36-122 (7) 517 WESTHAMPTON RD BP-2018-1097
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36- 122 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BASEMENT RENOVATION BUILDING PERMIT
Permit BP-2018-1097
Project# JS-2018-001974
Est.Cost: $33240.00
Fee: $216.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENE GAUTHIER 098654
Lot Size(su.ft.): 67082.40 Owner: GONTARUK DAVID
zoo Applicant: RENE GAUTHIER
AT. 517 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
82 PEQUOT RD (413) 455-5580 WC
SOUTHAMPTON MAO 1073 ISSUED ON:4/27/2018 0:00:00
TOPERFORM THE FOLLOWING WOR/GFINISH BASEMENT TO INCLUDE
BATHROOMNVETBAR, GYM AREA AND LIVING SPACE
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:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: 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 signature:
FeeType: Date Paid: Amount:
Building 4/27/2018 0:00:00 $216.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1097
APPLICANT/CONTACT PERSON RENE GAUTHIER
ADDRESS/PHONE 82 PEQUOT RD SOUTHAMPTON (413)455-5580
PROPERTY LOCATION 517 WESTHAMPTON RD
MAP 36 PARCEL 122 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypeofConstruction; FINISH BASEMENTE BATHROOM/WETBAR,GYM AREA AND LIVING
SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 098654
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF(jRMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
___Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay ,,,/&'
azure of
Buddin ficial Dw
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning& Development for more information.
RECEvtu-1 I
j
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
/ Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Pemtit Number, 8 - ( - /QQ 7 Date Applied: _
ingO ¢tal
art,
im Name) Sigiature Data
SECTION I: SITE INFORMATION
1.1 Property Addres : 1.2 Ass ors Map&Parcel Numbers
�7 n 911 - 0.--- I ;)-'a-
I.1 a Is this an accepted street?yes— no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Distract proposed Use Lot Area(sq lit Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.6.1.c.40,§54) 1,7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check ifyes❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner of Record-
�,_J CvOntrv�'C
Name(Print) City,Stale,ZIP
No.xad Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
Nev,Construction❑ Existing Building❑ Owner-Occupied ❑ Repmrs(s) ❑ Altemtion(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief D cription of Proposed Work: n _
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.
I. Building $ Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ GDO Sfd- ❑Standard City/Town Application Fee
OO ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ _ a(� 2. Other Fees: $
4. Mechanical (HVAC) $ List: _
5.Mechanical (Fire $
Su ression Total All Fees:$
1 Check No.zW'0 Check Amount: Cash Amount_
6.Total Project Cost: $ 3. O
Q Paid m Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) p j�a1?ew LicenseNumber Expiration
Name of CSL l[older
/
lr� List CSI.Type(see below) l/
No.ands t -- Type Description
Unrestricted(Buildings up to 35,000 cu.ft.
SQ(J U�11CJ'!Yl✓1; /✓'Gl (J�l�� � R Restricted 1&2 FamilyDwelling
City/I'owq Sta[c,Z �' M Mason
RC Roofing Covering
--- WS Window and Siding
SF Solid Fuel Burning Appliances
13'`i55'SSbO NtA'f"Ge� (cnn tit 3e 6,4adCOLt 1 Insulation
Telephone Email address D Demolition
5.22 Registered HomeIm/prov /
emenl Contractor(HIC) 141/_6Gq
-�1e �x7lJ' ICI _ 1IIC Registration Number xpiE radon Date
HICCom any Name rHIC Registrant Name
a e &/,J6e-Co n'113(V6 , 1, Cooi i,
gqAN .an Str et 01073 [�) -y.SS'ss Email address
r
Ci /Town, tale 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 ..........le No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACCTTn /
OR APPLIES FORBUILDING PERMIT
I,as Owner of the subject property,hereby authorize / 0p.e ( jGU4hI{e r-_
to act n my behalf,in all matters relative to work authorized by this building permit application.
I A, � ZY C -
Print Owner'st ame(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my time below,1 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 unders ding.
Pri Owner's or Authorised Agent's Name(Electronic Signature) D.
NOTES:
I. 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.eov/oca Information on the Construction Supervisor License can be found at www.maes.eov/dos
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"
Gontaruk Basement March 14, 2018
Rene Gauthier 10
NextGen Construction Service Inc.
82 Pecluot
Champ on —�
Southampton , Ma 01073 I'
Office 413.455.5580 NEXTGEN
NextG extGen113.net l.twm
www.NextGen413.net
License#:CS#098654 Ma REG#176989
Project Customer
Gontaruk Basement David Gontaruk Mobile 6179053121
517 Westhampton Rd. 517 Westhampton Rd. gontaruk@gmail.com
Norhtampton, MA 01062 Northampton, MA 01062
Finish basement
Description ., Guamiry Cost
Job prep 1 Ea 850.00
Remove existing srieelrock and Ramirg Nat can't De use0 an0 tlispose d it in a proper IantlAll
Insulate walls where tie deal 1 Ea 55000
Framing 1 Ea 1,200.00
Frame up a closet in the be0mem,a wall0 We the al tank.around Wtl woek ar d a wall to hide N4lurnace am wrier beater
Gym floor 1 Ea 1,440.00
Install3Ar Nick mbber Intedock,,gym fioon,
Vinyl flooring 1 Ea 3,200.00
Install Allure vinyl plank Ooonng everywhere except the mechanocal areas and trip gym area(material abtment$2 per sgh)
sheetrock 1 Ea 4,100.00
Srieetrock IM1e walls and ceiling b Ne entire basement Prep ail the pint Ior paint
Bathroom lighting 1 Ea 300.00
Install2 vanityscunoes
Can lights 1 Ea 2,500.00
Install 16 pan lights with switches
Fan 1 Ea 400.00
Install Norman exam ust tan
outlets 1 Ea 60000
Install outlets per code
NextGen Construction Service Inc., License# CS#098654Ma REG#176989 1
+ Gontaruk Basement March 14, 2018
DescrlinUon Quantity Cost1
Drains i Ea 450.00
Finish drain piping and Install a drain line for the wet bar
Pump 1 Ea 1,]0000
Install a Liberty PRG t 01A gander pump in the ecaling ph
Slower 1 Ea 1,40000
We will minali a 42'Stemrg Sped,Ne Angle shower with a netts slower valve and trim kit
Toilet 1 Ea 370.00
Install a Kohler Drol n person M1il bund
Vanity 1 Ea 1,10000
Install a 36"Vanity with I surface the mastered alolmebt$700 00)
Waterlines 1 E 1,100.00
Install the waterlines for me shower,sink,toilet,add the wet bar
Wet bar 1Ea 2,200.00
Install 5of base openers w/a solid sumac¢top and a sink(material alohnenl$1]00.00)
Barn door 1 Ea 570.00
Install a barn aye all door on me existing wall by the oh tank
Solid core costs 1 E L800.00
Instaii 8 solid core mark,doors
Finishes 1 Ea 1,560.00
Install 21iY colonial caalng on all ms doors antl windows antl install3 112"Waned base moulding where the wo u meets are tloor
Handrail 1 Ea 25000
Install a red oak harldrait
stairs 1 Ea 2,10000
Remove treads and mood pine risers and Calk small The stairway will be finished bandar to the other stairway minus the ballusters
Painting 1 Ea 3,50000
Seal,prime,and paint the walls,ceiling,doors,and him
Payment schedule 1Ea 0.00
$10,600.00 deposit$1(trude00 atter me electrical ant plumbing are inspected antl$13,24000 upon satlaked compabon
Project Total 33,240.00
Tax 0.00
Total with Tax 33,240.00
Thank you for choosing NextGen. We appreciate your business. al�
CIO
3S y%-0
Ne#Gen Construction Service Inc., License#:CS#098654 Ma REG#176989
Gontaruk Basement March 14, 2018
�Approved By: i Date: d 7 _Date:
�j �cl /
Contrector � 7j� / Customr
NextGen Construction Service Inc., License#:CS9098654 Ma REG#176989 3
�m
� «
_�-
\ � > a�Aq
»
_ (
s`
�
I
%
//�y . —
�
rww,
�±�± ��
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: n� / !7t /PS�ba,,n6, f o
The debris will be transported by: WBnP_ Gave-PG-
The debris will be received by: ( ( ],!I) 1v&A1q6W4'
Building permit number: / l
Name of Permit Applicant �/7et ,c/ � h It r
Date Signature of Permit Applicant
The Conanonwealth of Massachusetts
Oepartatent of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
tvernv.nrassgor/did
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aggl,icant Information Ptease Print I,ealbir
Naha R3:rinesv'Eh;,tnnizauoNindi,ldwJt j1 , k1
City/state/zip
AareS tmj an emplocer?Check the apilmor atc box: Type of project(require:
I am a employer with 4. ❑ t am a general contractor and J G. El construction
emgicses flan t-li
iodise pacme)* here Hared phre
'7
J._
2.❑ 1 ain a sole proprietor or panner- listed on the attached sheet 7. ❑Remodeling
ship and have Ito entp(o}-ees These sub•i tmctors have 3. ❑Dominion
uorking for roe in any capacit}. cmplopecs and have anyhers, 9 ❑Building addition
IND worRers, comp-insurance comp, insurance.;
required J 5. 0 We are a cotperithon and its � 10.0 Etect Teal repairs or additions
❑ (azo a hotruosvner Bourg ail work officers ban excicised their I I I,[]plumbing repairs or additions
On self,iNo ivortcers comp. right orcimption per MGL 12.(]Roof repairs
insurance required.1 e 152. 51(,7.and ere ha,c no
emnfo}ees. (No;+orkeri li.❑OFher__J,,,,__
Lcomp. insurance requia(I.l
',tn'urp[ M ! t9 ! 2 =t 'J',,fill II bJ
`ilom..� n�a.aha�ubmneh affidni,coda cinyt.v�'u..vo g..SI sH:an65Mz i oaviaa..mv 3. ::mrsS suFinafr anew aitidacrt in&.ming md�.
