31C-081 UNIT 10117 0LANDER DR-UNIT 10 BP-2020-0003
GIs#: COMMONWEALTH OF MASSACHUSETTS
MamBlock:31c-08I CITY OF NORTHAMPTON
Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category,New Single Family House BUILDING PERMIT
Permit# BP-2020-0003
Project# JS-2020-000003
Est.Cost:$164000.00
Fee:$200.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class:Contractor. License:
Use Group: SHAULPERRY 065400
Lot Size(sa.ft.): 273873.55 Owner: SUNWOOD DEVELOPMENT CORP
Zoning:vv Applicant: SHAUL PERRY
AT. 117 OLANDER DR- UNIT 10
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 Occuoancy Signature:
FeeTvpe: Date Paid: .Amount:
Building 7/120190:00:00 $200.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020- 0003
APPLICANT/CONTACT PERSON SHAUL PERRY
ADDRESSIPHONE94POTWINELN AMHERST (413)259-1000
PROPERTY LOCATION 117 0LANDER DR-UNIT 10
MAP31c PARCEL08I ZONE Vv
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid i
TTypeofConstruction: NEW SINGLE FAMILY HOUSE
New Construction
Nan 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
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.
Full Permit 10/30/19
1 ,
Department use only
City of Northampton - o it:
Building Depa
ani
L-C E uUDri away Permit
212 Mali St t Sawa Be ptl Availability
20Room10JUL — ) afar ell vailabiliry
Northampton, 01Q80 Two is of tructuml Plane4Dphone413-587-1240 Fagc 41 s e PI s
en,vr.luso NSpeci
iN/nTON
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATNkI
1.1 Prouartr Address:
1/
This section to be completed by 011111"
Q/ ,/ lr 1i/ /O Map 136G Lot 0Unit
nV Zone Overlay DI$Wct
EIm St Distrkt CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name Pd(PoMerit CuNI Atl ea:
TT ne
signulli
2.2 Authorized A pint:
Name(Print) Current MaAPIg Hddre w
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed it a plicant
1. Building tOvoo a)Building Pennft Fee
2. Electrical
J
b)Estimated Total Cost of
N 000 Construction from 8
3. Plumbing
61X0
Building Permit Fee
4. Mechanical(HVAC)
M(l(l N ]U"
5.Firm Protection
8. Total= 1 +2+3+4+5 Check Number
This Section For Official Use Only
Building Permit Number.
Date
Issued:
Signature:
Building Commissionedlnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
hI _ 1
P
v -
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This chum rob filled in by
Building Depu t
LotSize
Frontage
Setbacks Front
Side L: R:L R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
lei wmivua bid,&pavcd
of Puking Spaces
Fill:
volume&f.ocesiou
A. Has a Special Permit/Variance/Finding ever been Issued for/on the site?
NO O DON KNOW O YES 1(y/
IF YES, date issued:. OO
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YESO
IF YES: enter Book 303 Page'. l/Q,/ and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO lX) DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Comemation 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: s/y'r. .//
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(U ar ,grading,excavation,or filling)over 1 acre or is it part of a common plan
that vdll disturb over 1 acre? YES ffl NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5.DESC,,,,,,.R..IIPP71ON OF PROPOSED WORK(check all applicablel
New House Addlu Replacement Windows Alterations) Roofing
Or Doo s
Accessory Bldg. Demolition New Signs [DJ Decks [ Siding] Other[CQ
Brief Oescr pllon oJ,Propo/ad r
Work: New(ivrt'lrunHY v']e l/ .xst/
Attention of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
Ga.If New house and or addition to existin housin complete the following
a. Use of building:One Family Two Family Others
b. Number of rooms in each family unit: Number of Bathrooms_ L
c. Is there a garage attached?, A
d. Proposed Square footage of new construction. Dimensions
e. Number of stoles? tll
I. Method of hooting? Fireplaces or Woodstoves A_Numberof each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 fl.of wetlands? Yes x No. Is construction within 100 yr. floodplain_Ves,No
J. Depth of basement or caller floor below finished grade !7 r
k. Will building conform to the Building and Zoning regulations? —4—Yes—No.
I. Septic Tank_ City Sewer Pnvate 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 matlers relative to work authorized by this building permit application.
Sonsture of Owner Date
I, as Owner/Authorized
Agent hereby declare that the tements and Information on the foregoing application ere two and accurate,to the best of my knowledge
and belief.
Signed untl a Pat rh ran psrlelgbs of perjury.
Print
Sigretu Agent Dare
SECTION S-CONSTRUCTION SERVICES
1 Limnsed Constmction Sz,
visor NotApplicable
Name of License Holder...
wo
CS'O(aS//aD
r Uoerwe Numb
5 pm'L'TJ`K --Atltlrees r on b
Iti•°Y 3-GAG
SI u Telephone
S.Realsterad Home I rove tfractor: Not Applicable
Ir j„/
RW
Nema
G/i
Regis anon I be r
f/ n yrsha 0/00Wt
Address Ezpl n at
Telephone
SECTION 1a-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Il c.152,$25C(S))
Workers Compensation Insurance affidavit must be completed and submitted with this applica im.Failure to provide this affidavit Wit result
in the denial of the issuance of the building permIt.
Signed Affidavit Attached Yes....... No......
City of Northampton
Massachusetts
I.DfiPM1f6NT OF BDSLDZNG INSPECTIONS
212 Win Bi:eet •Nunici,,1 Building
Naixhempton, Nh 01060
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:
04
PIease print house num r 6nd street name)
Is to be disposed of at:
P ase pnntMam cation at fad Ity) r l
Or will be disposed of in a dumpster onsite rented or leased from:
Company Name and Address)
Si of PermRpp6ca 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.
The Commonwealth ofMassachuseas
Depar meat of Indus&ialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
H'ww.massgov/diaWwrielkers'Comperesertion Insurance Affidavit:Builders/Contractors/Eimtricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information
7
A r1gasePrint Legibly
Name(Business/OrgarrizetioMndividual):
Address: X OWYel
City/State/Zip: Phone#: ryft7 10a0
Areyav en employer?Ch«k me appropriate box: TYPa of project(required):
lue cmploym with-Vufp 7.t eonaWction
2.l erne sole pmpriannespmmershipendhavenoemployees working fmmein 8. Remodeling
any e.p fty.[No woixers'comp.instant. required.]
9.
3.1 son.homeowner doing all work myself[No worker'comp.inam+nce on tore .]t
10
Demolition
4.lamahomeownerantiwillbehiringmn tmswwoduciallworkonmyp wy. Iwill
Building addition
mute that all wvmctms eithm have worketa'cooWwseuov wsurmeos are sole 11.Electrical repairs or additions
propdeum with no eespki acs.
12.Plumbing repairs or additions
5.
Ties.
gw
isslwntracmweeci
ve Mren have,w
rstectoralisredontheanached
shed
I;[]Roof repaint
Theea subcwmemr have employ«e anti have worker'comp.imuranrc.l
6.We use a wryoranon end its officer have exercised their right ofaxemption per MGL c.
14.0thm
152,11(4),and we neve no employees.[No worker'romp.insurance requirM.]
Any applicant that checks hox#1 must also fill out the session blow showing their worker'wmpemation policy inforns iw.
t Homeownm who submit this affidavit indicating tory are doing ell work and sent eve outside wnmcmr mum submit a new aftidavit wainscot such.
lConsucmr out cluck this box must marched so additional sheet showiog the mese of the orb-contractor end state whether m not those entries have
earl IfNc subwotrmmr have employwa,they must provide the'v workers'comp.policy number.
am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
InsuranceCompany Name:_J( li j
Policy#or Self-ins.Lie.#: N r rBGi BQIxS/d B O Js Expiration Dater
ts
Job Site Address: DlntlrYrt City/State/Zip:_J 060
Attach a copy of the workers'compensation Polley declaration page(showing the policy number and sptratlon 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.
do hereby cergfy oder and penalties ofperjury that the information provided ab o is true and correct
Si Date-
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#:
ACOd CERTIFICATE OF LIABILITY INSURANCE
o EIYLDO vvYl
II I C6(1fl13019
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: N the cartNlpatA hoMar Is an ADDITIONAL INSURED,the policylies)must have ADDITIONAL INSURED proYfabnB or M endorsed.
If SUBROGATION IS WAIVED,subject to Me tam3a and conditions of Me policy,certain policies may require an endorsement A statement on
this..nUfkato doss not aardar dilift to Ula oniFram nada,In IMV of...h enderwming.)
NAME. LAMB PONS@,CRIS
Went.,B Gunnell PH""E (413)SIMAH11 NN (413)586-6481
8 North Kin,Street ADDRESS: ppNerIZIMebDemnd,rinneiLl9m
INSI SAFFdoMN000VEMOE MICA
NoMampbn MA 01080 INSUREAA: Union ImMKaIW 258H
INSURED NEUREM.: ANA 33758
URNOOd DaMMpnMt CorikhaNYI INSIRERC: AOga 1mW61MY Conway
AM:SIuu1 Pam, IxSIRW O:
84 Pontine Lane Ix9URERs:
AmNerot MA 01002 IMSURERF:
COVERAGES CERTIFICATE NUMBER: Si mvood Dev Exp 3-2020 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTYATHSTMOINGANY REOUIREMEM.TERM OR CONMM OFANY COMMCT OR OTHER MCUMEM WITH RESPECTM WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCEMFOROFO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALLTIE TERMS.
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS.
LTp IYFE OF IN WRINCE PpLICy NDYaaR Y UNIa
COMMERCIALOENEIMl W311nY fACXOCCVRREXLE S 1010000
C.M.D. ®OCCUR PMEMIMS 1,
300,000
MEDEKF An ore S 10,000
A CPA53Bt4Bp 0310112019 03/01/2020 PERSJM.ALaAMINJURY f 1.000.000
Mm-ACiAE(MTEMMITAF ESPER: GFHEMLAGGREGIJE 3 2000.0010
Pd.ICY ElI.T E LLC PRCDUCT6.CCMPrAUPAGG A 2.000'000
O XER
A
AmOMDaaEMA.M.1 CCMBINEOSNGIE LIMIT 6 1,0010,000
ANYAUTO BCDILYINJUFYIM,—M a
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AUTOS DNLY AUnM
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Medkdl prymanb A 5,000
VYaRF1lA W0
OCCUR MlC OL.R.E A
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DED RETENTION s
WCPNERSCOMRNNTON PER1 10
AND ENPLDYEAC UADMITY YIN
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NIA WMZBOOB005558201&1 OSI22ROte 05I2TI2020 EL FAcx AccloENT 3 500.000
OFFICERMEMB91 ERC W DED)
all
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pESCRago.CF OPEamoks o. EL.DISEkSE.POucY LIMIT 3 5on-00d
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APP BR VILLAGE HILL CO OMW2019 051302020 BuIdiW 7,400,000
CESCNMON OF OPE VMS LOCADONS I uEMIpEe IALORO liu AEENlonal P-In,l ell.ula,mry NMMd.M--MAA,Is 14PM1
CERTIFICATE HOLDER CANCELLATION
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATK M DATE THEREOF,NOTICE WILL BE DELNERED IN
Ce,0 NOMampbn ACCORDANCE WITH THE POLICY PROV4910M5.
240 Main SI,Sum 3
ANMORQ®REPRESENTATIVE
NaMampbn MA 01060 W lD
01588-2018ACORDCORPORATION. AIIN,Msresemed.
ACORD 25(201(1W) The ACORD name and logo ars registered marks of ACORD
City of Northampton
r Massachusetts
A
D212 Ha' S OF BaZLDici ZBBPSCTZ ONS212Mainetzaat • Municipal Building
MoxNampton, 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 or four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("IIIC").
M.G.L.Chapter 142A requires that the"reconstruction,alteration,renovation,repair, modemixation,conversion,
improvement,removal,demolition,orconstructlon of an addition to any pre-existing owner-occupied building containing
at least one but not more then four dwelling units....or to structures which am adjacent to such residence or budding"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity roust be registered
Type of Work: ':, a t nn iceeA Est.Cost:
Address of Work: 117"01.,L '-) 60
Date of Permit Application: 3(11A
I hereby certify that:
Registration is not required for the following moson(s):
Work excluded by law(explain):
Job under 51,000.00
Owner obtaining own permit(explain):
Building not oamerroccupied
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.GL.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 b ding t a owner of the above property:
Pvr
Dewe Owner Iflame