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36-159 (7) BP-2023-1603 1112 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-159-001 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-2023-1603 PERMISSION IS HEREBY GRANTED TO: Project# 2023 SIDING&WINDOWS Contractor: License: ALLIANCE HOME IMPROVEMENT Est. Cost: 27640 INC 104327 Const.Class: Exp.Date: 11/29/2025 Use Group: Owner: KWASNEY MICHELLE D Lot Size (sq.ft.) Zoning: WSP Applicant: ALLIANCE HOME IMPROVEMENT INC Applicant Address Phone:, Insurance: 375 CHICOPEE ST (413)883-3802 6562UB-4N622734 CHICOPEE,MA 01013 ISSUED ON: 01/03/2024 TO PERFORM THE FOLLOWING WORK: REPLACE VINYL SIDING, GUTTER, &REPLACE FRONT PICTURE WINDOW WITH 3 DOUBLE HUNG WINDOWS 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: • Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner iva={� U 1RCielQ `1 c D N O The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE o z Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Buildin Permit Number:Be 242, --i(o 03 Date Applied: EZ1,�J ss //L: // )•3.zozii Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers ( 1 I L4 r-f-S VI k+ 12d -36-/s9 00 / Li Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: tA)5 ,z1iielem Zoning District Proposed Use Lot Area(sq ft) Frontage(It) 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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of RecordL 1L4Z clel eU Q Z w aS h-e T-(Dve ne , Ma o I n 6?— Name(Print) City,State,ZIP Ill a f\G rf 3 P;-q- 41 4 13 S3-0 9D19 HD ku)agheA.i Q ens cc1,14_he71— No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(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 dI Specify: i d h Brief Description of Proposed Work':y�f73 11 n p.4,d/ vin S%c;rt CO7 e; . 0 v --F?C)fo z_ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ al_ cj u o 1. Building Permit Fee: $ Indicate how fee is determined: 1 ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: (A)t r,,j.nt) toe 5.Mechanical (Fire $ Total All Fees: $ 100 Suppression) Check No.L)g9 4. Check Amount: Cash Amount: 6.Total Project Cost: $ 1 (-(U 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS--(Dv 3a; /, 3 S erg tlk kAlaru vie �(( L License Number Expiration Date Name of CSL Ho1de p 1 3 4-5 n )c ok_Q Q a T List CSL Type(see below) No.and Street l�C�t.l Type Description n / U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,Stale,ZIP 1 LS R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding (� np? ^-1 I � SF Solid Fuel Burning Appliances "l(2J d O J 3god �e,-�d@ cact v1GP FLo v ;0C.G�`!�a I Insulation Telephone �J Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) c. 4-cYme o very , Ss� I�° oz 19 �2S A-lid t� HIC Registration Number Expiration Date HIC C any Name of HIC egistrant a �7 s cr t t e_o -ee rc? '�c ��c e k orKe the. (D(41 N and Street cC1J Email address LI.t..,c c) IuA oro(3 413 8P3 3d°c9cZ City/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 C9'nc No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR AP IES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize a91/771ret to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name be . , eby attest under the pains and penalties of perjury that all of the information container ' r i :op icatio •- and accurate to the best of my knowledge and understanding. // 0g(23 Print Owner's . Authori t Name'ents A (Electronic Signature) Date gg ) 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(H1C)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" foome All home improvement contractors and subcontractors engaged in WO bane" home improvement contracting, unless specifically exempt from i registration by Provisions of Chapter 142A of the general laws, 111A1111111 I; L V (`�� must be registered with the Commonwealth of Massachusetts. �/ j� Inquiries about registration and status should be made to the / \ Director. Home Improvement Contract Registration, One Prom your Imagination toourn.r� / Aki/litr � Ashburton Place,Room 1301,Boston,MA 02108(617)727-8598 375 Chicopee St.Chicopee,MA 01013 • ' Phones:(413)883-3802 1gyq Fax3(4 3)331-4358 you can pay more,but you can't buy bettetr MA Lic#154218 CT Lic#0635847 www.AllianceHomelnc.com C� SUBMITTED O:M1 ate,'le, JeI 1/3 Phone: Cell: 5 /n©S 7 J 1 Email: ,"i L/ kwats-eve e co fri _i va+ We hereby submit specifications and estimates for work to be performed and materials to be used: l r - 1 in VI�j S I n a I ylS O 1ce s.'d.vA ;\ct clAploco J 1 1+arlor bIute -7-11A4 viev Pv tilUM• V;"-y lAP cKer 4 ':M , V 64 c164 c A-1 O f ok -Fa.,491 d ba cke!'. ( 11 hit er �14 Wk c+c 0 id re 4111 cxi sf,v Aeu-keir p P ' ckor COt er S, ' ' -P k Ce, 4 mi- e G/d h bui-wiads 0 41/ -rh riee/ 0114 wiiiiolew , rvv.0 (e e yl ' ► W ‘ I A .7.Z. 0 44-'79(c..... pvied WORK SCHEDULE Profied Sta n tompl a ghedule-The following schedule will be adhered to unless or stance�' ,�-'.�,i the or's control arise: / LJ/ �+..] Datewhen contractor will begin contracted work. / W/ Date when contracted work will be substantially completed. Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired.The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes,Acts of God,shortages of materials,accidents,and all other delays beyond its control,shall not be considered as violations of this Agreement. WARRANTY /�„ All materials have , Warranty or as otherwise specified by manufacturer.Labor and workmanship have a warranty of one full year from the date of installation. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. PAYMENTS f tC SOP We propose hereby to furnish materi I and labor- omplete in accordance with Payments to be made as follows: `,, �lCw 11 U�g follows:_ ab s e 'ficatio r tf�gln of: %($ upon signing Contract; r�✓f_ dollars r/�V Name of Salesman �-� %($ )u n delivery of materials; (s' g 1 50$ n job completion; e.c a %($ shall be made forthwith upon completion work under this contract. Authorized Signature The customer hereby understands and agrees to pay finance charge of 1.5%per month(or annual percentage rate of 18%)on the outstanding balance not paid days after completion of work.All payments received after 30 days after completion of work shall be applied first to unpaid finance charges and then to outstanding balances.In the event of default,customer hereby understands and agrees to pay,in addition to the outstanding indebtedness,all costs associated with collection including reasonable attorneys fees. Acceptance of Proposal:I have read both sides of this document and accept the prices,specification and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do work as specified.Payments will be made as outlined above.You,the Buyer,may cancel this transaction at any time prior to midnight of the 3rd business day after the date of this transaction.Cancellation must be done in writing. DO NOT SI N THIS CONTRACT IF THERE ARE ANY BLANK SPACES. "� ��//{/�J Signa �' ' ( 1 r fe v e VitOignature y `0 f ate NOTICE OF CANCELLATION:YOU MAY CANCEL THIS A SACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUST DAYS FROM THE ABOVE DATE.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED.TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO:AWANCE HOME IMPROVEMENT,INC.,375 CHICOPEE ST.,CHICOPEE,MA 01013 (Date.Sunday and holidays excluded) I HEREBY CANCEL THIS TRANSACTION (Buyers Signature) The Common►s'ealt/l of.ilassachusetts , It Deportment of 1rttlustrial Accidents !,tom 1 Congress Street.Suite 100 ''"1 Boston. .%1.4 0 2114-201 7 kr,-;!......' ..: .. ►►'w►s.muss.gov/dia lsotker.' ( untlocu';otiun lnvurauce % liidesit: Builderi1Contracton,/Etrctricianx:Plumbers. 10 Ht.I ILIA)N I Ill I Ht.I'Elt..11I'F1IN6 At;THORl'C1. Applicant Information Please Print Leiibh Nitrite(flustneotiOrgantratiattindividual): /1 /1(aQ. i Q (--tor- e &April,)P /)7 efri4-- Address: 3-4 3 CAA( c..(- - S4-- City/State/Zip: CA. "ems ,e ( (4M D t O L3 Phone#: Le 1 S 4 393 O02 Ate yew an empls!e?Cheek rhr apprupruarr aria: Type of project(required): t dime a employer with cataaloyuoa(1W1 and/or per"nmr)-' 7. 0 Remodeling construction Lam/ p 2. i I am a mole pomace tat r uta p and have s/employees working for ow to8. CI/ _,� hag any capacity.(No warier,'comp.imentece mipired.] 301 am a 6onteow,rer&was all wmdt nay elf.(Now dotes'coup.totenoee ngmirad.l* 9. El Demolition a_0lain a hr:meoer es and win be lunymaireeaera so cw.dret all work on my poverty. I will10 Q Building addition eaten that all ooatractors either bare walkers*camps—ra(her iaama ter are stele 11 a Electrical repels or additions proprietors with m ineployeal. 12.0 Plumbing repairs or additions 501 an a general contractor and 1 how lured die aabconmoctos Weed on the coached shirt.`f 130 Roof tese wub.coertractots hews employees and have workers'comp.r oce.t a.D We are a corporaom and its officers have etureised their right of exemption par Mel.e. 14.DOther b O�1 ((.2f 152.41(s),and we hew no employees.(Na workers'comp immanent reviled" 'Any appbcaat that checks boot el anns ASO fill ant the section below slowing their workers'compensation policy information_ r tioanowaers who submit this of idni indicating they are doing all work and then hire outside onetdacass mina submit a new affidavit indwmtmg suck :Contre tars that check this bar men attached an additional skeet showing the name of the solscontrannes and ate Melba or not tbose entities hs.e ....-nisi,,,,,• i. ,.h-,,,n!*4t.kesha n hin se Wittrliees.t ,. iel:�an caoed,'. cat orktm'..,rit rr.L. . . sa+:rt ,LY. 1 am an employer that is proridiuttg workers'compensation insurance for my employees. Below is the poll(t and hoer site information. �!p ,./� (R� .^ (/ [/� /� in..!- .:Just:(,.umpany N3ene: A`C. A r e► .tW` r L� `-"r✓`2Svfra 1 .._._ "0(�L\�/ w�G - l"licy 4 or Self-km.Lic.#: 6 S�� u e—4,\)6 a a a.3 - Expiation Date: 1 (0tt 5 122_J_s doh Sete Address: ( I t e.. V L&cL f a!4-+- City'State.'Zip: .tl o r-e fri C_c_ HP D(D6 Z Attack a copy of the workers'compensation policy drelaratioe page(showing the policy number sad ettptiratt`os date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to 51,500.00 and or one-year imprint,as well as civil penalties in the form of a STOP WORK ORDER and a fare 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 o coverage verification. ,- lets iil1HM�certify wader .� ns `:0606 perjury.that the information provided a is true and correct 41low ri Signature: / 1>at�: �6 2� .. ..� 41`6 g4 3 18 I 1 0/fit dal use onus. Do not write in this area,to he completed by city or town official (*its of I.sari Pe rot it.I.ire nse 0 issuing \uilaw-+ts hairdo one) 1 Board of IIillittt 2. Building Department 3.( itA'own('krk 4. Electric ail Inspector S. Plumbing Inspci ttrr b. ()racer ( •rotas i I'ersou: Phone#: City of Northampton o "Amp,o: Ns .w s ' "' Massachusetts l47, "' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building C� Northampton, MA 01060 sslq 3I'3�`` 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: OS6 /qot t'ln 34 The debris will be transported by: Name of Hauler: [ ( a Cpaig4-e_ Signature of Applicant: Date: I/ _.f21,13 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtc [wt - Suite 710 Bostony-Massachusetts -tQ 118 "', caccar Registration Home ImQro -_� - .::: - ''`- �li��a A 1 _ I : "'r Type: Corporation .Registration: 154218 ALLIANCE HOME IMPROVEMENT, INC s 375 CHICOPEE ST ` ...� Expiration: 02/19/2025 CHICOPEE, MA 01013 = i 7 _.4.-- \:.� --y . �1`ate D---c"` o . -A. . _r-- Update Address and Return Card. -,--E COMMONWEALTH OF MASSACHUSETTS "I�e of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Coi*ation Office of Consumer Affairs and Business Regulation Registration :` Expiration 1000 Washington Street -Suite 710 154218 02/19/2025 Boston,MA 02118 .LLIA.NC.E HOME IMPROVEMENT, INC • - iERGIY SUPRUNCHUK .75 CHICOPEE ST r,1,�'^'..0{G.i.1a/..la�4i :HICOPEE,MA 01013 Undersecretary Not lid thout signature die" conwnonwasith of Massaettusstts Division of Pro�aasioriil LiCansure Board of Building T and Standards } r¢ • .pl4rr CS-104327 4' r 163pirec11/2912023 j •s..:,, Se.e^ER�CGpI��Y��LEWIS :• :,, !.q 60 LEWIS -l l'p .` e WESTFIELD 'r, , 1 •+ w1116 • Commissioner ./ ' K. C r 4,- ACc O� CERTIFICATE OF LIABILITY INSURANCE DA02/11s20'223 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 Jarry Neill 8 Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street INC.No.Extl: (A(C,No): West Springfield,MA 01089 ADDRESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: State Auto Insurance Companies STA INSURED Alliance Home Improvement, Inc. INSURERS: Safety Insurance Company 39454 Sergiy Suprunchuk Ace American Insurance Company 12165 375 Chicopee Street INSURER C: P Y Chicopee,MA 01013 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYYI LIMITS A V COMMERCIAL GENERAL LIABILITY PBP2689283 03/12/2023 03/12/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGETORENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 1 PRO- JECT I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 6226463 12/04/2022 12/04/2023 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY V AUTOS / HIRED - / NON-OWNED PROPERTY DAMAGE $ V AUTOS ONLY V AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ _ $ C WORKERS COMPENSATION 6S62UB-4N62273-4 12/05/2022 12/05/2023 PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y--/ANY PROPRIETOR/PARTNER/EXECUTIVE II Hs' E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Home Improvement Contractor CERTIFICATE HOLDER CANCELLATION Sergiy Suprunchuk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 375 Chicopee Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Chicopee,MA 01013 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE bg1,40:4 R 4,,,,,, ) i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD