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31C-081 (2) G/Z OLANDERDR-UNIT 4A&4B BP-2019-0943 G GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31C-081 CITY OF NORTHAMPTON Lop- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv�NEW DUPLEX BUILDING PERMIT Permit# BP-2019-0943 Proiect# JS-2019-001579 Est Cost: $233000.00 Fee: $225.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: SHAUL PERRY 065400 Lot Size(so.ft.): Owner: SUNWOOD DEVELOPMENT CORP Zoning, Applicant: SHAUL PERRY AT. OLANDER DR - UNIT 4A & 4B Applicant Address: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON:3/6/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.NEW CONSTRUCTION OF 2,000 SQ FT DUPLEX - 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/6/20190:00:00 $225.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner File 4 BP-2019-0943 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 4A&4B MAP 31 C PARCEL 081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLO REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiruz Permit Filled out Fee Paid T eof Construction: NEW CONSTRUCTION OF 2,000 SNLFLDtVLEX-FOUNDATION ONLY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 065400 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF912MATION PRESENTED: V 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: Cub 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 lam! 3S i Signature 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. Department use only City of Northampton Status of Permit: .✓�c Building Department Curb CuVDdveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterMell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office ��o/fCIU' Kir'%vV Fx7rr6ip�/ U�Yslr�/�p'//.-/ Map 310— Lot OZS t Unit iy (21060Zone Overlay District 2\d � Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDA ENT 2.1 Owner of Record: 'QL ', Z , J'�i�zy#0/oo.-t Currgnt Mailing rest TTee epiwne Si re 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �Wwc (a)Building Permit Fee 2. Electrical �fAxxJCnn/ (b)Estimated Total Cost of Wwo Construction from 6 3. Plumbing 000 Building Permit Fee J,( 4. Mechanical(HVAC) eY �7 5.Fire Protection 6. Total=(1 +2+3+4+5) fawwo Check Number OC) This Section For Official Use Only Building Permit Number: Date Issued- Signature: Building Commisslonernnspector of Building/s // / / Dale JU/fWOOC� �' (/DiY(Cotg7'. OCA EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING ALL Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Deportment Lot Size Frontage Setbacks Front Side L: R: L R: Rear Building Height Bldg.Square Footage % _fOBQ Open Space Footage % O' (Lot area minus bldg&paved parking) 4o Parking SpacesIY-e CIO, Fill: volume&location A. Has a Sp^-'aL Permit/Variance/Finding ever been issued for/ n the site? NO t� DONT KNOW O YES ya IF YES, date issued: 8/90 IF YES: Was the permit recorded at the Registry of Deeds? l� NO O DONT KNOW YES IF YES: enter Book tx/ Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conns'eervation Commission? Needs to be obtained O Obtained O ,,rDayte Issued: C. Do any signs exist on the property? YES O NO 2 IF YES, describe size, type and location: ! D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and Location: E. Will the construction activity disturb(cleeyng,grading,excavation,or filling)over t acre or is it part of a common plan that will disturb over 1 acre? YES (�s�tY NO O IF YES,then a Northampton Storm Water Management Penni)from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable) New House 1251 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ 7— Or Doons C Accessory Bldg. El Demolition ❑ New Signs [D] Decks [(] Siding[D] Other[[Q Brief Des ription of Proposecy Workoz { /y Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plana Attached Roll -Sheet ea.If New house and or addition to existing hous[na. Complete the following: a. Use of building:One Family Two Family_Other b. Number of rooms in each family unit:/�-.3 Number of Bathrooms_ ' c. Is there a garage attached?� d. Proposed Square footage of new construction. 0690- Dimensions /56 f WO- e. Numberofslodes? d / f. Method of heating? Zack�/ Fireplaces or Woodstoves�Number o�f�each_ g. Energy Conservation Compliance. d�/�Masscheck Energy Compliance form attached? /ad h. Type of construction &4i� i. Is construction within 100 R.of wetlands?—Yes _No. Is construction within 100 yr. floodplain_Yes_No j. Depth of basement or cellar floor below finished grade / k. Will building conform to the Building and Zoning regulations? —X—Yes No. I. Septic Tank_ CiftySewer Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS 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. Signature of Owner Date =dadwe as Owner/Authorized ments and information on the foregoing application are true and accurate,to the best of my knowledge Signed uder the pai s and penalties of perjury. Print Nam Sig at of Omer/Agen D A. 6 SECTIONS-CONSTRUCTION SERVICES 8.1 Licensed Constructions/S/uoemisor: Not Applicable �❑,( Name of License Holder! /rv/ em License sl=ber gw Address Expi anon Date sign Telephone 9.Re Istered Home Im rovemen Contr r/�� ^/ Not Applicable ❑ � Compp�a/n�N)am/e / Reg4Z,4117 Number (I K / i%tci ! [� M /S{ 0'�Vn�vr>� 4/04/19 Address Ezpir ion Date Telephonef 251-1� SECTION 10-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....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered p Ekotrope ID: 7d8anooL HERS' Index Score: Annual Savings Home: • • • ' Northampton, • 1.1 Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[Motu] Annual Cost criteria of the following: Heating 4.2 $205 Cooling 0.5 $21 Hot Water 2.5 $114 Lights/Appliances 14.0 $647 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 21.2 $1,060 Home Feature summary: Rating Completed by: LW— M Home Type Duplex,single unit Energy R•t•r.Adin Maynard Conditioned Floor Area: 1,298 s4 h RESNETID:9463452 Number of Bedrooms 3 Rating Comprry:H15&HERS Energy Efficiency Primary Heating System: Air Source Heat Pump•Electric•3M COP Mailing:l2 Perkins Ave.Northampton MA 01060 Primary Cooling System: Air Source Heat Pump-Electric•18 SEER 4136588784 Primary Water Heating: Water Heater•Electdn 3.24 Energy Factor House Tightness: 11 MH50 Rating Irnnlder.Energy Raters of MassachusettsVentilation: 43.0 CFM-20.OWads 2 Woodlawn Street Amesbury,MA01913Duct Leakage to Outside Untested978-2743911AboveGradeWalls: R-30Ceiling: Attic,R6 aWindowType U-Value:0.2,SHGC:0.25Foundation Walls: R-15Adln Maynxd.Certdied Energy Rater . Digitally signed: 111211 gat 221 PM • • • Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered p Ekotrope ID: BdNxnEg2 Score:HERS' Index Savings Co he Unit4b 2BR, / MA01060 33 k ,, ri )i, �i ii hir lk , ( , R' 1,11- 111'11 1) Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Um[Mstul annual cost criteria of the following: Heating 3.3 S160 Cooling 0.4 $16 Hot Water 2.0 $93 Lights/Appliances 11.7 $541 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 17.4 $882 Home Feature summary: Rating Completed by: ...rro Home Type Duplex,single unit Emi RinemAdin Maynard Conditioned Floor Area: 882 sq.k. RESNETID:9463452 s ei, Number of Bedrooms: 2 _ Primary Heating System: Air Source Heat Pump•ElMric•3b6 COP Rating CompaninHIS&HERS Energy NBdency Primary Conlin System Air Source Hear Punp•Electric 18 SEER 41365887 Perkins Ave.Northampton MA 01060 aere,.n<. r Yn 4136588]84 �wme son PrimaryWater Hearing; Waren Heater•Electric-3.24 Energy Factor _ House Tightness: 1.2 ACH50 Rating Pmvidar.Energy,Raters of Massachusetts .✓ -.....y. Ventilation. 