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36-393
BP-2021-2208 134 EMERSON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-393-001 CITY OF NORTHAMPTON Permit: New Build PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2208 PERMISSION IS HEREBY GRANTED TO: Project# NEW SINGLE FAMILY HOUSE Contractor: License: Est. Cost: 250000 SHAUL PERRY 065400 Const.Class: Exp.Date:06/25/2022 Use Group: Owner: SUNWOOD DEVELOPMENT CORPORATION Lot Size (sq.ft.) Zoning: SR Applicant: SUNWOOD BUILDERS Applicant Address Phone: Insurance: 84 POTWINE LN (413)259-1000 WMZ80080056582021A AMHERST,MA 01002 ISSUED ON:01/24/2022 TO PERFORM THE FOLLOWING WORK: 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , • Fees Paid: $1,593.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner '/ 1 Pi ' v4 i.-L E,-, 6004 4 V 2 , The Commonwealth of Massachus tts N lott Board of Building Regulations and Standards 18 20 7CIPAuTY FOR Massachusetts State Building Code,'? 2� o� USE Building Permit Application To Construct,Repair,Rend, ;,Q3n �JS� lish ised Mar 2011 One-or Two-Family Dwelling ?OM r,,Ip csi—loNs l This Section For Official Use Only Building Permit Number:M--ol I ,. (1 Date Appli(e�d: .�5' % 'lir. I aLI a Building Official(Print Name) Signature 1 • SECTION 1:SITE INFORMATION 1.1 Prop rty ddress: 1.2 Assessors Map&Parcel N m , e.r"€o/1 ii ( 36 1.1 a Is this an accepted street? es no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Q` Zoning District Proposed Use Lot Area(q 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 0 Zone: _ Outside Flood Zone? Municipalil On site disposal system 0 Check if yes❑ /// SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Oev/.JTmcJ rd:vrwood _A/j iAG,Sii Ail D/OD/ Name Print) // City,State,ZIP 8 2otwyir�inc/ 1/ 3 ' /O� YamieweleCoocasinel No.and Street 'Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New ConstructioncExisting Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Cl Specify: Brief D criptis,n o Proposed Work': • fNi SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official UseOnly (Labor and Materials) 1.Building $ /80000 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $��000 0 Standard City/Town Application Fee / 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $0000 2. Other Fees: $ 4.Mechanical (HVAC) $aa000 List: 5. Mechanical (Fire $ Suppression) Total All Feel: $ Check No /0 Check Amount: //Cash Amount: 6. Total Project Cost: Say0000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Cons ruction Supervisor License(CSL) 6 n_04�� Sazi/PC7 License Number Expi 'on ate Name of CSL Hol er V�{� hAttc, List CSL Type(see below) 61 No.an St eta W"1eJ Type Description h�s,� a ©00t U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town/,,State,ZIP �r/l1 V R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding /11 ��+ / SF Solid Fuel Burning Appliances 13 a6 /4vo S.MWoocl&60,11Ce.#4 rc1 I Insulation elephone Email address D Demolition 5.2 Registered ome Im ovement Contractor(HIC) or►wo 3v;/ c t'6' /0830/ HIC Registration umber E tion Date HI C ame or HI Re 'strant Name dr Wi%7 fgarlWood�(,'o/Yrc c//9No. dt Email address m4 ,f O/000 1M-a67/000 City/Town,State,ZIP Telephone 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 Issuance of the building permit. Signed Affidavit Attached? Yes No ❑ 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 contained in this application i-true if d a urate to the best of my knowledge and understanding. s/Ll.�� i� iQ o'l Print Owner's or Au on.t.Lents_ a e ec is Signature) / Date ( g ) 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.) d//f Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches I Type of cooling system Enclosed Open / 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 36 LOT: C.Mk.5 LOT SIZE: /Q / REAR LOT DIMENSION: g[o / REAR YARD 8f4z 'if 1 SIDE YARD J , SIDE YARD l0/0 f / /6' / / /8' ✓ 1 ogi FRONT SETBACKI. / FRONTAGE 86 City of Northampton _ Massachusetts 4." ._ '<<., C. ` l't it:::r DEPARTMENT OF BUILDING INSPECTIONS s2 ,_,. 212 Main Street • Municipal Building yJ'•. te. Northampton, MA 01060 syW % 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: cc��,siU-� Ow, o 7ra.../r' C _ Location of Facility: ac ,i,y, - i,L4 ,,,,,,,/„ rc� /�v, �,, The debris will be transported by: Name of Hauler: �2upppVoocf fav,i L 3 Signature of Applicant: Date: 0 The Commonwealth of Massachusetts ' 11111116 et, Department ofIndustrial Accidents r P Congress Street,Suite 100 _';f;t-_ Boston,MA 02114-2017 '.: a=rta... www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO RE FILED WI'TB THE PERMITTING AUTHORITY.. Applicant Information Please Print Lenibls Name(Businc a niffit n/Individuali: 6 riWooJ koolckeS Address: (5i Vw,nel e../ City/State/Zip:�l►4c4-157, , 7 O/OOoZ Phone#: /#6 d5/'/000 Are yen an employer?Cheek the appropriate bus: Types jest(required): 1 I ant a emplayur with_�L_employees(full andur part-time).* p7. New construction 2 f 1 am a sole proprietor or partnership and have no employ cm working for me in 8. 0 ling any capacity.[No workers'comp.insurance reguinai] C1 am a homeowner doing all trunk myself[No workers'comp.inset-ace required.]` 9. El Demolition 4_0 I am a homeowner and will be hiring awtractors to euoduct all work on my property. 1 will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11 a Electrical repairs or additions proprietors with no 12.0 Plumbing repairs or additions 5.10 1 am a general contractor arid I have hired the sob eantractots hated on the auaded sheet. These Sub-contractor:have employees and have workers'camp.insurance.: 13 Roofrepairs 6_0 We are a corporation and ire officers have exercised their right of exemption per MGL c 14.e r t Other 152,41(4),and we have no employees.[No wotkera'campy insurance required.] *Any applicant that checks but#1 must also fdl out the section below showing their workers'eoncenearion policy infortnffiioe_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors man submit a new affidavit indicating such #Contractors that check this box must attached an additional sheet showing the name of the Stan and state whether or not those entities have cmplo!mes. If the sub-contractors hive employees.they mnatt provide their workers'comp.policy number_ I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name: A/2-i ddoo-/ — Policy#or Self-ins.Lie.#: WMX8OO6OO6(o& ,/0//1/ Expiration Date: *at,//aZ Job Site Address: Al �Cc5 /1 n4, / Or/ct.05 ,hi1f City/State/Zip: 1/OOQ Attu a copy of the workers'compensation policy decitation page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 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. I do hereby certify un the ,r'ins and penalties ofperjury that the information provided above is true and correct. Signature: i Date: /O//Jf/ 22 Phone#: /V, '9/At) Official use only. Do not write in this area,to be completed by city or torn 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 b.Other (I/0Contact Person: Phone#/: AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 11/10/2021 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.Exti: (A/C,No): 8 North King Street E-MAIL kparker@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER : Selective Ins Co of Southeast 39926 INSURED INSURER B: Selective Ins Co of S Carolina 19259 Sunwood Builders,Inc.,DBA:Sunwood Development Corp. INSURER C: A.I.M.Mutual/A.I.M. 33758 Attn:Shaul Perry INSURER D: 117 Olander Drive,Unit 4B INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2133015357 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. ILTR R ADDL 1NVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) JMMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY 1,000,000 �/ EACH OCCURRENCE $ D CLAIMS-MADE X OCCUR PREMISESDAMAGEO(Ea occuE ence) $ 500,000 MED EXP(Any one person) $ 15,000 A S239905501 03/04/2021 03/04/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY OTHER:nPRO- JECT LOC 0000020 , $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED A910808200 03/04/2021 03/04/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 — A EXCESS LIAB CLAIMS-MADE S239905501 03/04/2021 03/04/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A 1NMZ80080056582021A 05/22/2021 05/22/2022 (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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Northampton is listed as additional insured with respect to liability as per the terms and conditions of the policies. 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 Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 /Pi - c I @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ;1.• - 4 City of Northampton ?oa�H M To Sys w sc `' Massachusetts 4 F7-Nk> e. " � t 7 DEPARTMENT OF BUILDING INSPECTIONS k -rN 212 Main Street • Municipal Building � Northampton, MA 01060 Fee Calculator for New Residential Construction ONLY Location : //3 ersoI7 ► 4/ /440.77 ,T Square Footage Amount Basement @ .20 da Pk" 1ST Floor @ .50 zi/g i 1,00 °o 2nd Floor @ .50 '/2 Floors, Finish Attic, Garage @ .20 i 0 O. o0 Deck I Porches @ .20 /01 ilW Total : i / 'g3. o0