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31C-081 117 OLANDER DR#19 BP-2020-1012 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-2020-1012 Project# JS-2020-001707 Est.Cost: $125000.00 Fee: $1379.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Group: SHAUL PERRY 065400 Lot Size(sa.ft.): 27387.3_.55 Owner: SUNWOOD BUILDERS Zoning: pv Applicant. SHAUL PERRY AT. 117 OLANDER DR #19 Applicant Address: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AMHERSTMA01002 ISSUED ON:3/13/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW SINGLE FAMILY HOUSE 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 3/13/20200:00:00 $1379.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2020-1012 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION 117 OLAN DER DR#19 MAP 3lc PARCEL 081 ZONE pv THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ri Buildina Permit Filled out Fee Paid TypeofConstruction: NEW SINGLE FAMILY HOUSE New Construction Non Structural interior renovations Addition to Existing Accesso 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 INVORMATION 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 . 1,97 313 ` 0 Sig ature of Building Official UU 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 `ice rr rx� City of Northampton �";' ----_ Status of Permit: Building Departmenut/DrivewayPermit r 212 Main Street ' r/Septic Availability Y Room 100 J MAR 1 0 Wat@r/Well Availability Northampton, MA 01 60 2R TwoliSets of Structural Plans C 4 phone 413-587-1240 Fax - 272 Plo Site plans �N �TN "1r))Nc rr_..__vS` er Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE O-RbEMBLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 7 1.1 Property Address: This section to be completed by office Map Lot l _Unit Zone Overlay District / Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 / 0 !OTWi%7'CJ C/ Name(P(nt) Currgnt Mailing Ad ss: Tee( phone t re 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by permit applicant 1. Building #p000 (a) Building Permit Fee 2. Electrical IF000 (b) Estimated Total Cost of i Construction from (6 3. Plumbing P61 O00 Building Permit Fee 4. Mechanical (HVAC) /�QM 5. Fire Protection / V�.J 6. Total = (1 +2 + 3 +4+ 5) Q Check Number This Section For Official Use Only Building Permit Number: '�^ Date Issued: Signature: 3 I Building Commissioner/Inspector of Buildings Date 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 Department Lot Size CD '00" Frontage Setbacks Front Side L: R: L: R: Rear Building Height 46 Bldg. Square Footage % /G Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q YES IF YES: enter Book f3 X3 Page #0 and/or Document# B. Does the site contain a brook, body of water or wetlands? NODON'T KNOW Q YES 0 129 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O , Date Issued: C. Do any signs exist on the property? YES NO Q IF YES, describe size, type and location: /'yLW X ����� D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clea ' grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition D Replacement Windows Alteration(s) E] Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] Other[C7] Brief Descr' tion of�ppose/,'Coc Work: C or Alteration of existing bedroom Yes No Adding new bedroom es No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. IDimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. yG6 Masscheck Energy Compliance form attached? h. Type of construction I. is construction within 100 ft.of wetlands? Yes —X—No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade 8, k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer_ Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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 Date I, CJ'' as Owner/Authorized Agent hereby declare that a statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name / A �O Si a f Owner/Agent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction S pervisor: Not Applicable �❑ Name of License Holder: A ���O �l oD License Numb r O Address Exp,L I lljkvr:?, - ///C5 tion ate OoO Sf nallk Telephon i 9. Registered Home Improvement Contractor: Not Applicable ❑ 10,60 oj� Companv Name *rati Number Addreess91Wn4ff--, 46z� ate '1 �/)`1 �.�JJ: 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. 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 Massachusetts �. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCA-BR")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 "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied 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 the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: A4WdibIY Est. Cost: Address of Work: //j�olaodU (J/ /Vn�'1�77ta�f�Tb�y Date of Permit Application: /12Q I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 / Owner obtaining own permit(explain):, _ �n,n� owml e 0AW �/ 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 h eby ap for ilding permit as the owner of the above property: �0AAA Dat6 LVviner Name an ignature City of Northampton Massachusetts ( '`f+ c, DEPARTMENT OF BUILDING INSPECTIONS r; 212 Main Street *municipal Building Northampton, MA 01060 JfNJt 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: -//;�'&"ca' 'D " (Please print house number and street name) Is to be disposed of at.- V0,11C,V ��C-4117rct & I-1d, (P ase print Vame,9nd lotation of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ZV,_0�n V SiogaUe of Permit Appy a or Owner 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 Industrial Accidents a I Congress Street, Suite 100 e Boston, MA 02114-2017 aM www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information a I A Please Print Legibly Name (Business/Organization/Individual): 51 IV J/ eilf _4=d Address: 01 24ma4z=Z City/State/Zip: j7 Phone#: Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with employees(full and/or part-time).* 7. New construction I am a sole proprietor or partnership and have no employees working for me in ' any capacity.[No workers'comp.insurance required.] 8• [:] Remodeling 9. F1 Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E] Building addition 4.[]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.*- 6.M We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workcrs'comp.insurance required.] *Any applicant that checks box t;1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: nn��� Policy#or SelfA &.MWZ -ins.Lic.#:� r�(J��������9� Expiration Date: Aoflm Job Site Address:0(1 010mn c or'l City/State/Zip: DwCO� Attach a co of the workers' compensation policy declaration page(showing the policy number and irati�. Py P P y P g ( g P Y P ) 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 veriftcati I do hereby certi under e p s and penalties of perjury that the information provided above is true and correct. Signature: Date: Q 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#: / 1 ® DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 03/09/2020 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kathy Parker NAME: Webber 8 Grinnell A/C HONE Ext: (413)586-0111 AIC No): (413)586-6481 8 North King Street E-MAIL kparker@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Selective INSURED INSURER B: AIM 33758 Sunwood Builders,Inc. INSURER C: Attn:Shaul Perry INSURER D: 84 Potwine Lane INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: CL203512689 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR IN WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ E 500,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,000 A 02932000 03/04/2020 03/04/2021 PERSONALS ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (CF OMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 02932000 03/04/2020 03/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED I X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIIAB HCLAIMS-MADE 02932100 03/04/2020 03/04/2021 AGGREGATE $ 1,000,000 X DED RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER Y/N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A WMZ80080056582019A 05/22/2019 05/22/2020 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 240 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 ��11 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Home Energy Rating Certificate Gating Date: 2020-03-13 HIS e Pro.ected Report Registry ID: HERS i p Ekotrope ID: kLZbwz8L • Index • Annual • Your home's HERS score is a relative ♦' • • • • $3,446 Northampton, i the ! energy • • 32learn more, visit www.hersindex.com *Relative to an average U.S.home Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[MOtul Annual Cost criteria of the following: Heating 7.3 $357 2015 International Energy Conservation Code Cooling 0.5 $23 Hot Water 3.1 $143 Lights/Appliances 15.8 $730 Service Charges $72 Generation (e.g.Solar) 0.0 $0 Total: 26.7" $1,324 HERSAndex Home Feature Summary: Rating Completed by: tw,.r Home Type: Single family detached Model: N/AEnergy Ra#er:Adin Maynard Exizt6n RL5NE1ID:9463452 Community: VHCHousing r Rating Company:HIS&HERS Energy Efficiency Conditioned Floor Area: 1,578 ft �xn Number of Bedrooms: 4 Mailing:12 Perkins Ave.Northampton MA 01064 Rere,ense 4136588784 Home 100Primary Heating System: Air Source Heat Pump-Electric-3.66 COP Primary Cooling System: Air Source Heat Pump-Electric-18 SEER Rating Provider:Energy Raters of Massachusetts e� Primary Water Heating: Water Heater-Electric-3.24 Energy Factor 2 Woodlawn Street Amesbury,MA 01913978-270.3911 « House Tightness: 1.2ACH54 t Ventilation: 53.3 CFM.20 WattsfO i ,�� ♦ Duct Leakage to Outside: Untested Above Grade Walls: R-28 Z"EZ94Y Ceiling: Attic,R-60 o Window Type: U-Value:0.23,SHGC:0.23 Adin Maynard,Certified Energy Rater Foundation Walls: R-20 Digitally signed:3/13/20 at 10:38 AM Ekatrope RATER-Version:3.23.2385 reportekotrope The Energy Rating Disclosure for this home is available from the Approved Rating Provider. This does notconstitute