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31C-081 #117 A&B 117 OLANDER#17A& 17B BP-2020-1010 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 DUPLEX BUILDING PERMIT Permit# BP-2020-1010 Project# JS-2020-001705 Est.Cost: $184000.00 Fee: $1715.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: SHAUL PERRY 065400 Lot Size(sa. ft.): 273873.55 Owner. SUNWOOD BUILDERS Zoning: av Applicant. SHAUL PERRY AT. 117 OLANDER #17A & 17B 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 DUPLEX 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 $1715.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-1010 APPLICANT/CONTACT PERSON SHAUL PERRY ADDRESS/PHONE 84 POTWINE LN AMHERST (413)259-1000 PROPERTY LOCATION 117 OLAN DER#17A& 17B MAP 31 c PARCEL 081 ZONE pv THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction:_NEW DUPLEX 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 INYORMATION PRESENTED: V 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 I T�X-4z -�) 3 ao Signure of Building Official VU 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 City of Northampton ; Status of Permit: Building Department v Purb Cut/Driveway Permit } 212 Main Street ' Sew Septic Availability f� ROOM 100 ��A� 10 202,Wate/Well Availability Northampton, MA 01 0wo ets Q1 Structural Plans ' phone 413-587-1240 Fax 4�1 P Site Pians NOq)NrrN' � Zcr Spocify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DiMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office �� Map Lot ! Unit Zone Overlay District C( y! Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: V /f7 Azrry Qlby%YCJ Name(P nt) CCurrtt ailing Ad ss: Telephone i 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 completed by permit applicant 1. Building A0000 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of #010'X0 Construction from 6 3. Plumbing oOo Building Permit Fee �/�#,40 / 4. Mechanical (HVAC) �M 5. Fire Protection # i X0 6. Total = 0 + 2 + 3 +4+ 5) Check Number / S// if This Section For Official Use Only M �- /0 Date Building Permit Number. Issued: Signature: i 3 c7`Q 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height 1/ 1 Bldg. Square Footage % /!I Open Space Footage % U (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 Q DONT KNOW O YES fi�- IF YES, date issued: V E IF YES: Was the permitd at the Registry of Deeds? NO O DON'T KNOW O YES IF YES: enter Book 1383 Page #40 and/or Document# B. Does the site contain a brook, body of water or wetlands? NO X DON'T KNOW 0 YES Q 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 K NO 0 IF YES, describe size, type and location: X "C.O/rl�rlaNij� /7. D. Are there any proposed changes to or additions of signs intended for the property? YES NO O 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 0 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 Replacement Windows Alteration(s) Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [p] Other[�] Brief Descr' tion of posed ,- _ Work: r' G Alteration of existing bedroom Yes No Adding new bedroom Yes 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 /fit c. Is there a garage attached? _ d. Proposed Square footage of new construction. Dimensions `X e. Number of stories? f. Method of heating? fFireplaces or Woodstoves Number of each g. Energy Conservation Compliance. GS Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes 2r_No. Is construction within 100 yr. floodplain Yes No Qi j. Depth of basement or cellar floor below finished grade Q 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 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 Date as Owner/Authorized Agent hereby declare that fe statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed u der the pains and penalties of perjury. tlqllawl Print Name A. A 112WO Si na f Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S ervisor: Not Applicable ❑ Name of License Holder: �g�a2g(00 License Numb r 42� I U LOW Address Expi tion ate OoO LA'. 1 SE na Telephon I 9. Registered Home Improvement Contractor: Not Applicable ❑ Com any Name Rdo N tuber 9 , v/y WDa[� 'CJUi/ crS Address�1wincoe Ex rati n Date /t? .J4—,,,/ 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 .I 212 Main Street • Municipal Building �� C +` 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:_4�w 6"rilb1r Est. Cost: Address of Work: //?