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43-009 (6) BP-2023-0257 123 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-009-001 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-2023-0257 PERMISSION IS HEREBY GRANTED TO: Project# DECK 2023 Contractor: License: VASILIE KUHARCHUK DBA MAJOR Est. Cost: 25485 HOME IMPROVEMENTS CS-103054 Const.Class: Exp.Date: 08/24/2024 Use Group: Owner: S DONNELLY BRIAN F&MARINA Lot Size (sq.ft.) VASILIE KUHARCHUK DBA MAJOR `-TOME Zoning: WSP Applicant: IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST (781)913-6405 WC5-31S-360160 WESTFIELD, MA 01085 ISSUED ON: 03/02/2023 TO PERFORM THE FOLLOWING WORK: REPLACE EXISTING DECK WITH NEW 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: ! , (� . �� g . v , Xa,( � • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner fL �,,� The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR = �►i Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 2-5'9 Date Applied: J�Ljv�a� �1Cuss1/1 . --Z•ZOZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers I�3 MedlA any _ iQd, • 1.1a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record:/�t FD Off, PA D/O Guy �nal_e e� Name(Print) as ity,State,ZIP /01 3 w.e3 1i ccnt/> ,Od. Qoj) z 9-.s2)3 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Gr- Owner-Occupied,H Repairs(s)$ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: * /,, '0 <. pip' (LI(k (,vi-f,5 A-C( L/ eOn-y)3)L ci c t 6w 1 a CC- CPAI/e c r /Le/ r -j G��1.%,yzia,vr SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ �S �I)r--' 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ �, / t.A) Check No.,30(jCheck Amount: '�f Cash Amount: 6.Total Project Cost: $ e (,�S' 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C ( 3c /� /4 / / JSL) ,t ,, / ! )a)(IL 0 �/ License Number Expiration Date Name of C Holder ~`'` /n Ptan List CSL Type(see below) No.and Street Type Description 4 , O/O J Unrestricted(Buildings up to 35,000 cu.ft.) ko�.t R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances �i3)31 Dv�b /)l p ' I Insulation Telephone Email a dress D Demolition 5.2 Registered ,Home Improvement Contractor(HIC) y S-/3/0N 4i.-&/t7�-/7 C�h(.� . ,Q-e2-Ervi-C I I f HIC Registration Number /Expiration Date HIC Co an Registr Name Name or HIC 0,.2 �1'wi a /)'I D/2�iv/k e cy a4 -colt /O j,' Email address 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 / r7 a 1 )( ? k;tL (-/)c A tte, to act on my behalf,in all matters relative to work authorized by this building permit application. cUL A.) z/,c /o/3 Print Owner's Name(Electronic Sign re) 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. /7 k hcnCl/Le—ei /./ 3/ 3 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.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 oµtHAMP Massachusetts 31C'{ ti t r' 't441e DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 3a, c$ + Northampton, MA 01060 j4y1; 3;:j(�" 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: �,��A �Ct.�� ac) �� f Ctj The debris will be transported by: Name of Hauler: UJ/ Hat, c / , I Signature of Applicant: Date:2 Q o The Commonwealth of Massachusetts Department of Industrial Accidents 1 aft Office of Investigations Lafayette City Center 2Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Il.egibly Name (Business/Organization/Individual): Ha/yt� ` — 7 I�C9 t/ej7t�LS Address: 2 I `/f4,0/1 c' J/L City/State/Zip: /J/ 'z/d,tC Wok.) Phone#: (3)1(3( -‘UC/‘ Are you an employer?Ch ck the appropriate 9x: Type of project(required): 1.❑ I am a employer with 4. I ;i'I am a general contractor and I * have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]1. c. 152, §1(4),and we have no A I , t, employees. [No workers' 13. Other /fir comp. insurance required.] *My 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 expira0on date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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: tt G' �— Date: 2 —oi 9 -'2 3 Phone#: AO/94 3 C -6 0 v4 Official use o ly. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 20 Building Department 311City/Town Clerk 4.0 Electrical Inspector 50'Iumbing Inspector 6.0Other Contact Person: Phone#: RO CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AME R.ND, 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 Neill&Neill Insurance Agency Inc NA E: David R Jarry 662 Riverdale Street PHONE 413-732-4137 Fax INC.N•.EMI` ADC,No).413 731-6629 West Springfield,MA 01089E-MAILDDRESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Nautilus Insurance Company 17370 INSURED Milet, Inc. INSURER B: Liberty Mutual Insurance Company 23043 Major Home Improvements 22 Verona Street INSURER C: Westfield,MA 01085 INSURER D: 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 ADDL[SUBR POLICY EFF ' POLICY EXP LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER (MM/DD/VYYY) '(MWDDWYYYY) LIMITS A J COMMERCIAL GENERAL LIABILITY NN1398696 04/28/2022 04/28/2023 EACH OCCURRENCE $ 1,000,000 ' CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ i MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JPOLICY L J PE O- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _AUTOS HIRED NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY __AUTOS ONLY (Per accident) $ UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B ,WORKERS COMPENSATION �i WC5-31 S-360160 06/09/2022 06/09/2023 i V STATUTE ER AND EMPLOYERS'LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YY N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE gliwaiLif R‘Lifes=to ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff-, Business Regulation 1000 Washing11- -Suite 710 Bosto r ,___._...._- av118 Home Im.ro' - - - istration �x. .A - W,Type: Individual e.', ation: 150841 VASILIE KUKHARCHUK =:_ E -lion: 05/03/2024 DB/A MAJOR HOME IMPROVEMENTS 19 HUNTERS SLOPE 14 — 4 �_! a,/WESTFIELD,MA 01085 I♦ Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer A &Business Regulation Registration valid for individual use only before the HOME IMPROV ' ONTRACTOR expiration date. If found return to: e__ r:__ ,, - Office of Consumer Affairs and Business Regulation � _ 1000 Washington Street -Suite 710 7 'r Boston,MA 02118 d VASILIE KUKHARCH � —�� D/B/A MAJOR HOM �_ - VASILIE KUKHARCHU -�.f %? �' — 19 HUNTERS SLOPE i,,,,,,q(/i.,,,z//n./. \ �'� WESTFIELD,MA 01085 Undersecretary Not valid without signature Commonwealth of Massachusetts Y Division of Occupational Licensure �� Board of Building Regulations and Standards Const(t>i Ctn IS ervisor CS-103054 z F yires:• 08/24/2024 VASILIE M K#KHARCHUK p 19 HUNTERS✓SLOPE 111 WESTFIELD M 101085 Commissioner d,i C, K. SFr,c Lta, STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HOME IMPROVEMENT CONTRACTOR VASILIE KUKHARCHUK 22 Verona St Westfield,MA 01085 1 MAJOR HOME IMPROVEMENTS Registration# Effective Expiration HIC.0611632 12/01/2021 03/31/2023 SIGNED