15-012 (2) • BP-2023-1387
368 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
15-012-001 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-2023-1387 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
VASILIE KUHARCHUK DBA MAJOR
Est. Cost: 4000 HOME IMPROVEMENTS CS-103054
Const.Class: Exp.Date: 08/24/2024
Use Group: Owner: MIRIAM PIILONEN,
Lot Size (sq.ft.)
VASILIE KUHARCHUK DBA MAJOR HOME
Zoning: RR Applicant: IMPROVEMENTS
Applicant Address Phone: Insurance:
22 VERONA ST (781)913-6405 WC5-31S-360160
WESTFIELD, MA 01085
ISSUED ON:10/06/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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 I •
2 .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
4)<(\
The Commonwealth of Massachu - s C,(•
,t v , Board of Building Regulations and ' and. . ``/ FOR
Massachusetts State Building Cod- 78%C14 ICIPALITYUSE
Building Permit Application To Construct,Repair, R• •Olts sct, *se. ,ar 2011
One-or Two-Family Dwelling by ?o� ,f•
This Sectionct For Official Use Only 6,7%
Building Permit Number: �^33• / . 7 Date Applied: �7�;‹cr,
4,0(2,
��Otis f, z _ g 6 zoZ3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Proper Add ess: ,d 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❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor • 'f
/7�l.c.�4.,OGOt_ "I/ ►� i 0I'ltdt-- 9c.0 4-') l(A7f 0 /°)3
Name(Print) City,State,ZIP
36 d' R' - 62f0 -0a- -n>0
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0' Owner-Occupied ❑-'' Repairs(s)R1 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: /2_t br cL C.4_I _(" alp/LA_ LJ(� i c� a& -L
Al-i t 44 cL c)-iP k ofttk nay c�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 4L D S % I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ — 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No.330Check Amount: Cash Amount:
6.Total Project Cost: $ It/ 0 SO 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6.5_(o3o511 cf,JoL t/Da/ik , 9
,n ��tAi i�(/(�, License Number Expiration Date
Name of CSL Holder
Ywi t. (R J�� List CSL Type(see below) C.)
No.and Street Type Description
n_ 1t S /r _ D ` ' ( O U Unrestricted(Buildings up to 35,000 Cu.ft.)
l Yl/ T"� c-& PA` R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
�('J)4 b(,�0��/ho �C,.c.4 o• Q%i� I Insulation
`Telephone (/ Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / / r13/I 2
/'Y OQ-1-fOr-Le iwez - -t S HIC Registration Number 0 �Expiratioon Date
HIC C pany Name pr HIC RegistraAi ame
eL�L V VIADitce Jti Q `U/Z P yR j. m
/p/.QS [e _ c.P c� c)(d �3)63gkj14
' r Email address
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 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 67a/al 1 t .c /C f `Cc 1 c`u IC
to act on my behalf,in all matters relative to work authorized by this building permit application.
rams-A_ /WO /./_3
Print Owner'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.
41/a411 '‘e CA-1( c(A C-LWIC 704-- 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"
City of Northampton
ORTHAM TOE
5 S
Massachusetts tea?•
DEPARTMENT OF BUILDING INSPECTIONS S' 4
"'` 212 Main Street • Municipal Building y< Oar
, ;.•' p rsy
Northampton, MA 01060
hr
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: -{i7 rnt ,,�� C�
The debris will be transported by:
•
Name of Hauler: u,s/4-n eu Z �f C i Licit]
v v�
Signature of Applicant: Date: to 3
The Commonwealth of Massachusetts
,"j Department of Industrial Accidents
5
Office of Investigations
Lafayette City Center
•
B MA 02111-1750
i r i oston,
v 2 Avenue de Lafayette,www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): (kW p/Z /�c�/l C.. �C �/)
Address: o2.L (/i�n� f ((ll L-
City/State/Zip: at),/3 'dot A.“-c.)(0 eJ Phone # i 3 6 31(-4 o q 6
Are you an employer?Check the appropriat box: Type of project(required):
1.❑ I am a employer with 4. (4 I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
workingfor me in anycapacity. employees and have workers'
p 9. 0 Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. 0 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. oof repairs
insurance required.]'1* c. 152, §1(4),and we have no
employees. [No workers' 13. Other
comp. insurance required.]
*Any applicant that checks box#I 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: w70 flC 4- 3
Phone#: — c
Official use nly. 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 30City/Town Clerk 4.0 Electrical Inspector 5EF'lumbing
Inspector 6.0Other
Contact Person: Phone#:
AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/VYYY)
t`-% 05/03/2023
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 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 Jarry
Neill 8 Neil!Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629
662 Riverdale Street WC,No,Exn: I(NC,No):
West Springfield,MA 01089 ADDRESS: dj@neillandneill.com
INSURERS)AFFORDING COVERAGE I NAIC#
INSURER A: Nautilus Insurance Company 17370
INSURED Milet,Inc. INSURERS: Liberty Mutual 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 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 INSO WYD POLICY NUMBER (MWDD/YYYY) (MMIDD/YYYY) LIMITS
A V COMMERCIAL GENERAL LIABILITY NN1534184 04/28/2023 04/28/2024 EACH OCCURRENCE $ 1,000,000
l CLAIMS-MADEr-V OCCUR DAMAGE TO RENTED 100,000
PREMISES(Ea occurrence) $
MED EXP(Any one person) $ 5,000
-
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000
VIPOLICY I I ECOT- I LOC PRODUCTS-COMP/OP AGO $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
_ (Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY _ S
HIRED NON-AUTOOWNED PROPERTY DAMAGE $
_AUTOS ONLY AUTOS ONLY (Per accident)
_ $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
_ DED RETENTION$ $
B WORKERS COMPENSATION WC5-31S-360160 06/09/2022 06/09/2023 V PER I OTH-
AND EMPLOYERS'I.IABILTTY STATUTE ER
WC5-31S-360160 S-360160 06/09/2023 06/09/2024
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? I Y l N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
D es,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
T
I
l
DESCRIPTION OF OPERATIONS I LOCATIONS I 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 REPRESENTATIVE
601.6.,:aRia_gem;:,
@ 1988-2015 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-.I . Business Regulation
1000 Washing -Suite 710
Bosto __- __>;.- _=118
Home Im r• - __ -� .istration
^f —_No Type: Individual
VASILIE KUKHARCHUK •----- _9istration: 150841
D/3/A MAJOR HOME IMPROVEMENTS = =xpiratio-: 05/03/2C24
19 HUNTERS SLOPE -" —
WESTFIELD.MA 01085 _ _ -
�i _
0.14
`� update Address and Return Card.
ThE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaixr&Business Regulation Registration valid for individual use only before the
HOME IMPROV ONTRACTOR expiration date- !f found return to:
Office of Consumer Affairs and Business Regulation
Real
1000 Washington Street -Suite 710
r x Boston.MA 02118
VASILIE KUKHARCH' '
D!B!A MAJOR HOMer-A
.ti
VAS:UE KUKHARCHU
19 HUNTERS SLOPE �r�� ` ;,,,,m..'% ✓.%+W -
WESTFIELD,MA 01085 Undersecretary Not valid without signature
Commonwealth of Massach::,d s
Division of Occupational Licensure
•
i Board of Budding Re ulations anc standards •
�cn``[��S Je.. s .
_ y
CS-103054 __ I's' -es 03/24-_^=.
VASILIE M K41KH . 1,
19 HUNTERS.SL'- _, i'
WESTFIELD MA OH_ - r 1,...
Commissioner _" ., -
-
STATE OF CO\\ECTICI T
,.l)EP-4RJALt.\T.w-L1J\it iliRPROTECJ/U.\
HOME IMPROVEMENT CONTRACTOR
VASILIE KUKHARCHUK •
22 Verona St
Westfield,MA
MAJOR HOME IMPROVEMENTS .
Registration# Motive Expiration
HIC.0611632 04/01/2023 03/31/2024
SIGNEC