313 CFM•20.0 Wags 2 Woodlawn Street Amesbury,MA 01913 js j Duct Leakage toOutsideUntested 978-2703911 Above Grade Walls, R-30 Ceiling: Attic,RfiO m srrxsn. Window Type: U-Value:0.2,SHGC:0.25 L Foundation Walls: R-IS . e Arlin Maynard,CertNMd Energy Rater Digitally signed 11/2/18 at 2:19 PM 1,0,2039 • • • AcoRD® CERTIFICATE OF LIABILITY INSURANCE M'�IMMDDI"�' Ot/1S12019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTR 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. N the certificate holder is an ADDITIONAL INSURED,the pocky(las)must have ADDITIONAL INSURED provisions or ba endomed. If SUBROGATION IS WAIVED,subject t0 Me farms,and conditions of the policy,Car In policies may require an srldoreem9M. Astet9rrNM on MW cod cats deals not confer rights to Me cerlifkets holder In Wu of such endorsements). PRODUCER ',A--MEI--- Linda P...,CRIS NRbOer 8 Gnnnell PxOxE (413)586-0111 No,_ (413)586-8481 8 North King Street LQ",, powercgAebherardgunner rqm INSURENISAFFORDING COVERAGE NIKE Northampton MA 01060 INSURERA: Ohio Security/Liberty 24082 INSURED INSURER R: AI M.Mu Wal Sunwood Build.. Inc. INaUBER C: Ohio SecuftylUOeny 24082 AM:Shaul Pon, m3URER D: M Potain Lane INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: Mester EXP3-2019 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 MAYBE 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. POLI YEF YE. LIMITS LTR TYPE OF INSURANCE POLICYNUMWR NNII NN)PYYYY X COMMMCIALGENERALL MLRY EACH OCCURRENCE 5 1.UGO,ODO CIAIMSMADE ®OCCUR PREMISE Fe o¢ rten s300000 MEDENPIA c 3 15,000 A BKS55442304 03104Y2o18 03104/2819 PENRVN La ADV INJURY s 1,000 000 GEN'LAGGREG4TE LIMITAPPLIEB PER: GENERALAGGREDATE E 2,000000 PC " ❑JE T LCC PRODUCTS-CCMPIOPAGG E Y,000,000 OTHER AUTOMOBILE LIABILNY CFDeMINED GI NGL LIMIT 3 1000,000 NPURntl vAUTO BDOILYINJURVIPPPgsml $ A 011Tos00Nv xsL�0..LED BAS55442304 0310412018 0310412019 CODIFY INJURY(%reoueno E HIRED PON., EO PROPERTY MMA E E AMOSONLY x AUTOS ONLY xti0 Medi�al payments 3 5.000 UMBRELLA UAB ocwR EALHCCCURRENCE 3 1.000 ow EXCESS UAB cuNSMACE US055442304 OB/20I201B 03104I201B AGGREGATE g 1,000000 UED RETEVI E E WORMERS COMPENSATION PE0. OTN AND EMPLOYERS LIABILITY TATBTE Efl B ANY PROPWETORNARTNERIEIFGTIVE Y❑ HIA WMZ80080058582018A OSI22R018 OSI12I2019 EL EAOH ACCIDENT E SODOM EXCLUDE VI IaM Mtlorvin NHl EL.DISEASE-EA EMPLOYEE E $00,000 IDEBORIPTOI OFOPENA ONStelmv EL.015EASE-PCLICV LIMIT y 500,000 DOICRIFIM OFOFERATOI51MPRONSIVEHICLES(ACORD 101,AddR Ii RxneMSueo,W,mrybaWCMOXmen epce le oNRIM1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Citi of Norhampton ACCORDANCE WITH THE POLICY PROVISIONS, 240 Main St,Suba 3 AI{TXORQFD R@RESEHTATIVE NoMampton AN 01060 ll11 D r 19 13 8 8-2015 ACORD CORPORATION. All Rights reserved. ACORD 25(2016103) The ACORD name and logo are registered narks of ACORD 1170LANDER DR- UNIT 5A&5B BP-2019-0944 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block:31C-081 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:NEW DUPLEX BUILDING PERMIT Permit BP-2019-0944 Proiect# JS-2019-001580 Est Cost $223000.00 Fee: $225.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SHAULPERRY 065400 Lot Size(sq. ft.): Owner: SUNWOOD DEVELOPMENT CORP zoning: Applicant. SHAUL PERRY AT. OLANDER DR - UNIT 5A & 5B Applicant Address: Phone: Insurance: 84POTWINELN (413)259-1000 WC AMHERSTMA01002 ISSUED ON.•3/6/2019 0:00:00 TO PERFORM THE FOLLOWING WORK NEW CONSTRUCTION OF 1,824 SQ FT DUPLEX - 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 9 Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy signature: FeeTvpe: Date Paid: Amount: Building 3/6/2019 0:00:00 $225.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck- Building Commissioner File N BP-2019-0944 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 5A&5B MAP 31 C PARCEL 081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCREQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstructiom NEW CONSTRUCTION OF1824S DUPLEX-POUKQALION ONLY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included' Owner/Statement or License 065400 3 sets of Plans/Plot Plan 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 Q Signature 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. Department use only -� City of Northampton Status of Permit: � .✓;�. Building Department Curb Cut/Driveway Permit 212 Main Street sewer/Sepsc Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specity APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 7.1 Proo/e/rN A!tl�tlress: /1 ) ,p"� ! /� This section to be completed by office O/CJlOU' l.JfivcJ </r'l/SO/Y �l41f/1.1 NS6 Map_L Lot Q "/ Unil / P 01060 .( Zone Overlay District Elm St.District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED XGENT 2.1 Owner of Record: Name(Pri ) Ul CGt��Ad rens: - -� none Sigotues 2.2 Authorized Anent: Name(Pent) Current Mailing Address; Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building J// OOO (a)Building Permit Fee 2. Electrical 3O�O (b)Estimated Total Cost of Construction from 6 3. Plumbing 1000 Building Permit Fee 7u)�.06 4. Mechanical(HVAC) O(l 0W VVV"' ,J/ 5.Fire Protection 6. Tot al=(1 +2+3+4+5) nao i Check Number 3� This Section For Official Use Only Building Permit Number: Dale Issued: Signature: Building Commissioner/Inspector of Buildings Data 670flWDod/ @ �iON7la 5'f. !1G'� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by // Building Deparnuent Lot Size Frontage Setbacks Front Side L R: L: R: Rear Building Height Bldg.Square Footage % a� Open Space Footage % (Int area minus bldg&paved Paddrou #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued�fo{r/on the site? NO O D07T KNOW O YES t_ IF YES, date issued: 8/9//C3 ///��- IF YES: Was the permit recorded at the Regi ry of Deeds? NO O DONT KNOW YES O IFYES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 9 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q ,�Date Issued: C. Do any signs exist on the property? YES O NO IX) IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(cle ing,grading,excavation,vation,or filling)over 1 acre or is it part of a common plan that will disturb over l acre? YES NO IF YES,then a Northampton Stonn Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(chock all applicablel New House Addition ❑ Replaocement Windows Alterations) ❑ Roofing or Do s Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [0 Siding[0] Other[m Brief Dascnp��C}yosn of Proposed / / Work: /Y,., ("..n4}/.._.}'n Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.if New house and or addition to existing housing, mmolete the following: a. Use of building:One Family Two Family lziOther b. Number of rooms in each family unit:_ Number of Bathrooms / c. Is there a garage attached? d. Proposed Square footage of new construction._f'6d"Dimensions 3� 66/ e. Number of stories? f. Method of heating? Fireplaces or Woodstoves /Y� Number of each g. Energy Conservation ComplianceMasscheck Energy Compliance form attached? _ In. Type of construction i. Is construction within 100 R.