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31B-034 (2) BP-2022-0750 22 MYRTLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-034-001 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-2022-0750 PERMISSIONIS HEREBY GRANTED TO: Project# KITCHEN RENO Contractor: License: Est. Cost: 7000 ALEX KOROTICH 115782 Const.Class: Exp.Date:08/23/2024 Use Group: Owner: ELI DWIGHT, Lot Size (sq.ft.) Zoning: URC Applicant: AJK LLC Applicant Address Phone: Insurance: 543 SPRINGFIELD ST (413)356-8310 GLP102222 CHICOPEE, MA 01013 ISSUED ON:06/22/2022 TO PERFORM THE FOLLOWING WORK: NEW KITCHEN CABINETS 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: ' .s2 CP1 0 Fees Paid: $65.00 • 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildinc Commissioner / C-k= The Commonwealth of tip ) Board of Building Regulations ���c %FOR Massachusetts State Building Code,7 � , ,,,5 MdNICIPALTTY USE Building Permit Application To Construct,Repair,Renovate p ' a 'Revised Mar 2011 One-or Two-Family Dwelling °eo Ns This Section For Official Use Only Buildinn Permit Number. _B P- . • «7S`0 Date Applied: K(urN �55 / 6 22-2Z Z Building Official(Print Name) Signature Dale SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel N " s� i14yr-i-k 5-heel, N a����* g1 ivo 1 2 0 7 1.1a Is this an accepted street?yes .X no Map "..- Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(it) 1.5 Building Setbacks(ft) Front Yatd Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Tone: _ Outside Flood Zone? Public Private 0 Check if yes1)0 Municip91l On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: &1,• 5 , bwish+ ©ak)und,69 9Y14/ Name(Print) City,State,ZIP No.and s 6/fin Oven t, Telephone EI i. DWi ar h qme ( rn dA� SECTION 3:DESCRIPTION OF PROPOSED WORK2(cheek aH that apply) New Construction 0 Existing Building jl( Owner-Occupied 0 Repairs(s) 0 Alteration(s)V Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ge t1 .hy �GSbtn (�j,i r4-1 s fri it'/ k i�cI P inOrlikrq MO CO b,K4s j r trAd �y ,on 541,,,t'r in -ic rrar 'en V W. SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs Item ' Official Use Only (Labor and Materials) 1.Building $ 0 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Cl Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List 5.Mechanical (Fffe $ 0 Suppression) Total All Fes$_ r' Check No.ION— Amount° V6 Cash Amount: 6.Total Project Cost $ 7,000.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 coral-action Supervisor License(CSL) CS.. t;S 7$.2 Oa/0- e 2oa t1 /"►l-eY 5 Koc C I License Number Expiration Name of CSL Holder '` ` ^ List CSL Type(see below) U 'S y �()(`i/1 G t►e�� ?�T No.and Street (("" �n�f� �1 Type Description C1 'co�oY v P � ®/t/1 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted l&2 Family Dwelling City/Town,Ste 7JP / M Masonry RC Roofing Covering WS Window and Siding 1 pv SF Solid Fuel Burning Appliances to' ?_$3/O ftxj ohlnro� +9ia J( I Insulation Tel a Email a D Demolition 5.2 Registered Home Imp rovement ContractorJ (HI ,l d/�a d i v Co 2 t Rex f o r m I(o 'Ch HIC Registration Number on HIC Company Name or BIC Registrant Name No and `'p ny-rid g- P-I AtX o Ian Io c%rinci L a� Email CM,Yo e 041) Otof 1 yIV 1S-6 l0 City/Town,Stag,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.f 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 0 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. `??"14# -0, 6/16/2022 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. jJ 21✓( 6/16/2022 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.fl.) 411. (including garage,finished basement/attics,decks or porch) Gross living area(sq.IL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of haltlbaths 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" 4 7,0610 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT ST7.F: 7, f 62 t, REAR LOT DIMENSION: 30o S' tr REAR YARD I SIDE YARD 10 -Pet SIDE YARD /D FRONT SETBACK /7 'PP I FRONTAGE /' -ke/ City of Northampton • !U '' Massachusetts s. Is .� l 1 :r, • DEPARTMENT NT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building y. Northampton, MA 01060 v'rsty', 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: ivecl S P_ W ii /4a1-I1 e/c/ /tl, The debris will be transported by: Name of Hauler: US/t wac,k Go) Pec iltioc Signature of Applicant: L Date: C b/S g2 City of Northampton SH M ?�,G - .'l;_ \5.. - SIC,•, V ' Massachusetts ftg DEPARTMENT OP BUILDING INSPECTIONS 212 Man Street • Municipal Building i4 h�0 Northampton, MA 01060 rsyh 8r,\^J HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT j, Eli S. Dwight (insert full legal name), born 512"'(insert month, day,year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this 16 day of June 20 22_ Eh Dwight(JO 6,2022 14:50 PDT) (Signature) The Commonwealth of Massachusetts =7:k Deportment of Industrial Accidents I 1 Congress Street,Suite 100 t Boston,MA 02114-2017 4: www.mass.go)/dia %S utters'Compensation Insurance Atldas it:Builders/CootractorstElectriciansfPlumbcn. to BED E 11E:0 Y,lilt THE PERNIITIING Al THt)Rfl . Annlicant Inrorination Please Print Leeibls Name aBusincssOrganir-ition individual): .__J ' n_---- Kor©'lid Address: 6 W 3 5 if) tj&id 514Teel-9.Ch,`__ $14 01 tOLS C'tri':'State;'Zip: — _ G►i(t]/pe P i 1/44 0/19t_.3 Phone#: (Yip)35-6— g�/O Are yew an employer?('arch Ibe apprrptiatr brs: I s 1►e of project(required)' 1.0IamaemployasXith employees(full amfur pan-time s.' 7. D Nett construction 20 I mn a sole proprietor of penmen tip and have no emplul".x-s H uiline tot tie in It. 'Remodeling aus o..p.mty [\u K.nL r,'.amip.uuunm« roqum l.; 9. ' Demolition 3JJ I ant a lotttwvaner dome Ai work myself.!\u w n4s1s comp rmuranec rcywiul.)' 10 Q Building addition 4.01 am a humeriµnor and µ:U be hiring.vnuadurs to conduct all work un my property. I will ensue that al:Cann:sours either hate w at cgs compensation mwtan=or are sole 1 1.0 Been-it-al repairs or additions prupn.Wrs w rth nu ertgsluyc.s 12❑Plumbing repairs or additions 50 I am a ccri.r ai ctmlractur and I lot c hued the suh-contractuts listed on the au:kited she.,. 13❑Roof repairs Tbesc soh-conirastun hase cnployet,and base µo,i cr .amp.in uramc. 6.0 We am a corporation and tL.uliicas btivc exercised their nghr of e.smi o pet W$L c 14.OUTVrt 1s2.(bit.and we base no anpluyieta.[Nu workers comp.msurare:c required.) `Any applicant that ami.boa PI mint also fill out the section below show mg then µurlen'c.mywnsatnm pulp.)information. +tiunnviµirn-,w I,..uimit Muir atliJaoit indtuimy tort arc durng all µorl�and Own hire uut,idc contractor..moot,ahiml a rice.aiti.lat it:r dating.u.b C' oniractor,that dick du.inn.belt attadsed are additional sheet stow mg the name of the sub-contractors and state u iie:hicr.r nut Moss:.auntie+haw employees. lithe soh-ctt:iracturs lute employees..they must pmtide their workers'.soup.pulley nwnhf I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. consurance.Company Name: / 7/ /VG/e _Ty ar)t1► („, ,, __ Pohcy»or self-ire.Lie.#: 6 ,0/O..Q22 1 Expiration Date: p 5-Ai/as Job Site Address: 0.1 �e $ ree 4 cityrstate!Lip: tveriiarhp4 Ito O/D60 Attach a copy of the workers' ' presidia.policy declaration pane(showing the polio number and expiration date). Failure to secure coverage as required under MMGL c. 152. ;25A is a criminal violation punishable by a tune up to S I.500.00 andror one-year imprisonment.ent.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Offiicce of Investigations of the DIA for insurance coverage verification. I do hereby eertffj-a rr the pains a penult' a 'us"-that the information prurided abort is true and correct. Sirature: l "'if Dale' 0/1/1/.--°-'2 Phone>r: (yl S cb- $ I 10 Official use only. a not write in this area,to be completed by city or town ofcial i City or Tonn: Permit:'License i! Issuing Autborih(circle one): 1.Board of Health 2.Budding Department 3.('ity?Torn Clerk 4. Llcctrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 4: A+ ® CERTIFICATE OF LIABILITY INSURANCE DATE 04110/20ro 22 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 NAME: Progressive Advantage Business Program Progressive Advantage Business Program PHONE FAX PO Box 5316 (Ale,No,tact): 844-306-4926 (NC.No): Binghamton,NY 13902 E-MAIL ADDRESS: commercialservice@homesite.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A: Midvale Indemnity Company 27138 INSURED INSURER B: AJK.LLC. INSURER C: 543 Springfield Street, INSURER D: Chicopee,MA 01013 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2826704410344224 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 LI TYPE OF INSURANCE ADDL SUER POLICY NUMBER POUCY EFF POUCY EXP LIMITSLTR INSR WVD (MM/DD/YYYTtiMM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE RENTED A CLAIMS-MADE n OCCUR Y N GLP1022224 05/11/2022 05/11/2023 ISES(Eaoccurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY s1,000,000 GEAR_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY PRO- LOC PRODUCTS-COMPIOP AGG $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BOOLY INJURY(Per person) OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRETORIPARTMF/EXECU -TIVE OFFICER/MENDER EXCUlOED7 N/A E.L EACH ACCIDENT (Mandatory in NH) EL DISEASE-EA EMPLOYEE If yes,desalbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LAST PROFESSIONAL LIABILITY OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached if more apace is required) Carpentry Framing Alex John Korotich is included as an Additional Insured. CERTIFICATE HOLDER CANCELLATION ALEX JOHN KOROTICH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 543 SPRINGFIELD ST AUTHORIZED REPRESENTATIVE CHICOPEE MA 01013 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r Board of Building Regulations and Standards Cons aii tittyprisor :S-115782 Expires:08/23/2024 ALEX J KOROTICH, `# 543 SPRINGFIELD STREET = ` ' CHICOPEE MAt�01013 • - t • • $' gi An A: Y)/SS'l:1 Commissioner de iS. ` nciatt • HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Fxlitation ALEX JOHN KOROT GCI_ 3 (.6(e �L' 1/ C� e i/G�(%CG11 QiCj�G1a!i(/Gtj amer Affairs and Business Regulation ALEX J.KOROTICH , Washington Street-Suite 710 543 SPRINGFIELD STREET ""`4 i '*. ;ton, Massachusetts 02118 CHICOPEE.MA 01013 Undersecretary xovement Contractor Registration Type- Individual Registration: 202204 ALEX JOHN KOROTICH Expiration: 06/02/2023 543 SPRINGFIELD STREET _ CHICOPEE,MA 01013 • Update Address and Return Card. 3CA t sa 20M-O5ll7 2022-06-16 000333 Final Audit Report 2022-06-16 Created: 2022-06-16 By: Alex Korotich(alexjohnkorotich@gmail.com) Status: Signed Transaction ID: CBJCHBCAABAA1Dzrtz4tF13SYmVwlaAwdXwdILQEjKMy "2022-06-16 000333" History t Document created by Alex Korotich (alexjohnkorotich@gmail.com) 2022-06-16-2:50:21 PM GMT L+ Document emailed to elidwight@gmail.com for signature 2022-06-16-2:51:53 PM GMT t Email viewed by elidwight@gmail.com 2022-06-16-2:51:57 PM GMT L2o Document e-signed by Eli Dwight(elidwight@gmail.com) Signature Date:2022-06-16-9:50:21 PM GMT-Time Source:server 0 Agreement completed. 2022-06-16-9:50:21 PM GMT la Adobe Acrobat Sign All measurement in ncnes ,}-7 Project name 22 Myrtle Kitchen _ Project number I 'y' 'I - 0001-4755-9322 .e alV 1 l • A: If 11 . t Et *end I I [rcivaea in me coy once Lighting S142.95 Appliances S2996 Total Price: $7836.95 Important IKEA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from IKEA,take home and assemble yourself. All requested delivery, assembly and installation services are charged separately and not included in the price.Although we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. EMI22 Myrtle Kitchen - Plan View 0001-4755-9322 All measurement in inches ,ta I I40 eM i A ` re 13.+4 w II I ..>rx >`w I 2s s t4 la 1 ,a,Yet lie,Y+�j— IT 0 N z 1 IIM61 11; s a - �_ I m 14 i it,., r �. �,�-- I tn,.a 15 1 I rat 1.!6 I 30'S.6 I I •St 1 24 ]t la 40 1 30 lal I as sin I 3'"is I 1 3 'r Important 1KEA cannot accept any liability for the accuracy of measurements or furniture layout. Prices in this program are for products you collect from 1KEA. take home and assemble yourself. Ali requested delivery,assembly and installation services are charged separately and not included in the price. Although we do try to ensure that the information in this program is correct, we apologise for any product alterations that may occur. M 11111111 22 Myrtle itchen-North Wall 0001-4755-9322AN measurement in inches yrtl to I ,may,. At I ! I � ?,,I I IV" I _ _ r t� 1 IC I * ' ua 1 o4a 1 �, - �- II _ _ [ - ir ct a t a rillImMINIk } IC'1�•i/ } :1...& :[ :t i a.: 4l ISn! DS 1341 ...-tf '4.. I K I a _____.4_.____._'"._.. 1 1' 1..'t I F",'! I 42t'Jtif I 22 Myrtle Kitchen-East Wall All measurement In inches MM. 0001-4755-9322 I I • 47 SO s k ' }i 3.4 21304 3,4 t! I t ' f 111'£ il.it