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36-267 (10) BP-2024-0558 235 MAPLE RIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-267-001 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-2024-0558 PERMISSION IS HEREBY GRANTED TO: Project# 2 BATH RENO 2024 Contractor: License: Est. Cost: 39450 VK DESIGNS INC 117535 Const.Class: Exp.Date: 12/25/2025 Use Group: Owner: GILSON STEPHEN M&LYNNE M SANER Lot Size (sq.ft.) Zoning: SR Applicant: VK DESIGNS INC Applicant Address Phone: Insurance: 51 Al HOLYOKE ST (413)527-1500 WC231S624125012 EASTHAMPTON, MA 01027 ISSUED ON: 05/07/2024 TO PERFORM THE FOLLOWING WORK: RENO 2 BATHS 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: /0 Fees Paid: $256.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i /- -4° C ''.;,-. '6/10,..--'-',,.: _ .... The Commonwealth of Massach etts Board of Building Regulations and tan ds �"I • F R NiUNI ALITY ,.. tk •. i Massachusetts State Building Cod 789,Fp 6 Dn., SE r ` r0F Building Permit Application To Construct,Repair,IZeno4 Z lish a Revis d Mar 2011 One-or Two-Family Dwelling "''ofv MSpFcr i This Sec ion For Official Use Only ~'�°�0s ory� t Building Permit Number: 6, ..V—56 Y Date Applied: t /leui U &55 /L/�✓G— 5-7-7Ozif Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 23. �v Ai �oe ' /r.Jrt a o 4) v 3 oZ.0- 000 l 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 54 /o 0i 4 s'-u 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 El Private 0 _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: , STr,4e, ‘,/s.- rI y-,.�( . 1'^'C2 �� /V%.Y'I w 1o.) 1, d/oG Z--"" Name(Print) City,State,ZIP J /� y/3-2L2 "Q 2G S',4✓ e<LM+t.,94^ t% Gv". 2 7 S" Pi who It /<i, a s M y 2) c. s 2— ? s, ,/, 6..--._No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: /!en o v cc l"C Z gA t1/'o4^'1-I r D.t.44 o x ,f-t -� PI n;S� ^ Fi V'1Gt YPS to r,f in TO i #7 oar f pi el— SECTION �J 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2f aro 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ _ 0 Standard City/Town Application Fee .5.7d 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 7-Ore 2. Other Fees: $ 4.Mechanical (HVAC) $ / vvv List: 5.Mechanical (Fire $ Suppression) Total All Fees„$L 5(1 Check No. w Check Amount: V Cash Amount: 6.Total Project Cost: $ 3 9 ?S-O 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) jAn1 b✓►w )N-�G / License Number Expiration Date Name of CSL Holder j9 9 0 r9 ry /�`-1 j/ List CSL Type(see below) No.and Street T Description /e Kulv 4 > l .I `f 4 , /a d ( 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 WY-el./2 JY-ell9—1/�J-V ✓V1-e t� ® SF Solid Fuel Burning Appliances T K•� ,,vd I Insulation Telephone Email address CP-. D Demolition 5.2 Registered Home Improvement Cotractor IC) J1 / ZoZasZ 8ENzoLT V K 0{s`'�-f TyJ t ql i� �.,r(� f1.1�/ HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name /�l S l 42 I�°I1 o 1L2 S'- e- U le 4-(�,,. �J,a 4)3 s 14.'1'471 fy"\ Noland S t Email addr s LA .( f �tvZ /�9 (�10� 51, - �dD City/Town,State, IP 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 Is7ce 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 1,as Owner of the subject property,hereby authorize WC aed rtu1 INC ✓� ""/4 /''ram`) to act on my behalf,in all matters relative to work authorized by thi uilding permit application. 4 ty 4.rue Sv../rA-- SS- V-z o 7, '-f 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. ')r ,..To(J i 1. f'- y-,2.0)y 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 Commonwealth of Massachusetts Office of Consumer Affairs&Business Regulation f Division of Occupational Licensure HOME IMPROVEMENT CONTRACTOR Board of Building Re ulations and Standards TYPE:Corporation Cons toni�rvisor. Registration Expiration f 202802 oa/lvzozs CS-117535 VK DESIGNS,INC, - - - _ gpires:12/25/2025 D/B/A VALLEY KITCHENS DOMINIC JAtiES O'CONNELL 89 DANA HIL.t - 46 - BELCHERTOVN MA 01007 a DOMINIC O'CONNELL 51 Al HOLYOKE ST �/N�slCG.l,�(M.!" EASTHAMPTON,MA 01027 rt.t_ �) t Undersecretary Commissioner dic t fi. 'FA:a ta_ City of Northampton c, � Massachusetts �5•s sc>`` DEPARTMENT OF BUILDING INSPECTIONS y �, i. ///"' 212 Main Street • Municipal Building vb �a y Northampton, MA 01060 S3'P, arD CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: III 1&Z7 GI .`t 2 CA ,,,,,,d p14) y M / ,. r �� �V141 '9Idtt) /v� �p9 The debris will be transported by: I r Name of Hauler: Jze k. »s ii\„, 01)k t/),A) / 9JtAJ 4A), 'A/v- fl� 'Le us Signature of Applicant: Date: r 'j Z 0 2.7 The Commonwealth of Massachusetts Department of Industrial Accidents YM_ ; I Congress Street,Suite 100 wt �er Boston, MA 02114-2017 • wwwmass.gov/dia 1lorkers'Compensation insurance Affidavit:BuildersfContracIura/EkctriciansiPlumbers. Cl)HI. t 11.1.1)11 ITN 1'llt:PtR%ITTINIC At'TIIORITI. Applicant Information Please Print Let[ibts Name(Business Organwation Indtt[Huail l V/C 4e jit^1^.� f n f... �- 15 _.. 40 /) `� Address: S../ /91 /I t)J y A e sr...� ,.✓ +� l City/StatetZip: 4.4s r4q,7,v s, .