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? _ Yes No. I. Septic Tank City Sewer Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date I, 4L/ g,: / ,as Owner/Authorized Agent hereby declare that r statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed un er the pains and penalties of perjury. Print Name Si reof OwnerlAg t Date SECTION S-CONSTRUCTION SERVICES 5.1 Licensed ConstructionSuoemisor. Not Applicable ❑ Name of Llcense Heltlar. , / /rv/ 69-0&,)�Wan License Number efw Address I Expl ion ate ya 1_ �o Sign Telephone 9.Re 1stered Home Im rovemen Contraelor/�� Not Applicable ❑ rl/YWDj0 : erS �/la r/lCr/✓ toicW Co(mJ.e[n/Name Registryat, Number GJ7 ,�• vliri kilts �in ��!S'f ��i� Address Expirallon ate Telephone �' � SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted vnth this application.Failure to provide this affidavit will result In the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered P Elsotrope ID: Ydxni HERS' Index Score: Annual Savings Home: • • : • Northampton, o 01060 321tirnrinfor, ill kt l, J Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[Mstu] Annual Cost criteria of the following: Heating 3.7 $183 Cooling OA $16 Hot Water 1.9 $87 Lights/Appliances 11.3 $523 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 17.3 $880 Home Feature summary: Rating Completed by: •..u�m Home Type Duplex single unit Energy Rater.Adin Maynard ConditionedFlArea: 778 sq.k. RESNET ID:9 i63u152 xuM Num Bedrooms 2 Rating Comprsy:HlS&HERS Energy EfBdency Primary Head Heating Syrtem: Air Source Heat Pump•Electric•3b6 COP Mailing:12 Perkins Aug.Northampton MA 01060 m Primary Cooling System: Air Sourte Heat Pump•Electric•18SEER 4136588781 8ef acme soo Primary Water Heating: Water Heater-Eleatic-3.24 Energy Factor - House Tightness: 12 ACH50 Rating Provir6r.Enxgy Raters of Massachusetts Ventilation: 303 CFM.20.0 Watts 2 Woodli Street Amesbury,MA 01913 Dud Leakage to Outside Untested 978-2703911 Above Grade Walls: R-30 Ceiling: Att :,R6 m rr.ly.. WlrWoType D-Value:0.2,5HGC:0.25 Foundation Walls: R-15 wu.,a Adin Maynard,Certified Energy Rater Digitally signed 11N78 at 2:12 PM • • • Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered 1 P Ekotrope ID: M28rP7Bd HERS' Index Score: Annual Savings Home: : ' , Northampton, $ 2,448 rer 321'i iJ h, Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[Mewl Annual cost criteria of the following: Heating 4.4 $213 Cooling 0.5 $21 Hot Water 2.3 $109 Lights/Appliances 12.9 $597 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 20.1 $1,011 Home Feature summary: Rating Completed by: ...s�Rr Home Type: Duplez,single unit Energy Rater.Adin Mayrsird .w Conditioned Floor Area 984 sq.k. RESNETID:9463452 Numberot8el..si 3 Rating Covspamy:HIS a HERS Energy Efficiency _ Primary Heating System: Air Source Heat Pump•Elec[ric•3.66 COP Priruzry Cooling System: Air Source Heat Pump•Electric 18 SEER 4136587812 Perkins Ave.Northampton MA 0106D RO— 4136588789 xome roe PrimaryWater Heating: Water Heater•Electic•3.24 Energy Factor House Tlghtnese 1.2 ACHSO Rating Provider.Energy Raters of Massachusetts ..✓��ti. Ventilation 398 CFM•24.0 Watts 2 Nbodlasin Street Amesbury,MA 01913 DuR Leakage to Ottsice, untested 978-270-3911 >� ' ^' • : Above Grade Wallin R-30 _6E. Celling: Attic.R60 m tnux... WlrWow Type: -Yalue:0.2,SHGC:0.25 emGyve lernrty '° Foundation Walls: RR-15 xs. o Aigi Maynard,Ce1/211 Energy Rater Digitally signed 11/2/18 at 153 PM ellimlitrope- ACO CERTIFICATE OF LIABILITY INSURANCE pA011MB12019 n IIII THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATWELY 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certMicate holder k an ADDITIONAL INSURED,the policyUes)..at have ADDITIONAL INSURED provisions or be Bndome0. If SUBROGATION IS WAIVED,subject to the terms and conditions of Ne policy,certain policies may require an endomen ent. A statement on this e*Mlca does nm confer rights te Me cartNkate holder in lieu of such enNar .nt(s). PRODUCER NAME.IA" Unda POW2B,CRIS Vdabber B GunnellPHoxE (413)SBB-0111 FixxP. (413)588-6101 8 North KIDS Street AGOREsy. Ipowere®webbeninagrinnell win INSURERS AFFORDING COVERAGE NAICtl NOMampton MA 01080 INWRERA, Orio SecurhylLiberty 24082 INSURED INSURER e'. A .M.Mutual Sumvooa Builders,Inc. msUMRC: Ohio Senudty,Llberty 24002 AM Shaul Perry Iin u en D: 84 PORI Lane IxauRFR E: Amherst MA 01002 NBURERF. COVERAGES CERTIFICATE NUMBER: Master Exp 3-2019 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOFFEE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAYBE 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. /Urn PE OF INSUfl NCE P ICYNUMBER MMNOMYY MM LIMITS 01IRERGALGENERALLWBILITV EACH OCCURRENCE S 1000,000 DLXNSSMAOE ©OCCUR PRFMISEs Ea ov' — $ 300,000 rnED COP(A, § 15,OW A BKS55m2304 03/04/2018 03ION2019 PERSONAL LADY INJURY S 1,000,000 GEN'L AGGREGATE LIMITAPPLIES HER GENEMALAGGFEGATE § ?000,000 POLICY❑PEC f7 L. PRODUCSmOOMProPAGG g 21100,000 OTHER AUTOMORIIF LIABILITY COMeaI�xEMO BINGLE OMIT g 1000.000 UX BOmLY INJURY VHM MMM § SCHEDULED BA555442304 03/0412018 03104,2019 BOOLY,uuFY(AMMu OMO 5 Auros NON�OWNEOPflOPERT'OMRLE AUTOe ONLY PxmOfMedical Payments s 5,000 LIAB OCCUREACH OCCURRENCE § 1,000000 e CWMSNAOE USOSW2304 08120f1 0 OWMI2019 s00REGATE S 1,000,000 RETENTION$ S VICRRERB COM PRNSATICN AHD EMPLOYERS LIABILITY RTAI➢TE Efl ANV PMOPnETD RFARTNEMIEXELIRIVE YIN EL EACH ACCIDENT a 500.000 JDARDRI OFFIC1111E.DPARTNEIRDDEJ NIA WMZ800B0055582018A 05122/2018 05122/2019IMMMO_InNHIE L DISEASE,EA EMPLOYEE S 500000 n YePM`Iuom, 500000 PiION OF O__GCNB OeIu EL.OISFASE-PoLICV LIMIT § DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES IACOFU 101,AddrovI Remake SOMPI,mry IM MG1W 11 more PROM IF MAXMIH CERTIFICATE HOLDER CANCELLATION SHOULDANY 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 Man St.Suite 3 AUTHIXULEO REPRESENTATIVE Northampton MA 01080 ®1989-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2015103) The ACORD name and logo ere registered mars of ACORD fir*7 OLANDERDR-UNIT 6 BP-2019-0945 GIS#: COMMONWEALTH OF MASSACHUSETTS MwBlock:31C-081 CITY OF NORTHAMPTON Loc- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Bulldina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catewrv'New Single Family House BUILDING PERMIT Permit# BP-2019-0945 Project# JS-2019-001581 Est.Cost:$163000.09 Fee:$200.0 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SHAUL PERRY 065400 Lot Size(sa R Y Owner: SUNWOOD DEVELOPMENT CORP zonine. Applicant: SHAUL PERRY AT: OLANDER DR - UNIT 6 Applicant Address: Phone: Insurance: 84 POTWINE LN (413)259-1000 WC AMHERSTMA01002 ISSUED ON.3/6/2019 0:00.00 TO PERFORM THE FOLLOWING WORK:NEW CONSTRUCTION OF 1,632 SQ FT SINGLE FAMILY HOUSE - 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Cli mpey: 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. Certificate of OccupancV signature: FeeTvpe: Date Paid: Amount: Building 3/6/2019 0:00:00 $200.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck -Building Commissioner file#BP-2019-0945 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 6 MAP 31C PARCEL 081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT AP ION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvoeof Co structin'_NEW CONSTRUCTION 32 SO FT SINGLE FAMILY HOUSE-FOUNDATION ONLY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included- Owner/Statement or License 065400 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION PRESENTED: TAI' _Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate ProjecC 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 3 51 Signature of Building Official Dale 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. Department use only %— City of Northampton Status of Permit: Building Department Curb CUVDnveway Permit a I'- 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of structural Plans phone 413-587-1240 Fax 413-587-1272 PloVShe Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION 1.1 Property Address: ) This section to be completed by office Map 13/C— Lot 09/ v / Unit /W 0/060 1 � Zone Overlay District i U` Elm St Distinct CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Rec/ord::� NOary CJcvc%n�yYti>� /� min/ 1LZ-14LNC(!ZL'1 "' N/19 �� Name(PdIt Curt t Mailin Atltl ss ti Tel phone Sig u 2.2 Authorized Anent: Name(Pnni1 Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building &O00 (a)Building Permit Fee 2. Electrical �//:!