24D-320-004 (2) BP-2024-1538
88 ROUND HILL RD COMMONWEALTH OF MASSACHUSETTS
UNIT 4
Map:Block:Lot: CITY OF NORTHAMPTON
24D-320-004
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2024-1538 PERMISSION IS HEREBY GRANTED TO:
Project# MOLD REMOVAL 2024 Contractor: License:
Est. Cost: 51000 CLAUDIO GARRIDO CS-089458
Const.Class: Exp.Date: 08/24/2026
Use Group: Owner: SCOTT FORMAN
Lot Size (sq.ft.)
Zoning: URC Applicant: CLAUDIO GARRIDO
Applicant Address Phone: Insurance:
140 NASH HILL RD 4132195906 SOLE PROPRIETOR
HAYDENVILLE, MA01039
ISSUED ON: 11/21/2024
TO PERFORM THE FOLLOWING WORK:
REMOVE BASEMENT WALL AND BUILD NEW, INSULATE AND CLOSE UP WALLS AND CEILINGS IN SOME AREAS
ON 1ST AND 2ND FLOOR
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:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: r/"
Fees Paid: $383.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVED
The Commonwealth of Massachusetts
.p „, � 2024 Office of Public Safety and InspectionsV
��1/ r Massachusetts State Building Code(780 CMR)
Btuilding Permit Application for any Building other than a One-or Two-Family Dwelling
aurLDlNC,►NS)ECA ION4 (This SectionForOfficial Uses
NORTHAMPTON.MA 01060 ( hOnly)
Building Permit Number: Date Applied: Building Official: ,
SECTION 1:LOCATION
S)6 P411 He I-Fr1L Rd, rlvkj(f1k NTDtt 0(0c10
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2 PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repairs Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No0
Is an Independent Structural Engineering Peer Review required? Yes 0 No/tit
Brief Description of Proposed Work: 4 4Lr tJc./v / i, )(/ ( -f i,St'&, tt si," Lvr}-IL, c)1t1
tyFA,i.,Mi 7'crG Oif) 1.91/ .b4 Tja v. (:i sd 41-46 eyo s'` ;�_A (��f( . s A.-03
�'rfll%CGS 1 ' -cc)'-`1'' ,.2.<tt F i1S1- I}," r.C' c'0 flYc ;C
I� <9 Val $ l w 6 ) 7(v. (!-rj v O v
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 1-2❑ I-3 0 1-4 0 M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0
S: Storage S-I 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IB ❑ HA El IIB ❑ MA IIIB ❑ IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site 0
)�Public . Check if outside Flood Zone 0 Indicate municipal A trench will not be Po
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Prix-css:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name aqd.Address of Property Owner ,..) ,S
,/ Wykr,ttsj-iAgi_ule__\ ' TC6 vg.144(1( 1-id . „c4-.s2a) imi,..1-07,) 0 )0/0.6
Name(Print) No.and Streeter City/Town Zip
Pro erty Owner Contact Information: t�Y� ^� r q
to2YU1A `? C;liP 1 1 S✓t"/ sIYIe-- ,;L'��2- Gt,„,Lk,CG,iNI
Title Telephone No.(business) Telephone No. (cell) e-mail address
a plicable,the property owner hereby authorizes:
If14 t>, U C Ci / c2 Nos/7L J? �`� ic 44 0lv ?
Name Street Address C ty/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
�k- r. ‘7‘1,i-dc.r2( 0 0
Company Name
c1,zit.tht``-, f!i c2c (4c9 65- 087l5e 6/
Name of Person Responsible for Construction License No. and Type if Applicable
IN (•f4-s W ,1 ii, 1;‘2r< y-tiyck,,✓L.%2Y': 6163?
Street Address City/Town State Zip
4(/3-lei 'fc6 - - CGA-Azle ibo 7I ac,i,44i4-r/ . CorAt
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes Pk No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Id c) J L Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ C , appropriate munici al factor)_$ .
3.Plumbing $ I d 00 /j,
4.Mechanical (HVAC) $ C1LJ�
Note:Minimum fee= "✓ '(contact municipality)
5.Mechanical (Other) $ Enclose check payable to �f
6.Total Cost $ 4) (contact municipality)and write check number here 0 ✓
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest and the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of y knowledge and understanding.
�1�1 v)(c) 64I 2 ii,M 46-J/? 570 t( 1t- -2
Please print and sign name Title Telephone No. Date
l � t/;1;sjL /pi f& g `/� �v✓iI 6/0 3 c CG '(‘iho_ ,vOG. ;/.CO el
Street Address Ci /Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ✓/i�/G-. 1/"Z 1 Z2ZL/
Name Date
_ City of Northampton
flit
Ki HA_.Y •N- S
(' Massachusetts �?'S r�`c
DEPARTMENT OF BUILDING INSPECTIONS 'G'•212 Main Street • Municipal Building yv`.,
.wr;e:=: Northampton, ,rs�.......-..:•;�0
- MA 01060 v1y i'
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: C60444 4(;A,L.A A_ _
Location of Facility: /sky CiY/14, C- .
The debris will be transported by:
Name of Hauler: (-1,�c,ti)/ b ' t L
Signature of Applicant: / Date: t 7 ,--9Y
e' •
The Commonwealth of Massachusetts
i. - t Department of industrial Accidents
= - 1 Congress Street,Suite 100
s.
1FEttlr 3- Boston, MA 02114-2017
> AZIr
www ntass.gov/dia
vikers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPluntbers.
TO RE HEED WITH THE PERti1ITTIINC AUTHORITY.
Applicant information G , ,n Please Print Lel:ibls
Name(Business/Organization/Individual):
�G /(.94i`A f-�l lU e)
Address: l 1/49 // ,/ ,/7jG ie6 /
City/State/Zip: /114/ :, /V% "F y/1.4. Phone#: 4lf 3 -2/ —Cciei O
Are for an employer?Cheek the appropriate box:
Type of project(required):
f.Q I am a employer with employees(full and'or part•timel-• 7. D New construction
►` am a sole proprietor or partnership and have no employees working for me m 8. 0 Remodeling
any opacity.[No workers'comp.iaowranee require!.]
ICII am a homeowner doing all work myself.[No workers'comp.insurance requires!.]' 9. Demolition
4.0 I am a homeowner and will be hiring oumtractors to oonduet all work on my property. I will 10 CI Building addition
trouts:that all contractors either haw workers'conas.nsatwn insurance or are sole i 1.0 Electrical repairs or additions
pruprieturs with no employees
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-cuntrnton listed un the attached dicer
These sub-contractors have employees and have workers'comp.insurance.: 13.0Rewf repairs
6.0 we area rporation and its officers have exercised their edit of exemption per NAGL c.
14.0 Other
co
152,§1(4),and we have no employees.[No workers'cutup.insurance required.]
•Any applicant that checks lot a 1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this atlidasit indicating they are doing all work and then hire outside contractors must submit a new:Midas it indicating such.
:Contractors that cheek this bus must attached an additional sheet show ing the name of the sub-contractors and state whether or not those entities haw
cmploycre- If the sob-cuntraetor>have employees.they must pros idc their worker'ivmp {['lies number
i am an employer that Ls providing workers'compensation insurance fur nm y employees. Below is the polies and job.site
information.
Insurance Company Nana::_
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation polio'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
cos crai;e verification. -,
1 do hereby certify under tht�ins penalties elf /u that the information provided above is true and correct.
signature: ."' Dale:
Phone#:(`('( yIf?' _57(7 6'
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):
I. Board of health 2. Building Department 3.C:ity'/Town Clerk 4.Eketrical Inspector 5. Plumbing Inspector
G.Other
Contact Person: Phone Si:
CONSTRUCTION CONTROL WAIVER
From: C4ii,4/c_ v eicw/.J�[�
(i r 9 /4(7L 86 l-k/ y0 j4/vvii2,< 044. r9 r C9
To:
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code,section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
because the work is of a minor nature,will not affect structural elements, health,accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,