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31C-066 CONTRACTOR CHANGE CaKteal,fe UVtT5L- 43 HIGGINS WAY- LOT 10 BP-2020-0125 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31C-066 CITY OF NORTHAMPTON Lot:-10 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-2020-0125 Project# JS-2020-000202 Est.Cost: $414395.00 Fee: $1394.12 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SHAUL PERRY 065400 Lot Size(sq.ft.): Owner: SHAUL PERRY Zoning: Applicant: SHAUL PERRY AT: 43 HIGGINS WAY - LOT 10 Applicant Address: Phone: Insurance: 84 POTWINE LN (413) 259-1000 WC AM H E RSTMA01002 ISSUED ON:8/2/2019 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 N 1 RTHAMPTO UP N VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signaturc:i FeeType: Date Paid: Amount: Building 8/2/2019 0:00:00 $1394.12 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner A 1 i , The Commonwealth of Massachusetts f; . FOR Board of Building Regulations and Standards MUNICIPALITY if o 8 WMassachusetts State Building Code, 780 CMR USE N W o O o. Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 `�' S One-or Two-Family Dwelling W *o This Section For Official Use Only o c. CO Building Permit Number: ' G'n I Jib cc- if Appl'ed: ��+ c 11 f/ ij w Building Official(Print Name) Signature lute o SECTIO 1:SITE INFORMATION , .. -.- 1.1 Pr9pe ty Addr/9ss: 1.2 Assessors Map&Parcel Numbers iej-#AO //- :9 '41,1 VI c61 1.1 a Is this an ace p d street?yesX no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: b Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided ' Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private Cl Zone: — Outside Flood Zone? I CI 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner' Record: / / l .`:ALI/.re-r / - tp01 0/00 ,irfL S/ / 0/0001 Name(P,�' t) / City,State,ZIP / eq.)o/w,nc�4C/ *i3 -do /az ch ce ii .e ,ed No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units ther 0 Specify: Brief Descriptio of Proposed Work': Ql1G-CAl lord ailf i%Yi.S r odCM r J SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ On Check No. 20A/aeck Amount: i Cash Amount: 6.Total Project Cost: $ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Co truc 'on Supervisor License(CSL) 6 6_O i oo 67 Ot.1 .GP'r License Number CJ Ex atio Date Name of CSL Hol er 8_1/ n List CSL Type(see below) # f D iefe-i G/ No. Str et Type Description .lU7ie er.s/ 4 o U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,l��l11! State,ZI�' V V R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 gistered HoTe Ipproverint Contractor(HIC) /^�30 onwood QcdC6 HIC Registrationst umber Ex ira on Date iHIC pal/te or HIC Rg�gistrant Name / **lied eJ SvNwood &Con 1Cc f sf1J Rio. otrtees/ ,A/ 0/000 ,`/J5 _ 4 9'/000 Email address City/Town,State,ZIP /lj( TelephoneTe SECTION 6: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 Issuann e of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information conttaaiin in this application is true and accurate to the best of my knowledge and understanding. \" a fi7 O Print Owner's or Autho zed Agent's Name(Electronic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton *Pk / �n Mer .. Massachusetts . tA „: ,, ' �- �' ., 41' DEPARTMENT OF BUILDING INSPECTIONS . ;14, x " 212 Main Street • Municipal Building yV4` .Cam '� Northampton, MA 01060 fsti".-. % rc. CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Vele/ � /Location of Facility: 06/{2/C1// !o✓�►�/ ion, rd Alact t 1 wrj /►L�f 01060O l , The debris will be transported by: Name of Hauler: 540/Derr - eor,vooc vi��ei'S Signature of Applicant: Date: Ot/ _- The Commonwealth of Massachusetts . la=—..— =!/ Department of Industrial Accidents i ,...,.. _,?nil= 1 Congress Street,Suite 100 1/4'1:,- ., Boston,MA 02114-2017 ;` www.ntass.gov/tlia Workers'Compeosstion Insurance Affidavit Builders(Contractors/Eketricians/Plumbers. TO BE FILED WITH THE PERMITTING;AUTHORITY. Applicant Information Please Print Legibly Name(BusinessiOrganization/Individual): sy�1WC)C)Cl 1C�c3,C.i.-6' Address: G ,L- odfl- r City/State/Zip:�j,y,L '/, Aa 0/Oat Phone#: f ?-7/000 Are yea as employer?Chedt the appropriate b : + m Type of project(required): Oast a employer wish._JQL.