31A-111 (6) 62 VERNON ST BP-2018-1117
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3IA- I I I CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2018-1117
Proiect# JS-2018-002007
Est.Cost: $18800.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PRECISION HOME REMODELING GROUP 107805
Lot Sire(sa. ft.), 14941.08 Owner: URBEL MARTIN H&AMY LEOS
Zoning: URB(100)/ Applicant: PRECISION HOME REMODELING GROUP
AT. 62 VERNON ST
Applicant Address: Phone: Insurance:
72 JEFFERSON ST SUITE 101 WC
MARLBOROMA01752 ISSUED ON:5/412078 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF, REPLACE 2 DH
WINDOWS
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:
FeeTVpe: Date Paid: Amount:
Building 5/4/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_ kp r
City of Northam n
In
D Ne •.,,rn,k1 ..reef
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH
NONEOR
RFAMILYDWELLOING
SECTION i -SITE INFORMATION V 19— 4- /117
1.1 Property Address. Wa- )`J2(,�v)/�j sdv',(�- This section to be completed by otBcs
Adarl4V4f'�lc'/. V / Oi"h-' Map ��� LotUnit
Zone Overlay Dlstril
On St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Nlafylr)
Name(Prmh Current Mailing Address
Telephone
Signature Signature
2.2 Authorized Atlantic
( Y 'lz _rfycc /Gi /Q9u�(�r�
me nod Current Mailing Address-
97K �US 1P93�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ' il�j(J (a)Building Permit Fee
2. Electrical OO (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) qD
5. Fire Protection 444
6. Total=(1 +2 +3+4+5) 1u6 1 `6CU Check Number
This Section For Official Use Only
Building Permit Numb Date
Issued:
Signa e' 3
Building Co issioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L R:-... L:.._ R _i
Rear -. -- --- - -
Building Height _--
Bldg.Square Footage
Open Space Footage
(Loi area minus bldgi pared
rk
eof Parking Spaces - --
Fel:
one se Lnearnn
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 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 i and/or Document#.
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW V 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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location: I.
E. Will the construction activity distum(clearing,grading,excava Drilling)over 1 acre oris it part of a common plan
that will disturb over 1 acre? YES O NO ()-
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION i DESCRIPTION OF PROPOSED WORK(check all aeplicablel
New House ❑ Addition ❑ Replacementtedows I Alterations) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[C31 Other[EJ]
Brief Desc�rp tion of PrGpose
Work' W� W ' / c '!4J GNU ✓�6nt GUi�� a�fiL
Alteration of existing bedroom_Yes No Adding new bedroom Yes % No
Attached Narrative Renovating unfinished basement Yes \ No
Plans Attached Roll -Sheet
ea.M New house and or addition to existino housino.oomohlbethe Eolluwfia.
a. Use of building One Family Two Family 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
1. Is construction within 100 ftof 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
I, as Owner of the subject
property
hereby authorize
to act on my behalf. in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, 10 cee't- V GLl2 aaOwner/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.
Sign d under the pains and penalties of perjury,
Pr t Na
7
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: INot Applicable ❑
/t
Name of License Holder_ ��✓)�b� �'('t �lJu� A
License Number
Addr Expiration Date
Signature Telephone
B.RaoYYUNJialu lmmovoaie tCanlnefor: Not Applicable ❑
Company Name Rai t Nu�"Id
�l eC S�n27u? v�na�aua D� l 3d(�20/ �J
-Address �) l nn OO Expiration Date
I ?1�2F/yYS Y 1a✓lbarocra6, 14� U/f�2Telephone � aG1av3o
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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....._ 0./ No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J'S\ pOD
NOrtTampton, M 01060 �1
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....or to structures which are adjacent to such residence or building'' be
done by registered contractors.
Note:Ijthe homeowner has contracted with a corporation or LLC,that entity must be registered
I
Type of Work: RcC� f is ��J,�IVId DU) i l(1E,Gl,/ Est. Cost:
Address of Work: (P) Vero or S� `
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 142A.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:
1 hereby apply for a building permit as the agent of the owner:
NWSg ?(�Os)at,1 &w 1 8870
Date 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
City of Northampton
Massachusetts
4
93
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
/ 5J 1L
Northampton, M 01060 1�eC
Massachusetts Residential Building Code
Section I IO.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 110.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 persons)
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
-s,
Massachusetts F2ri. °Q
DEPART NT OF BUILDING INSPECTIONS
212 Main Street •Municipal Builtl ng =Jb OC
North m ton, MA 01060
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:
(Please print house number and street name)
Is to be disposed of at:
I h wtsmn rc5. Nora ll fthd60er, Mo .
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit 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.
Office of Consumer Affairs k Buainesa Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corpora0on
Raa'stration Expirgon
188780 08,30/2019
PRECIS ON HOME REMODELING GROUP,INC
VINCENT BRANDOUNI _
72 JEFFESON ST.SUITE 101
MARLBOROUGH.MA 01752 Undersecretary
commonwaa¢n or
Drvisipn Ol Professocal L Tee Wioe of Conaumer Affairs&BuainesaegN
RMion
Boum of Bwltlinq Regulapons antln5ta nnartlz HOME IMPROVEMENT CONTRACTOR
^struc{7on Supervisor TYPE:LLC
CS-107805 Re limmOon .ration
`kplres: 02/05/2020 189770 11/202019
BRANDOLINI CONSTRUCTION,LLC
VINCENT N LIN1
6 PROVIDENCE
HILL RD
ATKINSON NH 03811 VINCENT SRANDOUNI
72 JEFFERSON ST.SUITE 101
1 MARLBOROUGH,TMA 01752
Undereecretary
COMMIssloner
HOME IMPROVEMENT CONTRACTOR
BRANDOLINI CONSTRUCTION,LLC
6 PROVIDENCE HILL RD
ATKINSON,NH 03811-2327
FIFE 'aE EHPIRT—
FHC.064790 I2/O1/2017 11/30/2018
The Commonwealth of Massachusetts
Department o(Industrial Accidents
I Congress Suite 7
Boston, MAA 021 02174-2017
www.mass.gov/dia
1wtl'orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PF.RMIT'flNC AUTHORITY.
Applicant Information //� Please Print Legible
Name(Business/OrganizatioModividual): y-risi6) 6TI yWke (CFJ .Crr�l111
Address:v- ()--
City/State/Zip: yob,
As ss as plover"Cbrck me worwifi to bo.: Type of project(required):
L6ztwe,,uh 6 eani(fail and/arpan-nmel7. ❑New construction
2_M I am asolepmpnemror Farmershm rdhavenoemploveesworkme &rmein $, E]Remodeling
am eapecar, [Nowmkers comp.iacurance required]
3�l em e homeowner Join Il work m self
[Envision,inion, core vrdnc. d 9. ❑Duildin I a
ge y l pin -regmre l'
4.[I am a nomwwoer and will be hiring tractors to conduct all wed on m Iwill 10 Building addition
g eon S,,sale are that all contractors either have workers compensation�rur ante or arc sole ILE]Electnical repairs or additions
pmprieton corm no employees_ 12.❑Plumbing repairs or additions
5 l an a general contractor and l have hired the son contractors lista i on me aaacneddneer 13.E]Roof repairs
These sub<ontacmrs have employees and have rrodeo'rnmp. sures cc.
6We are a corivation and its officers have exercised their right ofisend h nperMGLo 14.[JOther
152_§1(4),and we have no employees. No workers`comp.insur,.nce required.]
sAny applicant that checks box k I must also fill out the section below snowing their workers`compensation policy information.
"Homeowners who submit this affidavit indicating they are doing all wear and then hire outside contractors must submit anew affidavit indicating such.
ICommetoo that check this box must ordered an additional sheet showMg listener of the sub-contractors and state whether or not Mose entities have
employees If the sub-cantrndoo have employees,they must provide that, workers'comp_policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepoi and job site
information.
Insurance Company.Nai
Ijfj ,jr
Policy#or Self-ins
/Ql,�rrCdO�� � __ Expiration Dale:
Job Site Address:�✓I ��l'.��1 to Ciry/State/Zip: 6 r'{EQ3r VP Uiii
Attach a copy of the workers'compensation policy declaration page(showing the policy. and expire ren 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. copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification
7 do hereby end K, relimr enc ' s of perjury that the information provide/d above i,npu�e and correct.
Summon Date. 7/a3�/r'
Phone#" C
Official use only. Do not write in this area,to be completed'by city or town official.
City or Town: Permit/License H
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#:
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