31C-081 (4) 1 I7 0LANDER DR-UNIT 2 BP-2020-0001
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31 c-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-2020-0001
Proiect# JS-2020-000001
Est.Cost: S 159000.00
Fee:$200.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Group: SHAULPERRY 065400
Lot Size(sp.ft.): 273873.55 Owner. SUN WOOD BUILDERS
Zoning:vv Applicant: SHAUL PERRY
AT: 117 OLANDER DR - UNIT 2
Applicant Address: Phone., Insurance:
84 POTWFNE LN (413) 259-1000 WC
AMHERSTMA01002 ISSUED ON:71112019 0:00:00
TO PERFORM THE FOLLOWING WORK:SINGLE FAMILY HOUSE Type#3 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.
Certfcate of Occupancy Signature:
FeeTvoe: Date Paid: Amount:
Building 7/1/20190:00:00 5200.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File q BP-2020-0001
APPLICANT/CONTACT PERSON SHAUL PERRY
ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000
PROPERTY LOCATION 117 OLANDER DR-UNIT 2
MAP31c PARCEL081 ZONE Dv
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /i dot
Fee Paid2 0
Tvveof Construction: SINGLE FAMILY HOUSE
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
INF9*MATION 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 �//�
G�/�- 7/t / 19 _.
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,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 or Permit
/ `^^ Building Department Curb CuttDriveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
\ t Northampton, MA 01060 Two Sets of Structural Pians
phone 413-567-1240 Fax 413-567-1272 PlotiSile Plans
Other SpecBy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENO)F 1TE OR DEM SH ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1 1 '( 4 s Ion to be competed by office
// 1Q 1 �� Lo! unit
V/�r( 9' OE''TT ❑UII DINr;INSPEOTlON9
N "APT N. A01CT1
N Overlay District
` EM St dental CB DisMct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
Name(PrintMmli ass'
T
s
2.2 Authorized Aaerd:
Name(Pdnq Current Missing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
wrrl leted b It applicant
1. Building /�O000 (a)Building Penna Fee
2. Electrical ,,//nM (b)Estimated Total Cost of
.l'7Construction from 6
3. Plumbing nirn Building Permit Fee
4. Mechanical(HVAC) r
S.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Seadon For Official Use Only
Building Permit Number. Date
Issued:
Signature:
Bulking Canmisslonerllnspector of Buildings /1 Date
/'11N000Y/ @ 60 1/
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 Depnmment
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear _.
Building Height
Bldg.Square Footage / !�
Open Space Footage
(tat ama minus bids a paved
p ofParking Spaces
Fill:
wlume a launw
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O ON KNOW O YES
IF YES, date issued: a'V
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YESO
IF YES: enter Book [ JX3 i Page.. A0 �� and/or Document p�_ _
B. Does the site contain a brook, body of water or wetlands? NO a/ 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: I
C. Do any signs exist on the property? YES {X) NO O
Yri W 4additions
D. Are there an proposed changes to or additi
IF YES, describe size, type and location:
of signs intended for the property? YES O NO Rr
IF YES, describe size, type and location:
E. Will the construction activity disturb(dee'rg,grading,excevation,or filing)over i acre or is it pan of a common plan
that will disturb over 7 acre? YES NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑1 Decks [❑ Siding=1 Other[CA
Brief De Iptim)of Prppos d S610114,2
r�� v- / y
Work: (.enc). yY n i cJ 1.vn/✓ l�i rrb,Yl °..7�B157d
Alteration of existing bedroom es No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yea No
Plans Attached Roil -Sheet
ea.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: L3 Number of Bathrooms
c. Is there a garage attached?
r /
d. Proposed Square footage of new construction. /n Dimensions e�46 /` <V
e. Number of stories? d/
L Method of heating?^�/rei'�/."c/ Fireplaces or Woodstoves Iv. Number of each
g. Energy Conservation Compliaante. Masscheck Energy Compliance form attached?
h. Type of construction /r1
I. Is construction within 100 a.of wetlands?_Yes No. Is construction within 100 yr. floodplain_Yes 4No
r
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
SECTIONTe-OWNER AUTHOR17ATION-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 Wilding permit application.
signature ofOwner n/ Dole
I, r�Ll Y4,2y as Owner/Authorized
Agent hereby declare th t the 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.
Print N me
sig o Owns
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction S rvisor. Not Apppplicabllee ❑
Name of License Holder: !n"1�ay54,
l nse Numb r
00z '
Weare®e Emi run aro
1
Sig re Telephone
0.Be!t rad Ho a b r v m Contractor, Not Applicable ❑
, n 3rt�aelS 101230W
Company Name Registration umber
Address
ExplafillonDath
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,l 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 Affidavit Attached Yes....... No...... ❑
City of Northampton
Y S
Massachusetts 44�
i
DBPARTNSNT OF BUILDING INSPECTIONS
212 win Stxeet •Nmicipal Building
aortwvpton, MA 01060 O
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 construction work being performed at:
f
(Please print house number And street name)
Is to be disposed of at:
(P ase prin am cation atfacility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
4j —
Si of Permit plicenr caner Date
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 of Massachusetts
Department of IndushialAccidents
I Congress Street Suite 100
Boston,MA 02114-2017
wwmmassgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Eimtricians/Plumbers.
TO BE FILED WITH THE PERM MNG AUTHORITY.
Applicant Information Please Print Leeibly
Name(Business/OrganiaatioMndividual):
Address,ap`�p�yf "y //'','3
City/State/Zip: Phone#: 11ZIff-/0jqO
Art tease employer?Chas the appropriate box:
Type/of project(required):
1]fll am a employes with employces(full eater pen-time).• 7, prl New construction
2.❑Iamemle proprietor orpermership edbm no employees workin6 torwitn g.L❑—Remodeling
ony cnpadty.Mo women'comp.hue a rwuired.]
).❑Isora hommwnerdoing all work myulL[No woherscomp.insumve r uhed.)t 9. ❑Demolition
0.❑1 um a housaweer and will be hmn6 oonnoomro N conduct all work oa my pmp . twill 10❑Building addition
evaore tenet conuectom eiNe howwohvs'compeemion iosumnce,m are ale II.❑Electrical repairs or additions
P.P.W.with lm employees. 12.❑Plumbing repairs or additions
5.C3 I..genera conmemrvM I have hind use sub<onteaetms listed on Ne attached shett. repairs
Thane sub-cwtrecton haveemplolwa and hove worken'comp.wne
suce.r 13❑Roof[e p
b.❑We arc a corporation end its officers have exeuied dwirright ofesemption par MGL c. 14.[jOdeer
152,g1(4),end we heve no employees.[No wockere'comp.irmvmnce reauaed]
eMyapplicant estcheeks 1,ox#1 must also 911 out the senion belowshowing their workers'con aea,,policy informefion.
t Homeo .who submitrids atTWavitandkefin,the,arc dean,all work end Neo hire outside contramors mustsubmit a aewaffidavit indi®fin,such.
tconmctan tat check an,loos nnsn Oulal an addNonal shin showivg Ne name of the sub-cootractors and smte whiter or not Nose entities have
employees. Ifte sub-covaanors have employes.Ney mustpmvide Nov workers comp-policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
&C Insurance Company Name: 'F•I// Y�is p 9
Policy#or Self-ins.Lic.#: W,flZ8a�8ah:�f��lfo'O�y.4 Expiration Date: y760
/�k
Job Site Address: � O�ir1dU lY/ City/Smte/Zip: )100
Attach a copy of the workers'compensation policy declaration page(showing the policy number and apiration 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification,
I do hereby cardfy oder t p and penalties ofperjury that the information provided abis true and correct
Signature' Date'////,Z/9
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CORd CERTIFICATE OF LIABILITY INSURANCE eRT06OCyM2019
2U2U19
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. If Me c.M cam holder Is an ADDITIONAL INSURED,the policy(w)must have ADDITIONAL INSURED provisions or be endowed,
If SUBROGATION IS WANED,subject to the brill{and conditions of the policy,cervin pollcMa may require an endorsement A statement on
this carfi icata does not confer rights to Me uMl ft holder In lieu of such BndoreanlanRs).
MCD.ER NA.ETACT L.M.P. CRIS
Webber B Grinnell si m (413)586-0111 ga: (U 3)500-0x01
8 North Kir,Street A ys. Ipowen®WebberandgMan lloorn
INWW eAFPoRBxe CBV W x11Ca
Northampton MA 01080 NSURFRA_ Union lng0cadM 26044
INSURED NSIJRah 8, AIM 337N
SumvoM Development CorporaM IggpRERC, Acedia ln.mde CarlXeny
AM Shaul Polly IX9rIRENO:
BO Pob'l.I-N. INWU E:
Amherst MA 01002 NSURERF:
COVERAGE$ CERTIFICATE NUMBER: Suramod DeV Exp 3-2020 REVISION NUMBER:
THIS IS TO CERTIFYMKT TIE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ME POLICY PERIOD
INDICATED. NOTMIHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VAM RESPECT TO VMICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL ME TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMSNSR .
LTB TYPE or INSURANCE pd1CY XDYEA YMrLpVWY YN Miami
COMYERCIALGINEIULI-A&UTY EACH ccassa E F 1.000.000
CWMBMACE ®OLL'JR S 3000W
MEDw s 10,000
A CPA5381469 03IOInolq Da101n020 FBIspxLLeAu,NJUAY f 1.000.000
Gar-MOGREGATEUMITAPPLIESI£x. GE .AGGREGATE { 2+000.000
r ❑FRO
JECT LCC PRCWCTS-CCMPgPAGG f 2,000,00o
OgCUMERc'. {
AUTO..,.UA9'Um 'Easoodern NIXELIMIT F 1 gOp gpp
SONLYIWURYIPrteari X
AHA.YAUTO
ChainOXLY SCHEDULED MAA5381470 03IW2019 03IO4n020 eODRYIWURYIFar®1ae s
A.
HIRED xIX40MIFD i
AUTICS LY ANGadIYPareadeem
Medical Daylrlens, a 5,000
UYBRFILALW .CUR EACH OCCURRENCE a
E%CE98llAe CLNYBIHOE AGGREGATE i
OFU RETEND041 i
MORI{FRBCOYPB19AlIM PB1 OT4
ANY
ANO EYPLOvme WB1Jry
YIN
EDuTNB
ELLEACHACCIDE
FPoAIBILIYPILGIMYmEE 5�o0'•W�D
B E"FRFCM XIA M052o1A 05,2212019 OSn2/1020 R
da.ub,ImEL d$FAPE
pMeeaw
gIR0Nl OF D1£RPTOX9NoEL dSFSE!
C Builders Rlak App SR VILLAGE HILL CO 05I3012019 05Mn020 Building 57,100000
OE%NIIIIXI OF OPEMTIXIBI LOCAlNM01A£IIIGFB MCd101N,AYNNontl Rxnlb 6MMuM rM'd MH<MtlMman FpwHIpMMI
CERTIFICATE HOLDER CANCELLATION
SHIDULDANY OF MEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ME EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Ca,Of N inhiar ton ACCORDANCE WITH THE POLICY PROVISIONS.
240 Main St Suite 3
AUTIORDED REPREWNVmW
Northampton MA DINO {. A— -DL
01$88-ZOtSACORD CORPORATION. All rights monad.
ACORD 25(201&03) TMACORD nm.nd logo..lXgbbIW annuls of ACORD
City of Northampton
' Massachusetts i Q
DBFARTNRrr OF BUILDING INSFBCTIONS
212 Nein &tree[ a M icipal &"1l og
Nortbu [on, Na 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstrucb'on,aNeretion,renovation,repair,modernization,conversion,
improvement removal,demolition,or construction of an addition to any pre-existing ownero upiad building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.if rhe homeowner has contracted with a corporation or LLC,that entity mast be registered.
Type of Work: '444 ha/C .vy.S7i,�lc�ffEst.Cost:
Address of Work:
Date ofPermit Application:/�9
I hereby certify that:
Registration is not required for the following resson(s):
_Work excluded by law(explain):
_Job uoder$1,000.00
_Owner obtaining own permit(explain):
_Building not ownero upied
Otter(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBH,ITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for ding [11 a owner of the above property:
f / lour
Date Owner Vane anawature