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29-010 (3)
BP-2024-1412 BURTS PIT RD LOT 2 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-010-001 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-2024-1412 PERMISSION IS HEREBY GRANTED TO: Project# FOUNDATION 2024 Contractor: License: Est. Cost: 14000 SUNWOOD BUILDERS 065400 Const.Class: Exp.Date: 06/25/2026 Use Group: Owner: SUNWOOD BUILDERS Lot Size (sq.ft.) Zoning: SR/WSP Applicant: SUNWOOD BUILDERS Applicant Address Phone: Insurance: 84 POTWINE LN (413)259-1000 WMZ80080056582023 AMHERST, MA 01002 ISSUED ON: 11/04/2024 TO PERFORM THE FOLLOWING WORK: FOUNDATION ONLY 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: /Z. Fees Paid: $150.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ((iccPIans (�_,3 (' -C ` I__...� 1 ..,,e6 The Commonwealth of Mass lchus efts n�T 2 4 2024 FOR WI Board of Building Regulations mild Standa Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,RepLir, IMr� IONS Revased Mar 2011 One-or Two-Family Dwetting ont,MA This Section For Official Use Only Building Permit um Number: 15 �,� 1 ' /y/A Date Applied: i Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers lot 2 Burls Pit Road 29 010 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: SR Residential 15062 n/a Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 100 150 100 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Sunwood Development Corp Amherst MA 01002 Name(Print) City,State,ZIP 84 Potwine Ln. _ 413-259-1000 sunwood@comcast.net _ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:Foundation Brief Description of Proposed Work2:Foundation Only SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $12,0000 1. Building Permit Fee:$ Indicate how fee is determined: 2 Electrical $ 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $2,000 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $a .00 Check No. heck Amount: Cash Amount: 6.Total Project Cost: $14,000 0 Paid in Full 0 Outstanding Balance Due: y .• SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 065400 6/25/26 Shaul Perry License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 84 Potwine In. No.and Street Type Description Amherst MA. 01002 U Unrestricted(Buildings up to 35,000 cu.ft.) R _ Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-626-0244 Sunwood@comcast.net I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes . 0 No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION 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 the best of my knowledge and understanding. Shaul Perry 10/22/24 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" AC�d DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 10/01/2024 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 certificato dons not confor rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kathy Parker NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Eat): INC,No): 8 North King Street E-MAIL kathy.parker@aleragroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC a Northampton MA 01060 INSURER A: Selective Insurance Co of The Southeast 39926 INSURED INSURER B: A.I.M.Mutual Insurance Co. Sunwood Builders,Inc.,DBA:Sunwood Development Corp. INSURER c: Attn:Shaul Perry INSURER D: 84 Potwine Lane INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: CL244328431 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 TYPE OF INSURANCE AODL-SUBR" POLICY NUMBER POLICY EFF POLICYEXP LIMITS INSD WVD, (MMIDO(YYYY) (MMUDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE SD 1.000,000 CLAIMS-MADE OCCUR PREMISES a ocAGE TO currence) S D 500,000 _ MED EXP(Any one person) S 15,000 A S2399055 03/04/2024 03/04/2025 PERSONAL aADV INJURY E 1•°°°•" GEN-iAGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE S 2.000,000 —1 POLICY PRO- ❑ . JECT LOC PRODUCTS-COMP/OP AGG S 2.000,000 OTHER: E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED S2399055 03/04/2024 03/04/2025 BODILY INJURY(Per accident) E AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) S X UMBRELLAABI LI OCCUR EACH OCCURRENCE S 1.000,000 A EXCESS LJAB CLAIMS MADE S2399055 03/04/2024 03/04/2025 AGGREGATE E 1,000,000 DED >41 RETENTION S 0 S WORKERS COMPENSATION I MTh TE I I T 0 AND EMPLOYERS'LIABILITY Y I N B ANY PROPRIETOR/PARTNER/EXECUTNE ❑ NIA WMZ80080056582023A 05/22/2024 05/22/2025 E.L.EACH ACCIDENT S 500.000 _ (FFICER MEM ER EXCLUDED9 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) City of Northampton is listed as additional insured with respect to liability as per the terms and conditions of the policies. RE:3 Elm Street Rectory Building,Northampton MA01060 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Q v o`Northan: I: ACCORDANCE WITH THE POLICY PROVISIONS. 243 L',+ui Srr:et AUTHORIZED REPRESENTATIVE Northarnp':'I MA 01060 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD __ The Commonwealth of Massachusetts ; _ Department of Industrial Accidents _Fol,= 1 Congress Street,Suite 100 r..r� sib f, Boston,MA 02114-2017 wwwmass.gov/dia - Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeiblv Name(Business/Organization individual):Sunwood Builders Address:84 nPotwine In. . City/State/Zip:Amherst MA 01002 Phone#:413-259-1000 Are you an employer?Check the appropriate hoz: Type of project(required): LEI I am a employer with 8 employees(full and/or part-time)." 7. 0 New construction 2.1::1 1 am a sole proprietor ur partnership and have no employees working for me in 8. O Remodeling any capacity.(No workers'comp.insurance required.) 3 1 ant a homeowner doingall work myself. 9. ❑Demolition yse (No workers'comp.insurance required)t 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5CI 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.1 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 it I 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. 5Contractoes 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 Insurance Policy#or Self-ins.Lic.#:WMZ80080056582023A Expiration Date:5/22/25 lob Site Address:Burts Pit Road City/State/Zip:01060 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 certi nde he ") and penalties of perjury that the information provided abov is true and correct. Signature: A Date: 1 ,\%�%\)\ Phone#:413 626-02 4 1 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#: ACCORD DATE(MM/DD/YYYY) CCO CERTIFICATE OF LIABILITY INSURANCE 10/01/2024 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 Kathy Parker NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL kathy.parker@aleragroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Insurance Co of The Southeast 39926 - INSURED INSURER B: A.I.M.Mutual Insurance Co. Sunwood Builders,Inc.,DBA:Sunwood Development Corp. INSURER C: Attn:Shaul Perry INSURER D: 84 Potwine Lane INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: CL244328431 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. IEP LTR TYPE OF INSURANCE �gp wvp POLICY NUMBER POLICY EFF POLICY EXPLIMITS(MMIDDIYYYY) (MM1DDlYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE OCCUR PREMISES(atoccu occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A S2399055 03/04/2024 03/04/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S2399055 03/04/2024 03/04/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE S2399055 03/04/2024 03/04/2025 AGGREGATE $ 1,000,000 DED XI RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 B OFFICERiMEMBER EXCLUDED? n NIA WMZ80080056582023A 05/22/2024 05/22/2025 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $_ It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of Northampton is listed as additional insured with respect to liability as per the terms and conditions of the policies. RE:3 Elm Street Rectory Building,Northampton MA 01060 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main Street AUTHORIZED REPRESENTATNE Northampton MA 01060 ;.y. I I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD