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31B-151-003 BP-2023-0880 17 TRUMBULL RD UNIT COMMONWEALTH OF MASSACHUSETTS 2F Map:Block:Lot: CITY OF NORTHAMPTON 31B-151-003 Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0880 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: VASILIE KUHARCHUK DBA MAJOR Est. Cost: 3950 HOME IMPROVEMENTS CS-103054 Const.Class: Exp.Date: 08/24/2024 Use Group: Owner: MARGARET HOHMANN, INGRID Lot Size (sq.ft.) VASILIE KUHARCHUK DBA MAJOR HOME Zoning: URC Applicant: IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST (781)913-6405 WC5-31 S-360160 WESTFIELD, MA 01085 ISSUED ON: 07/06/2023 TO PERFORM THE FOLLOWING WORK: REPLACE ROOF ON PORCH 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: I; • if 0 . T ,. . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RF The Commonwealth of Massachus- s f ✓ �1 • Board of Building Regulations and S -ndars (/ F� Massachusetts State Building Code, :0 c 4 R 3 WIIUS, ITY F'OT Building Permit Application To Construct, Repair,Re : AKIN:- olish a R. ised i ar 2011 One-or Two-Family Dwelling Ttiq o Poc/NSpF This Sectione For Official Use Orly 41 o,c7o vs Buildi g Permit Number: �jl�- 3 a. 'Id ate Aplied: -_ Ev , a5, /4z 7 Za23 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 P o erty A/ cal ,�` 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rd: _.ino� kipk-rna M luo-viiiay n t v/a 6 0 Name(Pr ) City,State,ZIP 0--74unbuit. Hof !-it 3 - 6 gS-q41 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WOR,K2(check all that apply) New Construction 0 Existing Building CV' Owner-Occupied la Repairs(s) !a' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed ork2: kip-ea ce f--r�. JX l'LA,1' ( t\ (2_ f)O)C Cn ' C ,ba4.. 6 c th e - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ al r q 1. Building Permit Fe : $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/To 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: $ v ^� Check No.J' 1 h ck Amount: Cash Amount: 6.Total Project Cost: $ � G1 ) 0 Paid in Full ' 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_l b 3 v7 n t iYC//d-;) ( CLlc License Number Expiration Da e Name of CSL PIolder��` 1 U 2.0( V.exwn a r List CSL Type(see below) No.and Street Type Description /l l B r /� g v(U`,J U Unrestricted(Buildings up to 35,000 cu.ft.) 12 JT dt DWI d R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 1 / SF Solid Fuel Burning Appliances (XJub fit oioidkyitieDinitAD,(�/�'t I Insulation elephone Email adess D Demolition 5.2 Registered Home Improvement Contractor(HIC) /50J, / ,✓/�/� /� Iu R �l vl- l y 5 HIC Registration Number Expiration Date HIC ConOanyName or I)IC�shtr�l�� � � ,[ i/ 17)/i y3+2A olu •apAr No.an,2 J- t clid 1 f Email ad ess �1 �f v�c�� If/ .Sbq-C 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 Issuance of the building permit. Signed Affidavit Attached? Yes G2K. No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FO R BUILDING PERMIT I,as Owner of the subject property,hereby authorize ! / ( ��,�'(,(�/V to act on my behalf,in all matters relative to work authorized by this building permit application. h./I/La/tic_ /..z -/�3 Print er'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. 4/0m /r� c./ OA c,l kit 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" The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations a_- 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): o/Q Address: LI Vuoil a ALY,t ' City/State/Zip: /if-h.el d aO 'f Phone#: 4(.. )d3(C)(7 Are you an employer?Check the appropriate ox: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor d I employees(full and/or part-time).* have hired the sub-contract rs 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 workingfor me in anycapacity. employees and have worke s' p ry # 9. ❑Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and it 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised the' 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'comp°nsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cor tractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contactors 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 statenjent 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:Z/e[-dot- 3 Phone#: (lCOLf 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License h Issuing Authority(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5&lumbing Inspector 6.0Other Contact Person: Phone#: AR® CERTIFICATE OF LIABILITY INSURANCE DATE CERTIFICATE 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 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 David R,arty Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street (NC.No.Eat): (A/C,No): West Springfield,MA01089 ADDAIL RESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC X INSURER A: Nautilus Insurance Company 17370 INSURED Milet,Inc. INSURER B: Liberty utual 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 TIE 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 TYPE OF INSURANCE ADM SUBR POLICY EFF POLICY EXP LIMITS LTR -^ INSD WVD POLICY NUMBER GAM/ODM/YY) (MWDD/YYTY) A V COMMERCIAL GENERAL LIABILITY NN1534184 04/28/2023 04/28/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE V OCCUR PREMISES(EaENTED 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 VIPOLICY JEECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea acddent) ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _AUTOS r— HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR , CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC5-31S-360160 06/09/2022 06/09/2023 vPER OTH- ERAND EMPLOYERS'LIABILITY Y/N WC5-31 S-360160 06/09/2023 ',06/09/2024 STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • r)ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addklonal Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Agawam THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Suffield Street Agawam, MA 01001 AUTHORIZED REPRESENTATIVE ba..,_1 0 R 4.... ©1488-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff ,1^. • Business Regulation 1000 Washin• -Suite 710 Bosto Home Im ro . __-•istration ��•J • t � Type: Individual _ �_� VASILIE KUKHARCHUK -� �anon: 150841 DB/A MAJOR HOME IMPROVEMENTS � E ;'=ion: 05/03/2024 19 HUNTERS SLOPE ' -Y WESTFIELD,MA 01085 `/ IAf _S.;e Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer 8 Business Regulation Registration valid for individual use only before the HOME IMPRO : 1% • CTOR expiration date. If found return to: --_ _ - Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 =_- _ , • Boston,MA 02118 VASILIE KUKHARCH 4^ D/B/A MAJOR HOMr VASILIE KUKHARCHU 19 HUNTERS SLOPE {-- WESTFIELD,MA 01085 =05/ Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards • Cons fSrvIsor CS-103054 :' '*. = ires: 08/24/2024 VASILIE M K• - • 19HUNTERSSL•,- 111I s C WESTFIELD 111'4 . !t c i - kOI.LF d t Commissioner aiek K. 53/C41i Qra STATE OF CO\\ECTICUT DEPIRT.MME\'T OF('O\S( .III:R PRO-TE.CT/f)\ HOME IMPRO ENT-CONTRACTOR VASILIE KUKHARCHUK 22 Verona St West&eId,MA 01085 MAJOR HOME IMPROVEMENTS Registration# Effective Expiration HIC.0611632 04/01/2023 03/31/2024 SIGNED 1 4. City of Kevin Ross <kross@northamptonma.gov> 1 Northampton 17 Trumbull Rd. Vasilie Kukharchuk <majorhome@yahoo.com> Thu, Jul 6, 2023 at 11:17 AM Reply-To: Vasilie Kukharchuk<majorhome@yahoo.com> To: Kevin Ross <kross@northamptonma.gov> Good morning Kevin, The subcontractor we are using is GA Siding Construction with no employees. I am attaching his certificate of insurance to this email. Regards, Ilona Kukharchuk Major Home Improvements Office 413-636-6046 Fax 413-536-5907 Majorhome c©. yahoo.corn [Quoted text hidden] on GA Siding & Construction.pdf 212K AC R� Da CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) `r./ 03/27/2023 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 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 CONTNAME: CAROLINA CAROLINA MATOS POINT INSURANCE INC 191 CONCORD ST PlAtc NO Eae: 508-875-5600 11A/0 Not: 50A-875.5885 ADDRE IL SS:(` FRAMINGHAM,MA 01702 p�QLINA(g�POiNTINSLtRF.COM INSURER(S)AFFORDING COVERAGE NAIC I INSURER A:ATLANTIC CASUALTY INS CO INSURED INSURER B: AIM MUTUAL INS CO GA SIDING CONSTRUCTION INC 26 EVERGREEN STREET INSURER C MEDWAY,MA 02053 INSURER D: INSURER E: INSURER F: I 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. INBR AlitiCIIIIM T POLICY EFF ' POLICY EXP LTA TYPE OF INSURANCE INSR yyVD POLICY NUMBER I(MMIDO/YYYYI I(MM/DDIYYYY) LIMITS GENERAL LIABILITY II EACH OCCURRENCE S 1,000,000 i DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(En occurrence) S 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) S 5,000 A L375000576 07/17/2022 07/17/2023 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 5 2,000,000 GEN1 AGGREGATE UMIT APPLIES PER: ! PRODUCTS-COMP/OP AGG S 1.000.000 POLICY PRO- LOC S _ JECT - COMBINED SINGLE LIMIT I AUTOMOBILE LIABILITY F1 Aga acddent S ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SMOESULED ' I .BODILY INJURY(Per accident)]5 AUTOS HIRED AUTOS NON-OWNED i PROPERTY GE 1 5 _ AUTOS 1(Per accident) I 1S UMBRELLA LIAB ^_ OCCUR Er- EACH OCCURRENCE I S EXCESSLUIB CLAIMS-MADE! AGGREGATE 1 S I DED RETENTIONS I I I S WORXERS COMPENSATION 1 i WC STAT OT1 AND EMPLOYERS'LtABILRY Y/N' I X U•TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 15 1,000,000 OFFICEJMEMBER EXCLUDED? N I N/A'1 AWC400703910820223A 03/26/2023 03/26/2024 (Mandatory In NH) Et DISEASE•EA EMPLOYEE S 1,000,000 II yea,doaulbn under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 Er I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD WI,Additional Remarks Schodulo,If more space Is required) CERTIFICATE HOLDER CANCELLATION Major Home Improvements SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 22 Verona Street ACCORDANCE WITH THE POLICY PROVISIONS. Westfield MA 01085 AUTHORIZED REPRESENTATIVE l! 1 CAROLINA MATOS ,s/�'irs ©1988-2010 ACORDCt P TION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r "', l