25A-085 (7) BP-2023-1316
359 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-085-001 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-2023-1316 PERMISSION IS HEREBY GRANTED TO:
Project# deck replacement 2023 Contractor: License:
Est. Cost: 30000 VICTORIA VIKHREV 116722
Const.Class: Exp.Date: 05/14/2025
Use Group: Owner: J. CUNNINGHAM, MICHAEL
Lot Size (sq.ft.)
Zoning: SC/URB Applicant: VICTORIA VIKHREV
Applicant Address Phone: Insurance:
15 SUMMER AVE (413)386-8095
LUDLOW, MA 01056
ISSUED ON: 09/22/2023
TO PERFORM THE FOLLOWING WORK:
DECK REPLACEMENT
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: 3-1
"J •
Fees Paid: $195.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
y
le StAq
RFC
The Commonwealth of Massachuset �/V�/�
Board of Building Regulations and Sta,dar1 VNOR
W
S(P M ' CIP•i ITY
Massachusetts State Building Code, 7:1 C US
Building Permit Application To Construct, Repair, ' -nod:"-:0; I-molish a 6'4 Re ised ar 2011
One- or Two-Family Dwelling NogNyq( DON,N3pF
This Section For Official Use Only RI o,oetop�,s
Building PermitNumber: 3 P--• ...3 I at(,e Date Applied:
/<`u(A.)Z // 9.ZZ-Z0Z3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Ad ess: 1.2 Assessors Map&Parcel Numbers
359 Sri cre S( 7,54 0B50b1
1.1 a Is this an accePted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Res siAQle Pn currefritt, 22651 la(. it
Zoning District Propose Use fa Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
31 30j39 ti 90
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 Owp�er' f Record:
M104P.1 Cunningham 351City,State,ZIP briclae S71
Name , Norl41cIm p1on, IV 0100
(Print)359 grid & S,I 617-957-C412 ncunninglaaq� mail. cow
No. and Street Telephone Em l 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) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other lirSpecify:deck replaCemeA4
Brief Description of Proposed Work2: deck ref lacemen-F, no change in Footpr!nf1
appromimd y c OO- fz
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 9j s/000 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: $10116
Check No.\ Check Amount: Cash Amount:
6.Total Project Cost: $ 30i000 0 Paid in Full 0 Outstanding Balance Due:
DocuSign Envelope ID:173BF4AA-8EAA-49AB-8F36-5A6E28552760
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 116722 05/14/2025
Victoria vi kh rev License Number Expiration Date
Name of CSL Holder
417 Springfield St unit 108 List CSL Type(see below) Unrestricted
No.and Street Type Description
Agawam, MA 01001 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
SF Solid Fuel Burning Appliances
413-386-8095 vi ckyvi kh rev@gmai 1 .com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 204706 03/15/2024
victoria vikhrev
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
417 Springfield St Unit 108 vickyvikhrev@gmail .com
No.and Street Email address
Agawam, MA 01001 413-386-8095
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 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 victoria vikhrev
to act on my behalf,in all matters relative to work authorized by this building permit application.
e--DocuSigned by:
_UI ' /__,Akti 09/21/2024
Primt-Q mcsinchlarnix(Electr nic 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.
r—DocuSigned by:
itti
Ge
I 1 (MAAAi 09/21/2024
Priatlawrisseva2Atathorize 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.eov/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"
Commonwealth of Massachusetts
.0. Division of Occupational Licensure
Board of Building Regqulations and Standards
I i'
Constit ��'I on S visor
CS-116722 _ (%pires• 05;1412025
VICTORIA VII HREV f
15 SUMMER AVE - }
LUDLOW MA 91056
Y ,
1Commissioner K. bi&m.Pua._ .
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street . Suite 710
Boston,Massachusetts 02118
Home Improvement Contractor Registration
,' typ inavolual
VICTORIA VaWREV E aQtRroseason 204706
15 SUlMER AVE 1 1f tAson 03'15r202s
LUDLOW MA 01056
wear Address and Return Card
THE COYYONWEALTM Os MASSACHUSETTS
OfSos of Con.t na Affafq 6 Swatter*RquYtlrn Ratpstrafaon raid for" atrium*so onus Wont It.
HOME MNROVEtleNT CONTIIACTOR raptra1wn dais If found return to
TYPS.rota e0ur Offic.of Constant*,Affairs and Business Rrqu anon
1000 Washn+Eton Strom •Sues 110
,Riles = 0301S/2024 Boston,MA 0211a
VICTORIA V1101HEV
VICTORIA YIIWREV ,
IS SUMMER AVE ,,,A..i • ..011wd1
LI. 1O*MA 01066 Underwriter! Not valid without signature
The Commonwealth of Massachusetts
v. Department of Industrial Accidents
°s 1 Congress Street,Suite 100
'�;,?a c`� Boston, MA 02114-2017
�t �,,{ www:rnass.govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO SE FILED WITH THE PERMITTING AUTHORITY.
