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29-452 (8) BP-2023-0588 40 CRESTVIEW DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-452-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0588 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: VASILIE KUHARCHUK DBA MAJOR Est. Cost: 7700 HOME IMPROVEMENTS CS-103054 Const.Class: Exp.Date: 08/24/202 Use Group: Owner: H HOLEY ROBERT W& HEIDI Lot Size (sq.ft.) VASILIE KUHARCHUK DBA MAJOR HOME Zoning: WSP Applicant: IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST (781)913-6405 WC5-31 S-360160 WESTFIELD, MA 01085 ISSUED ON: 05/08/2023 TO PERFORM THE FOLLOWING WORK: NEW ROOF 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: 3-,)91T Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissi s ner t / l'Is �'1/ The Commonwealth of Massachuse,s 414), W Board of Building Regulations and SO.,_,dards S FOR : 7 'MUNICIPALITY Massachusetts State Building Code,,,7t i1,,, ' USE o c Building Permit Application To Construct,Repair, Reny & `'k� lish a /�, Revised Mar 2011 One- or Two-Family Dwelling o7 c1./6 // �n This Section For Official Use On y o s Building Permit Number: 69- 04�j- 62S S Date Applied: 44—)(IZ 5 //i - 5- 6 20Z3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 property Ad ress: J 1.2 Assessors Map&Parcel Numbers It 0 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property D'measions: j 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rd: Eh.2_ ti &/A i-/tdA 4- FloI & MA 6) 1 6 6 ._ Name(Print) City,State,ZIP I/ v 1.ecs�li et,v MA.lre 33 9-? d��' -/ 9- No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building iff Owner-Occupied a Repitirs(s) la' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: r Brief Description of Proposed Work2: cS -- -CO' � t L5J itk.%1G S•eQ f , -tC)Ji PtAJ al +e cJLa.e � -/'-C aS/� 45, n ' ,� L )2r) _,L— , tA.Acte,r ay&Lt./0 , SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ .)/ 9-00 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees�:,$'y CO Check No.b1 Y 1 Check Amount. Cash Amount: 6. Total Project Cost: $ ---2/ MN.) 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (//0i1J7')t L k_c.Lth License Number Expiratio Date Name of CSL Holder / ) /Q ( ,/� t&^ d (�/J/ List CSL Type(see below) �/ No.and Street t�K CJ Type Description /� )Q C-t-h'�d / , � Q(C ? ) U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,/l/ J State,ZIP AA R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding (fi 1SF Solid Fuel Burning Appliances 5J J6 kti J.Ce2ek I Insulation lex one Email address D Demolition 5.2 Registered Home Improve ent Contractor(HIC) f,rn a, C ( ,/ f��f3 fl(rk-C S HIC Registration Number Expiration Date H .parry Nameh or�H egis ;N e /� - / Varr(�.,((//1*Z � �l'1��✓2.�'h.Ql�✓(��-W•Gc7/'1'l/'„t t ypn (u434 �/oct6. Emailladdress Cii ty//TowA,State,ZIIP /"v` /DTeleephonne 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 //a/lf)7, Q �� i CAA a C to act on my behalf,in all matters relative to work authorized by this building permit application. 1-1 Ok 3 Print Owner's Name(Electronic SignatureV 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. /TOO f e kc ail_an 5V.Z 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 S1�" Massachusetts ��? �. . << 3t DEPARTMENT OF BUILDING INSPECTIONS ?- ._ Ste. D ` 212 Main Street 40 Municipal Building kJ, aC Northampton, MA 01060 SfW.. N'‘ 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: 6�(54►C)re(10 � The debris will be transported by: Name of Hauler: 0,5A Cu,e_WL, ) A Signature of Applicant { Date: 5/ 3/.2 3 The Commonwealth of Massachusetts m Department of Industrial Accidents _wi (0 Office of Investigations r. ammo Lafayette City Center —1 2Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): HO C/v Zr-Qf S Address: 2 oL V£/LO7i Ct J f L(,Q-1- City/State/Zip: A/(J/,V-I CI d ,(.,t-( 0( Phone#: /3 Are you an employer?Check the appropriatebQx: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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 working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. 