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31C-081 117 0LANDER DR -UNIT 12 BP-2020-0005 GIS#: COMMONWEALTH OF MASSACHUSETTS Mam:Block:31 c-081 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2020-0005 Proiect# JS-2020-000005 Est.Cost: $164000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: UseGroum: SHAULPERRY 065400 Lot Size(sa.R.): 273873.55 Owner: SUNWOOD DEVELOPMENT CORP zoning:ov Applicant. SHAUL PERRY AT: 117 OLANDER DR - UNIT 12 Applicant Address: Phone. Insurance. 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON.,71112019 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 711120190:00:00 $200.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2020-0005 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESSIPHONE94POTWINELN AMHERST (413)259-1000 -r P [� PROPERTY LOCATION 117 OLANDER DR -UNIT 12 1 C J MAP 31c PARCEL 081 ZONE Vv THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid TvueofConstruction: NEW SINGLE FAMILY HOUSE 101' 91/v New Construction el I 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 UNDRR:§ Intermediate Pmjecr. 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 ,� 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. RECEIVED Department use only City of Northam ton I jAailabilitY. 'N• Building Depart ent JUL ay Permit 212 Main St t Ilabilily • '( Room 100 DEPT OFaU1LDINGIN Northampton, MA NDPTNAMPTDN.muctural Plans phone 413-587-1240 Fax 413-587-1272 PloUsite 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: 1 / �J This section to be completedd by ofica /r J o� &,� �/1,'j /Ot J Map Lot �d i Unit Zone Overlay DISMct -1 Elm SL ba alet CB DIMC SECTION 2-PROPERTY OWNERSHIPIAUTHORDED AGENT 2Awner of Name(Pdnt) Curre�rJ]�IIIrp Atl a � 44/ 04 Tela ona / 5 2.2 Authorized Aaent: Name(Pont) Current Mailkrg Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COM Item Estimated Cost(Dollars)to be Official Use Only completed by Permit applicant 1. Building )/ /0(000 (a)Building Permit Fee 2. Elecbioal - (b)Estimated Total Cost of NWv Construction from 8 3. Plumbing �S�t�LO Building Permit Fee *L-)ub 4. Mechanical(HVAC) S.Fire Protection 6. Total-(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building CommisslonerMspec rof Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) LL',: a 'lni � �:� Section 4. ZONING All Information Meat Be Completed.Pemdt Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This mlumn to t e Riled in by eWlt ing Depummt Lot Size - - -_ Frontage Setbacks Front „.. Side L: R: U R: . ... I. Reer Building Height �r Bldg.Square Footage F Open Spa-Footage % (Lm we min.bldg a paved - akin #of Parkin S es Fill: volume a luottion A. Has a Special Permit/Variance/Finding ever been Issued�foorr/on the site? NO O -DD-ON KNOW O YES IF YES, date issued: //'/.�� IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YESO IF YES: enter gook j$ Page'. //Q�/ and/or Document# B. Does the site contain a brook, body of water or wetlands? NO tX) DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Coraervation Commission? Needs to be obtained O Obtained O , Date Issued: _ C. Do any signs exist on the property? YES NO O IF YES, describe size, type and location: W C�ay2sNyr}�J T G� D. Are there any proposed changes to or additions of signs intended for the property? YES O -NO OCl IF YES,describe size, type and location: . YN' E. Will the construction activity disturb(cl?��ee��aaynnn g,grading,a cavaaon,or filling)over i acre or is It part of a common plan that will disturb over 1 acre? YES NO d IF YES,Men a Northampton Stomn Water Management Penult from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK fcheck all applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [I Decks [O Siding[C33 Other Ja Brief Dew rjptlon oj,Pmpo/sd / v Work: uv .,:r, on Alteration of existing bedroom Yes_No Adding new bedroom_Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet sa.if New house and or addition toexistln housin complete the followl : 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? Alb d. Proposed Square footage of new consuuction.IM Dimensions W f x (m f e. Number of stories? 191 f. Method of heading?�C/« it/ Fireplaces a Woodstoves—.AL _Number of each g. Energy Conservation Complialpm. Masscheck Energy Compliance form attached? h. Type of construction /( / I. Is construction within 1 D ft.of wetlands? Yes _x-No. Is constructionwithin 100 yr. floodp _____Yes A,�No I. Depth of basement or cellar floor below finished grade /7P 1 k. Will building conform to the Building and Zoning regulations? -1!?-r Ves No. I. Septic Tank_ City Sswer—Id-, Private well Cay water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED= OMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMR I, as Owner of the subject property hereby authorize to ed on my behalf,In all matters relative to work authorized by this building permit application. Signature of Owner Dela long I, as OwnedAuthodzed Agent hereby declare that the istatememb,and information on the foregoing application are[me and wounds,to the best of my knowledge and belief. Signed and spa and p9didAbs of perjury. PON Siprelu dApenl Da SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Su e"Isor: Not Applicable ElName of License Holder: � ./lJ'Jy as'o&.,5,WW r License Numbe riik-i�irs/fU1S,�� ©/tea Adtlreaeellon Q ro Sitrpfufe ` Tal phone' D i ment C tractor. Not Applicable ❑ Wood /OR yrs 30� at lame Registration I mbar 0"Address i r Eq 'on aG Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,$25C(6)) W orkem Compensation Insurence affidavit must be completed and submitted with this application.Fallure to provide this affidavlt will result in the denial of the Issuance of the building pemlK Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton 0 Massachusetts (i) nanaazr®rr or sazznzBc zxseaczroas212 win SC i •Ibnicipnl BuildiwBoxt!� W 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: 11-11OLL a4 '41'v (Please print house number And street name) Is to be disposed of at: ZU/"i 3 / fon r1 /K�rJ1Jo r foil (P ase prin am tion at facility) ' Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Si a of Permit plir)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 Mi ssaehusetts Department oflnduserial Accidents 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 www.massgov/dia VWorkers'Compensation Insurance Affidavit:Buildera/Contractors/Elmtricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Eusiness/Organ�in]Uonnndividmp: Address: p�Yp� ', .//'''' City/State/Zip: - Phone#: �1/3 ;&7119J90 Are you to employer?Cheek the appropriate boa: Type oof project(required): A1area employer with _employees(full and/or Mad-time).• 7. KI New construction 1 2.❑Iemamle propdemror pumenhip mdNeve no uvployees waking efornaiv 8. Remodeling say capacity.[No e o tars'comp.immavce required.] 3.❑lune honmwnttdoing diwmk myself[No workers'comp.iraurev«r�uirtd.]t 9• ❑Demolition 4.❑I em a homrowmtt and will be hiring mvtnctors m Oviduct rll wok m mY PrepeM [will 10❑Building addition vsure Wet ell cevmuors eithtthavewokesi compwsaton wsuvece«ere sole 11.❑Electrical repairs or additions pmprietars wits no employees. 12.C]Plumbing repairs or additions 5.❑tametutemlconhsuormdoploehirandhave oakar'[aratstedmare,J rd set13.❑Roof repabs Taese sub-covtmc[ors have employeae and have workers'coo,.insuurce.t 6.❑We are a cerpmekon and ire oID«mhave exercised theirdght ofexempum per MGL c. I4.❑Othef 152,§1(4),road we have no employees.[No workers'emep.uuurence required.? 'Any epptca a than checks box#t moat also EII ons the eectm bebw ebovriegthev woktts'campwsetim polity infomutim. I Homeowners who submit co,affidavit indi«ting Wry me doing dl wok and Nen hive outside..mums mon submit anew affidavit indiadvg such. Wonvscaeu Wet check Ws box ov st teteded m set itmsl sheet showing the amu oftec sub-contractors and sure whether or not those nodes have employees. If the subcovbactma have employces,dray must provide their workers'comp.policy number. Tom an employer that is providing workers'compensadon insurance for my employees. Below is the policy and jab site information. /,/ /t Insurance Company Name: We ls/2cr ( f llidm a Policy#or Self-ins.Lia#: //Q7//IQQ�Z��d7S�D�9� Expiration Date: att��'��ts Job Site Address: h!;62 ltlU rYr' City/State/Zip;-A)a1060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and• xptration 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 certify tide? and penalties ofpedury that the information prov'deedd ab is true and d correct S tan ' �� Date S// Phone M ;0 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/To"Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: COBO* CERTIFICATE OF LIABILITY INSURANCE DATE,NMNdMWYI 08/1812019 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 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER IMPORTANT, N the certHlcata holder IN;an ADDIMNAL INSURED,Me PoNcylles)must have ADDITIONAL INSURED provitlems or be endorsed. N SUBROGATION IS WANED,sUbjentto the 0.and conditions of the policy,certain policlu may require an endorsement. Asft T nton MY card dote not confer rights to the wHBlcats holder In lieu of such endon mart e). PROD . CONi" Linda Posters,CRIS Mbbber&Gnnnell MOVEat (113)SN.011l AIIC xe: (413)) al 8 NoM King Street eM^L IpoUselsaambberandgronell.wm DDRE98. IN AFFpeaM3PAU GE al Northampton MA 01060 MMNERA: Union lna/Avtlls 25W INSURED MMI S; AIM 33758 Summed Developmam CorpurBSon eIRaY31c: Asada lmlaanca Carlpary Asn:Show Peng M3urtr D. BI PDMTe Lame MEARER E: Amharet MA 01002 NEGU ERF: COVERAGES CERTIFICATE NUMBER: Summod Dm Fxp 3-2020 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDING ANY REQUIREMENT.TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO PMICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E ICLUSIONSANO CONDITIONS OF SUCH POLICIES.LIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL NOME TYPEDFIMIJB CE POLICY NUMBER Y 11Y118 LOYYERCIRLDEHNUL WBILIIY EMNOLICURRENLE a 11000.000 CWYSYACE ®OCCUR g1EMl S 300,00, MEDEYP a 10'000 A CPA53S11&B 03NM2ON SNII20T0 PERSDIaAI e.Lw INJUm' a I.000,UUO GBJLA00RElMTEUMITAFYftSPER GENURALAGGREDATE 3 2.008000 PRO 2.000,000 FOl1CY JECT LCC PRCOULTs.LCMP,CV A(i0 t OTHER'. a AVTOMOBYELIAdLIIY COMBINED PJ IF LIN a 1.000000 2LVI1U`JURY0`vPNvv) a AHI.YAUT. OWNED acHEWLED MAA5381170 0310/12018 03NU2020 BDOav INJURVIwamc.q a AUR150NLV AUTOS NIREO NC .SoPROPESRlY AUTOSONLV MAUTOSONLY AJAAOE a Medical payments t 5,000 Wlaaa33AlMe OCCUR EACHOCCURRFNCE a E1.CE4SLMB CNIY$MADE AWREGATE a OED RETENTION a a .... SCOYPENSATHW RYA M ANDENROYEiSLLMUTY A B YIN AHYPRCPRIErpINAR UDEW CUTryE ❑ NIA WM23003005BSB2OIBA OSI2212018 OS(1T/T020 EL EACHACCIOEM s 500`me0 e FIC EMNBN6R E%CLUOEw EL dSFAEE-EAEMPIDVEE 8500,000 "N"A"mer umx 500,000 DESCRIPTNMCf OPERATI.S. x ELOISFASE-POUCYLMIT BuilOeYe Risk C APP OR VILLAGE MILL CO 05I31 0513012020 BuilNllp 57.100,000 oE&]tlPIMYIaF aPFAlTxxslllCATMINSIYE1WlF9 wOwmt In AOYXMHI M1nAM BtlYeKmgr WPMxAuePlq YnRdnll CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CM of Nornamplon ACCORDANCE WITH THE POLICY PROVISIONS. 260 Man SI.Suite 3 4VIHCI®R07E8Er1TATVE NOIMamplon MA 01060 ?, r 01588-201SACORD CORPORATION. All rights reserved. ACORD 25(2016103) The AGOING name and logo are registered marks of ACORD City of Northampton Massachusetts DEPARTAffi!T OF BUILDING INSPECTIONS tF' 212 Nein street • M Cipal BuilA ,, Borthup n, nx 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("RIC"). M.G.L.Chapter 142A requires that the"reconstruction, akerabon, renovation,repair,modemizallon,conversion, Improvement,ramoval,demolition,or construction of an addition to any pn>existing owneroccupied building containing at least one but not more than four dwelling units....or to structures which ars adjacent to such residence or building"be done by registered contractors. Note:If the bomeo/wner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Ayr�y� w i,I tf Est.Cost: Address of Work: /1f/C hanl� jg Date of Permit Application:1A I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job order$1,000.00 Owner obtaining own permit(explain): _Building not owner-occupied 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 RESPONSIBILITES 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 Ind ding 't a owner of the above property: J Pv, Date Owner Ifame andLWature