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44-093 BP-2022-0224 462 ROCKY HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-093-001 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-2022-0224 PERMISSION IS HEREBY GRANTED TO: Project# SIDING Contractor: License: Est. Cost: 23500 MAJOR HOME IMPROVEMENTS 103054 Const.Class: Exp.Date:08/24/2022 Use Group: Owner: CREPEAU BRIAN J Lot Size (sq.ft.) Zoning: SR/WSP Applicant: MAJOR HOME IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST WS470076 WESTFIELD, MA 01085 ISSUED ON:03/08/2022 TO PERFORM THE FOLLOWING WORK: VINYL SIDING 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:g • f• ''/ • Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 - Office of the Building Commissioner "c) tv 00•1 /r The Commonwealth of Massachu�tts .` R -ctfoj Board of Building Regulations and Standar+ds. 2 R Massachusetts State Building Code,780 C'Mikipr�o,% �� USA TY y !nA Building Permit Application To Construct, Repair, Renovate Opt , t ' Re ised ar 2011 One-or Two-Family Dwelling •a q o b7, This Section For Official Use Only Buildinn Permit Number: AR- 3 ,- ?.�c4 Date Applied: rieV) o7-5 5-e-7oZZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1,1 r operp Address: /2/ 1.2 Ass�sso_rF Map&Parcel Nu�b� 1.1a Is this an aacc street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: / 'Ui(t_f uLtpt out Ftoi. P 11 C.e. l ()(o, Name(Print) pity,State,ZIP AZ oi you' ( kal' Li(3)S.s '3 -��6 i No.and Street ✓ Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building In Owner-Occupied 17' Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ElSpecify: Brief Description of Proposed Work2: kQ p-QC{ L /Yl._LI(I. C¢ VirLye S i GU fl, SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ ()Z.3/ S) 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ y!/ Suppression) Total All Fees:$ 'iJ0,0 Check No.2700Check Amount: Cash Amount: 6.Total Project Cost: $ az 3/ sly, 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 JConstruction SupervisorJ / � License(CSL) C (030,� �/� (//�� ` I/Q 7/r'e ��-('_.l.K-! ►CJ�l't.�.Y� License Number Expiration7 Date Name of CSL Holder / ^ , n L 1 (�/J List CSL Type(see below) No.and Street (�/ , Type Description 0_ ,) `.i[ •„ ® �./ ! 11 0 l v cy , U Unrestricted(Buildings up to 35,000 Cu.ft.) V U I� t✓C C,( fvV' R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding /�uy / Q SF Solid Fuel Burning Appliances 7��-0 -6�( i��/ address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /5� S/// ��3 /�, �(Z / / c7me it 1 (.JtfkLitL f HIC Registration Number Expiration Date HIC Com an Name or HIC R gistrant &ne .z�L viA-o n 0 (I/w-t Moe.311znte ,cobSD.Le/2L N . d StreetEmail a'•ress ,c.:f-he.i ictA OMJ 3- (Z8 4U -6016 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 .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 T )7� ( . kuiclico Jut, to act on my behalf, in all matters relative to work authorized by this building permit application. 511-`GUL &'�&t& 3/3/z Print Owner's Name(Ele tronic 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 true and accurate to the best of my knowledge and understanding. 0/OVA atla 3/2/1-Z Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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.00v/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 Massachusetts(.1'4; "<< N � S 3. s DEPARTMENT OF BUILDING INSPECTIONS t)' b 212 Main Street • Municipal Building 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: Location of Facility: <S0c,c-414 tOi )cE J©'1 The debris will be transported by: Name of Hauler: U(SA galtQ Aty Signature of Applicant. Date: The Commonwealth of Massachusetts _*° 1, Department of Industrial Accidents ;=�►= 1 Congress Street, Suite 100 _41=< Boston,MA 02119-2017 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plum bers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly .-- Name (Business/Organization/Individual): 01--e-_6 9- it-a',LY Address: LuL A,o n G (57 1- City/State/Zip:41)e S-I'F) i-I'd d(o e) Phone#: (�)6 36 - 6 0(/1 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 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 ❑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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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 are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other S(LC�id/ 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration 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$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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: �� Date: 3/3/,L el— Phone#: 36 601 Official use nly. 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#: ACQR©® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 06/14/2021 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT David R Jerry Neill&Neill Insurance Agency Inc PE FAX 662 Riverdale Street WC.No,Ext): 413 732 4137 (A/C,No):413-731 6629 West Springfield,MA 01089 ADDRESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Northfield Solutions NOF INSURED Milet,Inc. INSURERS: Liberty Mutual Insurance Co. 23043 Major Home Improvements Go Vasile Kukharchuk INSURER C 19 Hunters Slope INSURER 0; Westfield,MA 01085 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 I ADDLrSUBRI POLICY EFF I POLICY EXP '!. LIMITS LTR • TYPE OF INSURANCE iiNSD I WV POLICY NUMBER (MMIDD/YYYY) (MMIDD/YTYY) i A j V COMMERCIAL GENERALL LIABILITY WS470076 04/29/2021 04/29/2022 (EACH OCCURRENCE 5 1,000,000 j !CLAIMS-MADE �/I OCCUR S DAMAGMITO( a occurrDence) 100,000 I �PREMISES(Ea oxurrence) 1 5 MED EXP(Any one person) ; $ 5,000 —J PERSONAL&ADV INJURY 1 5 1+000+000 I GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 PRO- —� POLICY I I JECT LOC I j I PRODUCTS-COMP/OP AGG ' 5 2,000,000 ; OTHER: I j AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT S I i (Ea accident) ^—ANY AUTO ( ! BODILY INJURY(Per person) S OWNED SCHEDULED I , AUTOS ONLY AUTOS I BODILY INJURY(Per accident) S HIRED NON-OWNED I PROPERTY DAMAGE I5 J'AUTOS ONLY ,AUTOS ONLY (Per accident) ` I j S UMBRELLA LIAR II OCCUR 1 EACH OCCURRENCE S EXCESS LIAR I CLAIMS-MADE ' I AGGREGATE 15 I I DED 1 RETENTION S ! • S B WORKERS COMPENSATION I WC5-31S-360160 06/09/2021 106/09/2022 II PER I OTH- I AND EMPLOYERS'UABILnY i V STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YlNN I E.L.EACH ACCIDENT . S 100,000 OFFICER/MEMBER EXCLUDED? Y N/A; I 1�o'QOQ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE'$ If yes.describe under f I DESCRIPTION OF OPERATIONS below l E.L.DISEASE-POLICY LIMIT :S 500,000 i I I 1 I 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE$ENT4TIVE t (1 / } i ©1988-2015 ACORD 6 RPORATI ll rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts (�1 Division of Professional Licensure Board of Building Regulations and Standards Constrottt1111S15psrvisor CS-103054 b4 Fitpires:08/24/2022 VASILIE M KUKHARCHU • 19 HUNTERS'SLOPE WESTFIELD MBA 01086 �f 1 Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 150841 05/03/2022 VASILIE KUKHARCHUK D/B/A MAJOR HOME IMPROVEMENTS VASLIE M.KUKHAREHUK , • 19 HUNTERS SLOPE WESTFIELD,MA 01085 Undersecretary STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HOME IMPROVEMENT CONTRACTOR VASILIE KUKHARCHUK 22 Verona St Westfield,MA 01085 MAJOR HOME IMPROVEMENTS Registration# Effective Expiration HIC.0611632 12/01/2021 03/31/2023 SIGNED - - -- - _.