__empioyeea(fill anderpurtime)' 7. ew construction 2I m l am a sate pruptier or partnership and have no employees working for en,in 8. 0 Remodeling e any rapacity_[No workers'canp.uwurance required_] 30 I am homeowner a homwner doing all wart myself.[No waken'comp_instance required.]• 9. ❑Demolition 10 0 Building addition 1.0 I am a homeowne rand will be hiring tractors to conduct all mark on my property. 1 will ensure that all contractors either have wntters'compensation insurnace or are sole l I.a Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5O dam a grrrural contractor and I have hired the sub-cootracwar listed on the attached sheet_ These sub-contrarian lure employees and have waite rs.'coop.insurance.: ]3❑Roof repairs 6.0 Wt are a corporation and in officers have excveised their tight of exemption per MGL e. 14.a Other 152.(1(4).and we have no employees.[No workers'camp.insurance requited] 'Any applicant that checks boa al must also fill out the section below showing their waters'compensation policy information_ t Haneuwoers who submit this affdavit indicating they are doing all work and tiara hire omtaide cattracwrs must sttbait a new affidavit indicating such ;Contractors that check this box must attached an additional shirt showing the name of die sub-contractors and stage whether or not those entities have employees. If the stab-eontracwrs have employees.they natal 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: ,i_z, v $rj(plfCC./ 4io'/I Policy#or Self-ins.Lie.#:W OO80a56&e 1O/,l6i) Expiration Date: lob Site Address: S ' Cit /Stt /Zi 4J�tr''�� Cf 00/0 0 Attach a copy of thew mpeu4ation policy declaration page(showing the policy number and'espiro(Ion date). Failure to secure coverage as required under MGL e. 15Z,¢25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifica' I do hereby certify untie/1,a and penalties of perjury that the information provided above i true and correct Signature:40 Date: C004 Phone#: / J - - 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: A`ORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/02/2020 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 (A/C.No,Ext): (A/C,No): 8 North King Street E-MAIL kparker©webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Selective Ins Co of Southeast 39926 INSURED INSURER B: Selective Ins Co of S Carolina 19259 Sunwood Builders,Inc. INSURER C: A.I.M.Mutual/A.I.M. Attn:Shaul Perry INSURER D: 84 Potwine Lane ' INSURER E: Amherst MA 01002 I 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO R CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 500,000 MED EXP(Arty one person) $ 15,000 A S239905500 03/04/2020 03/04/2021 PERSONAL SADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRO 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED A910808200 03/04/2020 03/04/2021 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) ' Medical payments $ 5,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADES239905500 03/04/2020 03/04/2021 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE EERH Y/N 500000 C FY PROPRIETOR/PARTNER/EXECUTIVE [] N/A WMZ80080056582020A 05/22/2020 05/22/2021 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? 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/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 'j1G:—. t7 c , I �I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SUNW000 1 sr. 1 m7,tiviiii r ...,Pi-- ` BUILDERS % M 'J� 84 Petwiee Lane.Ambent,MA 81802 �� Office 1/413-259-1000 www.sunwood-bullden.com DcAT V40:71447or op 80 �,NSP03/26/20214q° City of Northampton Building Department 212 Main Street,#100 Northampton, MA 01060 RE: Lot#5 (Unit#23)Higgins Way Lot#10 (Unit#43)Higgins Way Northampton Building Inspector, We are writing to formally request the transfer of 2 active Building Permits,Lot#5, and Lot#10, located at Higgins Way. The permits are currently listed with Pecoy Construction Company. Sunwood has formally purchased the Homes on Higgins Way, from Pecoy Construction, as of Wednesday, March 24th and Sunwood will immediately begin completing the existing and incomplete homes, Unit#23 and Unit#43. We have included a$100 permit transfer fee for the 2 units, (total check of$200). Th. you, Oaul Perry