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37-022 (34) 600 FLORENCE RD- 14 MOUNTAIN LAUREL PATH BP-2019-0181 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 37-022 CITY OF NORTHAMPTON Lot: -000 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-2019-0181 Protect# JS-2019-000298 Est.Cost,$24000.0 Fee:$156.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CLAUDIO GARRIDO 89458 Lot Size(sp.ft.): Owner: EHRLICH PAUL zoning: Applicant. CLAUDIO GARRIDO AT: 600 FLORENCE RD - 14 MOUNTAIN LAUREL PATH Applicant Address: Phone: Insurance: 140 NASH HILL RD (413) 268-9052 HAYDENVILLEMA01039 ISSUED ON.8/15/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.FINISH UNFINISHED BASEMENT 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: FeeTvoe: Date Paid: Amount: Building 8/15/20180:00:00 $156.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-0181 APPLICANT/CONTACT PERSON CLAUI O GARRIDO ADDRESS/PHONE 140 NASH HILL RD HAYDENV' .LE (413)26;9052- PROPERTY LOCATION 600 FLORENCE D- 14 MOU`ITAIN LAUREL PATH MAP 37 PARCEL 022 000 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLO REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvaeofConstruction: FINISH UNFINISHED BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 89458 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOItItlrTION PRESENTED: Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ .3 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 em lilion Delay l Buildmg 11 Date 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. r SNO11C3d5Nl'JNlg llltp dO ia3g Use (i / "D In afPem il "y Ii!!:' ! 41 "N f Building De rtm nt I' r. " h uwc PI;Don Ptree ptcA E Room 100 WeliarAVOK A 060 Temrsets 'flaw l fiyi FY - �am 13587-1272 PD*Sile Other Imm IM, „ 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 � VTI Map '37Lot Od�— Unit �[ Zone Overlay District Elm St Bllrlrlct CB Billtrkt SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: r " �'>2-5 1Lowakki Ave XName nt) C.l�^` � /f Cunent Mailing AJtlress'i� �1 J nK S0.V�fr7� R,ir�17uYG y rrT i 9`J [Q) I! Telephone O _ 70 'Signature 2.2 Authorized Agent: r^ Name( dnp C rent MaiI'ngggAddress : Q� Sign lure T2leph04 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Dollars)to be Official Use Only completed by pennnit applicant 1. Building // % (a)Building Permit Fee 2. Electrical f� �,g i (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 160 5. Fire Protection 6. Total=(1 +2+3+4+5) C9c9d Check Number Q This Section For Oficial Use Only Date Building Permit Num4wn Issued: Signo ure: Builtlirgo issiunedlnspectur of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) CnTa A + j0kwL(_ Cry 0 ,1 tf I C Pu(qk Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by ZOaJng This column m be filled m by Building Depsnmenr Lot Size . . ..__ Frontage Setbacks Front Side L ... R: ... L.,... R ._ .--. Rear Building Height -- -- — Bldg.Square Footage / -- --- -- Open Space Footage % ._ IL.area minus bldg&paved _ arkin ...._.. _.. . __._ #of Parkin Spaces --- Fill: _. ......... volume&Location).....____. 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 © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: E. Wil the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or Is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK lcheck all applicaW New House ❑ Addition ❑ Replacement Wind... I Alteration(s) Rooting Or Doors 0 Accessory Bldg. ❑ Demolltlon ❑ New Signs [0] Decks [O Siding[0] Other WorkDescription of Proposed yY Sc� L�G��S�4 Work' / (i ' Alteration of existing bedroom as No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.H.New house andor addition to eAsttna housing, remalete the foliowina: a. Use of building : One Family Two Family—46-1 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 T" )_{/lr' ) ck as Owner of the subject property he thorize to o y If, in atte Trelati YOto work authorized by this building permit applicatio . Signa re of Owner Dale �Gy I-✓V�r� (7�la`/c 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 pedury. t PnM Signa Agent Date SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supearaili . } Not Applicable ❑ Name of Licanse Holder: �f19r/UI) f2_t�t t"Y`tC/ License Number ILIO 65 Q Address Expiration Date Signalul ,, - Telephone o R.maftaid"arne lrmfevMMM CoMraclar" Not APPiicable ❑ -'AILO a C Comoanv Nemo Regisdabon Number (Yo P�E�FFr��1 6HAyo�fi�✓difG� fc✓�� o3/oY 7, ��� Expim�ation 00 to Address �y ,q Telephone , ff 4v SECTION 10-WORKERS'COMPENSATION INSURANCE APPIDAVfT flit .d.142,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit wAl result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes..._j< No...... ❑ City of Northampton � Massachusetts a c x r 212 Mri. a OF BUILDING Ia3PBOT -, Z 212 Hsin Stneet • loon 010 BuilCing tha�ton !A 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC'). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units....cr to structures which are adjacent to such residence or building"be done by registered contractors. Note:/f the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Est.Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): —Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter I42A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 0e, I AI^10o 1 5 Jars Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature G6�9PR)-�o 7-6Q, 0) pvt`L . �ttit . City of Northampton , Massachusetts Z DEPARTMENT OF HOZLDZNG INSPECTIONS �T 212 Main Street • I icipal Build nq Northampton, !N 01060 �\V♦�0c Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section I IO.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts DEPMTNENT OF BNZLDZNG INSPECTIONS QV 212 Nei �nxcipal Bu Northe tan, M 0060 ildinq 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: I tl 1AIlAa N'Trq (Please print house number and street name) Is to be disposed of at: moi` tAl` ✓ rRFcycC �on Plea a print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signatu e o d Applicant 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. 14 y� �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02174-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/ContractorsMectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print L obl Natne(Business/Organiza6or✓fndividua0: ( .�Ar t 7 `[, r yJ r� Address:—1((o "(A WrL go . City/State/Zip: & C,/ Phone Are on an employer?ChsA praapptopdam has: Type of project(required): 1,El I am a employer with employees(Poli and,or pan-tone).' 7, ❑New construction 2 lam aside pmpdemr or ownership and haven.employees working for me in any capacity.[No worker'comp.announce mqubed.] 8. ❑Remodeling 3 r7 am a hoawwver doing all work mymlf.[No workers'cnmpresonance renewed t 9. El Demolition 4.❑I am a homeowner and will Is,nahving coir ytracors to conduct all work or pmerty (will 10 E]Building addition p . era me but all c. acmrs Amer have works%compensadoo irtmanee nr are into 1LEI Electrical repairs or additions pmprim.rs with no employees. 12.E]Plumbing repairs or additions 5❑l nm a general curywhrmd l have hires the sub-conn-esters listed on me crashed sneer Thse IJ. Roof repairs esub-contractors have employees and surn have workers'comp ance. 6 We are a corporation and as of kers have exercised their right ofexempti.n per MGL c. 14.❑Other 152.A I(4),and we Mve eo employees.[No workers'camp.imormee required] 'My applicant mat checks box sit must also fill out the section below showed;their workeri compensation policy inf anon. 'Homeowtrers who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicators such. :Cmamoma mat check Nis box must attached an i di ifional sheet showing the name ofthe sub-contractors and scam whether or ma those entities have employees. Yore sub-coouec ms have employees,they must provide their workers'camp,policy number. I am an employer that is providing workers'compensadon insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 a 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 farm 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 and e p ' s des of perjury that the information providedyQabove is nue and correct Si store: �..// I Date: t/ Phone4 �( 'sL . 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"._every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner o£a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)narni address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be resumed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia R Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment he deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of comp]iance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia F.—Revised 02-2}-15 �� . 5 ,& y 4M \ \f7< 50P _ . . . - �