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38A-013
BP-2022-1203 33 CHAPEL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38A-013-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-1203 PERMISSION IS HEREBY GRANTED TO: Project# 2022 INTERIOR RENO Contractor: License: Est. Cost: 82000 SUNWOOD BUILDERS 065400 Const.Class: Exp.Date:06/25/2024 Use Group: Owner: SUNWOOD DEVELOMENT CORP Lot Size (sq.ft.) Zoning: URB Applicant: SUNWOOD BUILDERS Applicant Address Phone: Insurance: 84 POTWINE LN (413)259-1000 WMZ80080056582022A AMHERST, MA 01002 ISSUED ON:10/06/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENO 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I 4 cfr, I � Fees Paid: S533.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office,of the Building Commissioner 14 The Commonwealth of Massachusetts W Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: i-Z 2 .--/203 Date Applied: ..9 i% as Building Official(Print Name) Signature Date J SECTION 1: SITE INFORMATION 1.1 Pro er ddre s: 1.2 Assessors Map&Parcel Numb rs 44/itei 1.la Is this an hccepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 PIop� rty Dimensions: 046 Zoning District Proposed Use Lot Arbasqft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water_er Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Publi9 Private 0 Zone: — Outside •Flood Zone? MunicipallJ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 wneri of e ord: /� ' a‘..) /YIAICKS 11/ , 0/0DO`— f Name Pnnt) City,State,ZIP dffir Pedwkic... c./ *3 o 9-/ate Scorwoodeic masl.>el No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s)A1 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Descr tion of Proposed Wor 2: Mx' f'Jirr rr Wets' Mt AI,: 04,✓ ' 7 6 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1/4.516;000°O 1. Building Permit Fee: $ Indicate how fee is determined: /�QQD°o 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x o 3. Plumbing $ Jpf000, 0 2. Other Fees: $ 4. Mechanical (HVAC) $ 8000.°° List: 5.Mechanical (Fire Suppression) $ Total All F 3 Check No. Check Amount: 6.Total Project Cost: $ad,OQO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /rA O (1/00 0 4 / ( t��rd►t,1/Parr License Number Expi{ation at Name of CSL H lder List CSL Type(see below) el a W/Wed 104CI Type Description !rJ No.an Street �C13 T /�Y1/ �/� O/�� U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �j� SF Solid Fuel Burning Appliances RAJ o09 000 e .IL1J I Insulation Telephone Email address D Demolition 5.2 egistered�me Imp ent Contractor(HIC) /08(301 ‘,/..,u/nwo0 vI Gre HIC Registratio Number Date HIC y ame or HI Registrant Name 1 �i tw,•rfci lone/ surrwo &coniccd.'rU No.auil Aof des/ ,// D/oo/ ,1 2, rip,/OOO Email address City/Town,State,ZIP /l�lJ QTlellepphone 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 0 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 contained in this application is N e . % acc , :to to the best of my knowledge and understanding. __dad Per he Print Owner's or Aut rued 40it's Name lectn,Signature) Date ( gn ) 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.go%/dps 2. When substantial work is p,�1 ed,provide the information below: Total floor area(sq. ft.) l L0e (including garage,finished basement/a 'cs,decks or porch) Gross living area(sq. ft.) /Jilt- Habitable room count Number of fireplaces ' Number of bedrooms 3 Number of bathrooms Number of half/baths Type of heating system c/ Number of decks/porches 0 Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts l' =_*,'l�l�!� Department of Industrial Accidents ::rh= 1 Congress Street,Suite 100 _:14_-_ :w Boston. MA 02114-2017 •�v•tti` w ww mass govfdia ;1,ukers' ( unipewation Insurance:Affidavit:Buildertt/('nntractors}:krrtricians 'lumbers. TO BE FILED'WITH THE PERMITTING All IIIORI'f1'. Applicant Information Please Print I.etibhr Name t 1usincsslOrPanizationllndivukiall:__ 5v/7WooQ Ji/ U'S Address: U Akiyie,./4,/c/ City/State/Zip: 4„t cr / j ' O/40,1 Phone #: 1fiE3 'p&9'/OOO Are yea,ut employer!Mark the appropriate box: Typeof project ro"ect(required): 1 . am a employer with /0 employees(hill:imd or part-tuna.'Xr``T� 7. 0 New construction 2. I ant a sole proprietor or partnership and leave no employees working tot Inc in 8. RR:emodeling any capacity.[No worker:ealtnp.imurance mooned.] 9. ❑Demolition 3. I ant a honinownin doing all work unseal.