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35-203 (13) BP-2023-1620 1280 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-203-001 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-2023-1620 PERMISSION IS HEREBY GRANTED TO: Project# roof 2023 Contractor: License: VASILIE KUHARCHUK DBA MAJOR Est. Cost: 11540 HOME IMPROVEMENTS CS-103054 Const.Class: Exp.Date: 08/24/2024 Use Group: Owner: RANDALL FURNASH-STEWART Lot Size (sq.ft.) VASILIE KUHARCHUK DBA MAJOR HOME Zoning: WSP Applicant: IMPROVEMENTS Applicant Address Phone: Insurance: 22 VERONA ST (781)913-6405 WC5-31 S-360160 WESTFIELD, MA 01085 ISSUED ON: 11/17/2023 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 1 i • r 1 • II Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner R ..C� C The Commonwealth of Massachuse � Board of Building Regulations and Sta rd NOV OR Massachusetts State Building Code, 78 C 1 6 203 CI ITY US itt Building Permit Application To Construct,Repair, R atet �g • a R sed ar 2011 One-or Two-Family Dwelling rNgMPTON lNSPFCn This Section For Official Use Only �q 070s-"b Building Permit Number: �✓I'al 3 - I U Datete AApplied: eu ii'Z i/. 1I-17.Zoz3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1Property ft •.f�/ *) 1.2 Assessors Map& Parcel Numbers Rcif 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 Ownerof Rerd•' o z id a,ju _jjeov(z k ?p,1 c t ,LI✓4 C)r 6 6. . Name(Print) City,State,ZIP /cie by &Ati / / ved _ cc) -1,16-34/2 9 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied `i/ Repairs(s). Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: "- Brief Description of Proposed Work': (Fi - .r J-1�7, S• C/`J-f f'14(Al Q, )CAc le �ie c2S ,I A. _ (2 A /.) ? tAr>rtkr hoc ., 4e c-v ,I. .fds q I . SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ fir CV D 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.Dheck Amount. " l O Cash Amount: 6.Total Project Cost: $ //r 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C C"ID D 3Ci �/'(744 4/0/)//. _ .. >e(%/a4 aj License Number Expiration Date Name of CSL Holder 020Z List CSL Type(see below) v ,i��� a (I,L�No.and Street Type Description r /�,, ,/ / U Unrestricted(Buildings up to 35,000 cu.ft.) ' / ✓�J1���C / v�U� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / / SF Solid Fuel Burning Appliances 3 /2 6 i7 f�— o t6�I ,�/�-�,yke Caen I Insulation Tel one a Email ad ess D Demolition 5.2 Registered Home Improvement Contractor(HIC) 'o4 1�i �a-nt O cr-4.E.d s H� �' y/ 3 HIC Registration Number Exp ion Date HIC C any,Name or HIC Registr ame / n a „,)‘ ,‘ / {/'o,2 �i 0,c No.and Str et , Email dress ity/Town, tate,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 APLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 71 ll £ ) LL 7,Cf/7C to act on my behalf,in all matters relative to work authorized by this building permit application. ,C d a(V) — S a /i—/ 3-.2 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. q )/ ( /e,c.t/?coC e /(-/ 3 e3 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 SNa�rPt 5 �....SSG`--, Massachusetts j. '` _ it ! * � ''� DEPARTMENT OF BUILDING INSPECTIONS 14,tOaa '� e > 212 Main Street • Municipal Building4,011 �A. �b�, Northampton, MA 01060 hg %*° 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: A5/f Rac-le-rc 1 , cy c_L� 7c6 y _ The debris will be transported by: Name of Hauler: (,(,J4 (� .1 Signature of Applicant:( Date: //—/ °1 3 The Commonwealth of Massachusetts Department of Industrial Accidents '� Office of Investigations Lafayette City Center r/ 2 Avenue 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): u/Q yc)i%..( Address: e2 0 v ,c)/-) cl _e.e,L City/State/Zip: .tiI,l 1 ,t et iti f OfO i Phone#: 43-4 3-‘—‘04-4 Are you an employer? Check the appropriate b x: Type of project(required): I.❑ 1 am a employer with 4. [ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction listed on the attached sheet. 7. 0 Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' comp. insurance.*• 9. 0 Building addition [No workers' comp. insurance required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3. 1 am a homeowner doing all work myself. [No workers' right of exemption per MGL Y comp. 12. Roof repairs insurance required.] c. 152, §1(4),and we have no 13.0 Other • employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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'compr 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. SiQnatur ' / Date: //_/3_ Phone#: (Z-/./ 3‘ yb Official use only. Do not write in this area,to be completed by cite'or town official. City or Town: Permit/License# Issuing Authority(check one): IDBoard of Health 20 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 5Jlumbing Inspector 6.DOther Contact Person: Phone#: AC M, CERTIFICATE OF LIABILITY INSURANCE DATE ‘...�� 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 CON David R Jerry Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street INC.No.Eat): (NC,No): West Springfield,MA 01089 E-MAIL dj©neillandneill.Com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Nautilus Insurance Company 17370 INSURED Milet,Inc. INsuRERB; 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 SUBR POLICY EFF POLICY EXP LTR INSD V0 POLICY NUMBER (MWDDIYYYY) (MWDD/YYYY) LIMITS TYPE OF INSURANCE VA/0 A V COMMERCIAL GENERAL UABIUTY NN1534184 04/28/2023 04/28/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE I V OCCUR PREMISES(Ea 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 PRO- VI POLICYLOC 2,000,000 PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA UAB — OCCUR EACH OCCURRENCE $ EXCESSII LIAB CLAIMS-MADE AGGREGATE $ DED 1 RETENTION$ _ $ B WORKERS COMPENSATION WC5-31S-360160 06/09/2022 06/09/2023 STATUTE R ER AND EMPLOYERS'LIABILITY Y/N W C5-31 S-360160 06/09/2023 06/09/2024 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? n N/A 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 R al....L„ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD c.)ThCc ccn )oC I/_ A� CERTIFICATE OF LIABILITY INSURANCE DATE A E .DD/3Y") 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 POUCIES 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 CAROLINA MATOS POINT INSURANCE tNC PHOINC NO.ExL): 5f18-875.66(10 FAX No):5011-875.5B85 191 CONCORD ST EMAIL ADDRESS:CAROLINA@POINTINSURF COM FRAMINGHAM,MA 01702 INSURER(S)AFFORDING COVERAGE NAIC F 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 I 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 R POUCY NUMBER M/DDY EFF IYYYY)1 1 M/DCY EXP DIYYYY) LTR TYPE OF INSURANCE LIMITS GENERAL UABIUTY I I EACH OCCURRENCE $1,000,000 I DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $100,000 CWMS•MADE X OCCUR MED EXP(Any one person) S 5,000 A L375000576 107/17/2022 1 07/17/2023 PERSONAL&ADV INJURY S 1,000,000 I GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000.000 POLICY I �I JPE T LOC i $ AUTOMOBILE LIABILITY, F —Do1U$IRED SiNGLYLIMIY 17- (Ee sadden!) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS 1 BODILY INJURY(Per accident)]S NON-OWNED I PROPERTY DAMAGE S HIRED AUTOS `^AUTOS '(Per aGddont) I S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS B CLAIMS-MADE AGGREGATE I S W I DED I RETENTIONS I 1 1$ WORKERS COMPENSATION I WC STATU- OTH•I AND EMPLOYERS'LIABILITY Y I NI I i I x TORY LIMITSER B EiCL �ECUTNE OFFICE/MEMBER EXCLUDED? (N I N I A n AWC400703910820223A 03/26/2023 03/26/2024 E.L EACH ACCIDENT $1,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYE1 S 1,000,000 If yea.dosafbe under DFSCRIPTION OF OPFRATIONS below E.L.DISEASE•POLICY LIMIT $1,000,000 EE I I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach AGGRO 101,Addldonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Major Home Improvements SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 22 Verona Street ACCORDANCE WITH THE POUCY PROVISIONS. Westfield MA 01085 AUTHORIZED REPRESENTATIVE CAROLINA MATOS H r � ©1988-2011 OR C RP TION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORDr:re„ I�/.{(r ri_ . Commonwealth of Massachusetts IP Division of Occupational Licensure Board of Building Regulations and Standards Constr t nn 1S rvisor CS-103054 83,pires: 08/24/2024 VASILIE M K§fKHARCHUK 19 HUNTERS, LOPE WESTFIELD fM11 01085 / C, • • Commissioner Baia K. b&,,i.ta,_. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff•,f,I,".� • Business Regulation 1000 Washing -Suite 710 Bosto Home Im.ro_ - - ---•istration Type: Individual VASILIE KUKHARCHUK ( ation: 150841 D/B/A MAJOR HOME IMPROVEMENTS = E T .lion: 05/03/2024 19 HUNTERS SLOPE "' _ : ©!7 WESTFIELD,MA 01085 a " r. Update Address and Return Card. _ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer A &Business Regulation Registration valid for individual use only before the AR HOME IMPROV ' 1. ONTRACTOR expiration date, if found return to: Y •-' Office of Consumer Affairs and Business Regulation _, -, •_;._ ,., 1000 Washington Street-Suite 710 n7 Boston,MA 02118 VASILIE KUKHARCH•,,.�_.��•=:'r DIB/A MAJOR HOM- VASILIE KUKHARCHU'i', 2 19 HUNTERS SLOPE .• c_ WESTFIELD,MA 01085 = Undersecretary Not valid without signature STATE OF CONNECTICUT DEP-I RT.1JE\T OF CO.\'S('NER PROTECTION HOME IMPROVEMENT CONTRACTOR VASILIE KUKHARCHUK 22 Verona St Westfield,MA 01085 MAJOR HOME IMPROVEMENTS Registration# Effective Expiration HIC.0611632 04/01/2023 03/31/2024 SIGNED