31C-081 117 OLANDER DR-UNIT I 1 BP-2020-0004
GIS#: COMMONWEALTH OF MASSACHUSETTS
: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-2020-0004
Pro ject# JS-2020-000004
Est.Cost$164000.00
Fee: $200.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use GMUD7 SHAULPERRY 065400
Lot Size(sa.ft.), 273873.55 Owner: SUNWOOD DEVELOPMENT CORP
zoning: Dv Applicant. SHAUL PERRY
AT: 117 OLANDER DR - UNIT 11
Applicant Address: Phone: Insurance:
84 POTWINE LN (413) 259-1000 WC
AMHERSTMA01002 ISSUED ON:7/1/2019 0.00.00
TO PERFORM THE FOLLOWING WORK•NEW SINGLE FAMILY HOUSE Type #5
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 7/1/20190:00:00 $200.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0004
APPLICANT/CONTACT PERSON SHAUL PERRY
ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000
PROPERTY LOCATION 117 0LANDER DR-UNIT 11
MAP3lc PARCEL081 ZONE ov
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building.Permit Filled out if TT
Fee Paid
TvoeofConstruction: NEW SINGLE FAMILY HOUSE P/ 5V"0„ '�
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,PMATION PRESENTED:
pproved_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 Del/ay / n
/Gam✓ 610 t
Signature of Building Oficial 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
i City of Northam ton Status D Perm t:
Building DepaA alit Curb Cu Drive ay Pemii[
/ 212 Main Stre t " ) Ivens ptic vailabildy
Room 100 WaterAN II Av liability
Northampton, MA 1 pT OF em101Ne II Wassail St cturel Plans
phone 413-567-1240 Fax 1 W nTDN
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1A Propeft Addissac
I 1 >This section to be completedfleby office
U/i U/1r'j // Map J�1-- Lot ntt
Zona Overlay District
Elm St Dlstrkt CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
2.1 f fL /a/
Nemo(Print Curre Yln A�ass:
Tele tune
Slgn
2.2 Authorized Aaent:
Name(Print) Corson Mailhg Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)M be Official Use Only
completed by rmit applicant
1. Building f ` ./ooO (a)Building Permit Fee
2. Electrical 71 /OLJ (h)Estimated Total Cost of
Construction from 6
3. Plumbing wo Building Permit Fee
4. Mechanical(HVAC) /O r+(.v(./
5.Fre Protection
6. Total=(1 +2+3+4+5) Check Number 300
This Section Fw Official Use Only
Building Permit Number: Data
Issued,
Signature:
Building Commissionerllospector of Buildings Dais
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Ll .. �:.:.L.. .. '.o
t
•gym
Section 4. ZONING All Information Must be Completed.Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This wlumn to MW in by
Build gDepmmeot
Lot Sin ! l
Frontage
Setbacks Front
Side L: R: Lc R:
Rear
Building Height
Bldg.Square Footage Aw
Open Space Footage % -
(a,. in.bldg&pved _
g of Parking Spam
Fill:
volume&Wwdw
A. Has a Special Permit/Variance/Finding ever been issued�for/r/on the site?
NO O DO/N OKNOW O YES W
IF YES, date issued:!.?/7/(� -'I
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YESO
IF YES: enter Book ' /$/�3 Page' /�Q and/or Document#.
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q
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 A NO
IF YES, describe size, type and location: i�// ot-�tnrTlJ!!t J t�n.�l�n}rncrJ'
D. Are there any proposed changes to or additions of signs intended for_the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(c��l aa ng.grading,excavation,or filling)over 1 acre car Is it part of a common plan
that will disturb over l acre? VESAr NO O
IF YES,Men a Northampton Storm WW`att'er Management Permit from the DPW Is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
Now House U�1 Addition ❑ Replacement Windows Alterations) Roofing
Y" Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [a Decks [I--3 Siding Ipl Other[C�
Brief Desc' tionJ�'(�Propo ed
ucJ.Mk oMCI
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Naria" Renovating unfinished basement _Yes _No
Plans Attached Roll -Sheet
ga.If New house and or ad ition to existin housing, complete the follcril
e. Use of building :One Family Two Family Other
b. Number of rooms in each family unit:_ Number of Bathrooms_
c. is mere a garage attached? Alb
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? t
I. Method of heading?�C/ Fireplaces or W oodstoves A/-_Number of each
g. Energy Conservation Complialince. Masscheck Energy Compliance form attached?
h. Type of construction :A /A/�_ —
I. Is construction within 100 n.of wetlands? Yes :No. Is construction within 100 yr. floodplain_Yes,.N:fNo
J. Depth of basement or cellar floor below finished grade e
it. Will building conform to the Building and Zoning mgulaflons? Yes No.
I. Sepfic 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 permlt application.
Signature d Oener Deb
I, as Owner/Authorized
Agent hereby declare that the statements and Information on the foregoing application are We and accurate,to the beat of my knowledge
and belief.
Signed and a pal en pgt{al%as of perjury.
Print
signawdAgent Da
SECTION 8•CONSTRUCTION SERVICES
.1 Licensed Conshaction S evi Not Applicable
❑
Name of License Xoltlar. es'o��_
License Num
Atltlreea y EW eon
al u Telephone
9.Realstared Home re Cart ctor. Not Applicable ❑
L 4• ,��
Co aMl NNamame Registration I mbar
.3�/ r'� �nfierst M 0A90V Z.
Address f y Ezpr ion att;
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.Follure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
City of Northampton _
Massachusetts
DS12 ftin T OF BaI icl 18S 1d"g
CTXCWS
112 Main 9[av�C •Mmicipsl 6uildinq
aottLemptoe, W 03060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, 1 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:
lj- f'OLL 04 -;E//
(Please pant house number bnd street name)
Is to be disposed of at: / 1
.-.�>�N j /y��jo�rnpla//
(P ase prin amgya cation ffacility)'� /
Or will be disposed of in
a dumpster onsite rented or leased from:
(Company Name and Address)
JSiof Permit plica �r 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.
•..ti �
o .:.. .'
C-N The Commonwealth ofMassaehusens
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
VIV,urkeds'Compensation Insurance Affidavit Builders/Contraakors/Electriciane/Plombem
TO BE FILED WITH THE PERNTITING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Orgmiznationnndividual): jlzrfwa�j All
Address: sw w, lav Le .9
City/State/Zip: Phone#:
Are you an employer?Chair me appropriate bee: Type of project(required):
lei ma.meN__
playm wi _�T—emplayemthat].&at pan-time).` 7. RI New construction
2.❑lamaeole propdemrmpertamldP and have no ermployem working formein 8.GG❑"Remodeling
any cepaclty.[No worries' W.iouvance required]
3T1 oma homeowner doing all work myeelf.(No wmkas'comp.nmmeme an mod.]t 9. ❑Demolition
4.0I she a homwumer and will he hiring ronamemn an conduct all work on my mount. I will 10❑Building addition
amore that ell romaecmn eiNerhave workers'cougwwmw.iwusay.or ate sole 11.❑Electrical repairs or additions
,motion.with ao employees.
12.❑Plumbing repays in additions
ranatuareas how, ave dihaveta�the eub-rovs' hired ontheatmched sheet.
These sub-rovtracmn have employeem and hwmkoen'comp.insunoaz.i 13.E]Reof repairs
6.❑We arc a corporation and its otfianhave ameised their right ofournamiom pm MOL c. 14. Other
152,§1(4),and we have no employees.[No workw'sump.wsunam required.]
"Amy awficamt the checks hos#1 must aim all mm the section below showingdark workers'wmprneation polis,informmion.
t Homeowners who submit this affidavit indicating they are doing all work and Nen hate outside contncmrs must submit a new,affidavit indicating much.
rConmectorc that check this box mart amchN an additional sheet shown,the name altar sub sonewtors and state whether or not those entities have
employees. Iffcmbcovtnmorshaveemloy s,feymartprovide Neo workerscomp.politynumber.
lam an employer that is providing workers'compensation insurancefor my employees. Below is the policy and jab site
information.
Insurance Company p
Policy#or Self-ins.Lic.#: YYA�ZBQ78Ql.LS/d�B�Of fi� Expiration Date: �1�n�,n�,� kr�/�i
Job Site Address: ��(J/ot/tYrl rl// City/Statelzip:'�� a/✓w
Attach a copy of the workers'compensation policy declaration page(showing the policy number andW plration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up in$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.
l do hereby cerdfy nder p and penaltiu ofperjury that the information provided abov is"rand comca
Si Z I����
Phone#: ?!>---2n
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#:
c Rd CERTIFICATE OF LIABILITY INSURANCE W E ON
NDM VI
Dsnen019
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERAFICATE DOES NOTAFFIRMATTVELY 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: If the certificate holder Is an ADDITIONAL INSURED,the policy(bs)must have ADDITIONAL INSURED provisions or he endorsed.
It SUBROGATION IS WAIVED,subject to the terms and coodldons ofthe policy,certain policies may requlrean andoe nt AstatarrMmon
this certificate does not confer rights to me cNtMkab holder M Has of such endoneenum qab
PnaoucER CONI
MYE: Linda P.,CRIS
Webber S GrinnellPxaNE (a1315SBB111 (H3)366JM61
NNE
8 NDM King Street Ap55. IpMven®xebOWaINIpNNNNI mm an,
INSURE SAFFORpraICOV OE NAIL.
Northampton MA 01060 NNJRINA: Union INNAcadla 25844
NWRED INSURER a'. AIM 33758
SumvOod Devebpmend Corporation INSUMRC Acedia Inwmrlce Company
AN SMuI Pen, INSURER o:
BO POtYAte Iane WXUMRE:
Arosest MA 01002 INSU F:
COVERAGES CERTIFICATENUMBER: SuIMNadDNYExp3-2020 REVISION NUMBER:
THIS IS TO CERTIFY THAI 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 CONDUCT OR OTHER DOCUMENT WITH!RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERFAIN,THE INSURANCE AFFORDED BY ME POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXOLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY MID CLAIMSINN —1—i HAI.
Era TYPE OF INMIMNCE POLICY NUM. MYIDtlIY1'Y MMIC LJMnS
COMMMCMLO.J MB EACNOCCURRENCE f I.ODD000
CWMBIMOE 19OCCURa wwo
MEDFARLARc,aRi a 10.000
A CPA5381169 1131012019 OOdNNOOM PBbOALaAmili' a 1•�•�
OENLAGGREGATE UWTAfR1F8PER: GENEM AGGREO TE 2.00D•DOO
POIJCY �JFyT O U. PRCp1CTS.COMAOI f 2.000.000
OT ER'. a
AUMMMU MBIMTY CCMBINEDMNGIELMIT f 1,000,000
ANYAUTDILY INJURY(Parani f
A O BODILY
SCNEDIJi MAA53811T0 03101/1019 0310/12020BODILY INJuflY IVN.nMeW a
AUTMgILY AURIC
R
HIRED NOHiOMNED
AUTOS p1Lv AUTMONLY a
Medical pymanb f 5.000
UMBREl1A lMB OCCUR EACH CCCURREHLE f
EYCESSMB GAy61MCE AWRE0.AlE f
pIU I I N1F` ILII a
==ERS COMPENSATION P OTR
AND EMR-OYERS UAIMUTV YIH
B oFrIGERMEMeFP ExcwD oaEcumE ❑ NIA WMZBOOBOD6B5820t8A 05122/2018 05/2212020 EL.FACNAcclDsrrt f 5�•�
Mawar re nXN) EL.NBFASEEAEMF-OYE£ f S0'NQ
umi.e....r
CESCRITION OF OPERATVJXS EMavI I E1-.OBEg9E-IgUCY UNIT f "QO'ND
C Baker,Risk APP BR VILLAGE HILL CO 0511N1019 OS/3D2020 Buildn' $7.400,000
OEFCRWfNMI OF aPE ..IIAC1TgNBN,WN mW.red ...kImM RnubcuRA'-mry MMMMFa Msw.M't.IF iepi.0)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS.
200 Main St,Suite J
AUTIN:NiEII REPRE5ENTAT E
Northampton MA 01060 IJA- r'
01366-2015ACORD CORPORATION. All right,starved.
ACORD 25(2 01610 3) The ACORD name and logo are ragletersd mads of ACORD
_ City of Northampton
Massachusetts
DEPAR!r E'W OF BUILDING INSPECTIONS �I
212 Min Street • Nunicipsl Bui1GLq
\ aorthv tcn, 1W 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 perforating improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor most be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair,modernization,conversion,
improvement,removal, demolition,or construction or an addition to any pm-exisb'ng owner occupied building containing
at least one but not more then four dwelling units....or to structures which ere adjacent to such residence or building'be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: x1/eM/JL tiry/liter c�oA Est.Cost:
Address of Work: 1�f 0L4� I-
Date of Permit Application, �9
I hereby certify that:
Registration is not required for the following remon(s):
_Work excluded by law(explain):
—Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owneroccupied
_Other(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 RESPONSIBILITFS 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 a b 'ding 't a owner of the above property:
l / u
Date Owner hiame ariffiWature