(04faeyl 1[�j Nar ID- Date of Permit Application: Q Q 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): vrlw 4 nn/rf GWj1S 0AW y 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, 111 eby ap for ilding permit as the owner of the above property: su 19/0wQ Da er Name an ignature City�� f Northampton __ _� _ ~--__�� ~,~ Massachusetts oEPoaznENr OF BUILDING IooSPEcrzcmS uzo Main Street *Municipal o"ilui"s ^ m"=tu"mpt"=' MA ozuoo Debris ~ �� ° � Affidavit � �� ° =� ~ �~ �� N� �� *� �� = � In 8CCOrd8nC8 of the provisions of MGL C 40. S54. | 8ChO0VV|8dg8 that as 8 condition of the building permit all debris resulting from the construction activity governed by this Building Permit Sh8|| be disposed of in a properly licensed sV||U waste d|Sp0S8| f3C|||ty' as USf|O8d by K4GL o 1 1 1' S 150A. The debris from construction work being performed at: (Please print house number and street name) |St0b8disposed Ofat: '/ ��CWIIMZ —,2� (P�mao print vfame u Orwill bedisposed ofinaUunnpsteronsite rented orleased from: (Company Name and Address) SiogaUe of Permif—Appi C/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 8StOthe |OC8tiUM where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street, Suite 100 Boston, MA 02114-201' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: 8� J"ni/7CJ �,neJ City/State/Zip: lq4 Q/aa Phone#: �/�_WF-lakoQ Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with_employees(full and/or part-time).* 7. New construction 2.r_1I am a sole proprietor or partnership and have no employees working for me in g, ffff'❑' Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E] Building addition 4.[:]1 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.[]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.❑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 workers'comp.insurance required.] *Any applicant that checks box#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. Contractors 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 Self-ins.Lic.#: zgo+<10yQ,�t0.7�p�Q�9� Expiration Date: i,_054flAo Job Site Address: &0/amn' r olrl✓e/ City/State/Zip: WE ��V11p0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and piration 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 verificati I do hereby certif under e p t s and penalties of perjury that the information provided above is true and correct. Signature: Date: V J %.e/W 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#: ACS D1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 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&Grinnell PHONE (413)586-0111 FAX (413)586-6481 AIC No Etl: A/C No 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. INSURERC: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR AMA 500,000 PREMISES Ea occurrence $ MED EXP Any one person) $ 15,000 A 02932000 03/04/2020 03/04/2021 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY EPRO F 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED XSCHEDULED 02932000 03/04/2020 03/04/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIIA6 HCLAIMS-MADE 02932100 03/04/2020 03/04/2021 AGGREGATE $ 1,000,000 X DED RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYYIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? � NIA WMZ80080056582019A 05/22/2019 05/22/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • M-• HERS* Index Score: Annual Savings Home: Your home's HERS score is a relative � . 32performance score.The lower the number, Northampton, NIA 01060 the more energy efficient the home.To $2,750 Builder. learn more,visit www.hersindex.com *Relative to an average U.S.home StrInwood Builders 3 , • nr-K3 Index i �: • a i J ` MiAk ! 1 IN f tt w 4 1 kot ro e Ekatrope RATER Version:3.2.x.2385 R tette Enemy Rating Disclosure for this home is available from the Approved Rating Provider, This-t000rt dues not constiMeany,warrantv or ouarantft, Home Energy Rating Certificate Rating Date: 2020-03-13 HIS Registry ID: HE RSProjected Report EkotropeID: DLzVgP7L Index • Savings Your home's HERS score is a relative 33performanceThe lower number, Northampton, i 160 the more • efficient the home. i $ 2r099 • - learn more, 4 i *Relativei an •' U.S.home Sunwood Builders Your Home's Estimated Energy Use: This home meets or exceeds the Use[MBtul Annual cost criteria of the following: Heating 3.4 $164 2015 International Energy Conservation Code Cooling 0.3 $15 Hot Water 2.0 $93 Lights/Appliances 11.7 $541 Service Charges $72 Generation(e.g.Solar) 0.0 $0 Total: 17.4 $885 HERSAndex Home Feature Summary: Rating Completed by: HomeType: Duplex,single unit Energy Rater:Adin Maynard Model: N/A Community: VHCoHousing RESNt f 1D:9463452 Homo% Rating Com a» -`HIS&HERS Ener EfficiencyConditioned Floor Area: 882 fta Mailing;12 Perkins Ave.Northampton MA 01060 Number of Bedrooms: 2 4136588784 100 Primary Heating System: Air Source Heat Pump-Electric•3.66 CCP Primary Cooling System: Air Source Heat Pump•Electric-18 SEER Rating Provideffnergy Raters of Massachusetts Primary Water Heating: Water Heater•Electric•3.24 Energy Factor 2Wood lawn Street Amesbury,MA 01913978-270-3911 House Tightness: 1.2 ACH50 `< Ventilation: 31.3 CFM-20 Watts l� E . . Duct Leakage to Outside: Untested *, Above Grade Walls: R-28 ' zervEn�om� a Ceiling: Attic,R-60 i Window Type: U-Value:0.2,SHGC:0.25 Adin Maynard,Certified Energy Rater Foundation Walls: R-15 Digitally signed:3113120 at 10:28 AM + • RATER Energyekotrope The • Disclosure for this home is availableApproved Rating reportThis does not constituteor guarantee.