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32C-078 (7) BP-2023-1333 14 CONZ ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-078-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1333 PERMISSION IS HEREBY GRANTED TO: Project# DECK REPAIRS 2023 Contractor: License: Est. Cost: KEITER CORPORATION 102457 Const.Class: Exp.Date:06/20/2024 Use Group: Owner: 14 CONZ STREET LLC Lot Size (sq.ft.) Zoning: URC Applicant: KEITER CORPORATION Applicant Address Phone: Insurance: 35 MAIN ST, 2ND FLOOR (413)586-8600 MCC20020005382022 FLORENCE, MA 01062 ISSUED ON: 09/25/2023 TO PERFORM THE F LLOWING WORK: �..Ft h1- 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: r � , 1 Fees Paid: S100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Mas etts 7 s o Office of Public Safety and Inspecti ��: Massachusetts State Building Code(780 CM' r,�i o Building Permit Application for any Building other than a One-o T v'qs, amily D lling (This Section For Official Use Only) g � `%0 4'4. Building Permit Number: 0?,34' (333 Date Applied: Building Official: S SECTION 1:LOCATION 14 Conz Street Northampton 01060 No.and Street City/Town Zip Code Name of Building(if applicable) 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 0 Repair O Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy ❑ Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No�✓ Is an Independent Structural Engineering Peer Review required? Yes❑ No�✓ Brief Description of Proposed Work: Rot repair of deck. 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) El 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 NA NA NA Total Area(sq.ft.)and Total Height(ft.) NA NA NA 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 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 ❑ I-2 0 I-3 0 I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IBEl HA CI IIB0 IIIAC IIIBD IV 0 VA CI 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: A trench will not be Licensed Disposal Site iii Public 9 Check if outside Flood Zone 8 Indicate municipal required O or trench or specify:USA Waste Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable O Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No O Yes 0 No O 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 P4 erty Owner 14 Conz St,LLC do Scott Keiter 35 Main Street Florence 01062 Name(Print) No.and Street City/Town Zip Property OwnkContact Information: Scott Keiter 413.586 _8600 413.320 _9035 skeiter@keiter.com 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 here O. 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) NA-See Control Waiver Name(Registrant) Telephone No. e-mail address Registration Number 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 413 586 8600 413 320 9035 skeiter@keiter.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 0 No 0 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 10,000 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 10,000 Building Permit Fee=Total Construction Cost x 10_°0° (Insert here 2.Electrical $ appropriate municipal factor)=$.007 , 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$100 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost $ 10,000 (contact municipality)and write check number here 6O7d- 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 application is true and accurate to 1e best of my knowledge and understanding. Scott Keiter I/ President • 413 586 _ 8600 9/19/202 Please print and sign name Title Telephone No. Date 35 Main Street Florence MA 01062 skeiter@keiter.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: //�j�:—� 9"Z5'26?-5 Name Date City of Northampton A � Massachusetts = 'f` w ! g DEPARTMENT OF BUILDING INSPECTIONS , 212 Main Street •• Municipal Building rr �'" Northampton, MA 01060 � �Y., ��f CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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, S 150A. The debris will be disposed of in: Valley Recycling Location of Facility: 234 Easthampton Road, Northampton, MA 01060 The debris will be transported by: USA Waste Name of Hauler: USA Waste _________p_____4.z Signature of Applicant: Date: 9/22/23 The Commonwealth of Massachusetts Department of Industrial Accidents ... 1 Congress Street,Suite 100 Boston, MA 02114-2017 lclV but nl ass.go vldla Wu/kers'Compensation Insurance Altidasit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH"1'11E PER MITI U`st;AUTHORITY. Applicant Information Please Print Leeibly Corporation Name(1Iusrtess'thgstu,atttion,�lncfi 'i�ualj:.Keiter Corp Address: 35 Main Street City/State/Zip:Florence, MA 01062 Phone#: 413-586-8600 Are you an entplis tr?Cheek the appropriate b. ! Type of project (required): 1. ✓�1 am a employes with 83 employees(full sntf or part•time)! 7. New construction 2.01 am a sole proprietor or Pauper hi:r and have na entoloVoes working for me in K. Remadeting any capacity (No workers'eoanp insurance regained] 30 1 am a homeowner doing all work myself.(No workers`coats.insurance nviirad.)t 9. J Demolition 4E1 1 am a homeowner and will be hiring o►ntractors to conduct all work on my property, l will 1 ❑ wilding addition crayon;tha:all 04n:tractors either have workers'saamponsatiott insuranax or are axle I I CI Electrical repairs or additions opior with no employees, 1 2,0 Plumbing repairs or additions 131 am a general contractor and 1 Kas a hired the sob-contractors listed on thte attached sheet. 13 Roof repairs These subcontractors lava employees and lave wotkets"cstnp insurance.; p 6.0 We area corpsoation and its officers has e exercised their ri i of exemption14.�Oilier b ip per MU c. 152.i l(4).and we have no employees. [No workers'comp.insurance required.) *Any applicant ilui clmck!oX P I most also�i 1l ut i�tC se on below ahow nt their workers'compensation policy infarmation, t Uomeowne:x who submit this affidavit indieating they are doing at work and*ben hire outside contractors mast submit a new affidavit indieatns,such. :Contractors that cheek this bex must mac/Lit an additional sheet showing the name of the sarkwccxttracturs and state whether or not those oritities have employer*. If the sub-contractors hole eug,kyirs.they must provide their wrut:4:6'camp,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 MA Employers/AIM Policy#or Self-ins. Lie.#mMCC20020005382023A Expiration Da:e:6/11/2024 Job Site Address: 100 Green Street _City State/Zip:Northampton, MA 01063 Attach a copy of the«orkers'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 S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250,00 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 certify under the pains and penalties of that the information proruded abiiye is true and correct. Sionanire: Date: 9/22/2023 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 ti Issuing Authority(circle one): t. Board of Health 2. Building Department 3.Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector • 6.Other ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ^� 05/30/2023 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: y Alera Group,Inc. PaHONr o,Ext): A (413)586-0111 FAX No): (413)586-6481 Webber&Grinnell Division E-MAIL chenderson@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of S Carolina 19259 INSURED INSURER B: MA Employers/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 2024 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 10 CLAIMS-MADE X OCCUR PREM SES(a oc u ence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2023 06/01/2024 PERSONAL&ADvINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC 2,000,000 JECT 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 06/01/2023 06/01/2024 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 $ 10,000,000 A EXCESS LIAB CLAIMS-MADE S2265567 06/01/2023 06/01/2024 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X STATUTE X ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A MCC20020005382023A 06/11/2023 06/11/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 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) Waiver of Subrogation can be obtained should Insured win the bid for project. 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 35 Main Street,Florence,MA 01062 0 413.586.8600 F 413.280.0124 w keiter.com Commissioner September 22, 2023 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the repair of a rotting deck at 14 Conz Street, Northampton, MA 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, Scott Keiter Keiter Corporation 35 Main St Florence, MA 01062