�^1�^�n (b)Estimated Total Cost of Ogwo Construction from 6 3. Plumbing 000 Building Penult Fee 4. Mechanical(HVAC) Q U v 5. Fire Protection 6. Total=(1 +2+3+q+5) Check Number Qv This Section For Official Use Only Building Permit NumberDate Issued: Signature: Building Commissioner/inspector of Buildings Data &Url WOO J C GO///C,.el /fe_lL/ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filed in by / /Kq/C_ Building Departrnmt Lot Size Wof S Fronto e Setbacks Front Side L R: U R: Rear Building Height Bldg. Square Footage % Open Space Footage (Wo area minus bldg&paved parking) / #of Parking Spaces 0• / Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/ the site? NO O DONT KNOW O YES IF YES, date issued: &0//d' IF YES: Was the permit recorded at theRegi ry of Deeds? NO O DONT KNOW YES O IF YES: enter Book !!!"' Page , ,/and/or Document# B. Does the site contain a brook, body of water or wetlands? NO pC) DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO tyJ IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construcUon activity disturb(de g,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over t acre? YES NO IF YES,than a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition Ell New Signs [❑] Decks (❑ Siding Other[❑j Bnef DescriP/yon of P pose Work: /V •J 11FiY'n� Y/ if O� ��-M .n1. Y/ 7•H . [�/ /fOMG� Alteration of existing bedroom_Yes No Adding new betlroom / Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa.If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit:-_ Number of Bathrooms 04 _- c. Is there a garage attached?_L0 r d. Proposed Square footage of new construction. &3oZ Dimensions e. Number of stones? d,�/ // f. Method of heating? C/«,kz / Fireplaces or Woodstoves_ _�-Number of each g. Energy Conservation Campliance. OS Masscheck Energy Compliance form attached? Y,_ In. Type of construction I. Is construction within 100 ft.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes_No j, Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank_ City Sewer Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Dale 1, '4"J1 -as Owner/Authorized Agent hereby declare that the s Cements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed u9der the pains and penalties of perjury. Print Name Signdu.4 of OwnerlAgent 41ZDate SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable /❑ Name of License Holder: , �rf✓ [ ��n License Number Jf l �dT�i/O Address ,r Expi tion ate Ad, // / Sign t Telephone 8.Re.1stered Home Im rovemen Contractor: Not Applicable ❑ 1nwo6 A .- ci'S Gom an Name Registration N mbar 7; Address Expiration ate Te1ephone&-d-51-" SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(8)) 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 At0davil Attached Yes....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered p Ekotrope ID: g2ROQg6L Index Score: Savings • • UnitfS, Northampton, ' • 01060 31 " Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use lMatul Annual Cost criteria of the following: Heating 6.9 $336 Cooling 0.6 $26 Hot Water 3.1 $143 Lights/Appliances 15.8 $730 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 26.4 $1,307 Home Feature summary: Rating Completed by: a� Home Type. Single family detached Enargy Rabr.Adin Maynard Conditioned Floor Area: U78 sq.ft RESNETID:9463452 snvma Numberof6edroom, 4 yes Primary Heating System: Air Source Heat Pump•DoRacing Coniparry:HIS a HERS Energy Efficiencytri<•358 COP Mailing:12 Perkins Ave.Northampton MA 01060 primary Coding System: Air Source Heat Pump•Electric•17.7 SEER 41365887M P"wm`e10o PrimaryWater Heating: Water Heger•ElecMc•334 Energy Facto -- HouseTightness: 11 ACH50 Raeng Psovlder.Energy Raters of Massachusetts Ventilation: 533 CFM•20.0 Watts 2 Woodlawn Street Amesbury,MA 01913 Duct Leakage to Outside Unrested 978-2703911 i �✓' (.' n Above Grade Walls: R-30 — Ceiling: Attic,RfiO m Window TYPl: U-Value:0.2,SMGC:035 rem l...rs 'O foundation Walls: R-15 w e Adin Maynard. III ed Energy Rater DigiDigitallysigned:;I1/2/18at 2:15 PM 02039 • • • WTE I18wig'1'1 I.- R CERTIFICATE OF LIABILITY INSURANCE ov18nw9 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 cert0cats holder IS an ADDITIONAL INSURED,Me policy(les)most have ADDITIONAL INSURED provolone or be endoreed. It SUBROGATION IS WAIVED,suh)Bct to the temp and condhlons of the policy,certain policiee may require an endorsement A sMtemerrt on this certificate time not confer rights to Me certMcate holder In lieu of sucM1 endormarent(c). PRODUCERXPM 'MEr T Linda PaRm s,CRIS WEOderB Gunnell PxouE (413)58fi-0111 ° xe.. (413)586-8481 8 NOM King Street App q. IpFEEoweratiMwedhemndgrinnelLoom INSURE s AFFgidNICOVEAAGE I NOMampion MA DIWO INSURER A: Ohio SewntylLlberyINSURED INSURER B' AM.MutualSunINood Builders IDC. INSURER c' Ohio Secuntyll-iheny Aft Shaul P.M INSUREED: 84 P01WIne Lane INSURERS: AThend MA 01002 INSURER E: COVERAGES CERTIFICATE NUMBER: Master E,3-2019 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MTH RESPECT TO MICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, EFF E D /LTR TM OF INSURANCE PCLICYNUMBFA MMNDIYYYY M LINITIS COMMERCMLGENERALUBBWtt EACHOCCUERENCE E1.000,000 CIAIMSIMOE ©-I,-unEB IF.—I E 300,000 MED.Any e S 15000 A BKS5W2304 031N12019 0310412019 PEESCALa ADVINIURY S 1000000 GEMLPGGREGATELIMITAPPUIESPER. GENERPLAGGREGATE S 2000,000 POLIOY 0P_T ❑TOD PHODUCTSm OOMPIDPAGG 12,a 04.000 1 OTHEP AUTOMOBILE LIABILITY W1R01NaED SINGLE LIMIT 31,000,000 ANY AUTO 6COILYINJURY(FKg -i E A OV.NEO x SCHEDULEo BAS55442304 03/0412018 03/040019 EODILYIN.IURYF-0,U) S AUN80NLV ADI NONOVMEO PROPEflTV OAAUGE 1 AUTOSONLV AUTOS ONLY PorasiaM Medical payments 3 5,ODD x UMMR UAB CCCUq FACHCCCURRENOE 3 1.000.000 MESA UAB DICIUS E US055442304 08/2012018 031042019 AGGREGATE 31000000 DED I I RErexTION 1 $ MRSEERSCOMPENGAnox X snnTE is" ANDEMPLOYERVUABIDtt 500,000 B ANY ROPPETOWPARTNERIEXECUIIVE YO NIA V�MZ80080056582016A 0512212018 D512&2019 EL EACHACCIDENT s OFFICERIMEMBER EXCLUDED/ $00,000 mand.ry In Nm EL DISEASE-EA EMPLOYEE S if yea areae uiwr 500,000 DESCRIPTION OF OPEWIDNS IBM EL DISEASE-POLICY LWn S DESCRIPTION OF OPERAPCNS I LOCATUIRS I VEHICLES(ACORD 101,AIIIIN l RemeM SMJugm Bv a UBMBM M man BB-n BRI CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Clly M Nor nampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main St,SURE 3 AUTxowaR REVRESExTAmE NoMampton MA 01080 lit- So 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(201803) The ACORD name and logo ere registered marks of ACORD OLANDER DR-UNIT 7 BP-2019-0946 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31C-081 CITY OF NORTHAMPTON Lot- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2019-0946 Project JS-2019-001582 Est. Cost: $152000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SHAULPERRY 065400 Lot Size(sq.ft.): Owner. SUNWOOD DEVELOPMENT CORP zoning: Applicant: SHAUL PERRY AT.- OLANDER DR - UNIT 7 Applicant Address: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON:316/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.NEW CONSTRUCTION OF 1,248 SO FT SINGLE FAMILY HOUSE - 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 001: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occuoancv signature: FeeTvpe: Date Paid: Amount: Building 3/6/20190:00:00 $200.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0946 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 7 MAP 31C PARCEL 081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction NEW CONSTRUCTION OF 1.248 SO FT SINGLE FAMILY HOUSE-FOUNDATION ONLY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included' Owner/Statement or License 065400 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)tMATION 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 p 4247 ^ Signature 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. Department use only —� City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water[Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 7 -SITE INFORMATION This section to be completed by office 1.1 Property Address: ryn( O�M +CJ/i vC/F^"'�"•5r/O!� �'� Map/rLot (0 "/ Unit 0'0i o �'1 � Zone Overlay District 01 Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORRED AGENT 2.1 Owner of R/ecordnw�Qa : 1 / Name(P rt) Curte Mailin Ad ess: �.� Tele ho e Si re 2.2 Authorized Aaent. Name(Pant) Current Mailing Address. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building //0000 (a)Building Permit Fee 2. Electrical p0// (b)Estimated Total Cost of /oo 000 Construction from 6 3. Plumbing /C/000 Building Permit Fee —` 4. Mechanical(HVAC) 4Wi /l^f'1 v 5. Fire Protection / 000 6. Total=(1 +2+3+4+5) 1 1 4kV000 Check Number This Section For Official Use Onl Date Building Permit Number: Issued: Signature: BuiMing Commissioner/Inspector of Buildings // Date 6017WOOd @ (�YlMGo6t. flej- EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Sxtion 4. ZONING Ali Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tbir column to be filled in by Building ovemment Lot Size G.a 14'Z6— Frontage 'Z6Fronta e Setbacks Front Side U R: L: R: Rear Building Height Bldg. Square Footage on [9�� Open Space Footage % /O (lot nrea minus bldg&paved parking) N of Parking Spaces / Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/ the site? NO O DONT KNOW O YES }LJ IF YES, date issued: 8/9//B l IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW YES O IF YES: enter Book /�'LJ(J Page ,,,,,,......��(((( and/or Document q B. Does the site contain a brook, body of water or wetlands? NO Q1 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O ,,Date Issued: C. Do any signs exist on the property? YES O NO p() IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and [citation: E. Will the construction activhy disturb(de ng,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO ex IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Atltlition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Pd Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[[:I Brief Descnplton of,�P/7apasetltl// // �+ Work ' a2/11 Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 5a.If New house and or addition to existing housing. complete the following: a. Use of building :One Family�� Two Family Other b. Number of rooms in each family unit: \ Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. 444E Dimensions 6A r'r A e. Number of stories? �� f. Method of healing? ,�///xTOGI Fireplaces or Woodstoves�Number of each g. Energy Conservation C�ompli�ancee.. 40-S lh3 Masscheck Energy Compliance form attached?�.S h. Type of construction j ��j�L7z i. Is construction within 100 ft.of wetlands?_Yes _No. Is wnsimction within 100 yr. floodplain_Yes_No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. L Septic Tank_ CitySewer Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date I, aLi ,as Owner/Authorized Agent bareby declare that a statements and information an the foregoing application are true and accurate,to the best of my knowledge and belief. Signed u der the pains and penalties of perjury. Print Nam Sig of OwnerlAge Date / SECTION S-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holtler:� lrt/ 69-0(,,�Wae? License Number Address 0 Expi anon ate SigneytTelepnone ' 9.Re Istered Home Im roveman Contractor:: �//� Not Applicable ❑ ic Co Name Regisirehon Nmbar ,l# D/OOH Address O �i�nn Expir ion ate Telephone . ,f_iwy SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(6)) Workers Compensa0on 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....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered p Ekotrope ID:jL9B3x3d HERS' Index Score: Annual Savings Home: • • Jnit7, Northarnpton, MA 01060 331 "n 'l,", w ,,,rid, op Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[Motu] Annual Cort criteria of the following: Heating 6.9 $337 Cooling 0.5 $21 Hot Water 2.5 $115 Lights/Appliances 13.7 $634 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 23.6 $1,179 Home Feature Summary: Rating Completed by: ...,,� Home Type. Single family detached Energy RalamAdln Maynard Conditioned Floor Area: 1,221 s4 it RBNUID-WM52 Number of Bedrooms: 3 Primary Heating System: Air Source Heat Pump•Electric•3.66 CAP Rating Comprry:H15&HERS Energy Efficiency Mailing:12 Perkins Ave.Northampton MA 01060 c Primary Cooling System: Air Somme Heat Pump•Electric-19 SEER 4136588784 •'�xume s•• Primary Water Heating, Water Heater•Eleatic•3.24 Energy Factor House Tightness: 13 ACH 50 Rating Pmlder.Energy Raters of Massachusetts Ventilation: 422 CFM.20.0 Wafts 2 Wnodlawn Street Amesbury,MA 01913 Duct Leakage to Outside Untested 978-270-3911 Above Grade Walls: R-30 --- Ceiling: Astir,R60 m ren.•... Window Type: 1.1-Value:0.2,SHGC:0.25 C�y� e,.er�..4y 1O Foundation Walls: R-15 a o Arlin Maynard, ed Energy Rater Digitallysigned, Ilt2/18a[2:17PM • • • , lim�� DATE IMMNdYY1'Y) CERTIFICATE OF LIABILITY INSURANCE Dv182G1s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGNTS 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 cartifkete holder N an ADDITIONAL INSURED,UIe policy(lea)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,cub)ect to the terms and conditions of the pocky,certain policies may require an endorsement A statement on this certificate does not confer rights t0 the certMisats holder In lieu of such endoraemer iq. PRODUCER NAME' Linda PGWeB,CiRIS Webber&Gnnnell Pxoss _ 8-0111 AIc xM' H13)(413)58586-6481 8 North King Stleet A Ise.. IpowersgrwebDRrandgrinnell.com INSUREWS ATORDING60VERAGE RAIDY Northampton MA GOING tNSURERAI Ohio SewntylCiberty 24082 INSURED INSURER B'. A.IM.MUWaI Sulw+God Sunni Inc. INSURERO: Ohio SewnrylLiberty 24082 Ann Shaul Petry INSURER D M Poovine Lane IXWRER E: Amherst MA 01002 INSURER r: COVERAGES CERTIFICATE NUMBER: Master EXp3-2m9 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHONM MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILIP PE OF IN51111ANCERAIL P DYNUMMR .N EGNICY MMNMTYY LIMI3 COYMEACIALGFHERAWABILITV EgEXOCCURRENCE E 1000,GOOD DAMAGE TO XDN IFO OUIMSMAOE ®OCCUR EA rccumnm s 300,ODD AFT PAP(Any wN isnii s 15.000 A BKS554423M 03IDA2018 031098019 PERSONAL aADV INJURY $ 1,000,000 GEN'L AGGREGATE UNITAPEURS PER GENERALAGGREGATE 5 2.000,000 POLICY jET Q LCL PRODUCTS-OOMWOPAGG E 2.000,000 E OTHER AUMMOBIUS LIABILITY COMBINED SINGLE LIMIT F$ 50O ANVAUTO BODILY IWURY IPx ymn) $ A OVMED SCHFDULFO 9AS554433D4 031048018 OWMI2019 EODILY INJURYIPrt seadino ALT os ONLv AN -S nu os ONLY X AiJ1S iOY PROPERTY DAMAGE Memwl paymenis UMBRELLAOAB p(gUR EALH OLCUflRENCE EXCESS UAB CAI:.DE US055442304 08808018 031042019AGGRFGATE WORNE0.5 COMPENSATKKi X $TgTI1TE EORAND EMPLOYERS LIABILITYB ANY PROPRIErORmARTNErIlUTIVE YxlA VAA280080055582018A 05222018 05I2Z2019 EL.EACHACCIDENT GEFIOEflMEMBEREXLUI G(M.P.,NX) EL.DISEASE-EAEMPLOYEE OE6CRIPTION OF OPERATIONS Labw E.L DISE45E-POLICY LIMIT § 500,000 DESCRIPTIONOFWERATIONSILOOAPONSIVEHICLES ACORD 101,AEEXIonM ReIIaN$vin4ula,my XeeMCMElfmon epw larpullW) CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City M Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main St,Sude 3 AUTHORIZED REFRESENTATYE Northampton MA MORE, , ®19884015 ACORD CORPORATION. All rights reserved. ADORE,26(2016103) The ACORD name and logo are mgHtemd mato of ADORE, OLANDER DR-UNIT 8 BP-2019-0947 GIS a: COMMONWEALTH OF MASSACHUSETTS Mao:Block:31C-081 CITY OF NORTHAMPTON Lot- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2019-0947 Project# JS-2019-001583 Est. Cost:$152000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Green: SHAULPERRY 065400 Lot Size(sq. ft.): Owner: SUNWOOD DEVELOPMENT CORP zonlnz Applicant: SHAUL PERRY AT. OLANDER DR - UNIT 8 Applicant Address: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON:3/612019 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW CONSTRUCTION OF 1,248 SQ FT SINGLE FAMILY HOUSE - 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Cbimney: 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. Certificate of Occupancy Signature: FeeTVpe: Date Paid: Amount: Building 3/6/2019 0:00:00 $200.