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24A-060 (2) 31 RIDGEWOOD TERR COMMONWEALTH OF MASSACHUSETTS BP-2021-1794 Map:Block:Lot:24A-060- 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-2021-1794 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est. Cost: 32320 SERGIY SUPRUNCHUK 104327 Const.Class: Exp.Date: 11/29/2021 Use Group: Owner: DUSO ADAM and REBECCA BROWN Lot Size (sq.ft.) Zoning: URB Applicant: ALLIANCE HOME IMPROVEMENT INC Applicant Address Phone: Insurance: 375 CHICOPEE ST (413)883-3802 CHICOPEE,MA 01013 ISSUED ON:08/26/2021 TO PERFORM THE FOLLOWING WORK: 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. Signature: .yQ • • r ' l Fees Paid: $60.00 • 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner `.n o`" The Commonwealth of Massachusetts Vo i� 0, o lit< Board of Building Regulations and Standards FOR �. R, MUNICIPALITY 1 • v Massachusetts State Building Code, 780 CMR USE cv Buil.hiig Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 0 m Q One-or Two-Family Dwelling W a a o Thi Section For Official Use Only II din Permit ltdinzber: 6 L? I R/ Date Applied: 0/0 4,,5: /, 8.2y-202) Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro erty Address 1.2 Assessors Map&Parcel Numbers 27 I ?d CA)Opd I-err Li Is this a4 accepted street?yes 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: beck bio�n /)Ov•{� Q 0-0v„ i-/I9 nho6J Name(Print City,State,ZIP gal f ici ,e .)ood T€ vr 6o3 yao02,25 rbraznt1a No.and Street 0 Telephone Email Addre SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other Other l"Specify: C Brief Des iption4of rvoposed Work': g move c.)/ $(a,.a.k e V, � , . \ t r vl (91 , � tP U'�" e_0 r, V r Ot t( W l vu95 O v�o r t. Lt e.� V SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $3g, ),0 00 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑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 No. Check Amount: Cash Amount: 6. Total Project Cost: $ S di 5 , 0 J 0 Paid in Full 0 Outstanding Balance Due: ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_I0(4 3a f, JZ 4(Z/ 3er J SN.i �h � License Number Expiation Date Name o Holder b No.and Street List CSL Type(see below) 3 s I �-- Type Description n � n O(�t Unrestricted(Buildings up to 35,000 Cu.ft.) l� St te,ZIPS , ) R Restricted 1&2 Family Dwelling City/Town, M Masonry RC Roofing Covering WS Window and Siding f /h SF Solid Fuel Burning Appliances g(3 �3 3PC 3-es CL i[� 0u.�1 -(C I Insulation Telephone d Email address D Demolition 5..2//Registered �Home Improvement Contractor(HIC) 5-1-0 Y l (� I i g i p /f'O tL t47.0 V e'-e'" r 4 1�— HIC Registration Number Expiry ion ,25 (!'?! ate HIC Company Name or HIC Registrdth Name 31 s Gt c—fe,e s s e Cat kei,u4J ine. No.and Stree Email address GG�`Co iee , A-l19 9(063 it/3 i 3 3�D� 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 Issuanccee 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 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 n elow, I y attest under the pains and penalties of perjury that all of the information contained' is appl' ati is e and accurate to the best of my knowledge and understanding. cri af/c2 P ' t is o thorize gent's Name(Electronic Signature) Dat NOTES: 1. An 0 who o ains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not re stered 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 Jt Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www muss.gov/din 11 eskers'('onipensation Insurance Afftdar it:BuilderslContractorslEkctriciansfPlumbers. 1'0 BF FILED%4I III THE PERMITTING AUTHORITY. Ani licaut Information / \P/lease Print Leeiblr Name 413usinc s Organizationlndt►:dual l: l /( �?L. 0Y�e clit�1l V-enYt P e.LrL- Address: 3 7s LEA City/State/Zip:C' Phone#: L//3 ?P3 3d9CbZ — Are yaw an employer°Check the appropriate boa: Type of project(required): 41 am a employer with employees((full and'or part-time 1.' 7. a New construction 1 am a sole proprietor or partnership and have nu employee.w orking fur me in Ile 0 Remodeling any capacity.[Nu worker.'comp.insurance regrind.) 9. ❑ Demolition 3❑1 am a humouwm-r doing all work myself.[No oozier.'cusp.iraurance urred.]- .L01 ant a lwrnevvrwne-r and will be hiring exrrrtra.9ura to conduct all work on my property_ I will 10 0 Building addition ensure that all contnieturs either ha%e worker.'compensation uourantx or an:sole I 1.0 Electrical repairs or additions pruprieton w ith nu employees. 12.0 Plumbing repairs or additions i 1 ant a general contractor and 1 har a hind the cub-contractors listed un the attached sheer. Thcsc sub-cuntracturs hake employee.and hak a workers.comp.insurances 130 Roof repairs1 6.❑We an a corporation and its utitcers have cain 1sed their right of exemption per hilCiL c. I4. tilt! ✓ 152.$1(4).and we here nu employees.[Nu workers'comp.insurance required.] (J J 'Any applicant that chi eks bin.]:must also till out the section below showing their u urker.'compensation ,l i,. information. t I-hunk-owners who submit thus atlidarit intbcalme they an doing all work and then hire outside contractors must subnut a new attrd rti it rrxlicatrng such. 1C'untracturs that check this box must attached an additional sheet shun ins the name of du:sub-contractor.and state wlrrtlter or not thus:omits:.hake employee... If the sub-c0'51rat:tos hake employees.they most pro,idc(heir worker.'comp.policy number. I am an employer that is providing workers'compensation insurance for my.employees. Below is the policy and fob site information. Insurance Company Name: in ce- rf}wl e-vt'GQ.ln Sa riz.vl c_e_ - `Y�6Date: / 031z... Polley�or Self-rise Lie.#: �S��j a��3�f Expiration / � Job Site Address: 5? d oeL�)O O c i l- 01)0✓d h Oii- CityfStatar'Zip: /c //Q d(060 Attach a copy of the %•orkere compensation policy de4aration page(s owing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, ►*',25A is a criminal violation punishable by a tine up to S1,500.00 andjor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I du herehl-t-crti/j r - s and penaltiesofperjur(•that the information pro iiilerlaboie is true and correct. Siature: �/ en Dale: D 49/D9�Z( PhorIc ;*. Li !I Official use only. Do not write in this urea. to be c-omplcted hi city or town officiaL (it:, or Toren: Permit/License p Isuin;Authority(circle one): I. Board of Health 2.Building Department 3.Cit)fFown Clerk 4.Electrical Inspector 5, Plumbing Inspector G.Other Contact Person: Phone#: City of Northampton p0 "?P a. S1.S ..:�- $4, t. '°L 1 Massachusetts ��+ w._ '<< ''': ; :,Ir-4. 4. ,: . c. DEPARTMENT OF BUILDING INSPECTIONS 7` ;' k ` t.,7 212 Main Street • Municipal Building 9O6 CDC Northampton, MA 01060 srb•... 114 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: ; f ? ,5•a /___/ey, ___e. The debris will be transported by: 1-16/vo4 Name of Hauler: (7gZ c -e e 0 pp Signature of Applicant: Date:e /aY 2 g ® DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 03/01/2021 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 David Jarry Neill&Neill Insurance Agency Inc PHONE 662 Riverdale Street IA/C.No,Est): 413 732 4137 FAX No):413-731 6629 West Springfield,MA 01089 ADDRIESs: dj@neillins.com INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A: State Auto Insurance Companies STA INSURED Alliance Home Improvement,Inc INSURER B: SAFETY INSURANCE COMPANY 39454 Sergiy Suprunchuk m Ace American Insurance Company 12165 375 Chicopee Street INSURER C: 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. IL R TYPE OF INSURANCE 'ADDLISUBRT POLICY EFF POLICY EXP LIMITS INSR I WVD_ POLICY NUMBER (MM/DDIYYYYI (MM/DD/YYYYJ A GENERAL LIABILITY PBP2689283 03/12/2021 03/12/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE V OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO t$ 2,000,000 V POLICY PRO LOC $ JECT B AUTOMOBILE LIABILITY 6226463 12/04/2020^12/04/2021 COMBINED SINGLE LIMIT 1,000,000 (Ea accidentl _ 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 I RETENTION$ _ $ C WORKERS COMPENSATION 6S62UB-4N622734 12/05/2020 12/05/2021 ./ WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 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 f I 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 R — NTATIVE . ,c,... 7 . .f... " . A. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD s9Z, gielbeiSO4€04104fre*/41e0fikiadfeadiee4 Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boon, : I 102118 `` Registration 11f YType Caparalon ALLIANCE E HOME ET E#P110VEMENT,tllC '~ = IC 1� 1�88 /2025 CHICOPE E,ILIA MEM - 1 loA 1 O A1�HP I Maus aid u Cat HOME�I*a+nraoNnao' c�ie MM:rogrj= z iorgie • ALLIANCE • - 181C Ede,M* 61, * iE 'PP EM011r smCFUCOPEE OFNOOPS.CIA 01 • and 0r t • • • 110 • reibiommillk Missishnolls d tiler C84O4 7' . *Was:11NJ8p211l1 g WU$T .DIlk) a: 4 cammlusionsr 01,44.0.1+ads--- • �tb IV All home improvement contractors and subcontractors engaged in t home improvement contracting, unless specifically exempt from i registration by Provisions of Chapter 142A of the general laws, ,. T3'... + must be registered with the Commonwealth of Massachusetts. V. I, �� D� � Inquiries about registration and status should be made to the AL99fa7srat�mvees,r9nrrawenvr+,memo /////1 JC \\� Director. Home Improvement Contract Registration, One Ashburton Place,Room 1301,Boston,MA 02108(617)727-8598 375 Chicopee St. / �� it � I Chicopee,MA 01013 . ��q� 6 • Phones:(413)883-3802 A „ r, or(413)331-4357 Tau Carl pay more,but you can't buy beset MA Lic#154218 CT Lic#0635847 Fax:(413)331-4358 www.AllianceHomelnc.com/� S BMI L}�TO:&Gl� W Phone: Cell: 6o 3 % ?O 0 /c oi47W3t14 e rb la �,i1. coM Q/�� 0 Email: �WY t I We hereby s mlt cificati ns an estimates r IV(to be a rmed an ma vials to be use y ,I(._,,,,,fflivi. ti git et kes . ii ci'-ec d 5k )• 5VA (- TG1n OV. bka d all i' '- oAC-- no 1 1 ,,,t s G i in_c1u O 7v $+CkAk hQAA) p S G4 114Ai\ kflOrr. A'k'o i- c rect,S - C b'ts S. -dt` 4 SIDING Type:C. a 00 l ' v IP-it Color: yetrAA nspect Wall Sheeting: ❑Insulation ❑HomeWrap trip J Blocks&Dryer Vents Color: ❑Forset/Blocks Color: Sh utters Color: ❑ able Vents(LLuvers)Color: ❑R&R Gutters ❑New Gutters Color: Soffit}ST-Fascia Vented: YES El NO Type PVC.Co Color: o Location: I - ❑Aluminum Trim ['Alliance Trim El Flat Coil PVC Coil ❑G8 Coil Color: utter Lr✓I►k. Corners Color:�l'10(M Dumpster Location: laterial Location: ❑Waste Disposal: WORK SCHEDULE Pro ed Starrdpmple hedule-The following schedule will be adhered to unless circ rgstances a the vac is control arise: g(,p6/� / D/ Date when contractor will begin contracted work. 1A / / �bfp�{Il�o Date when contracted work will be substantially completed. Contracted work may not be in u til both parties have received a fully executed copy of the co tract,and tee day"Ws period has expired.The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are cot avoidable by the Contractor including,but not limited to strikes,Acts of God,shortages of materials,accidents,and all other delays beyond its control,shall not be considered as violations of t: ree tent. WARRANTY )All materials have 1 i Warranty or as otherwise specified by manufacturer.Labor and workmanship have a warranty done full year from the date of installation. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. PAYMENTS We propose hereby to furnish material and I bor-comple cords e with Payments to be made as folio to ✓� above specification for tt�e sum of: %($ J upon signing Contract /L " a �� [�� Kx `�/lIV7 4� 4 1Tv �4 _ dollars ($ V on delivery of materials; ($ I %($_1 upon job completion; Name of Salesman �C�� QMS 3 4. )shall be made forthwith upon c mpletion work under this contract. Authorized Signature The customer hereby understands and agrees to pay finance charge of 1.55a per month(or annual percentage rate of 18%)on the outstanding balance in 30 days after completion of work.All payments received after 30 days after completion of work shall be applied first to unpaid finance charges and then to outstanding balances.In the event of default,customer hereby understands and agrees to pay,in addition to the outstanding indebtedness,all costs associated with collection including reasonable attorneys fees. Acceptance of Proposal:I have read both sides of this document and accept the prices,specification and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do work as specified.Payments will be made as outlined above.You,the Buyer,may cancel this transaction at any time prior to midnight of the 3rd business day after the date of this transaction.Cancellation must be done in writing. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signatu Q�)�,�� Da .r 21 Signature Date ` NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED.TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO:ALLIANCE HOME IMPROVEMENT,INC.,375 CHICOPEE ST.,CHICOPEE,MA 01013 (Date.Sunday and holidays excluded) I HEREBY CANCEL THIS TRANSACTION_.____ _(Buyers Signature)