24A-154 (5) BP-2023-0379
40 NORFOLK AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-154-001 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-2023-0379 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 DECK Contractor: License:
Est. Cost: 14000 CLAUDIO GARRIDO CS-089458
Const.Class: Exp.Date: 08/24/2024
Use Group: Owner: ENDER ARNOLD THOMAS D &AMELIA
Lot Size (sq.ft.)
Zoning: URA Applicant: CLAUDIO GARRIDO
Applicant Address Phone: Insurance:
140 NASH HILL RD 4132195906 SOLE PROPRIETOR
HAYDENVILLE, MA 01039
ISSUED ON: 03/30/2023
TO PERFORM THE FOLLOWING WORK:
CONSTRUCT 17'X19'DECK
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:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
c/ ,CD r
Fees Paid: $91.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Z o
•
cisbN
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNICIPALITY
Massachusetts State Building Code,780 CMR USE
•
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:: ' 03�7^ Date Applied:
• TrI27 3/XP3
Building Official(Print Name) Signature Da/
SECTION 1:SITE INFORMATION
1.1 Property Address:/ 1.2 Assessors Map&Parcel Numbers
D ( O R&2/K ni/PC.
1.1 a Is this an accepted street?yes / ` no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
.2ZQ iere-
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 g Private 0 Zone: — Outside Flood Zone? Municipal' On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Nvv(44 5 01-41/OJ(t uD -111-TA"t tP 7-01A/ U/1 -
N e(Print) City,State,ZIP
L/d orzfollc ` '-/13. 3242• ' 5% `jr4 P I- �-' �rnitriL .ram
No.anti Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction l Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
/q-'x ( J ` 6/ < (c),v5-revcsn'o ,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ((( LA9 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ / 0 Standard City/Town Application Fee
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ `1.1 Check No.SO6) Check Amount:-;/T/92 Cash Amount:
6.Total Project Cost: $ / /v�J� Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) c5, 06C1(. 8 C ,/Jj2 7
2A LA(rQ 66 I'�-,-('Lc) License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
I�/D 1 f 5/ ft/L2 le tD
No.and Street Type Description
`,A y 6vvr•/% /�,,-_ 6637
U Unrestricted(Buildings up to 35,000 cu.ft.)
( `L t/"v r R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
/ Q.� SF Solid Fuel Burning Appliances
( l(/3j)jf(_r6 p C6�} (r�)D��1�� I Insulation
Tele one Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) (- '81/'( __ oit
�/ e&I'P D HIC Registration Number xpiration Date
HIC Company blame or HIC Re strap e /
I ye • ts(t / 11 e C (t c 7'2* 1 . -(
No.an Street
_n E1/1////�� (/((3)2/7
)2/7 Sc/O / Email address
City/Town,State,ZIP p p �`� 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 No . ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize C`h4,�(C) t2-4 22O "tS
to act on my ehalf,in all matters relative to work authorized by this building permit application.
0'3/z l hAiZ5
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 t e best of my knowledge and understanding.
Cidt( )( e (%60 s 037217/0 J3
Print Owner's or Authorized Agent's Name 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"
City of Northampton
Massachusetts ��f''" ``..
?pc4.-7,1t.5.4,.:,,,1 „ss,
' °�k � DEPARTMENT OF BUILDING INSPECTIONS ��
�`w ' 212 Main Street • Municipal Building .), Aa
ez 4Y.�; Northampton, MA 01060 :rkri
��OC
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. 2/ Y t--CyA;,,G .
The debris will be transported by:
Name of Hauler: C14 060 ci4/22(-1DC
Signature of Applicant: r Date: 23 043
&"\. The Commoi:weaIth of Massachusetts
t �' •1 Department of Industrial Accidents
• -e'= 1 Congress Street,Suite 100
t;Tl1t/•" Boston,%L102114-2017
,rirlr.ntass.goiVdia
•te-% s
Wgekers'Compensation Insurance Affidavit:Builders'C•ontractors'Electricians`Plumbers.
TO RE FILED WITH THE PER 11Tr1NG AUTHORITY
Applicant Information / Please Print Legibly
dame C, �l tl,
' (Business'Organizatixi'I>rdisidusi): ��G'�-(.�)t � -�G c
Address: t <l O g45 1.1712 /C&
City/StatefZ _ y th E//vr/J#/,�v9- Phone#:97( ?(?—s`70
Are yea e■employer'.Check the appropriate boa
Type of project(required):
1.0 I am a employer with employee'(full audio/parrtace).• 7 New construction
? I am a cols propcietoe cr pactyact ip and have no amployaaa working for ma to S. El Remodeling
any capacity.[No waken'comp.iaru_'anca req-.ir.i] 9_ ❑Demolition
3.0I as a homeowner doing all work thyself.(No wariwa'comp.insurance required.}t
4.❑I are a homeowner and will be hiring contractors to cnnfiuct all work on my property. I will 10❑Binlritng addition
ensure that all concactcrs either have workers'compansaaoa in.--"a or are solo 1 1.0 Electrical repairs or additions
prapDahoit with no employees.
12.El Plumbing repairs or addtticalis
..❑I and a general contractor and I have hired the sub-ceanacoon listed on the attached tar!. 13.n Roof repairs
These sub-ccsrectors have employers and ha•.e workers'comp.insurance.:
Othet
6.0 We are a corporation and its ofry-s have exercised thou rigba of exemption par MGL c. 14'a
152,11(4),and we have no employees.(No touters'coaQ.insurance required.)
•Aay applicant that checks box t 1 taut also fill out the tection below showing their wooers'compansacan policy information .._ �.�
Homeowner'who subout this aindacit indicating they are doing ail work and than hire ootsida contractors lust submit a new affidavit indicating'rich
'Contractors that check this box must articled an additional sheer showing the name of the tub-contractors and stun whether or not those ennnos have
employees If the sub ccstractma have employees,they must provtda their workers'comp.policy r mi.ar.
I am an employer that is providing utiorkers'compensation insurance for me employees Below is the policy and job site
infonaration_
Insurance Company Name: —
Policy;i of Self-ins.Lic#: Expiration Date:
Job Site Address: Ci y 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 c- 152.§25A is a criminal violation punishable by a fine up to S1,500.00
and'or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day ag inst the violator.A copy of this statanvnt may be forwarded to the Office of Investigation'-of the DLA for insurance
coverage verification.
I do hereby certify under the pains and penalties of .njurvthat the information provided above is sue and correct
Si=attire: Date: 0
Phone ik_C C
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Perurit;License:x
Issuing Authority(circle one):
1.Board of Health :,Building Department 3.Cit7Town Clerk 4.Electrical Inspector Plumbing Inspector
6.Other
Contact Person: Phone R:
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