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35-287 (6)
29 SYLVAN LN BP-2021-1321 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-287 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1321 Project# JS-2021-002187 Est.Cost: $19860.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MAJOR HOME IMPROVEMENTS 103054 Lot Size(sq ft.): 66124.08 Owner: MURPHY GREGORY R Zoning: Applicant: MAJOR HOME IMPROVEMENTS AT: 29 SYLVAN LN Applicant Address: Phone: Insurance: 19 HUNTER SLOPE (781) 913-6405 WC WESTFIELDMA01085 ISSUED ON:5/11/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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: 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 Signatu t4A1/4_ FeeType: Date Paid: Amount: Building 5/11/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Nck\N. The Commonwealth of Massachusetts FOR *,9 /�`� W Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR ALITY/ \,., Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised 1 ��! One- or Two-Family Dwelling tip_ This Section For Official Use Only c). ` oso Buildin Permit Number: 06P'at'f13a'� Date Applied:72 *,° tis ,� c u,v,KoS} 5-11-202I Building Official(Print Name) / Signature Date SECTION 1: SITE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map& Parcel Numbers Q7 q (5VA)Sul l_I) :�b 1.la Is this an accepted street?yes V no My 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 OJ ner'of Reco,,r,�d: l lVl.t�, t �� pc.0 ( MA O(c, G -2 Name(Print) City, tate,LIP .2 9 (5U ! UL l . til3 - mv-o) s) -------------- No.and StreetTelephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied pf Repairs(s) LV Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units �"Other 0 Specify: Brief Description of Proposed W rk2: L t O'((1>,l V ND- �t t h� n r wiTh (a-toikn Und-rBea-cd/14 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ rQ� 0 i. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee - 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fell (�D Check NoZ Check Amount: ! Cash Amount: 6.Total Project Cost: $ (Cr( ( 10 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) O,511 Sid // � License Number Expiration Date Name of C Holder / ) I a I �fJ^_ List CSL Type(see below) No.and Street D Type Description TAM-1field 0 ( b� U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ( d�b SF Solid Fuel Burning Appliances �/cz.1�,a ik J yotit J�orki I Insulation Telep one Email address D Demolition 5.22��Registered Homem Improysment Contractor(HI � +C)) L 1 e Ck )_L fCms, l i,� h HIC Registration Number Expiration Date HIC Name`I-�K S& l c e K itll LD No.and Ste S /(,( Doe 3)��_/ j�� Emai address w tty/Ton,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 17f No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGPERMIT I,as Owner of the subject property,hereby authorize V ,�1 I/ ,f ktj.L-hc?/ a.LLk to act on my behalf,in all matters relative to work authorized by this building permit application. C77.12. flt-CCAP /ti Print Owner' 1 11 e(Electron Si ure) 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. (Y0A1 cL.t_ ��s X1-/ 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 ¢fir a i t40 tc, Massachusetts f � - DEPARTMENT OF BUILDING INSPECTIONS 7 1 212 Main Street • Municipal Building\rt 4 - r 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: O-l„vt 11 k)i d 1 , L4 The debris will be transported by: Name of Hauler:() SA H Cu.etui 02 Oa./ (JC Signature of Applicant. 7 - Date: The Commonwealth of Massachusetts Department of Industrial Accidents .=z Office of Investigations - =Mid= 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 Legibly Name (Business/Organization/Individual): I-fiO- tt f Address: (Q f-Cu ct I2A City/State/Zip:DU1Q 1LQCd ti(A ) Phone#:( �L Are you an employer? Check the appropriat box: 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. ❑Building addition 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.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other 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 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. Signature: - Date: (-5 5 /0 Phone#: `f( / 3b -6 Official u e only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3UCity/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.DOther Contact Person: Phone#: I ii � i Commonwealth of Massachusetts I Division of Professional Ucensure Board of Building Regulations and Standards Constr t;;%Supervisor CS-103054 �pires:0812412022 VASILIE M KOKHARCH* 19 HUNTERS-SLOPE = WESTFIELD MA 01095 • Commissioner i. I7i � CCCttt Office of Consumer Affai &Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 150841 05/03/2022 VASIUE KUKHARCHUK DB/A MAJOR HOME IMPROVEMENTS VASLIE M.KUKHAREHUK • 19 HUNTERS SLOPE �! WESTFIELD,MA 01085 Undersecretary STATE OF CONNECTICUT Of CONS' '•i ER T'i /Tf C TTO,\, A HOME IMPROVEMENT,cOMTRACTOR VASILIEXL S CjTE 1911iintesitSlive Westfield,MA 01085 MAJOR HOME IMPR,OY_EMENTS Registration#— :_Effecrice Expiration HIC.0611632- 12/01/2020 11/30/2021 SIGNED 2 ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) r..—' 06/11/2020 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 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 Christina Penna NAME: .._._ BERKSHIRE INSURANCE GROUP INC (NC,PHONE. (413)4473519 (A/C,No): E-MAIL ADDRESS: cpenna@berkshireinsurancegroup.com 43 East St INSURER(S)AFFORDING COVERAGE NAIC# PITTSFIELD MA 01201 INSURERA: LM INS CORP 33600 INSURED INSURER B: MILET INC INSURER C: DBA MAJOR HOME IMPROVEMENTS INSURERD: 19 HUNTERS SLOPE INSURER E: WESTFIELD MA 01085 INSURERF: COVERAGES CERTIFICATE NUMBER: 542989 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF IN6URANCE 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 I POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER i(MM/DD/YYYY)I(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE $ DAMAGE TO RENTED CLA1MS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY[ PRO-JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE_IABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED_ AUTOS AUTOS N/A BODILY INJURY(Per accident) $ ROPERTY HIRED AUTOS NON-OWNED (Perr accident) $ AUTOS $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS JAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH - I AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT I $ 100,000 A OFFICER/MEMI3EREXCLUDED? N/A N/A N/A WC531S360160050 06/09/2020 06/09/2021 (Mandatory in IJH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE POLICY LIMIT I $ 500,000 - DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefts to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of th s certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at Www.mass.gov/Iwd/workers-compensation/investigations/. 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. PUSNORIZED REPRESENT ASNE MA 01085 Daniel M.Croy,CPCU,Vice President—Residual Market—W CRIBMA — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-- � 05/06/2020 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 CONTACTON David R Jarry Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street (A/C,No,Ext): WC,No): West Springfield,MA 01089 E-MAIL d neillandneill.com ADDDREDRE SS: j© INSURER(S)AFFORDING COVERAGE NAIC N --- INSURERA: Northfield Insurance NOR INSURED Milet, Inc. dba Major Home Improvements INSURER B: 19 Hunters Slope Westfield,MA 01085 INSURER C: 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYY) LIMITS A Y COMMERCIAL GENERAL LIABILITY WS424227 04/29/2020 04/29/2021 EACH OCCURRENCE $ 1,000,01 CLAIMS-MADE V I OCCUR DAMAGE 70 RENTED 100,0( PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,01 PERSONAL&ADV INJURY I $ 1,000,01 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0( 7 POLICY JECT n LOC PRODUCTS-COMP/OP AGG $ 2,000,0( OTHER: $ 'AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION PER 1 i OTH- AND EMPLOYERS'LIABILITY YIN❑ STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under t DESCRIPTION OF OPERA i ION_ below E.L.DISEASE-POLICY LIMIT $ 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 REPRESS ATI EIR f •,�t ti ©1988-2015 ACORD COT ORATIO ights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD