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24D-230 (5)
BP-2023-1661 222 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-230-001 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-2023-1661 PERMISSION IS HEREBY GRANTED TO: Project# FIRE ESCAPE 2023 Contractor: License: Est. Cost: 102284 KEITER CORPORATION 102457 Const.Class: Exp.Date:06/20/2024 Use Group: Owner: TED BOYER Lot Size (sq.ft.) Zoning: URB Applicant: KEITER CORPORATION Applicant Address Phone: Insurance: 35 MAIN ST, 2ND FLOOR (413)586-8600 MCC20020005382022 FLORENCE, MA 01062 ISSUED ON: 12/01/2023 TO PERFORM THE FOLLOWING WORK: DEMO PORCH AND CONSTRUCT NEW 3 STORY FIRE ESCAPE 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: C Jam, st 'I'• Fees Paid: $716.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Z.—O iK File #BP-2023-1661 APPLICANT/CONTACT PERSON:KEITER CORPORATION 35 MAIN ST,2ND FLOOR FLORENCE, MA 01062(413)586-8600 PROPERTY LOCATION 224 PROSPECT ST MAP:LOT 24D-230-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $716.00 - Type of Construction: DEMO PORCH AND CONSTRUCT NEW 3 STORY FIRE ESCAPE New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: )( 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 .� . \a a3 Si • 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. / //\^ �" do / The Commonwealth of Massachusetts •,, 5 •`< Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) 19'9 : ing rmit pplication for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit \ -y: '. '/ I Date Applied: Building Official: SECTION 1:LOCATION 222 Prospect 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❑ Repair 0 Alteration O Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Q No Is an Independent Structural Engineering Peer Review required? Yes No Q✓ Brief Description of Proposed Work: Demolish existing three story porch and construct new three story fire escape as per structural drawings dated 10.26.23 by Robert Leet. 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 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❑ I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility❑ Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB 0 IIA 0 IIB 0 IIIA 0 IIIB 0 IV 0 VA 0 VB 0 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 lil Public li Check if outside Flood Zone O Indicate municipal O 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 O. or No O Yes 0 No 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 Fitzgerald Realty Corp 37 Mary Jane Lane Florence 01063 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Ted Boyer 413 835 5689 - fitzgeraldproperties123@gmail. 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) Robert T. Leet 978.544 _8000 whetstoneeng97@gmail.com 38942 Name(Registrant) Telephone No. e-mail address Registration Number PO Box 881 Wendell MA 01379 Structural 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 O No 17 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 102,284 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $102,284 Building Permit Fee=Total Construction Cost x '007 (Insert here 2.Electrical $0 appropriate municipal factor)=$716.00 3.Plumbing $0 4.Mechanical (HVAC) $0 Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $0 Enclose check payable to City of Northampton 6.Total Cost $102,284 (contact municipality)and write check number here 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 a best of my knowledge and understanding. Scott Keiter President 413 586 _ 8600 11/21/2023 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: ' �'�h I • 1' o� ti Name I ate City of Northampton ii "rya '*~ j }<cJl Massachusetts s, ? $�k DEPARTMENT OF BUILDING INSPECTIONS �r " i�R, 212 Main Street • Municipal Building Aso% , ils C $ --� Northampton, MA 01060 p% � 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: uSAwaste Signature of Applicant: �% - Date: 11/21/23 The Contntonwealth of Massachusetts — 't Department of Industrial Accidents 1 Congress Street,Suite 100 w�zz Boston, MA 02114-2017 tt'1Vittntacc.gov/dla %%otkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH"fllE PL1LMITt tic AUTHORITY. Applicant Information Please Print Legibly Name(f3usi; ss`t}rguni:ttstionu lnditidual):,Keiter Corporation Address: 35 Main Street City/State/Zip:Florence, MA 01062 . phone#: 413 586-8600 Are you an cnti4.ytr?Cheek the approtrriatett..te Type of project (required): • 1.Ell am employer with 83 employees(full andror part•time).• 7. New construction 20 lam a sole promietex or oottaershita and have n.entolovests working for me in ht. Q Remodeling any capacity[No workers'ewnp insurance regained] 30 i am a hocieowner doing all work myself.(No workers'corm.insurance required.) 9. ® Demolition 4.D lam a homeowner and will be hiring o►ntreeetors to oanthtct all work on my property I will WE Building addition mum:tha:all c nrtrxlorst either have workers'esrttyensatioa insurancx or ate sole I I.[] Electrical repairs or additions propridOt with no employees. 120 Plumbing repairs or additions 501 am a geretal contractor and 1 have kited the sob<onttactan listed on the attached sheet. 13❑Rt>bf repairs These aub.contractors late employees and hate wotkers'comp insurartte.• 6.0 We an;a corporation and its officers ha c exercised their rigs of exemption per 2,4GI.e. I .D Otltet 132.i 1(4).and we have no employees. [No workers'eoonp.insurance required.) *Any applicant that cheeks bpi s I MUM also ill out the section Maw shouting their workers'compensation policy infannati n. t F(omeownc:s who submit this atlitktvit indicating they ate doing all work and then hire outside contractors must submit a new affidavit intik:dm such, :Contractors that check this his must attached an additional sheet showing the name attic.sub-contractoey and state whether or not those entities have employees. lf the sub-contractors have employers.they must ptovirk 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 MA Employers/AIM Policy#or Self-ins. Lic. MCC20020005382023A Expiration Da:e:6/11/2024 Job Site Address: 100 Green Street _City-State'Zip:Northampton, MA 01063 Attach a copy of the tsorkers'compensation policy declaration page (showing the Policy taumber and expiration date). Failure to secure coverage as require i under MGL c. I52,§25A is a criminal violation punishable by a fine up to S 1.500.00 andtor 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 firwarded to the Office of Investigations of the DIA for insurance coverage trerification. I do hereby certify'under the pains and penalties of prrjar� that the information provided above is true and correct. pf,-z Sionantre: Date: 11/21/2023 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# Issuing Aulhorite(circle one): I. Board of health 2. Building Department 3.Cityfl'own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE V' 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: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 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 j(MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE REED CLAIMS-MADE X OCCUR PREMISESO(Ea occu ence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2265567 06/01/2023 06/01/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEpi LOC PRODUCTS-COMP/OP AGG $ 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 06/01/2023 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 PER X ORTH- AND EMPLOYERS'LIABILITY X STATUTE /� Y/N 1,000000 B OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A MCC20020005382023A 06/11/2023 06/11/2024 E.L.EACH ACCIDENT $ , (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 l i �r- - ) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD