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31C-081 Unit 3a-b117 OLANDER DR-UNIT 3A&3B BP-2020-0002 GIS#: COMMONWEALTH OF MASSACHUSETTS MV-.Block:31 c-081 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Peril: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category,NEW DUPLEX BUILDING PERMIT Perit# BP-2020-0002 Proiect# JS-2020-000002 Est.Cost,$223000.00 Fee:$225.00 PERMISSION IS HEREBY GRANTED TO: Const.Class:Contractor. License: Use Group: SHAULPERRY 065400 Lot Size(so.ft.): 273873.55 Owner: SUNWOOD DEVELOPMENT CORP Zonine:vv Applicant: SHAUL PERRY AT. 117 OLANDER DR - UNIT 3A& 3B Applicant Address: Phone. Insurance: 84 POTWINE LN 413) 259-1000 WC AMHERSTMA01002 ISSUED ON.7/112019 0.00.00 TO PERFORM THE FOLLOWING WORK NEW 2 FAMILY DUPLEX Type#2 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/Chimncy: 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: FeeTvpe: Date Paid: Amount: Building 7/1/20190:00:00 $225.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2020- 0002 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESSIPHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION 117 OLANDER DR-UNIT 3A&3B MAP31c PARCEL08I ZONE Dv THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1, 1 Fee Paid Tvceof Construction: NEW 2 FMAILY DUPLEX ' P. 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 LMATION PRESENTED: toofAppsoved_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 ficial 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 RECEIVED Department use only CI of Northampton Status of Permit. Bu Iding Department Curb Cut/Driveway Permit 12 Main Street Sewer/Sepgc Availability Room 100 WateVWell Availability n o ampton, MA 01060 Two Sats of Structural Plans 7-1240 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 Map .?ic' Lot n 8 Unh d Zone Overlay District_. Elm St District Ce District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: W%Jt i M/1l LAWOr Name(P ) Curfl f{flfeNipg larjdre1 TeleNpironne(J ure 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION S-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building o/1^ a)Building Permit Fee 2. Electrical LNV b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S.Fire Protection 6. Total= 1 +2+3+4+5 Check Number d ->C This Section For Official Use Only Building Permit Number.DateIssued: Signature: Building CommisbnedlnspeMrof Buildings Cate Svrrwtao @ cvlwca.sT n EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) a l Section 4. ZONING7 All Information Must Be Completed.permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This.1.to be filled in by Building Deparlmmt Lot Sim Frontage Setbacks Front Side L R:L: Ri L—J Rear Building Height pr Bldg.Square Footage r Open Space Footage l .minus bldg a Paved afparkin S aces Fill: lame a Iu.non A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES VSJ IF YES, date issued.! 81if 1d IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O Y6 IF YES: enter Book L 13/ 3 { Page //O mss( and/or Document# OCJB. 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 Conservation 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: r reawwun'1/ 5; D. Are there any proposed changes to or additions of signs intended for iheoperty 7 YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb ng,grading,exc n;atlon,or filling)over 1 acre or is tt part of a common plan that will disturb over 1 acre? YES NO O 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 WindowsAlteration(s) Roofing Or Doors13 Accessory Bldg. Demolition New Signs f01 Decks [r3 Siding[O] Other[C Brief De criptigr of yroP ee i 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 to existing housino, Complete the followin : a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: d,-5 Number of Bathrooms_ c. Is there a garage attached? r /r d. Proposed Square footage of new construction. Dimensions J x ,/(l e. Number of stories? L Methodofheafing? ZI-I,, Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of mnsbuction c 1. Is construction within 100 g.of wetlands?_Yes –4?(—No. Is construction within 100 yr. floodplain_Yes_No j. Depth of basement or cellar floor below finished grade 2pt k. Will building conform to the Building and Zoning regulations? —X—Yes_No. I. Septic Tank_ City Sewer Private well_ City water Supply SECTION Ta-OWNER AUTHORVAATIOON-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 / n1 Date as Owner/Authorized Agent hereby declare that Ire statements and information on the foregoing application are true and accurate,to the beat of my knowledge and belief. Signed urider the pains and penalties of perjury. Iq Print theme 1/0 Sig OwnerlAgen Date SECTION 8-CONSTRUCTION SERVICES 1 Licensed ConstructloiIsor. Not Applicablee El Name of License Holder: CS'0(LLl r Lloeme Numba IO mhel.S ©iY EIaZ Add. Ifico q e SIC u Telepnone r I H na t t r Not Applicable till log30w Comp /N ama r u/ Registration I mber Address ExpifrAionDati, Telephone! ' SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(li c.162,§2$C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this of davit will result in the denial of the issuance of the building penniL Signed Affidavit Attached Yes....... No...... City of Northampton Massachusetts i DSPARTTf6NT OF aUILO I ZCAIOMa 212 Main ST t o Wnicipal Sodding0 Y gMom+= g —, WA 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 construction work being performed at: Please print house number Rand street namb) Is to be disposed of at: 4.11_ iiln ti Nf Jai iOP1/t4 ,YDl/llo r f,/! P ase print paa ("M cation atacility) Or will be disposed of in a dumpster onsite rented or leased from: Company Name and Address) i2i Si a of Pertnil7kppliV, Dwner 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. PZS The Commonwealth of Massachusetts Department oflndustrialAecidents 1 Congress Street,Suite 100 Boston,MA 02114-2 01 7 whna mass gov/diaWIV,orkers'Compenstation Imorauce Affidavit Builders/Contmcmrs/ElecMcians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Businesss//OrganinmtloM/ndividual):ilkvanl Address: r Q/1C2%LULGK; s City/State/Zip: Phone#: 1113 22nry DDD Are you an employer?Check Ne appropriate hos:Type of protect(required): I lama employer with_emploYvva(full end/orwrt-time).•7. New construction 2.[]l pmprietororpmmershi and have no employees workin for me in any c.pariry.(No wotkm'w P P Y 8 8. Remodeling cop.wsocmce requited.) 3.lama homeowner doing all work,myselE(No notion'comp.insurance requra)t 9. Demolition 4.I em a hoewowmer and will be hidn8 contrwrcms m covduct all woh on mY MOPettY. 1 will 10 Building addition acether a0cmmmors eifet hevewmkm'coaWepsetiw ipsunvice or are sole IL Electrical repairs or additions proprietor,with an employee.. 12.Plumbing repairs or additions 5.l am agmen contractor and l have hired the sub.coatruror listed on themeched.taxa 13 ROof repair;These inacovmmes,have scatter a and have worker'comp.inautavicet F1 We mea fion and its offmers have exercised their tofu per 14.Other coanom gh ce na,v MGL c.152,§1(4),and we have no employees.[No worker'camp.insurance anluired.l aMy applicant Nat ch¢cb box#1:tort auto fill net Me account,below showing theta wohm'corgrtnaetion policy infomutioo. t Homeowner who submit this affidavit indicating they are doing 01 work and then hive outside contractors must submit a new affidavit indicating such. Connectors Nat check this has must i nachedan additional sheet showing the ones of the sub-contractors and state whether or not thane entities have emp]oyees. Ifthe aubcovtrctots have employes,fey must provide their workers comp-policy number. lam an employer th rt is providing workers'compensadan insurance for my employees. Below is the policy andlob site informnti kvsurauce cCompany Name: a/lrvfap Policy#or Self-ins.Lic.#: t'y ZBGb8a 1(tfltixttRo'O J.4 Expiration DatimberJobSiteAddress: 1 I01.rfjer4' City/State/Zip:,, 110 W Attach a copy of the workers'compenmtlon policy declaration page(showing the policy nd mirztlmr 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 m the Office of Investigations of the DIA for insurance coverage verification. 1 do herebycertify nder p and penalties ofpeduy that the information provid eedd ab is true and correct Signature, te Phont#:i' Oficial 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/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CORd CERTIFICATE OF LIABILITY INSURANCE OATEI=019 1TW=019 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 certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of Me policy,certain policies may require an endorsement A StatareM on this eoNR does not co der rights to the certmcate holder In lieu of such endoreement(s). PRODUCER NAME: Linda Poners,CRIS lMebEeFB Grinnell PxwEvo (413)50&9111 ry: (413))))) 41481 8 NOM King Samet AppylEu; Ipo rs®webbemnvllyr lell.colm INSURE 6AFFORMIDCOYF W XNCS NoIdump100 MA 01060 INSURERA: UI ruJACadla 25W IxsuREn INSURER.: AIM 33758 SN.d Development COrporetlon INSUMRc: AcadW Insurance Company Ali Shaul Perry sonal RD: M Pohnne lJ ne UNWe E: Amherst MA 01002 INWMF: COVERAGES CERTIFICATE NUMBER: SUnvvood DeVEKp3-2020 REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERI00 INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENTWITH RESPECTTO WMCH THIS CERTIFICATE MAY 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. Ivan I.N1 LTR TYPE OF INWRANCE P0.ICY NYMeER NMDD(WYY MN MMIr6 Lp1MFACIALfEXEAAL W9altt EACX OCOURRENCE S1.000.000 CWMSNAOE N tEMI S wo'NO MEDEM f 10`000 A CRA5981059 03/00/2019 031W2020 PERSONAL.AUIINJURY a 1.00'000 GFNTAGGREGATEOMIAMURSRJL GENEAALAGGREGATE S 2,0001 FOLIcv i Lac PRODUcr3-CONAO"AGG a 2.000'000 O xER: a AUTONoenAuamury coMNx50 SINGLE UMIT a 1.000,000 ANYAUTO ILYIWURY(Ptr Pnoo S A ON11E0 Bf.XmUIED AUFONSNLY AUTOS 3IOMAA$3B1d]0 0CYZ019 03/0/12020 BCOILYIWURY(MCNnp f HIRED x NUX OWIiED PR FERTYW AGE AUTOGONLY AUTOSOWY Fw. no Medical payments f 6,000 UMBRELLA UAB pCCUR EACH OCCURRENCE E- SE WB CLAW .E AGGREGATE S DED I I RETENTION$ S mamstso.MPENSAnov54 PBI TH' ANDEMPLMEi5 LIADLnY B NYPAOPRIEfONPARTNE2EXECUTYE YIN NIA WMZBOOBM$B$82019A O52'L2019 OSY12/2020 E.L EACHACCIDENT f 500.0 OFFICERa1FMBEfl EXC WOE% IaaMMay In NN) ELLRSEAEE EAUDYEEB4Pf ' Itpe GBM.ober CESCRIPTgN OF OPERAT10N6.1dr ELDSEAM POUCY(UMIT S d0• l Builder's Risk C APP BR VILLAGE HILL CO 0513M2018 O5I30F1020 Bui1011Ig 37,100,000 CESCRunON OF OPERAIII LOCATKKiSIVEnOUNS MCgID let,AEGbxI RamaMa SOeeub,may N,edacW If men specs Ia ny,itl) CERTIFICATE HOLDER CANCELLATION SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXWMTION DATE THEREOF,NOTICE WILL BE DELIVERED IN City Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main SI,Scale 3 AIITXDiI}FD AEPIESEI WTYE NOnhampton MA 01080 0 191111 16 ACORD CORPORATIO N. All rights reserved. ACORD 25(2016M3) The ACORD mm end logo en megtstsmad marlusof ACORD City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Noctlunpton, M 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR'j regulates the registration of contractors and subcontractors performing improvements or renovations on detached one in 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"reconstruction,ahemtion, renovation,repair, modemizatlon,conversion, improvement,removal,demolition,or construction or an addition to any praexisdng owner-occupied building containing at least one but not more than four dwelling units....or to sGuctures which are adjacent to such residence or building'be done by registered contractors. Note:if the homeowner has contracted with a corporation or LLC,that entity md.ust be registered. Type of Work: N.... 1ni1,Est.Cost: Address of Work: i 0LXZ ion; Date of Permit Application: el.//? I hereby certify that: Registration is not required for the following reeson(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 RESPONSIR11JTES 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: q skPu Date Owner Verne antKWature