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File d BP-2019-0947 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 8 MAP31CPARCEL081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid vat Typeof Construction NEW CONSTRUCTION OF 1,248 SO FT SINGLE FAMILY HOUSE ham'+/IA-f New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 065400 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO MATION PRESENTED: proved_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: Cub Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Pertnit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management _Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all inning requirements and obtain all required permits from Board of Health,Conseryation 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. Department use only City of Northampton Status of Permit: % .>•1 '` ' Building Department Curb Cut/awewayPermit 212 Main Street Sewer/Septic Availability _ '! r Room 100 Water/Well Availability Northampton, MA 01060 Twp Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PloVSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office /,r, �riyU F S Ol7 LN t fl�J Map we . Lot a Unit I/off, �n 0/060 N1� �L Zone Overlay District St.District CB Dlatrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owmar of Record: Neme(P t) Cu,rer(t�3ailing�tJress: d Tele//{{ona re 2.2 Authorized Anent. Name(Print) Cunere Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only co leted by Permitapplicant 1. Building //0000 (a)Building Permit Fee 2. Electrical /p (b)Estimated Total Cost of O �4O Construction from Jai 3. Plumbing /V000 Building Permit Fee rN 4. Mechanical(HVAC) I//�OOO -`� 5.Fire Protection /1r� i 6. Total=(1 +2+3+4+5) Check Number This Section For Oficial Use Only Building Permit Number: Date Issued: Signature: Building Commisslanerllnspeclor of Buildings Date 161jl7woo @ �mcoGt. ncT EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) S;tlon 4. ZONING All Information Most Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be Had in by / �+I Building Oecparmvan Lot Size Frontage Setbacks Front Side L R: L: R: Rear Building Height Bldg. Square Footage % IVW8 Open Space Footage (Lot area minus bldg&paved arUb A ofParking Spaces Fill: aolume&Locaeion A. Has a Special Permit/Variance/Finding ever been issued �for/yn the site? NO © DONT KNOW O YES Olt IF YES, date issued: 9 /9/0 //TT IF YES: Was the permit recorded at theRegi try of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page �.rand/or Document# B. Does the site contain a brook, body of water or wetlands? NO W DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO le IF YES, describe size, type and Location: !l/C��"'"""" D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and Location: E. Will the construction activity disturb(deag,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? VES/1'30t NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Deere 0 AccessoryBldg. ❑ Demolition ❑ New Signs [0] Decks [I7 Siding[01 Other[CA Brief Des cri tion of P o Alteration of existing bedroom_Ves No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.If New house and or addition to existing housing, complete the following: a. Use of building:One Family—712(" Two Family Other It. Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached? Aln d. Proposed Square footage of new construction. 42W Dimensions 6& HU e. Number of slimes? f. Method of heating?�C/c� nG./ Fireplaces or WoodstovesNumber of each_ g. Energy Conservation Compliance. Ns 1J,3 Masscheck Energy Compliance form attached?,Y(S h. Type of construction i. Is construction within 100 h.of wetlands? Yes _No. Is construction within 100 yr. floodplain—Yes—No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Sepik;Tank City Sewer_ Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 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. Signature of Owner Date 1, kpt/ ,as Owner/Authorized Agent hereby declare that ih statements and information on the foregoing application are true and accumte,to the best of my knowledge and belief. Signed u at the pains nd penalties of perjury. a Print me Sign of Owner/Agen Date SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor f^/ Not Applicable ❑ Name of License Holder: gx /)/ / CIS-06 n License Number ✓� D DOot _ � Address Eapi. .ate jqj Sign [ Telephone H.Re Wintered Home Im roveme on metor. Not Applicable ❑ t r Cri4 vl�.��cl/t/ �/Jlli Gompa�/n!N]am/tee Registration Number Expiration Date' �---- Telephone jAl , SECTION 10-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....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered 1 p Ekotrope ID: Od4axGjv HERSO Index Score: Annual Savings Home: Northampton, 9001060 31 i�,� htr,,,rwf, , w ,,i r ,,jk ki hr,), Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[MBtul Annual Cost criteria of the following: Heating 6.9 $337 Cooling 0.5 $21 Hot Water 2.5 $115 Lights/Appliances 13.7 $634 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 23.6 $1,179 Horne Feature summary: Rating Completed by: wr,.v Home Type: Sirglefamilydetached Energy Raber.Adin Maynard Conditioned Floor Area: 1)21 s4 k RESNET ID:9463452 s Numberofiledrooms 3 _ Primary Heating System: Air Source Heat Purr•Electric•3b6 COP Radar Conspa^Y.HIS&HERS Energy EfBclency Primary Coding System: Air Source Heat Pump•Electric-18 SEER 413hiai65887812 4 Primary Ave.Northampton MA 01060 aeraerce m 4136588784 wme sao Primary Water Healing: Water Hearer•Electric-3.24 Energy Factor House Tightness: 12 ACHS0 Rating ProvldemEnegy Raters of Massachusetts Ventilamm 422 CFM•20.0 Watts 2 Woodamm Street Amesbury,MA 01913 Duct Leakage to Outside. Untested 978-2703911 ssF" '• �' Above Grade Walls: R-30 -- Ceiling: Attic,R60 m laNaan, Window Type: U-Value:0.2,SHGC:0.25 foundation Walls: R-15 x e A Maynard, Energy nergy Rater DigitllysigreCEll/2/18a224PM • • • ACC>R& CERTIFICATE OF LIABILITY INSURANCE 111 1 01/182018 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 INSURERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT. If the certHlcaut holler Is an ADDITIONAL INSURED,the pollcy(Ns)..at have ADDITIONAL INSURED provisions or M endorsed. It SUBROGATION IS WAIVED,subject to M.W.and conEMon&of Me policy,certain polkka may require an endorsement A statement on this cerMkets does net center rights to Me certiBeals holder In Il.0 of such endorsements). PRODUCER TACT"AME, Lind]P... CRIS Webber&Gnnne lPxONE (413)586-0111 (413)586-6481 I.,Na. 8 Norm King Street AooX..IN Ipowers@svebbelandgrinnell.com INSURER(UAFFO DING COVERAGE N.J.I NortM1amp tOn MA 01060 INSURENA: OMO Seourlty)DIDerty 24082 INSURED anuntm8: AI M.WDW SunI Buikers,Inc. mSUMENC: Ohio Security11-fly y 24082 Ann:Sr.ul PeM NSURER o 84 PoWiine Lane I : INSURER E: Amnerst MA 01002 INSURER E: COVERAGES CERTIFICATE NUMBER: Master Exp32019 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAV 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 LTR TYPE OF INSURANCE I.. POLICY NUMBER U MMND Y Us. COMMERCDILGENERALLIABIl1TY EACHOCCURRENCE E 1 000,000 CLAIMSMPDE ®OCCUR PREMISES Eama,nmca E 300,000 MED E%P A a E 15 000 A BKS55442304 03IN12018 031042019 PERSONALIADVINJURY s 1,000,000 GEVLAGGREGR LIMITAPPLIESPER. GENERALAGGROMTE y 2,000,000 POLICY ❑ O LCC PRODUCTS-COMPIOPAGG 5 2.000,000 OTHER AUTOMOBILELIABILItt CEO aNamaED151NGLE LIMIT E 1 000,000 ANVAUTO BODILY INJURY IParpelwnl B A OYMED x SCHEDVLED BAS55442304 03/042016 O3104201B eODILY I NJ URY me,.orm E A,U OT.NLY UTO$ x N10.E0 NO x-OWNED PROPEF, AMn .l y AUTOS ONLV AUTOSONLY pN,1 Medical Payments E 5,000 x UMBRELLA WBOCCUR EACHOCCUNRENCE y 1,000,000 EacESSUAB CUIMSMADE USO55442304 081202018 03104/2019 AG ,,O F 1000000 OED I I RETENTION E S WDN"ERSCCUAKNSIMBOV x PEPOHTH W - ANDEMPLOYERS' BILITV AT E B ANY NOPRIETORJFARTNEmE ECJTIVE YO NIA WMZKCSDDW582018A 0522/2016 051222019 EL EACH ACCIDENT E $ 500,000 OFFICENIMEMBER EXCLUDE% (Mandatary NNH1 EL°ISFASE-FA EMPLOYEE S 500,000 11 ea emame um' DESCRIPTION OF OPERATIONS amw EL DBFASE-POLICY UMIT $ 000,000 DESCRIPTION OF WERANON51 LOCANONS I VEHICLES(ACORD 101,Atl1 ammaMe sma4ulq may W"J[M]anamv as N nPulMl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City Of NOMampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main S,Sure 3 AUTHORNFL REPRESENTATIVE NoMampton MA 01060 01988-2015 ACORD CORPORATION. All right mServed. ACORD 26(2016103) The ACORD nem.and logo am mglatsrsd marks of ACORD OLANDER DR-UNIT 9 BP-2019-0948 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31C-081 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategorP New Single Familv House BUILDING PERMIT Permit# BP-2019-0948 Proiect# JS-2019-001584 Est.Cost:$152000.00 Fee:$200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SHAUL PERRY 065400 Lot Size(sa. ft.): Owner: SUN WOOD DEVELOPMENT CORP Zoning: Applicant. SHAUL PERRY AT: OLANDER DR - UNIT 9 ApplicantAddress: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON.31612019 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW CONSTSRUCTION OF 1,248 SQ FT SINGLE FAMILY HOUSE - 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy denature: FeeType: Date Paid: Amount: Building 3/6/2019 0:00:00 $200.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0948 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE IN AMHERST (413)259-1000 PROPERTY LOCATION OLANDER DR-UNIT 9 MAP31CPARCEL081 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Pad h Bu'Id' np rmtFlledo t Fee Paid NQ Tvueof Construction: NEW CONSTSRUCTION OF 1 148 SO FT SINGLE FAMILY HOUSE ruWl.r� •�' d New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 065400 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INMATION PRESENTED: 7(_/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: § _ Findino Special PermitVariance* 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 Storrn Water Management -Demolition Delay Signature of Building Official Date C 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/DdvewayPermit 212 Main Street Sewer/Septic Availability _ Room 100 WaterMell Availability Northampton, MA 01060 Two Sets of Structural Plane phone 413-587-1240 Fax 413-587-1272 Plol/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by oi�fice 0/M -4rr'jib/y arl.7 ? Map c� l c, Lot_in Unil 01060 ^\1 �� Zone Oveday District t r� Elm St.Distdd CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(P t) Cuneryy�allin� fess Tale hoMe Si re 2.2 Authorized Anent. Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building //0000 (a)Building Permit Fee 2. Electrical ///p�O (b)Estimated Total Cost of !< OO Construction from 6 3. Plumbing p 000 Building Permit Fee ^F! 4. Mechanical(HVAC) p/�OQO 5. Fire Protection / i 6. Total=(1 +2-3+4+5) Check Number This Section For Ofgclal Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of au4eings Date SJ/7wo0 @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. JZONINGAll Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning TMscolumn to b,filledIn by Building Dwarmrnt Lot SizeFronta e Setbacks Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % /O (Lot area minus bldg&paved rain 4 ofParking Spaces Fill: volams&Locatiov A. Has a Speciat Permit/Variance/Finding ever been issued for/ the site? NO O DONT KNOW O YES }p/ IF YES, date issued: S/g/e C IF YES: Was the permit recorded at the,R.e,g/i�try of Deeds? NO O DONT KNOW Q[) YES O IF YES: enter Book //��" Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO tw DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ODattee Issued: C. Do any signs exist on the property? YES O NO e IF YES, describe size, type and location: /" D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clIgilling,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO ex IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable New House Addition ❑ ReplacementWindows Alterations) ❑ Rooflng ❑ er Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [E:3 Siding M] Other[ Brief Descripption of poseQ/ / p / Work. 4A f Alteration of wasting bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet its.If New house and or addition to existing housing, complete the following: a. Use of building :One Family_ Two Family Other It. Number of rooms in each family unit: Number of Bathrooms_ c. Is there a garage attached? Aln _ d. Proposed Square footage of new construction. ,(d�(y Dimensions I/A K W( e. Number of stories? � f. Method of heating? C//Cc nC./,/�r�? Fireplaces or Woodstoves�Number of each g. Energy Conservation Compliance. 4E& Masscheck Energy Compliance form attached? h. Type of construction 41 1. Is construction within 100 fl.of wetlands?_Yes No. Is construction vnthin 100 yr. flaodplain_Yes No j. Depth of basement or cellar floor below finished grade / k. Will building conform to the Building and Zoning regulations? T Yes_No. I. Septic Tank_ City Sewer Private well_ City water Supply_ SECTION?a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS 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. Signature of Owner Date t // I, Ll �G/n/ ,as OwnedAuthorized Agent hereby declare that th statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed u der the pains and penalties of perjury. ArPrint e Sig re of Owner/Ag t Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: } o/re/ 6s-, /`fdn License Number Address Expi ation ate Sign t Telephone 9.Re a Im rov men om etor: Not Applicable ❑ Com an Name Registration Number olow Address Expiration ate Telephone SECTION 10-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....... No...... ❑ Home Energy Rating Certificate Rating Date: 2018-10-15 Projected Report Registry ID: Unregistered p Ekotrope ID:jL98GY4d • - x Score: Annual Savings Home: Co • • , /1060 331L in ,,I... I I! hi ,ind,- o,, Pc'!, ",i , • • Builders Your Home's Estimated Energy Use: This home meets or exceeds the U"(Matul Annuel Cost criteria of the following: Heating 6.9 $337 Cooling 0.5 $21 Hot Water 2.5 $115 Lights/Appliances 13.7 $634 Service Charges $72 Generation(e.g.Solar) 0.0 -$0 Total: 23.6 $1,179 Moms Feature summary: Rating Completed by: ...u� Home Type: Singlefanilydetached ■asrgYR•t•r.Ado Maynard Conditioned Fkor Area: 1,221 sq R RFSNET ID:9463452 s Number of Bedrooms: 3 Primary Heating System: Air Sourte Heat Pump-Ell-3b6 COP Flitting Comprry.H15&HERS Energy Efficiency Mailing:12 Perkins Ave.Northampton MA 01060 Primary Cooling System: Air Source Heat Pump•Electric•18 SEER 4136588784 PN rtrce — xome t•o Primary Water Heating. Water Heater•Dedtic-3.24 Energy Factor House Tightness 12 ACH50 Rating Provid•r.Energy,Raters of Massachusetts ✓ '1. Ventila0on: 422 CFM•20.0 Watts 2 Woodlasvn StmM Amesbu ry,MA 01913 j Duct Leakage to OuWde: Untested 978-270-3911 Above Grade Walis: R-30 Ceiling: Attiq RfiO n tmaNwix Window Type: U-Value:0.2,SHGC:0.25 G�O� uoc�•y w foundation Walls: R-15 xmK o �r,a AEIn Maynard,CeEnergy Pater Digitally signed: 11/2/11/V1 B at 245 PM ACil CERTIFICATE OF LIABILITY INSURANCE 0111812019 THIS CERTIFICATE IS ISSUED ASA 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 INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the cerUlceM holler is an ADDITIONAL INSURED,Ne polloy(les)must have ADDITIONAL INSURED prorislons or be endorsed. N SUBROGATION IS WANED,subjection Ne term;and con0lUons of Ne pol cartel policies my require an endorsement Asi meMon this ceMic deals not confer rights of Me urtMcab holder In Iku of such endomemanNs). P.CER NAME: LInd3PoyUde CR1S Webber B Gunnell PxOxE ed', (413)Sel X'l (413)586-6481 B Noll et King StreADDRESS: I hossf 5tirNebbemreognar elicpm INSURERISI AFFORpNG COVERAGE NARX NOMarrol MA 01080 II4sURERAOhio SeruntylLiteny 24082 I.W. INSURERB At M.Mutual Sun Wood Builders,Inc. INWRERC: Ohm Ser ntylLlberly 24082 AM:Shaul Parry INWRERO: 64 Poll Lane INWRER E'. Amherst MA 01002 Ix WRERF: COVERAGES CERTIFICATE NUMBER: Master Exp 3-2018 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWATHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO VMICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU&IECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY Hil BEEN REDUCED BY PAID CLAIMS. IN TR TYPE OF INSURANCE INR. POLICY NUMBER MRIN MYYYY MMNWWYYUs. x COMMERCIALGEHEAALWBIU- 66HOCCURRFNCE S 1,000,000 FINISMACE ©OCCUR PR MI5 s 300000 MEOEXP AEemre s 15,000 A SKS664423N 03/04/2018 03/04/2018 pERWxALSAON,,,,RY $ 1.000,000 GEN-AGGREGATE LIMITAPPUES PER. GENERALAGGREGATE $ 2.000,000 PIX1CY PET LCC PRODUCTS-COMP'OPAGG S 2.000,000 OTNE, AUTDMOSILELIA&Lll COMSINEDol HIM' s 1000000 sel VAUTO ece"ILuRY(Fa osml S A oYlNED scxepmED BA355442304 03/04/2018 03/04/2019 eooav Nmxv lwr.aremp $ AUTDSDNLv UTos HIRED NON OVMEO HFCERTYOWAAGE i x AUTDS ONLY AUTOS ONLY Px and Medical payments S 5,000 UYBxEL1L HAN "I FACT OCCURRENCE S 1.000.000 EXCESS VAS OIAIMSMADE US055442304 08/2612018 0310412019 AGGREGATE S 1,000,000 Cf0 I I RETENTION$ s AOR`ERSCOMPENSATON PER OTH- ANDEMPLOYERS'LIABIl STATUTE ER B OFFl0. Y rvrCE0PO ? RCO M28008006582018A OSI22R018 05/201REEErEL EACHACCIDFrvT $ 500,D0 MBaFxwll 9 500 000 IMmEtlayll ELOSEASE-EA EMPLOYEE S IF yes dmvlb under W0000 DESCRIPTION OF OPERATIONS Mon' E L 015EASE-MLICY LIMIT i OESCNPTION OF WEMnMS I LOCATIONS I VEHICLES IACORH 101,Aryou aRalScMEula,may M aXaoMd If monepaw le requlrMl CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cly Of NOMarrol ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main SI,Sul AUTNORRED REPRESENTATIVE A NaNampton MA 01060 h/��D r O 1988-2015 ACORD CORPORATION. All righb reserved. ACORD 26(2018101) The ACORD nem;and bgo are re0bbred=m of ACORD City of Northampton Massachusetts ti DEPARTNENT OF BUILDING INSPECTIONS Ell Hain Street •Hunicipel Building V" C HortE' to., MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from rconstruction work being performed at: O/ulrOc! V/ivt� �x7N5lO!/ (Please print house number and street name) Isto be disposed of at/: 'n Va�/a r JJc c.�rJlna — Oot7rl rd/. /✓o�.Y// m�7lO n ,{�D1060 Please print n nd lcat 66aYoy)m2 } Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Q /tP / SigWure of Permit Applicpl or Owner Dat If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. �\ The Commonwealth ofMassaehusetts Department of IndustrialAccidents I Congress Street,Suite 100 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 Leathly Name (Business/Orgaannni�mti//oMndividml): ']urlw 1 / '1�$ Address: /SJ'atweire. Ln.rc- ��5; N� O/00%2 City/State/Zip: Phone#:�/3 Amyouan employer?Check the appropriate box: TypeO project(required): 1, I am a employer with employees(full and/or pmt-fimel." 7. New construction 2!!!❑1 I am a end maintain or tormentor and have no employees working for me in $. Remodeling any capacity.(No workers camp,msumnce required.] 3❑1 am a M1om orwner doing all work myself.[No workerscomp.insurance requited.]' 9. ❑Demolition 4.❑I am a homeowner and will he hiring contractors to conduct all work on my property. I will 10❑Building addition enserethatalleonvacmrs either have workers'emerwanmor wsurnevem ue sole l L❑Electrical repairs or additions proprietors with an employees 12.❑Plumbing repairs or additions i❑lama gcnemltxwmr,or haand1havehiredthe hve warkers'caslistedon the`trached sM1eel ]; Roofrepairs These subeonuamors have employees and havewotkea'comp.ivsmama 6.❑we are a corporation and to officers have exercised theirrighmfexunption pa MGL c. 14.❑Other 152.§I(4),and we have no employees.[No workers comp.insurance required 1 * Any applicant that checks box#1 must also fill oar the station below showing their workeri compensation policy information. t Homeowners who submit Nis affidavit indicating they are doing all work and then hire outside community must submit a new affidavit indicating such. 1Cmuse us Nat chink this box must attachW an additional sheet,howing the name ofthe sawemaacmrsend cram whether en not those entities have employees. If Ne subwntractors have employees,they most provide their workers camp.policy number. I am an employer that's providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance CompanyName:�1� Policy#or Self-ins.Lic.#:_�/ BG1780(//,AT/ rY/f�/[3� Expiration Date: 4 Job Site Address: 01.4' 0',Vu ge r> '5'd rr City/State/Zip: 01460 Attach a copy of the workers'compensation policy declaration page(showing the policy number aexpiration te). 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. Ido hereby certify nder t e pa' and penalties ofperjury that the information provided above is true and correct. Signature: A / Date' Phone#: �fylj -(cr�lo ' Official use only. Do not write in this area,to be completed by city or town official City or Town: PermtULicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 7.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I i LLA , _a e :e ct i 1 g 11 , , , i i , 1 d\ , , , , i , n . I y qJPmUmrWlm Louis Hasbrouck<lhasbrouck@northamptonma.gov> lv�; Fwd: Re: Cohousing O&M 1 message Doug McDonald<dmcdonald@northamptonma.gov> Mon, Feb 4, 2019 at 9:13 AM To: Louis Hasbrouck<Ihasbmuck@northamptonma.gov> Louis, See my latest email below to Jeff Squire and Shaul Perry regarding the Stonnwater O&M Agreement. I have been working with them to finalize the O&M Agreement. Thanks, Doug ---- Forwarded Message ------ Subject:Re: Cohousing O&M Date:Wed, 30 Jan 2019 09:35:35 -0500 From:Doug McDonald <dmcdonald@northamptonma.gov, To:Jeffrey D Squire <jeff@berkshiredesign.com> CC:Shaul Perry <sunwood@comcast.net>, Christopher Chamberland <chnsc@berkshiredesign.com> Hi Jeff and Shaul, Thank you for sending the draft of Attachment A to the O&M Agreement for Village Hill Cohousing. Chris Harlow had sent another version of Attachment A so you will need to work with him to finalize one version of this. We will need to receive a full draft of the 0&M Agreement and Attachment A for review. I have not seen the draft of the Agreement itself.A template for the Agreement and Attachment A is attached.The Agreement will also need to include reference to the recorded documents that define the ownership and responsibilities for maintenance of the drain line and treatment chamber that will take drainage Flows from this property as well as the Community Builders site and reference documents that allow this property to discharge to the detention basin owned in common.These references should be included in an Attachment B to the Agreement and should be reviewed by the owners lawyer. The draft Attachment A needs additional revision including the following: 1.Attachment A should be labeled as such and should describe only the post-construction 0&M. The section for "During Construction"can be cut. 2.Catch basins are specified to be cleaned annually or more often if required. Please replace"if required"with a clear statement such as when the sump is greater than 50%full. 3.The Stormwaler Treatment Chamber O&M section is confusing.The specification of when to clean the structure should clearly say one time when to clean the structure and should include a statement to clean it at least once per year. The draft text says to clean it when sediment is 6"deep and when the level of sediment is 75%full which are not the same thing.Which is it? Please send a draft of both documents back to myself. Once these documents are complete and approved by the DPW the Agreement will need to be signed by the owner and an original returned to myself. We will take care of signing by the Mayor. Please do not submit anything directly to the Mayor's office. Let me know if you have any questions.)will not be available today, but I will try to review revisions quickly when they come in. Thanks, Doug