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32C-127 (8) 38 FRUIT ST BP-2021-0987 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 127 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2021-0987 Project# JS-2021-001687 Est.Cost:$44744.00 Fee:$60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SERGIY SUPRUNCHUK 104327 Lot Size(sq. ft.): 11107.80 Owner: LYNCH VALERIE C Zoning: URC(100)/ Applicant: SERGIY SUPRUNCHUK AT: 38 FRUIT ST Applicant Address: Phone: Insurance: 375 CHICOPEE ST (413) 883-3802 WC CHICOPEEMA01020 ISSUED ON:3/9/2021 0:00:00 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature:I . . Q • 11/2 p Y � s� FeeType: Date Paid: Amount: Building 3/9/2021 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner b �;\. The Commonwealth of Massachy‘etts FOR / to) Board of Building Regulations and Standdr 6<9Q CIPA(LITY Massachusetts State Building Code, 78 lb , � ' t q�vi!G�" US Building Permit Application To Construct,Repair,Renovate ti ised ar 2011 One-or Two-Family Dwelling ti"-q o�c , ection For Official Use Only �OT�c ° i' Building Permit Number: 61.0- R 7 Date A lied: f 4-alio a5 3_gzoz, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addres • 1.2 Assessors Map& Parcel Numbers 38' Feu .-f- 1,C 7 1.1 a Is this an accepted street?yes no Map NumberParcel 31z 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: 1�alarie Ly K % kt1 Per_k(us yor� a kJ +p /4 Name(Print) V 0Y City,State,ZIP 3g Fru /� S* ii3 2103216 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief escriptioon of/ Proposed Work2: /to S46a( V i if S r l r K` , or �t '-Ol l S e � k e-g/ , ✓i� 151,r(:.1 4 i k�'S/C3( 9-c' f b w{' 1 4e.�.4-� �gl t -' a. �y, (A% , /'t7��rq/ cal/ �oLiS . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 4(_ T. Ltt( 1. Building Permit Fee: $ Indicate how fee is determined: ( ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No3 33 2Eheck Amount GO Cash Amount: 6.Total Project Cost: $ C/��) 41q 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) es ,D[7'324 f!1 2 g72d'J2 -Ce-r 1� [.L� �(� License Number Exp tion Date Name of Ltfltolder 3 c / `e ��,,/6 e Q List CSL Type(see below) No.and Street ��Lt i c.� > Type Description 4 L/(/A I/"T. e�� �I 0 l3 U Unrestricted(Buildings up to 35,000 Cu.ft.) ( R Restricted 1&2 Family Dwelling City/Town,State, IP M Masonry RC Roofing Covering WS Window and Siding n SF Solid Fuel Burning Appliances >er0�( / i,,//g0e.e G C tLC. I Insulation Telephone (� Email address C btAot D Demolition 5.2 Registered Home ImprovementContractor(HIC) / r—(.�2 / r� o2 2� ( I I t 0,A4 ' i o.A-e �~f ��� (K HIC Registration Number E p' 'on Date H C y Name or�IIC Registrant Nam ' " GfiL► �-- geo�6 a/,e f ee���ce .�e. C c-� No„apd tr et t ©; 2802 (f Email address City/Town,prate,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 e ra✓t 1-r.C7( 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 • I hereby attest under the pains and penalties of perjury that all of the information contai'-. in • is true and accurate to the best of my knowledge and understanding. i / D3/d//2 Print 0 s or, thorized 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" The Commonwealth of Massachusetts Department of Industrial Accidents ' 1 Congress Street,Suite 100 Boston, MA 02114-2017 ;y www mass.govidia evo 11 writers`('ompensation Insurance Affidavit:Builders'(.ontractorslElectriciansfPlumhers. It)HE 1-11±1)%S[III THE PERMITTING Al ikJORI IN. Annlicant Information Please Print Lcl!ihly Name(llusirtcss•'thgantzatioa individual): I 1&-4�� O f_ ' y re)l! 421.1 ( l 1 Address: 3 7 X r!//-1,+e V - CityfStateiZip: / eo•e1Q 7ti# Phone#: 9/_? APcS33 ��d2 try you an empluyer°Cheek the a pnupriate hem Type of project(required): 1.211 yen a employer with 2 employees(full an J-or part-tune'-• 7. 0 New construction 2.,n I am a sole pcupnctur or partnership and have no employcm working forme in 8. ( �Remodeling any capacity.[Nu workers'comp.uuur.mci required.) t—+ 9. ❑ Demolition 3.0 I am a homeowner doing all work myself.[No wurk.xa'cunv.insurance my aired.]" 10 Q Building addition 4.11 I am a lrurnixawner and will 6e hiring exmtrarlurxto conduct all wok on my property. I will enure that all contractors tither hoe sow ken-compensation ensurane'c or are sole 11.Q Electrical repairs or additions prupnetors is ith no cmpluvecs. 12.0 Plumbing repairs or additions 5.1:1 1 am a general contractor and 1 Ins a hired the sob-contractors listed un the attached sheet. These Sub-tun um:ors hale employees and has e w urkcr,'cmnp.insurance; 130 Roof repairs 14_ Other 109 G.�1A'e are a Liorpuration and its officers have exercised their nght of exemption per hl(iL c. 152,41(4),and we have nu etmpluyees.[No workers'comp.insurance required.' •Any applicant that checks bss I gnust also till out the section below show ing their wurken>'compensation policy information. "Homeowner who submit this attidat it indicating they an:doing all work and then hire outside contracturs must submit a new affida%it nxlicatmg such. C'untractors that check this box roust atta:•hcd an additional sheet show ini the name oldie sub-contractors and state wire:tier or not tlwse mimes have employees. It tlx:sub-contractors Ilse ctmpkr ces.they muss(piusidc their workers".wimp.pulley number. I am an employer that is providing'yea-Arcs'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /62- Awbe►r't C a v(^/ 1 K Sara/4( Q (�n2 — Policy#or Self-ins.Lic.#: 5 e t I e� Expiration Dated 2 � 2 �/� y � y p / / �� I Job Site Address: 38 city'Statelzip: /1/or-A fo1 /y A Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex ration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cot erase verification. 1 do hereby eerily[ rttler th penalties of perjury that the information provided above is true a, d correct. Signature: l?nice. 03 d/ 2 / Phone 4: Official use only. Do not write in this e,reu. tr,he completed by city or town official Pitt or Town: PermiLiLicense Issuing Authority (circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone##: City of Northampton aYH+M 44 5.. Ste, 7;4 • Massachusetts ' t I �. s a 7 DEPARTMENT OF BUILDING INSPECTIONS y M 212 Main Street • Municipal Building Jd PD Northampton, MA 01060 SSNA, ��`� 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: 1 Location of Facility: �� Ha)✓I �`� /�U/ C 814 O/0 90 The debris will be transported by: Name of Hauler: e / a /ia 71e 5 �e Signature of Applicant: Date: D3/ 17/9 7 AC CERTIFICATE OF LIABILITY INSURANCE DATE 03/01/2021 Y' 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(les)must 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 Jarry ME: Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street (ac.No.Ext): (A/C,No): West Springfield,MA 01089 E-MAIL d neillins.com ADDRESS: )� INSURER(S)AFFORDING COVERAGE NAIC S