31A-319 (4) 106 VERNON ST SP-2019.1311
GIS a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:31A-319 CITY OF NORTHAMPTON
Lot. -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv:ROOF BUILDING PERMIT
Permit k BP-2019-1311
Proiecta JS-2019-002119
Est Cost:$11920.0
Fee:s40.00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
U,ce Group: RENE GAUTHIER 098654
Lot Size(sa. ft.): 154,20.24 Owner, BERGER DAN H&LAURA A KATZ
Zoning: URA(100U Applicant., RENE GAUTHIER
AT. 106 VERNON ST
Applicant Address: Phone: Insurance:
PO BOX 1959 (413)455-5580 WC
WESTFIELDMA01085 ISSUED ON.5121/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:ST RI P & SHINGLE ROOF
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:
Driveway Final;
Final: Final:
Rough Frame:
Gu: Fire - e rt Hent Fireplacc/Chimney:
Rough: ❑: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si-nature:
FeeType: Date Paid: Amount:
Building 5/21/2019 0:00:00 540.00
212 Main Street,Phone(413)587.1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
(Caaf
L Department use only
City of Nortrep E tus o Permit:
Building Degax4
nt c rb C Driveway Permit
212 Main MAY 1 ) 2019 S en epticAvailability
Room ter ell Availability
Northampton, tfAp�lNw� o Se of Structural Plans
phone 413-587-1240 ra>PffiKMn °t o Sd Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
106 Vernon SL Map 3-1n Lot -z (q Unit
Northampton, MA 01060 Zone Overlay District
Elm 81.DMtrIck_ CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 owner of Retard: 106 Vernon St.
Dan Berger Northampton, MA 01060
Name(Print) Current Mating Address:
.413-575-2997
Telephone
Signature
2.2 Authorized Anent:
Rene Gauthier 301 N Elm St. P.O. Box 1959 Westfield MA 01085
Ne`z(Pnnt) Current Mailing Address:
Inatu 6a"— 413-579-5798
Spature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
completed by permitapplicant
1. Building 11,920.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(Hi
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number I
This Section For Official Use Only
Building Permit Number Issued:
ed:
Signature: S-Z)-Zo Iq
Building Canmissionerlinspedor of Buildings Date
info @ nextgen413.net
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING Alt Information Must Be completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Deparunent
Lot Sim
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height J
Bldg.Square Footage h
Open Space Footage % .--
(Id area minus bldg&puved
Pending)
#of Puking Spaces
(Fill ..
&lacadon
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#j
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing.grading,excavation,or filling)over i acre or is it pan of a common plan
that will disturb over t acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) E3Roofing EDOr Doors
Accessory Bldg. El Di moll0on ElNew Signe 10j Decks [D Siding[O] Other[CQ
Brief Description of Proposed
Work: rpmnvp and rAplarp mof to mrtp and manidartiirprc SnTrifiratinns
Alteration of existing bedroom Yes_No Adding new bedroom_Yes No
Attached Narrative Renovating unfinished baseent _Yes No
Plans Attached Roll -Sheet
an.N Now house and or addition to existing housing, complete the following:
a. Use of building One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is diem a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ff.of"tends?_Yes _No. Is construction within 100 yr. floodplain_Yes_No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank_ City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Dan Berger as Owner of the subject
property
hereby authorize Rene Gauthier
to act on my behalf, in all matters relative to work authorized by this building perk application.
05/16/2019
Signature of Owner Data
1, Rene Gauthier as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Rene Gauthier
Print N ye
/�/r.F 05/16/2019
Signature of Owner/Agan Data
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name o1 License Holder-. Rene Gauthier CS-098654
License Number
301 N. Elm St. Westfield, MA 01085 08/19/2019
Add Expiration Deb
7,F 413-579-5798
Slgnatum 11 Telephone
9. Registered Home improvement Contractor: Not Applicable ❑
Rene Gauthier 176989
Company Name Registration Number
NextGen Construction Services Inc. 10/20/2019
Address Expiration Date
301 N. Elm St. Westfield. MA 01085 Telephone 413-579-5798
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C.152,§25C(e))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit Vdll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... 0 No...... ❑
City of Northampton
Massachusetts
c
DEPAa2'D1CNT OF eorxorsc xaspscrxoxs
212 3 in 8tc t *p icipal a 1i nq(9
Northampton, ! 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
106 Vernon St.
(Please print house number and street name)
Is to be disposed of at:
Casella Waste 888 Main St. Holyoke, MA 01040
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name anddAAddress)
� lirLr✓�L 5/10/2019
Signature of Permit Appli t or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 01114-1017
www.mass.go ildia
Wmiurken'Compensation Insurance Affidavit: Builders/Coetmetors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITI'.
Applicant Information Please Print Leeibly
Name(BoamendOrganimtiors4ndividual)1 NextGen Contrucbon Services Inc
Address: 301 N. Elm St. STE. 2
City/State/Zip: Wes6eki, MA 01085 Phone#: 413-579-5798
Am you an employer?Cheek the approprlate box: Type of panjed(ria ).
I.Er I am a employer with_7 employees(full roster pen-time)a 7. ❑New construction
2.C]1 am a sole proprietor or partnership and have no employees working forme in $, ❑Remodeling
any capacity.[No workers'comp,insurance requireal
3.n I an a homeowner doing all woh myself.Mo workers ra
camp.insurance required.]t 9. El Demolition
4❑1 an a homeowner and will be hiring contractors m conduct all work on my property. I will 10❑Building addition
emum that all wnbamaa either have wormrs'rnmpereaion i......me sole I I.C]Electrical repairs or additions
proprietors with no employees.
12.[]Plumbing repairs or additions
5.[]l am a general comracmr end I have hired the mbantruc ors listed on the ameched sheet. 13 Roof repairs
These sub-conaectms have employees and hive workers'coop.iomearce:
6.[]We are a ompomion and its officers have exercised their right of exemption per MGL a 14. Other
152.kl(4),and we have as,employees.[No workers'comp.insurance,requested.]
'Any applicant that checks box N most its,fill on the section below showing their wmkers'compensation poli,information.
I Hommwners who submit this affidavit indicating they art doing all work and Nen hire outside contractors must submit a new andwit indicating such.
$ontraators that check On box most switched an additional sh.1 showing the name of the mbconnactors amt,cora whether or out those entities have
employers. If Ne sub-contractors have employees.they most provide their workers'comp.policy number.
I am an employer that is providing workers'compensaaon insurance for my employees. Below is the policy and job.site
mformmtiom
Insurance Company Name: Aim Mutual ---
Policy#or Self-ins.Lic.#: VWC-100-502311 8-2018A Expiration Date: 07/14/2019
Job site Address: 106 Vernon St. City/Stete/zip: Northampton MA 01060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dam).
Faihae 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 imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby c/e/rjify under the pains/,and penalties of perjury thin the information provided above is nue and correct.
Simature 4Kur a� Date 05/16!2019
Phone#: 413-579-5798
Official use only. Do not write in this area,robe completedby city or town i ffich l
City or Town: Permit/License,#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ACCM& CERTIFICATE OF LIABILITY INSURANCE " .
armwe
THB CERTIFICATE IS I38UED AS A W TfER OF INFORWTION ONLY AND CONFERS NO R , U THE CER'IFiCATE HOLDER. Tr
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAIWELY AMEND. E NO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIIL'rE A CONTRACT BETY/EEN Tiff ISBVItou 1KSURER(S). AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THECERTIFICATE HCLDER.
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Fes: 1505)33017:1 a :Wtlea$AoardII oLoao C 1988=5AC0RDCORPORATION. All ngMs reserved
ACORD^5 MIU03) Tne ACORO name and logo era regiylacd mMks of ACORD
Corrrr+onweafth of MasiochuS►tiS
Division of Professional lrcensur*
Board of BuilAing Regufations and Sfer4drds
vonstructfen SopW Asor
CS -09804 Wires.- 08119;2019
RENE E GAUTHIER, JR
82 PEQUOT RD
SOUTHAMPTON UA •1073
r y
Ofhe M Censumw Alun a Busirm" Re"tanon
NOME IMPROVEMENT CONTRACTOR
TYPE: Iro .i-kyt'
8190com E-wtom
1TO" ;0.'2A20t9
RENE GAUTHIR
RENE GAUT HMR -
82 PEQUOT RS �f t� -
SOUTHAMPTON. MA 01076
Jndersec:retar;
NeatGen Construction Services, Inc.
CONTRACTING AGREEMENT
Thlr egnerlent("Ageemmt-)o made me;13th day of May.W19 hmween Ne2tGen C.nencHm Services,la0woefonh known a-Cnnr9rhn,"and feet
Bever hence form Tarr.as-OwOsr.-
Pursuant to the w0&described the Conluanr and Owner epee to the following:
Section t The Work
7MContnemrad Oweeagrte Wat me fdlowwg xmk.n716c mllcov(dthus) 105 Vernon SLNorlluuptnB,MA 01060;see smelted call mate for the wept:
E-1006
Sa'"im 2 Timeline
The Comramrad Owner alone mat the wale dwildnbove for oo dmehrd rl eetl will be anglmod azwrding rade following moth.
W ocir Start May 290,2019
Wok Canplewn:May slat,2019
This date is subjxt In change m neadd. We will he to mnuriroconlhmomarrivalprrorwjobsuH.Anry deleysthatert+e during themarmefthe work mndbe
dere eed with Owxr imrrolumlY.
Sesion l hymeat
Owner agrees to pay the Connhectu a bond off11.920.00 pmmblc in the following n®na:&7,994.00 due at sign lag and balantt due upon comploian
Sectloa 4 Changer/Power Supply
SImuM thnc a any Nunga svdc by me Uvm,tMe my h dd4ionat mats which ueadded to dIe lsrk2 baud m labor and rmtvials,cm
Owic egress m pm'de a wuta of poxes u no eddnbond expereebo me mnvacor.Shwd a rause ofpOwer ora w ercilaplw the canmaor mry povide a gmerernr w
provide m9uacd power el nn ndditwoel upaec w the owar.
SeCHna 5 permits
Conuaeorngrar and has pmnassma m secure nn,permits aecoeesat,w,Hun this work will he doer within the pwrcwn of me laws of Metmehuands.C9 MCW
mea Ind any fico fa drew rynnns are alnzt)imlmuel m the IoW asthma chmeed to me(Jwnc
SeeHoa 6 Snheoatnnon
(Tuna qua s that the Cousenor into,hire sulmormaoom at his discretion,the Contractor agrees that the payment for mid menonnaaon is entireb do Cootumorr
rapomTility Owner ormtwevy way luble forambcotmecta's missed passant.
Seerioe 7 lummatellLLidh
Owns.geest,minWn dem,ai ed by
ons the propmy'. COOVeCIm ogresmrrummwanimmmme pointydW covarman and englnywawbcootnemn.
weir equipmmnL end my damage.used by the work
Owner agrees to rake nsmsmy mectowns to pmuel their personal prop ny,and Odher mall mmndc mat M a result ofvlbWions lacing caused by work lacing due ran
Wore a n1lhangings aM done on shdvs to ahifi ed fill,and mnhecmr shall rot be liable for soy damages as e mutt
Sminn g Cleanup
Conozom apes Hut airy debris,woipllrnt. will he removed fmmthc tmrpernvpov completion offhejob The loodoem will be remnrd to the Hao in xWm a ors
farad prior m me wor,excepmg,of wore,the chugs made to a rsull M the work.
aernov v woram men p WamMy
Convenor agrees to a ten year warranty on all wmmmuahip.Tim nwlmny is your osvemge union wm6vtaw3ip.m inAdluctn emsrt.
mveltdny or utmfacab0ity m ox or some pmvobou ofdth ApmrM shall no&&a ay'.mer povuim ofthis A,romma.
Coohaemr and Owner acknowledge me this Aloalment On subjecta9n ad regulations ofthc Car®oewrWth of Mmaaehmcm.
1 - 5
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Gwnargipmrmc AV-C6) �ocrin
Nexli Construction Sarace Inc. Owrredoperat"
82 Pequot Rd Rene Gauthier 'x
Southampton,MA 01073 (413)4565580 NEXTG E!V
(413)455-5580 neztggKml413®gmad.com
to.arel mo>aeutu
wwwrandOPs473� nr
CSa098654 Me REGai78989
Dan Berger
Fs1YM$r `-10M
106 Vernon St.
Northampton, MA 01060 Date 1;-;pOhq
Item .. Deecripeon MY Pr" Amount
Jab prep for roofing protect the property from damage.Protect wintlows. 1.00 $500.00 $500.00
siding and landscapes by using plywood,Tarps,end
a revolutionary piece of equipment called the roofing
buggy(Equipter R54000)
Removal of Shingles Remove existing 1 layer of shingles,edge metal. 1.00 62,82000 $2,820.00
and underleymert OR the house.
Application of roof system •Inaell Na rows(6)of Ire and water tamer M the 1.00 $8,100.00 $8,100.00
eves of the no..•Instill Ica and water bamer in all
valleys,around all roof perwhatiars,around
chimneys,and wherever a roof lee meal a siding
wall•Install synthetic shingle underlayrem on roof
sheathing wherever the roof isn't protected by ice
and water banner•Install new 8'while drip edge
metal.Install W year GAF Timberline RD shingles
to no manufacturers Specifications Install GAF
match Ing cap shingles•We will Replace pipe boot,
And damaged roof vents(t any sheet of plywood
need to be replaced mere will be an aditional charge
of S45 pershee0
Cleanup We will clean up all construction dater.and dispose, 1.00 $500.00 5500.00
of it in a proper landfill.We Wil run a magnet over
your lawn to ensure that we don't miss any nails.
warranty, At NextGen we are Certified GAF Installers so we 1.00 $0.00 50.00
can offer a 50 year menulamues warranty
Sub Tonal $11.920.00
Total $11,920.00
SPECIAL INSTRUCTIONS
This quote is for the rest of the house including the garage.
Thank you for you business".