ction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: *'�vs,‘ Fire No. 635 � hM�Psi Phone number: 413-549-5799 Email: lfitch@facdarchitects.com X2ze„,,,t. _ Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013