9. El Building addition required.] 5. ❑ We are a corporation and its 10.❑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.]t c. 152,§1(4),and we have no employees. [No workers' 13. Other 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. 1Contractors 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. /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 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 a above is true and correct. Si nature: .— -- Date: tJ/ 3/.2 3 Phone#: 7/()7. 3 d(f Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): I❑Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5E/Plumbing Inspector 6.0Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff- I> • Business Regulation 1000 Washing = -Suite 710 Bosto - - 118 Home Im•ro_t._ -- -=-•isstration _v r�, _ vr r =_ � ,� Type: Individual VASILIE KUKHARCHUK • e. ation: 150841 —= E -tion: 05/03/2024 DB/A MAJOR HOME IMPROVEMENTS 19 HUNTERS SLOPE A '-Ti-i— M. WESTFIELD,MA 01085to � f r I�l e 0 -"--10, 44 MI Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPelria1Ydual Office of Consumer Affairs and Business Regulation RegiEttofl43 E8QL9ti.4T 1000 Washington Street -Suite 710 1§0841 ,05fd3/2024 Boston,MA 02118 VASILIE KUKHARCHUK r _ DB/A MAJOR HOMFylwP•+ -= I / VASILIE KUKHARCHUK "_-�1. .2 I 19 HUNTERS SLOPE re' „,ea. %,/,f,.4." WESTFIELD,MA 01085 > — • Undersecretary Not valid without signature K,. Commonwealth of Massachusetts IIDivision of Occupational Licensure Board of Building Regulations and Standards Constry¢e rSrvisor �' F , CS-103054 _� ' Otires: 08/24/2024 1 VASILIE M KVKHARCHUj ' p 19 HUNTERS/SLOPE WESTFIELD NIA 01 t.,•. i !/ F / �° ?t, ,O '40I.Ly l Commissioner (16,Iea ,. %Eimc . STATE OF C•ONNECTIC UT DEPARTMENT OF CONSUMER PROTECTION HOME IMPROVEMENT CONTRACTOR VASILIE KUKHARCHUK 22 Verona St Westfield,MA 01085 MAJOR HOME IMPROVEMENTS Registration# Effective Expiration HIC.0611632 04/01/2023 03/31/2024 SIGNED 1 � ACODATE(MMIDDIYYYY) RO CERTIFICATE OF LIABILITY INSURANCE OS/03/D/YY 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 David R J ry Neill&Neill Insurance Agency Inc PHONE 413-73-4137 FAX 413-731-6629 662 Riverdale Street INC,No.Extt: (NC,No): West Springfield, MA 01089 E-MAIL dj@neillandneill.com d' neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Nautilus Insurance Company 17370 INSURED Milet,Inc. INSURERS: Liberty Mutual Insurance Company 23043 Major Home Improvements -- - 22 Verona Street INSURER C: I Westfield,MA 01085 INSURERD: , INSURER E: INSURER F: 1 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 TYPE OF INSURANCE •�SD SUBRw POLICY NUMBER POLICY EFF POLICY EXP UNITS ////�� (YMIDDIYYYY) (MMIDDIYYYY) A A COMMERCIAL GENERAL LIABILITY CLAIMS-MADE V OCCUR NN1534184 04/28/2023 04/28/2024 EACH OCCURRENCE $ PDAMAGE TO REMISES(Ea occurrence) $ 1,000,000 RENTED 100,000 MED EXP(Any one person) $ 5,000 I PERSONAL&ADV INJURY $ 1,000,000 GEN��'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT V 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-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per acddent) I $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC5-31S-360160 06/09/2022 06/O9/2023 vPER STATUTE oTH- AND EMPLOYERS'LIABILITY ER Y WC5-31S-360160 06/09/2023 06/09/2024 ANY PROPRIETOR/ R/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ 100,000 EXCLUDED? OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under I 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 Town of Agawam THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Suffield Street Agawam,MA 01001 AUTHORIZED REPRESENTATIVE ba„.4.14,R4.1„, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD