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31B-204 (7) BP-2024-0026 94 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-204-001 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-2024-0026 PERMISSION IS HEREBY GRANTED TO: TALBOT HOUSE PHASE 2 RENO Project# 2024 Contractor: License: Est. Cost: KEITER CORPORATION 102457 Const.Class: Exp.Date: 06/20/2024 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 MCC20020005382022 FLORENCE, MA 01062 ISSUED ON: 01/10/2024 TO PERFORM THE FOLLOWING WORK: PHASE 2 RENO TO BATHROOMS, ELEVATOR, FIRE ALARM AND ELECTRICAL 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: III I�is Fees Paid: $ 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r-� OF REc - phau 2 Con ��nwt. �'`a7''— ' Iv _ The Commonwealth of Mas acl}use - 5 024 Office of Public Safety and Ins ecti Massachusetts State Building Code 80 Cal R)of 8u Building Permit Application for any Building other than a D ling tn1 01060 hS (This Section For Official Use Only) Building Permit Number: . "kr (s Date Applied: Building Official: SECTION 1:LOCATION 25 Prospect Street Northampton 01063 Smith College Talbot House 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 0 Alteration II 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 ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No D Brief Description of Proposed Work:Interior renovations to provide new heatinq/cooling terminal units, new bathrroms f on the lower and first level, new LULA elevator between the lower and first floor levels, new fire alarm system, electrical modifications as required, new finishes as required. 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)&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❑ A-2 0 Nightclub 0 A-3 ❑ 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 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❑ S-2 0 U: Utility 0 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA CI IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV CI VA El 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 El Check if outside Flood Zone O Indicate municipal O A trench will not be Licensed Disposal Site O Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:USA Waste 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 II 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 126 West Street Northampton 01063 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Javier Campos, Project Mgr. 413.585 _2404 413.270 _3298 jcampos@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 here 0. 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) Garth H. Schwellenbach 413 549 _3616 garth@candharchitects.c 091054 Name(Registrant) Telephone No. e-mail address Registration Number 17 Kellogg Ave, Suite 2 Amherst MA 01002 Architecture 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 Cl No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee=Total Construction Cost x ' (Insert here 2.Electrical $ appropriate municipal factor)=$.007 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to Paid with permit#BP-2023-0533 6.Total Cost $ (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 e best of my knowledge and understanding. Scott Keiter Ise President 413 586 - 8600 1/5/24 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 i / j IR' Municipal Inspector to fill out this section upon application approval: it: 'r�° li 41)(_6W Name Da e City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 � Y,-+.2‘",'''' 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: 01/05/2024 The Contntonwealth of Massachusetts !t Departntent of Industrial Accidents • =74117^:= 7T---110,41== 1 Congress Street,Suite 100 Boston, MA 02114-2017 ti•ww ntass.gov/dla 11'0tkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO HE FILED WITH THE PEILMI'FUNG AUTHORITY. Applicant Information Please Print Leeihly Name(muss icas.'Organ!torn tndividuai):Keiter Corporation Address: 35 Main Street City/State/Zip:Florence, MA 01062 phone #: 413-586-8600 Are you an entplo tr.?Cheek the appropriatchui: Type of project (required): 1. ✓01 am a employer with 83 ,employees(full and*:part•time).' 7. 0 New construction 20 am a soli prim ietoa or vortne/shin and have no eneotoyaes wodc Mg for the in g. O Remodeling any eapaeaty [No workers'comp insurance srquirutad] 301 am a hocseowtter doing all work myself.[No workers'comp.insurance required.]' 4. ® Demolition 4.®lam a horsoowner and wilt be luring o►ntrtetors to conduct all work on my property 1 will f 0 El Building addition tensors:tlta all mammon either have workers°iaompertnatiot Mumma:,or are sole i In Electrical repairs or additions proprietors withno employees. 120 Plumbing repasts or additions 501 am a geresal contractor and 1 have hired the sub-con s ctors listed on the attached sheet. 13®Roof repairs These subcontractors have employees and Irat insurance; workers`camp insura e• 6❑We are a corporation and its officers have exercised their rigs!of exemption per MGL e. 14.0 Other 152.¢1(4).and we haw no employees.[No workers'coup.insurance rearmed] *Any applicant ih i cltcekr bsx I mint also fill out the section below showing their workers'compensation policy information, t Fiomcowiw,wlo submit this affidavit avit indicating they*redoing all work and then hire outside contractors must submit a new aftidavir indicafrsg such. :Contractors that cheek this box must attached an additional short showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors Inee ettgrlcyies.they Wrest prav,&their wolktrs'onmp,policy number. i am an employer that is providing'porkers'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: 25 Prospect Street CityState'Zi :Northampton, MA 01063 P p Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requirs d under MGL c. I52,*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 S250.00 a day against the violator.A copy of this statement may be firwarded to the Office of Investigations of the DIA for insurance coverage ticritication. I do hereby certify under the pains and penalties ofprrjary that the information provided above is true and correct. Sionanue: g,fz Date: 01/05/2024 Phonet;: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 4 Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.CityIf'own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other DATE(MM/DD/YYYY) AC RD CERTIFICATE OF LIABILITY INSURANCE 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. 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 (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGE I 0 RED 000 CLAIMS-MADE X OCCUR PREMISES(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 PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ 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 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? N N/A MCC20020005382023A 06/11/2023 06/11/2024 I (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) 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 i J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document 91 To be submitted with the building permit application by a loll Registered Design Professional for work per the 9th edition of the m . Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Talbot House Date: 1/5/24 Property Address: 25 Prospect St Northampton Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Interior renovations to provide new heating/cooling terminal units,new bathrroms on the lower and first level,new LULA elevator between the lower and first floor levels,new fire alarm system, electrical modifications as required,new finishes as required. I, Garth H. Schwellenbach,AIA, MA Registration Number: 951084 Expiration date: 8/31/24,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural for the above named project and that to the best of my knowledge,information, and 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 my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 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 manner consistent with the approved construction documents and this code. 4. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 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 Construction Control Document'. , Enter in the space to the right a"wet"or I electronic signature and seal: r t44, 4� Phone number: 413-549-3616 Email: garth@candharchitects.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013