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35-203 (14) BP-2023-1727 1280 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-203-001 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-2023-1727 PERMISSION IS HEREBY GRANTED TO: Project# SIDING 2023 Contractor: License: VASILIE KUHARCHUK DBA MAJOR Est. Cost: 37266 HOME IMPROVEMENTS CS-103054 Const.Class: Exp.Date: 08/24/2024 Use Group: Owner: RANDALL FURNASH-STEWART Lot Size (sq.ft.) VASILIE KUHARCHUK DBA MAJOR HOME Zoning: WSP Applicant: IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST (781)913-6405 WC5-31S-360160 WESTFIELD, MA 01085 ISSUED ON:12/14/2023 TO PERFORM THE FOLLOWING WORK: NEW 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: 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: 8614‘.- .> • T. . . Fees Paid: S60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massac use ,:tr: Board of Building Regulations and tan rds FOR MUNICIPALITY Massachusetts State Building Code, 780 WAG - 8 7023 USE Building Permit Application To Construct, Repair, eno ate Or Demolish a jevised Mar 2011 One-or Two-Family Dwelli g DEPT.OF BUILDING 1 SPECTI DNS This Section For Official LT Only NORTH AMP I U"' o�'�"_-- Building Permit Number: Q/ la' 'I. 7 Date Applied: 4)A-)/�55 ///7 12-13-20�3 Building Official(Print Name) Signature Date 1 [�,S,/ECTION 1: SITE INFORMATION 1.1 roperty,i �'�7 J'�t 1.2 Assessors Map& Parcel Numbers 1.1 a 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 0 Private 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record• , Cell-d-a t- 77vt a 6/'L - (/&va t 1Cv a it--(7¢ e)( v d 1_._ame(Print) City,State,ZIP f,1 to 13-6vvtS IA )4 0240 -4d -66/°1 ? No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied a Repairs(s) Er Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units L Other 0 Specify: Brief Description of Proposed Work': -/ -h h SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 / 0/( 6 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 Feisi V IdCheck N 1.0 heck Amount: Cash Amount: 6. Total Project Cost: $ 3 /,,z. a 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �G%� ���,c. 1C�/IUZe.G�C �S�Co 3 �y License Numberber Expiration Date Name of CSL Holder 10 , / f^ on a j/1' List CSL Type(see below) (J No.and Street !/U - 7 Type Description n„ /i Ps/Cad Cad (,�( 0(0 i) U Unrestricted(Buildings up to 35,000 Cu.ft.) �C/ityl//Tolwn, ate,ZIP /"�� R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding /��� .W- SF Solid Fuel Burning Appliances _ / 0 bv7 b ruI Insulation Tel hone Email address I) Demolition 5.2 Registered Home Improiement`Contractor n(HIC) /a) d-6(/ �C'-J0 Nc�/1Z_Q ..L' ��Q�� 4t&Z5 HIC Registration Number Expiration Date HIC C�Pjjth►pany Name or HIC RegistratS ame No. d trt � COGO— 4;46 C(6 Emai address ity/Tow , tate,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 //�( )LL/ 4 CLU--1_ to act on my behalf,in all matters relative to work authorized by this building permit application. feall da -«ir as A_ -d-fewa t t 70(h/3 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 true and accurate to the best of my knowledge and understanding. //z � -t6L ,� 7çi,�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 .4"(ys ti Massachusetts �.,„ . �'e FrLw'A IS �4 $ DEPARTMENT OF BUILDING INSPECTIONS '' +r `r' 212 Main Street • Municipal Building vb Ob \ �` Northampton, MA 01060 �J , .WOV,�4 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: / /2- U The debris will be transported by: Name of Hauler: /7L) -4 11:( i_ 1 4 9 Acc(Gn-/�` Signature of Applicar�t— ^/ Date: /d"�`�3 The Commonwealth of Massachusetts Department of Industrial Accidents '`'—� Office of Investigations ==111'= Lafayette City Center • =�,j'ZI 2 Avenue de Lafayette, Boston,MA 02111-1750 4. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 411.tv/Q- /l f i-Q l / (�llc. .ct Address: /0- V�i,onC1 L11 t / City/State/Zi VA �LJd W-CYO Y.0 Phone # 43 ‘3‘ " c(C Are you an employer? Ch ck the appropriat box: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 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 Y P 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13. Other ��e ^ 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 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. Signatu ��� ' Date: ,2 —//r .3 Phone#: 4/3—'6 36 - Ol Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Tow n Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYY) �� /Y05/03/2023 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 CE!CT David R Jerry Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street INC.No.Ertl: (A/C,No): West Springfield,MA 01089 ADORE: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIL• INSURER A: Nautilus Insurance Company 17370 INSURED Milet,Inc. INSURERB: 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 POLICY TYPE OF INSURANCE ADDL SUBR EFF POLICY EXP LIMITS INSD MND POLICY NUMBER (MWDD/YYYY) (MWDD/YYYI) A J COMMERCIAL GENERAL LIABILITY NN1534184 04/28/2023 04/28/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE I OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I PRO- 2,000,000 Nil POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY (Ea 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 accident) $ UMBRELLA JAB - OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION i WC5-31S-360160 06/09/2022 06/09/2023 VI STATUTE ER AND EMPLOYERS'LIABILITY Y/N WC5-31S-360160 06/09/2023 06/09/2024 ANY PROPRIETOR/PARTNER/EXECUTIVE Y 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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEISCLES(ACORD 101,Additional Remarks Schedule,may be attached If mom 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 bahuaR4....,:,, I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts 9J Division of Occupational Licensure Board of Building Regulations and Standards Constttitilton(S*Jeervisor e. CS-103054 v .:..,, ires: 08/24/2024 VASILIE M K?KHARCHU' 19 HUNTERSILOPE p WESTFIELD NIA 0108 Commissioner c o8Q i. `t '&mOi&, THE COMMONWEALTH OF MASSACHUSETTS . Office of Consumer Affle • Business Regulation 1000 Washing_":"' -Suite 710 Bosto - - - 1 118 Home lm.ro_y7'L :-r,:-•isstration Ir ----v Type: Individual e,- ation: 150841 VASILIE KUKHARCHUK 1 _ c`� E 7 tion: 05/03/2024 D/B/A MAJOR HOME IMPROVEMENTS 19 HUNTERS SLOPE , —_ 'r-- Q! WESTFIELD,MA 01085 e. = 4 m ii, OOP Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer A &Business Regulation Registration valid for individual use only before the 110P- HOME IMPRO -' 1 ONTRACTOR expiration date. If found return to: Tve- •�� j Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 ��! Boston,MA 02118 ri�: VASILIE KUKHARCH•:,=__ ..,��= D/B/A MAJOR NOM=R = _ - ri VASILIE KUKHARCHU�'' �_ r('�'_-✓ 19 HUNTERS SLOPE Gam"'^�./wfy.!" WESTFIELD,MA 01085 .t`l Undersecretary I Not valid without signature STATE OF CONNECTICUT DEPARTMENT OF('O.\S(MER 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