24 HYDENVILLE RD_ INNITIAL CONST_AFFIDAVITVersion 01_01_2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Commercial Space Renovation Date: 04/23/2021
Property Address: 24 Hydenville Rd, Leed, MA 01053
Project: Check (x) one or both as applicable: New construction Existing Construction X
Project description: The project includes the renovation of interior spaces throughout the building. The area of
work is approximately 3,715 sf and falls under the work area compliance method.
I Darguin Fortuna MA Registration Number: 951922 Expiration date: 09/31/2021 , am a registered design
professional, and hereby certify to the best of my knowledge, information and belief that I have prepared or
directly supervised the preparation of all design plans, computations and specifications concerning1:
Architectural X
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code. The contractor shall be responsible for
performing the work in accordance with the contract documents.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a ‘Final Construction Control Document’.
Enter in the space to the right a “wet” or
electronic signature and seal:
Phone number: 978-498-4370 Email: Dfortuna@flow-design-studio.com
Building Official Use Only Building Official Name: Permit No.: Date:
Note 1. Indicate with an ‘x’ project design plans, computations and specifications that you prepared or directly supervised. If ‘other’ is
chosen, provide a description.