✓ ,,,.,q ova Phone y )3 .re you an employer!cheek the appropriate but: Type of project(required): I el I am a employer with S employees atoll mats r pan-tame I• 7. ❑New construction 1 am a sole pruners-tor or puatnerstup and hate no Carleytt^+workinE for me m $. g,Remoddmi any,capacity.[No workers'comp.insurance required y. ❑ Demolition CiI ant a I141rnuuwtrct doing all work myself.[No workers'eurtrp assurance rc^ytnreill 10® Building addition 4.0 I am a humet tsncr and will be horns cxintractors to conduct all work on my property I will rrnure that all contractors other have workers'compensation Insurance or are sole 1 l.p Electrical repairs or additions proprietor,with no employees 12.0 Plumbing repairs or additions ' I am a general contractor and I have hared the sub-contraiaors limed on the anae.hcd sheet_ 1 3E3 Root repairs f hc,e tcib-contractors hate employees and have workers'comp.insurance. n.❑ rcer Vie a a corps ion and its officer*twee exercised then nght of evernptacm per M(&L c. 14.O 0th 152.*1(4 r.and we hate no erupluyttes.[No workers"eomp insurance rcyuired.j 'Any applicant that eharks box U1 must also till out the section below showing their worker, .untpxnsatron policy infurmattton 'Homeowners who submit this affidavit utdacatme they art deans It work and then hire outside contracktrs muu submit a new artulatit indicating suck "('ontr.t.tor,that check this hits,must at Ladled an althuonal sheet xhem mg the name of the site.++nuack r.and state a Ritter or not those motes hate .r.tt,f,,«, It the soh-.ontraetws tease employees.thee,must pound,ihcir +s.,r. ..nil+ nutntsct I um an employer that is providing workers'compensation insurunce Ji.r mr employees. Belot-it the polity and job.site information. Insurance CompanyName: L .''/ '�r /�y'a y ��,j t�/4. c s ( w n1 � / Policy#or Self ins. Lin.#: e L 3/ S G 2 Y l tiS 0Iy Expiration Darr. 3- Z i- 2 d L5— Job Site Address: 1-33 IAA,k. / " 40 s•� City+/StateiZip: r r l� /41'11�l 0 L L Attach a copy of the workers'compensation inky declaration page(showing the policy number and extrration t1 te). Failure to secure coverage as rcyuired under 11GL c. 152,*25A is a criminal violation punishable by a line up to SI.500.00 and or ore-year imprisonment,as well as cif it penalties in the form old STOP WORK ORDER and a fine of up to S2.50.00 a day against the violator. A copy of this statement may be forwarded to the Office of investigations of the DiA for insurance coverage%ertilt:ation I do hereby railer the pains and penalties of perjury that the information provided above is true and correct. Signature Date. 7- b Z 7 Phone Official use only. Do not write in this area.to be completed by city or town ofjiciaL ('its or Town: PermiliL.icense# Issuing Authority (circle one): I. Board of Health 2. Building Department 3.('itytl own Clerk 4. Electrical Inspector 5. Plumbing inspector 6.Other ( untact i'erson: Phone k: ".----.4. Sri ACC0Ro CERTIFICATE OF LIABILITY INSURANCE DATE(M M!ODNYYY) kk.—/ 05/02/2024 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). CONTACT Michael Banas PRODUCER NAME: -.-.. BANAS&FICKERT INSURANCE AGENCY PHONE 413 527-2700 FAX �A/C.No.Extl: ( ) (A/C,No): E-MAIL ADDRESS: so@banasinsurance.com 63 MAIN ST INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: VK DESIGNS INC INSURER C: I INSURER D: 51 HOLYOKE STREET UNIT Al INSURERE: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 1003961 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 ADDLSUER POLICPOLICY NUMBER (MDDY EFF POLICY EXP LTR INSD TYPE OF INSURANCE WVD M/ /YYYY) (MM/DD/YYYY) LIMITS LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION S $ (WORKERS COMPENSATION IN PER H STATUTE ER I AND EMPLOYERS'LIABILITY A OFFICEOR/MEM EREXCLU ED?ECUTIVE NIA N/A N/A WC231 S624125014 03/24/2024 03/24/2025 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,0O N/A 1 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwdlworkers-compensation/investigations/. 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. Lynne Saner, Stephen Gilson 235 Maple Ridge Road AUTHORIZED REPRESENTATIVE Northampton MA 01062 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD in AMR ay CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDDiYYYY) 05/02/24 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 NAME: Michael R.Banas FAX Banas and Fickert PHONE ): 413-527-2700 (A/C,No): 413-527-0849 (A/C,No,Ext Insurance Agency ADDRESS: mb@banasinsurance.com 63 Main Street Easthampton,MA 01027 INSURER(S)AFFORDING COVERAGE I NAIL ft INSURER A: Safety Insurance Company INSURED INSURER B: VK Designs,Inc. INSURER C: DBA Valley Kitchens INSURER D: 51 Holyoke Street Unit Al Easthampton,MA 01027 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 ADDLBUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 250,000 MED EXP(Any one person) $ 10,000 A BMA0033064 07/28/23 07/28/24 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY JECOT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Bath&Kitchen Furniture Sales,Installation and Remodeling 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. Lynne Saner Stephen Gilson 235 Maple Ridge Road AUTHORIZED REEF S IVE Northampton,MA 01062 15 AdORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD