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31A-099 (4) BP-2022-1267 73 VERNON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-099-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-1267 PERMISSION IS HEREBY GRANTED TO: Project# SHOWER Contractor: License: Est. Cost: 5800 CLAUDIO GARRIDO CS-089458 Const.Class: Exp.Date:08/24/2024 Use Group: Owner: MACKINNON CUTLER WILLIAM S&M LEE Lot Size (sq.ft.) Zoning: URB Applicant: CLAUDIO GARRIDO Applicant Address Phone: Insurance: 140 NASH HILL RD 4132195906 SOLE PROPRIETOR HAYDENVILLE, MA 01039 ISSUED ON:10/05/2022 TO PERFORM THE FOLLOWING WORK: SHOWER INSTALLATION 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: Smoky: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: . 7:1 'I Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 • Office of the Building Commissioner The Commonwealth of Massachuse s 1 ) Board of Building Regulations and Sta dard 1. i FOR ? T /g Massachusetts State Building Code, 78 C OCT - ICI ALITY Building Permit Application To Construct, Repair, R nov e Or Demolish22 R ised ar 2011 One- or Two-Family Dwellin cEpT op This Section For Official Use n RTHAMnT;2 tNspF Building Permit Number: P a - 1,47 Date Applied: • il i ,), Ill I ig, Building Official(Print Name) Signature ' (pate 13 SECTION 1: SITE INFORMATION 1.1 Proper Address: Veenc•' Si.' A L 1.2 A,ssesso�,s Map& Parcel Numbers 9 °J` MapNumberer- Parcel I�Tumber 1.la Is this an accepted street?yes � no 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owners ¢ Gil ` f Recor/( i, t .tJi ✓" ''�� "'n�+, 31 1''ti'd - . r h .,4 ,,,.4 Name(Print) City,State,ZIP 0/o60 1113 32o z.y z/ r;JC c!'1'[.,ER r7 G'54,4.1 tclk No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other pecity: Brief Description of Proposed Work': !7�,� �n !, �- �/('t���v`� �vt/ST�IL,vt►t 1 crb4,/ (;(./ l�r,✓ U�Cf��c/O"- --/ ROO/4. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 45e,t) Cr"...- 1. Building Permit Fee: $ Indicate how fee is determ ned: 2.Electrical $ 0 Standard City/Town Application Fee �� % 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 150 4 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ G i Check No.A� Check Amount. O J Cash Amount: 6.Total Project Cost: $ _j 8/�0 CI Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C► CJ�4,g��3� JJ(2D. Lj,6 � (J/c� 6pW(L Q LicenseNOumber E iration Date Name of CSL Holder / / C�!� f4$(4 ,,i ` w z 6.n ` List CSL Type(see below) No.and Street (� Type Description (� / / / 2 / U Unrestricted(Buildings up to 35,000 Cu.ft.) -rrt/�� - © (�J / R Restricted 1&2 Family Dwelling City/To n,State,ZIP 7 M Masonry RC Roofing Covering WS Window and Siding �y //" n SF Solid Fuel Burning Appliances 41< i[ t r l�E6 C,�( '`t�f�i�IQ 7V0 44 c I Insulation e ephone Email address D Demolition 5.2 //Regi�st�'e/nred Home Improvement Contractor(HIC) aft IGG9(/�( 0 (�G9,ei2I C� HIC R�Registration DE irafr'on Date HICompany Name or HIC gistr Name p No. y St m- -{ �'T 16 , C�rpo�06 cid4d.cry Pln �1/1� _ofo p(la 2, r16 Email address City/ o ,State,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 elK No .0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize ( / v/iv 9 r it 1 to act on my behalf,in all matters relative t work authorized by this building permit application. 411Y/A Caee,_ Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to best knowledge and understanding. Cj fb (7 rkc, Print Owner's or Authorized Agent's Name( I oni ignature) Date NOTES: 1. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" M �\ I'4W / -__. 1 C Feu h Door 3 I 1 i C.i44 Nj ROW ; 44�. *0 I IA oc Wye( 35* ( 1 g ___ . - - - -- -- 1 4. ne of -it rr= Fx i-4i.4 L-4 v P 3 Vv.c. . elitAleJ- ac ►h Ow, 37 9.4h A Rom 56'te las (PI G-sit rt 8 c 1 1, Ice*, tikALIC Ccr-ifd- (6.4, 4, ‘ 1/0o ‘„, / 2 r"t Li I � w2 _ /1 ti7 The Commonwealth of. Iassachusetts Department o f I n dustrial Accidents rztligi"fi 1 Cangre.N _5t�cet,Suite 100 �. "' .� . Boston. .11.1 11 2114-201 7 www.ntass.gov/dia ?1 uikers'Compensation Insurance Affidavit: Builders'Contractors,'Eleetricians.Plumbers. to BE FILED WI CH 'I HF I'E:RMITIIM.At I H()RI t l. Applicant Information Please Print l ei:ibis Name{13usu th antzationilndivaduat}: (� yr � .2 Address: [ 1(0 1J4Se-1 ALD C'ity-Stater`Zip: " l rl rt/1/()G;�. Phone rt: ��� )2/?S j*0 %re iuu an employer'('heck the appropriate late: type of project(requ'red). .21a enrplax,er +iili enxltSvTs:es!lull 3trct+'6r part-UrtM@I. - 7. J New construct/ �Q I.int a auk proprietor 1)1 partnership and have nu employees workins for me in K. o Remodeling capacity. (Nu workers'cwnp.insurance moved.] 9. ❑ Demolition l�I am a homeowner doing all work myself.[No workers'camp.insurance required.) l(t E3wldtng additiu i 4.0 tam a hwnteewnei and will bt hirutg tontine ors to conduct all weak on my property. I will ensure that all contractors either have workers'conformation insurance or are sole 1 I.Q Electrical rcpai . or additions proprietors with no employees. 12.Q Plumbing r pat : ctr additions S I am a general contractor and I have hired the sub-contractors listed on the attached street_ 130 Roof repairs These sub-contractors haw employees and have workers'comp.insurance.: 14_LJ Othet h.O 14'e an a cumeratrun and its of ken.have ex...1eiscd their nghl of e.sernption per 11t it.c. L'2. It4t,and we have no employees.(No workers'comp.insurance required.] •Ant applicant that cheeks bus al must also fill out the section below staining their worker,':uinperuatit n policy unfurmatiun Homeowners who submit this atfitdaiit indicating they are doing all work and then hire outside contrr..tuts most submit a new affdw it inch sting such. :Contractors that check this bee mush attached an additional sheet slowing the name of the suMcamtra.tors and state whether or nut these cat ties bane c�nplrrse 11 th5 sub-cuniraerm,ht. employees.then !rust proside their wuttlers'cc rep.lea licy numk 7 1 am can evnployrr that is providing wurAers'eolnpcnsatiun insurance for errs'emj a, ees. Below is the polity a d job site information. Insurance Company Name: Policy#or Self ins. Lie. #: Expiration Date:___ Job Site Address: City'State'Zip: Attach a copy of the ti or Lc • COW pvilsatiun police 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 tine up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a da. against the violator.A copy of this statement may be forwarded to the Office of ins a stigations of the DIA for insurance ec>�crage s eritication. /de hereby certify tunicr the prof s and i i Th-c y n/lrsv'iurl. that the information provided above is true and correct Signature: 1.: , 6/0'3451- Phone : (2(i)) l?— t� >� Ojjicial use only. On not write in this area.to be completed by city or tower official C'in or roan: PermltiLicense# Issuing.kuthorith (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing lispettor b. Other Contact Person: Phone 4: City of Northampton 41 c s sy �•' : Massachusetts 4� y-- °'<< * G w i ( o DEPARTMENT OF BUILDING INSPECTIONS 1 , 212 Main Street • Municipal Building yvt i,tx,. Northampton, MA 01060 smy .W\ 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: Location of Facility: 1`-�' (e97,2//v6. The debris will be transported by: Name of Hauler: 62c1 (. (:0 407e (A' a ,-- -7' Signature of Applicant: Date: is