Anplirant Information Please Print Legibly
Name(Business:Organtution Individual): C 1 " . Vic c a _.VI Wafer
Address: 151 Lailth S(' 417 .Spdi f13cietd S41 Ut 4- 108I I}ilaivarnt (hf 01001
City/State/Zip: j Phone_ #: 868095
Are yor an employer?Check the appropriate tot:
Type of project(required):
1.0 lam a ernitloyer with employees(full andi'oe part-time)_• 7. 0 New construction
201 am a aisle proprietor or partnership and have nu employees working for:r in K. 0 Remodeling
any capacity.[No workers'comp.insurance required.)
9. ❑ Demolition
3❑I am a homeowner doing all work myself.[No wor'kert.cUrep-nosuninee required_)'
4.0 1 am a honsiowner and will be hiring ocentraetora to conduct all work on my property. I will 10❑ Building addition
ensure that all edam-actors either have wortters'cortrpensaticai utaurance or are sole 1 I.Q Electrical repairs or additions
pruprieton with no employers. 1213 Plumbing repairs or additions
123 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.; 64
^
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other cLeck
152.§1141.and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box n I must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this attidavit indicating they are doing all work and then hire outside contractors mint submit a new aftidav it indicating such.
+Conitacturs that check this box must attached an additional sheet showing the name of the hub-t-cattrac tors and state whether or nut those entities have
employers lithe sub-contractors have employees.they must provide their workers'comp.policy number
I am an employer that is prodding workers'compensation insurance for my employees. Below is the policy and job site
Information.
Insurance Company Name: sub lncis no meloyees
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 MGL c. 152, §+25A is a criminal violation punishable by a tine up to 51,500.00
aM'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 do hereby certifysVitlia/A
under theains and penalties of perjury that the information provided above is true'and i rrtr i r.
Signature: halt. 9-1 l- 20217
Phone#: 4133?6 Rog 5
POfficial use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 4:
''
Ace-urn- CERTIFICATE OF LIABILITY INSURANCE DATE(MMfOD1YYVY)
�,..- 06/3012023
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
NAMF
Mass Trans Insurance Agency a ri.(413)732-0310 FAX Nnr(413)274 2068
425 Union Street,Suite Al Ao RIFSR, romantWmasstransins.com
West Springfield MA 01089 INSURERISIAFFORDING COVERAGE NAIC 4
INSURER A: Western World Insurance Co.
INSURED
INSURERS
RC Exteriors LLC INSURER C
151 Labelle St INSURER D: ,
West Springfield MA 01089 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 ADOLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IN St) WVri POLICY NUMBER ,(MM/OtVYYYYt 1MMlfDJYYYY1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
A CLAIMS/MADE X OCCUR DAMAGE
RP SPK TO RENTED rr„,„y $100.000
NPP8919508 07/14/2023 07/14/2024 MED EXP jAny oot nerxoni $5,000
PERSONAL&ADV INJURY , $ 1,000,000
GEN`L AGGR AT OMIT APWE S PER. GENERAL AGGREGATE $2,000,000
JECT
X POLICY I I II LOC PRODUCTS/COMPIOP AGG, $1,000.000
OTHER Deductible $250 BI/PD
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
(Ea onn/oeo4
ANY AUTO BODILY INJURY(Per person/ $
OWNED SCHEDULED BODILY INJURY(Per accidnt) $
_ AUTOS ONLY .........AUTOS
HIRED NON•OWNED PROPERTY DAMAGE $
AUTOS ONLY _4 AUTOS ONLY (Par arrvlant)
S
UMBRELLA LIAR — OCCUR EACH OCCURRENCE , $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEO RETENTIONS $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YYY111NNN STATI ETF FR
OFFICER/MEMBER EXCLUDED?ECUTIVEANY PROPRIETOR/PAR TNER/EX
N I A E.4.EACH ACCIDENT $
(Mandatary in NH) E.L 0!SEASE'EA EMPLOYEE,i
it yes.dascribe under
DESCRIPTION OF OPERATIONS bekxw E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.may Ea attached if more space is required)
Coverage for Each Professional Incident Limit(if applicable)is included in the policy.
CERTIFICATE HOLDER CANCELLATION
PROOF OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1
AUTHORIZED REPRESENTATIVE e.'`' <YA>
�++
0 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
359 Bridc e S1-.
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT: a5AO8 500
LOT SIZE: 2265/ f1 2
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
* n1 ' drown �° C
sd c k $ wid e
Pease si-eps l&r �i�re,kr to
dimensions 30, you41,
in drawl n2s
Peck will (1ot- '0' aoa
38'
be +ouci,i9 rra$e)
or+ si.)
FRONT SETBACK
FRONTAGE 1 a 1.7
City of Northampton
^' MF,�HA ...
>, Massachusetts Z x. 'e
l ethl
0 f DEPARTMENT OF BUILDING INSPECTIONS 5 }
212 Main Street • Municipal Building Jy Cb
wore.- Northampton, MA 01060 r.SNh; 3,7x-‘
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: vp,U9 Rtn5 GIl'aii, a3u Ects414a►r {on Rd, IJor4am t- n, mfl D‘°Go
The debris will be transported by:
Name of Hauler: (qOr kotornin
Signature of Applicant: Date: 9-I1- 2D23
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