(No vsMom'comp-nc amine Irwinall' 10 Q Building addi " n 41 I am a ho seam tam and will he hiring cram-factors to Oundue'[all Maus aln Illy property. I w ill ensure ivat all cwuraeiorx nihcr have waxt.en`-conperts:rtiowt uwinance or ave.sole. no Electrical or additions pruprictors with n o tiupiuyccs. 12.0 Plumbing repairs or additions 50I am a general cunt:actor and 1 has c lined the subcouiiracum listed on the attached shell_ 130 Roof repairs l'hcsc sub-conira..1...p.tune einployees and 1IJs c wi ilerS'C411141.tRlnralrie'_' 14.0Other ti.Q We arc a coapxratio*n and its offreen,have exercised then nen"of exemption per.Ng il_c. 12,§1{4h.and we have nu employees.[No workers'coup-insurance reyuned_( *Any applicant that checks hos w I must also fill nut the auction below shorwing their wurkoas-camtpeosaitioa policy ieiw iio e +Ilorneuwnen who submit this affidavit indicating they an doing all work and them hire uuttadc cunrractuts mot emboli a ae•r affidavit. g such. ':Contracture that check this lam room attached an=Minimal sheep showing the name of the s+ul.curdractursand dale whether ar rat those es base orpioy yes- If Ion sub-co ntractu.have employees.iIc mint provide their workers"u:unp.policy nttinlrer_ I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � Insurance Company Name: /A /0/_;01_„,,, ,s2aNgrer,„„/ I — Policy#or Self-ins.Lic.#: WykiX8008O0L 68d0Q1 Expiration Date: (�,1//80 lob Site Address: (13 Chip drcc.fl, City/State/Zip:/%ovy7 ,'i 0/060 Attach a copy of the workers'//compensation policy decimalise page(showing die policy another at�txpi Lion date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up S1,500.00 and/or one-year imprisonment*as well as civil penahies in the form of a STOP WORK ORDER and a fine of up $250.00 a day against the violator.A toy of this statement may be forwarded to the Office of Investigations of the DIA insurance coverage verification. I do hereby rerti an r lb sins and penalties of perjury that the information provider!above i' true and correct_ Si:mature: Date: 9 /9 de, Phone/t: /V (2 9-/ 0 Official use only. Do not write in this area/to be completed by city or town official City or Town: Permit/License At Issuing Authority (circle one): I.Board of Health 2.Building Department 3.Ci1 ITown(jerk 4.Electrical Inspector S.Plumbing Inspector G.Other Contact Person: Phone#: A CPRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/16/2022 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,Extl: (A/C,Nr: 8 North King Street ADDRIesS: kparker@webberandgrinnell.com 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.,DBA:Sunwood Development Corp. INSURER C: A.I.M.Mutual/A.I.M. I 33758 Attn:Shaul Perry INSURER D: 84 Potwine Lane INSURER E: Amherst MA 01002 INSURER F: I COVERAGES CERTIFICATE NUMBER: CL2242618181 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 INSO WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LI ITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED i 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A S239905501 03/04/2022 03/04/2023 PERSONAL BADV INJURY j $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRO- piLOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ONED X W SCHEDULED A9108082 03/04/2022 03/04/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS 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-MADE S239905501 03/04/2022 03/04/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WMZ80080056582022A 05/22/2022 05/22/2023 ri 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 I 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. RE:31-33 Chapel Street Northampton MA 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 bf il«--. - y/ i' I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton oaH _Mp°4 'A Massachusetts 4,- r.: .0 ' '4 DEPARTMENT OF BUILDING INSPECTIONS w a: , ,. a� 212 Main Street • Municipal Building 04. � 77 _.,. , Northampton, MA 01060 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: 6niped.7y D //-0,-,vc.„„f„__g7 Location of Facility: d.511 Aell(tain lhri /�cJ /S/oia yr pbi>, A41 b/GAO p The debris will be transported by: p Name of Hauler: Yurtwood (,/ch'd Signature of Applicant: Date: 9/ei doe • / 8, t dal' . . f II,"'• (" l "A1 4dd'" /, d-i t�i !/" 3G `/ ar. +.w.n.rr.er. . _ .an lifiliZ t 1N1 KI?CHEN i' MASTER SUITE . It L a P S A ill AZN `1F(Yi R iD j 1 w:'nt _ Of'a/„ C3o x19•) d-WZ'(da fAey) y 33a-,:pci7-617r-j- 64116(8 � � 8uirwood /1/0,-4 �'7 4r1, A - • -