INSURER A: State Auto Insurance Companies STA INSURED Alliance Home Improvement, Inc INSURERS: SAFETY INSURANCE COMPANY 39454 Sergiy Suprunchuk Ace American Insurance Company 12165 375 Chicopee Street INSURERC: P y Chicopee,MA 01013 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 LTR TYPE OF INSURANCE INSR,WVD POLICY NUMBER POLICY EFF POLICY EXP A GENERAL LIABILITY (MMIDD/YYYYL(MMIDDnYYY) LIMITS PBP2689283 03/12/2021 03/12/2022 EACH OCCURRENCE $ 1,000,000 ✓COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300 000 PREMISES(Ea occurrence) $ CLAIMS-MADE V OCCUR MED EXP(Any one person) $ 5,000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN%AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG $ 2,000,000 71 POLICY n JECaT 1-7LOC $ B AUroMOBILE LIABILm 6226463 12/04/2020 12/04/2021 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED . / SCHEDULED AUTOS V AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS / NON-OWNED PROPERTY DAMAGE AUTOS $ (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - C WORKERS COMPENSATION 6S62UB-4N622734 12/05/2020 12/05/2021 WC STATU• OTH- $ AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE IS FOR PROOF OF INSURANCE PURPOSES ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sergiy Suprunchuk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 375 Chicopee Street ACCORDANCE WITH THE POLICY PROVISIONS. Chicopee,MA 01013 AUTHORIZED 14 R, NTATIVE . . ' iiio ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t �!l�ir /1,r 111 home Improvement Contractors and subcontractors engaged in v ASV! home Improvement contracting,unless specifically .tempt from ,t registration by Provisions of Chapter 142A of the general laws I)*1 t 1•O O `y/ must he registered with the Commonwealth of M at tt asshuscs tnyullies about registration and status should he made to the Alliance Nome Improvement • N Duector Ilonie Improvement Contract Registration One ///�/// •, \\� Ashburton Place,Room 1301,Boston,MA 02108(617)727,8598 375 Chicopee St \\ Chicopee,MA 01013 1' Phones (4131883.3802 elyt ,.°- Fax:(413)331-4358 Yo'can pay more, but you can't buy beef MAuc01sa21F. CT�,caD63sBa' www.AllianceHomelnc.com (vo.. ) 6. SUBMITTEDL TO: c / 4' Phone: )U) —97g—64 ' Cell: //S'' 2i4-' j . 4 \L IO-O r'jai • 4*iti / i'fj rn.,It- /]mot Email: /;(.J.4.terkn-S`yAOJ.�./fa r i,,/can[ _l-,4 <,Al ,Cat2 N.a slim s eci Ions ] J /C, `ter/ We hereby subm�.9specificatlons and/estimates for work to be performed and materials to be used: lncL+'siG3 tJ J • -s9 Lined„Va.ii l�t,lsr.c•�! file. c c3 '. L vr'rc_ �/1/ai,rrd./,i5 dr /fort._ /sr,ai,41i7 to , . = t Clo 24'e f j,j linidit.i-its r'L' 1 `l11 at" cf C. - r S' • irk I nE 0r.a)rk i-hsQ,P� /r-RG�t . r tr e l tarclt• �CIPr •i v['a ) (. . 17711 i' ti 1 ;' / ,3.r row- Tr y ,, , al i i ifArllrct/ �9T n 256ING Type: i. , 4- !fZ 1I rJCy114s17�Color: v inspect Wall Sheeting• ///4 y1 �t eirisulatton HomeV rap/fJ Strip laI locks/&Dryer Vents Color: O / �orset/Blocks Color / /, fj1L Shutters Color: n/&. Catel tale Vents(Louver?)Color: r , 4'1 ❑R&R Gutters f-fw Gutters Color: ,,./;,.t.�. .2 Soffit Q'asna Vented:❑YES ❑NO Type flout Color: 1i/c,/, + Location: t r-r/t Aluminum Trim Iliance Trim Flat Cod e}PvCCoil 0 G8 Coil Color: �/r d/ ErcOrners Color: e ej master Locations/till 214terial Location: '- lie Disposal %lost[ A WORK SCHEDULE Popped sun and Complexr.f rnedu* The loilow,ng irhedulr rein to adhered to unless crcurhsl nce 9 beyo the cunt attors control arise 1 / A / -n j Date when contractor will begin coedracnd ark. 1 (5 / Dan when contracted wort will be substantially completed. Curti-ailed..ask may mat begin until toth palsies hart rete,aed a linty eretuied cope of the contract and the three day resriislor period nal rip led The Owne'"ereby arknp sk:ges and agree.that the sctedulmidat.s are approximate and that sith relays t liar ate nor avowable by the Contractor mcludttrg but net housed to atr,kes,Acts of God,shortages of materiii,accidents.and an Crier delays t.e fond its rantrpl shad not be tonyalered as srp4(ttmS of ton Agreement WARRANTY //. (�J Ail materals Pratt 1[C II#1t 1 warranty or as otherwse specified by manufacturer tabor and workmanan,p have a warranty of ore tall year Trani the date of,nsullatuon At work to on completed in a wotkmanbke manner atbrddrg TO ctardatd Draftees Any allera'for of*esteem,front the alone specifications invoking eats costs will be eseruted only upon written order and win became an extra Charge one,and above the estimate PAYMENTS We propose hereby to furnish material an abor complete in accordance with eayrrems to be made as follows A �t ab a specification f�or/t�he/)um�f � _tCtyi_�/rY.,�1�. fIi vs 4r Sv� 1 upon Signing Contract. jli +I44IL'/se4 f C __ & A, JG /, /yy 1.. / �OIIirS a`Y�j MS f Ii,�1J_ f upon delwery of lit atenalt iS 41 a_Zll eL p 3aL 'Pr I #G MS. /7a d 7 - iwOncompltion, Name of Salesman .._ _ 1,,�/!J► fp_yys_ � 4 I snail be mane torthrnh upon /J/� � completion wort under Inn contras Authorized Signature �'r 'Z�' The customer hereby understands and agrees to pay r name charge oft 5l per month(or arn,aai percentage rare of 1I.i on Ire outstanding ba ore paid wiHun so days after complerron of worE Au payment., reserved attar 30 der,atter completion of work shad be applied twit to,,pad feance irrarget and is.,to outstanding pats nth In the evert of de cult customer hereby uncle glands and agrees to pay.,n additun to the auutandrrg,ndebteotets all Celts assoaated wish collet r.an including reasonable attorney',lees a..captainc.Of Proposal I have read bo(h Noes oI this oblument aid ar cent Tire antes specltcat,and lonatrom stated I urdersta le hal',;port}evert this po':al becomes a binding Contract you are apdtOriled to du work as cpecdted Payments will be made as oArmed above roe the Hoye,.may cancel:Pis,ra,cacren at any rim.pats.to mdn:gnr-r i',a I'd Saline art,the dale of the transaction Canoe(anon moot be done w,,hng DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACE .-1120t '21 Signature Date ` Z.(Signature _Date ll 24 NOTICE OF CANCELtAtION COL/MAY CANCEL THIS TRAh5ACT10N WITHOUt ANY PENALTY OR CRill(iATiON,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE IF COU CANCEL,ANY PR TY TRADED IN ANY PAYMENTS MADE BY tOu UND1 R!hit CONTRACT DR SALE.AND AMU NEGOTIABLE INSTRUMENT EXECUTED to YOU STILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY Tilt SURER OF YOUR CANCELLATION Nome E AND ANY SECURI rf INTEREST APISINtc OUT OE THE TRANSACTION WILL SE CANCELLED TO LANC1l THIS IRANSACTION MAIL OR DELIVER A SIGNED AHD DATED COPY Of ThIS CANCELLATION NOTICE Oft ANY OTHER WRITTEN NOTKF OR SEND 4 TELEGRAM TO AWANCE HOME IMPROVEMENT,INC,37S CHICO►EE ST,CHICO►EE,MA 01013 ___ Mite Surdas and ndldaes etc/deal I HIRER,:ANCtt THIS TRANSACTION (dvyyr 5,gnaturel Air