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24D-186 (2) 54 FINN ST BP-2020-0909 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 186 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT, Permit# BP-2020-0909 Proiect# JS-2020-001546 Est.Cost: $2810.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENE GAUTHIER 098654 Lot Size(sq.ft.): 5183.64 Owner: SIMMS AARON Zoning: URC(100)/ Applicant. RENE GAUTHIER AT. 54 FINN ST Applicant Address: Phone: Insurance: PO BOX 1959 (413) 455-5580 WC WESTFIELDMA01085 ISSUED ON:2/10/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE AND REPAIR PORCH ROOF, FACIA AND SOFFIT 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 2/10/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only tgjj>i`��rJ. City of Northampton \Status of Permit: < f� Building Department �qOurb Cut/Driveway Permit r 212 Main Street' F �. Sewer/Septic Availability Room 100 �B Wafar/Well'Availability Northampton, MA60 c=�v Twq`Sets of Structural Plans phone 413-587-1240 Fax 4-1 272 Pltit/Site,Plans IP ther Specify l APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENO DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be compJe by office 52 Finn St Map G D Lot vC� Unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 52 Finn St Aaron Simms Northampton, MA 01060 Name(Print) Current Mailinq Address: same as above Signature Telephone413-585-0763 2.2 Authorized Agent: Rene Gauthier 301 N. Elm St. P.O. Box 1959 Westfield, MA 01085 Nam (Print) Current Mailing Address: 413-579-5798 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,810.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 +3+4+ 5) 2,810 0o Check Number 2 n �q This Section For Official Use Only Building Permit Number: 1/9 _ ,�o ' qV q Date Issued: Signature: I lu Building Commissioner/Inspector of Buildings Date info @ nextgen413.net EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing LX, Or Doors 13 Accessory Bldg. ❑ Demolition ❑ New Signs [[--3] Decks [Q Siding [D] Other[O] Brief Description of Proposed Work:_remove and repair porch roof, facia, and soffit Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New 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 there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? 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, Aaron Simms 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 permit application. 02/02/2020 Signature of Owner Date I, 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 Na e 02/02/2020 Signature of Owner/Agen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Rene Gauthier CS-098654 License Number 301 N. Elm St. Westfield, MA 01085 08/19/2021 Add r s Expiration Date 413-579-5798 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ NextGen Construction Services Inc 176989 Company Name Registration Number NextGen Construction Services Inc. 06/27/2021 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(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...... ❑ City of Northampton P Massachusetts e DEPARTMENT OF BUILDING INSPECTIONS 4.• -#"� 212 Main Street *Municipal Building Northampton, MA 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: 52 Finn St Northampton, MA 01060 (Please print house number and street name) Is to be disposed of at: Casella Waste 686 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 rom:(Company Name and Address) v 4444 02/02/2020 Signature of Permit Applica6t 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 s 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le6bly Name(Business/Organization/Individual): NextGen Contruction Services Inc Address: 301 N. Elm St. STE. 2 City/State/Zip: Westfield, MA 01085 Phone#: 413-579-5798 Are you an employer?Check the appropriate box: Type of project(required): 1.O I am a employer with.5 _employees(full and/or part-time).* 7. New construction 2.F1I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10E]Building addition 4.ET am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.E]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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'comp.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: Aim Mutual Policy#or Self-ins.Lic.#: VWC-100-6023118-2019 Expiration Date: 07/14/2020 Job Site Address: 52 Finn St city/state/zip Northampton, MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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. Signature: Date: 02/02/2020 Phone#: 413-579-5798 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC>® DATE(MM10D/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 07/15/2019 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 Jeffrey Brochu Brochu Insurance Agency Inc A/CN u X . 413)5363311 lA/C,NcI: (413)536-0900 725 Grattan Street n M REss, 'eff@a brochuinsuranoe.com INSURER(S)AFFORDING COVERAGE NAIC# Chicopee _ MA 01020 INSURERA: Northland Insurance 00000 INSURED INSURER B: Commerce Insurance Company 34754 NextGen Construction Services Inc INSURER C:Aim Mutual Insurance Co 0075 82 Pequot Rd INSURERD: INSURER E Southampton 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 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 TYPEOFINSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICYEXPLTIR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT U— CLAIMS-MADE X OCCUR PREMISES LFa occurrence $ 100.000 MED EXP(Any one person) $ 5,000 A N N WS364568 10/162018 10/162019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 X POLICY 0 JEST LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B AUTOWNOSED ONLY AUTOS SCHEDULED N N RPLO82 10/042018 10/04/2019 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ --T—DEDTI RETENTION $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. ACHACCIDENT $ 1,000,000 C OFFICERIMEMBEREXCLUDED? ❑Y NIA N VWC1006023118-2019 07/142019 07/142020 (Mandatory In NH) E-L.DISEASE-EA EMPLOYEE $ 1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000.000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Construction and Remodeling 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 REPRESENTATIVE Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters) of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass_govidpl Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C o nstruction'Supervi sor CS-098654 Expires:0611912021 RENE E GAUTHIER,JR . 32 PEQUOT RD SOUTHAMPTON MA 01073 1 Commissioner �� Jz Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Ro_g&itti4_r1 f xuiotim 1913063 06/2712021 NEXTGEN CONSTRUCTION SERVICE INC. RENE E.GAUTkER , 301 N.ELM ST P.Q.BOX 1959 Undersecretary WESTFIELD,MA 01085