�Gbninmwn @c�abwA J�ic bac count mud,ad mi addiUon:d shce�ehowil��mrnnme of d�c subuamranors.lid sLrtt.vhedlar or not lhos ennon'have
anpioa.x. ffllm naMwnusars lima<a+nleyas,SM¢r ews�rrocidupciv n'or6`�a couar_Roii4mvmbuc
!urn an employer that is pror cling aorkers'compensation i'nsurarretr for on,employees. Belmv is the polio mrd jab site
information. r
Insurance Compam Name
r', S
Police oor self-ins Ltc SIG_ ��-"",`�G- Expiration Date/
Job Sit.AddreSs'.-s, . / '+ `_ ? 4,."'1�,OSf.?�- _______Cr)lStatelzip_tm v.� OrCAa
Attach a ett}»of the vvorf ers`contamination poli«-deciarui'ion page(sluicing the policy number and expiration date).
Ratan to secwn,coverage as tequired under Section 25A of kh3L o 1$2 can lead to the imposirlon of Mallard penalties of a
Site up to 31.500.00 arldlor one-penr imprlsonmcnc as yell as civil penalties in the fbnn of a STOP WORK ORDER and a fine
of-up to $250.00 a dao against the Violator. 13c advised loan cop,-of this statenrern may be foncarded to the Office of
fir)esdgations of the DIA for insurance coverage r'etifiC&tion.
i do teemky cernf•under thepabi mud ptma6i6Y afperjnn that the information provided above is hoe and corred.
Official ase onFr. Ua not write in this area,to he completer!br city lir faun official,
Cit.or Toon: Perlin/License#—
8ssuiag Aothorit7(circle line):
i.Board of Health 2. Building not
3.City/Torvn Clerk J.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Pereon: Phone#:
ACOPRibl CERTIFICATE OF LIABILITY INSURANCE DA11/0112017
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).
PRoouaRCONTACT
AAMRRJefiey Brochu
Brocou Insurance Agency Inc PHGNE (413)536-3311 _ �aC No. (413)536-0900
725 Grattan Street EMAIL eft blochumsurance.COi
aoDREss 1 �
INSURER S)AFFORDING COVERAGE_ NAG _
Chicopee MA 01020 INSURED A Northland Insurance _ 00000 _
PSURED INSURER Commerce Insolence Company 34754
Nextgen Construction Service Inc INSURER C Aim Mutual Insurance Cc 0075
Nextgen Construction Service LLC INSURERD.
82 Pequot Rd INZL FR E -
Sou9Tam ton MA 01073 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 ABODE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT HATH 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,
EXC W SIONS AND CONDITIONS OF SUCH POLICIES.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
)LTR TYPE OF INSURANCE A POLICYEFF POLICY EXP
POLICY NUMBER MNN)ANyYY Mer DttYYY URNS
X COMMERCIAL GENERAyL LABILITY EACH OCCURRENCE S 1,000,ODO
CLAIMSM /R
PDE OCCUR PREMISED(Ed occurrenre)_ $ 100,000
IMED E%P(Ary one,person) 15,000
A _ N N WS282656 10/162017 10/162018 PERSONPL a_ATo m,IRY 31,000,000 _
SIT L AS GR EGATE OMIT GEULD PER _ GENERAL AGGREGATE 32,000,000
POIIT1 LOC PRODUCTS-COMPIOPAGN_ E2,000,000
��OTHER E
0. TOMOBLEL ABILITY COMBINEDSINGLE HMIT E 1,000,000
AN'AUTO
BOD)LY INd1RY)Per PHw) E
"'RED SCHEDULED Pe
B wmsoNLY AUTos N N RPL082 10N4/Z017 10N42018 BODILY wARr Eorercwenn g
HOED O -0NNED PROPERTY D AGE
AUTC1ONLY AUTTSONLY P 4 1
E
UMBRELLAIIAB GCCVR EACH OCCURRENCE__ $
E:CE4 LigB CLNMSMADE AGGREGATE
DED RErENTON $
WORKEP$WMPENSATION X STATUTE EOF
A
ANDEMPLOYERS LIABILITY yN j
ANY PROPdETORHPARTNERIEX2LUn VE EL EACH ACCIDENT g 100,000
C COCCERrtAEMBEU EXCLUDEPC V� NTA N VWr 1006021669-2017A 07/142017 07/142018 -
nnanaemrvTNH) ELDISEASE-EAEMPLOYE 8100.000
Ares dosenoe-ender - —
DESCRIWIONOFOPERATDNsoolOr EL DISEASE.POLCYUMIT $ 500,000
i
7!OCAHONS1VEHICLES ACORD111,AmNonal Remarks Schedule.mey oe evechedIH more speed,rePAre,a)
ng
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NeXtgen Construction Service Inc ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATI bE
Fax: Email: ®19882015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD