37-078 (4) 49 PLATINUM CIR BP-2021-1543
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:37-078 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2021-1543
Project# JS-2021-002565
Est. Cost: $21500.00
Fee: $138.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRAMUCCI CONSTRUCTION 110834
Lot Size(sq. ft.): 36241.92 Owner: CONNLY GLENN R
Zoning: Applicant: BRAMUCCI CONSTRUCTION
AT: 49 PLATINUM CIR
Applicant Address: Phone: Insurance:
17 MT WARNER RD (413) 221-3942 WC
HADLEYMA01035 ISSUED ON:6/29/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE PT DECKING AND RAILING AND
REPLACE WITH COMPOSITE
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.
)2 • T I .1 0
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 6/29/2021 0:00:00 $138.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_ I
The Commonwealth of Massachuse 0�
Board of Building Regulations and S ndar•• e/G� / FOR
Massachusetts State Building Code, 7:: ',I.
c7 IPALITY
Building Permit Application To Construct, Repair,Renov.��9 • ► - olis Revi -el Ma 011
One-or Two-Family Dwelling q1fA°tic j /
This Section For Official Use Only o ti t,s.
Building Permit Number: BP- al- I543 Date Applied: °' ''o ///
/ U /Z7Z IrJ ��D 1-29 zi
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Aq PLAT INum tIQ• 37 0 .?
1.1 a Is this an accepted street?yes ty no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(It)
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 III_ Private 0 Zone: _ Outside Flood Zone? Municipal M.On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
6L4n1 c °NNE Ltry mogyrllAnnPTON +v1A of o(, 0
Name(Print) City,State,ZIP
4q PLATI n►urn C Ia. 413- C19- 0127 _r_gNN6RLYN aoomGAST.N6T
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building P.. Owner-Occupied 0 Repairs(s) IS- Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other lik.Specify:
Brief Description of Proposed Work2:fZenvrvE ISK►cr t N6 P.T. D E C K.►N6 AND rA I L I Ndr
Aw1p iRisPL4C 0 WITLI w6W comPos'la 0^1 i* 2 254R DBCk-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 2% s S o 0 • 00 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee .5'n so
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier(.0, x Z(
3.Plumbing $ — 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ �, ,
Suppression) Total All Fees:,�$(138 --
Check No.�95 Check Amoun . 13�• Cash Amount:
6.Total Project Cost: $Z 1 .500 . 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C 3 _ 11 O$3 q 9 3- ?d 2 Z
Ric I A*.b BRAw%a C C 1 License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) tJ
M-r• r,l AIQNBR. R .
.
No.and Street Type Description
�U Unrestricted(Buildings up to 35,000 cu.ft.)
4A0teaV VOA 01635 R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-221.3442 y2amde etc oNrrROc-ri awl gErmAlr..reNl I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
iso908 s
$RAPYk CC 1 CO Ms•r12%Jer i 0 NI HIC Registration Number Expiration to
HIC Company Name or HIC Registrant Name
7 MT• WAK.WGC Rv. brAnsUeCICelhTlt t)CTLON(f &OWit..Oasi
No.and Street Email address
LAD 1.14►! " 010as" 413 •221' 3442
City/Town,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 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 Ric l,4U) 150/1407 ac C
to act on my behalf,in all matters relative to work authorized by this building permit application.
&LEN 011ONNr1-0/ ‘,/t/ ‘2./
Print Owner's Name(Electronic Signature) te
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 the best of my knowledge and understanding.
b JZI/Ll
Print Owner's or uthorized Agent's Name(Electronic Signature) 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"
The Commonwealth of Massachusetts
_ ---. Department of Industrial Accidents
Tog
I=IT 1 Congress Street,Suite 100
—+ -
;_`•• Boston, MA 02I/•1-201"
•,._,vs4k" www:niass.gor/dia
11 orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
f()Bit: Hi l:D SS till't Ilk:P1.R0111-fIM;At I IIOK1 1l
Annlicaut Information Please Print Ixiibls
Name(business ilrgantratian Individual l: 8124nri I.)C C I C ON ST OCYI OrQ
Address:V 7 evil- t..)ale K cs le Tat .
City/State'Zip: 144UL-EY v1101 01035 Phone#: 0415 - 221 '3942
Art you an employee(leek She appropriate boa_ T),pe of project(required):
_,m a en4+lo1,o7 Meth cnnployccs(full and or part-time)• 7. New construction
20 I am a mk pn.prnto or punn-rahip and hate nu.-nrl+lw.-c.Mufltna for me m 8. lRemodcling
any capacity.!No worker.'coup.Insurance required_"
9. ❑ Demolition
3.1=1 I ant a homeowner doss all work myself.1%o workers.comp_,,trance n-quo.d]'
lU Building addition
i❑I am a lrmrvwncr and will he hung.tinurartora to conduct all w.el on my pwp.-rty. I will
ensure that all C011graction.father(rats'wWlcfa'cu p.nsahon Insurance tar an:site 11.0 Electrical repairs or additions
pi-tipisctor t with no.7rgdoycos_
1_.D Plumbing repairs or additions
50 I am a L.7rial uuniza.tur and I Iut c hued the nub-cuntr:rtun lett,d on the attached dicer_
Ihese sub-c mtractun hate employees and hate worker.'comp. insurance. I ID Roof repairs,
60 We an:a c'urpuealsun and its officer.haae cun.ised their ugh of exception per MtiL c. 14.Q Other
132.il(4),and we hate nu employee..INu woken'cutup.insu ernereyutted.'
*Any applicant dial chocks has al mutt atm fill out the see tiun below slsuw um their wut era.compensation pit.} Information.
Reanuounen who subunit this atim alit indicating they ace doing all wurl and then hire outside contractor.mint suturut a new atlida%it mdreatmg such
:C ontractun that check this box must attached an ad htiunal shunt show me the name of the sub-cuntraetoa and state w hotter on nut those cn17t/e%lute
cinployera. lithe tub-curaractoa hale employees.dry must provide then wutkcr% Lump.policy number..
l um an employer that is providing worLers'compensation insurance for my employees. Below is the polio'and job site
information. ,l,�ar�,/�
Insurance Company Name: 11/6 M OieD
o 20 Expiration Date: tl If► ?otl
Policy#or Self-ins. Lie.#: �S`ot181 K7 9 7 3 /
Job Site Address:qq Pl.AT I f%M Y G 112 • City,StateiZip:v0,e71/402fi 2A, NIA v t o 1.0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGL c. 152. §25A is a criminal violation punishable by a tine up to S1.500.00
anti+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 against the violator.A copy of this statement may be kit-warded to the Office of Investigations of the DIA for insurance
coverage verification.
t do hereby eerdfy under the ins and penalties of perjury that the information provided above is true and correct
Si mature: / Date - 21 - 2021
Phone=:
Official use only. Do not write in this area,to be completed by c•itl•or town official
('its or Town: PermittLicense#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Iowa Clerk 4.Electrical Inspector 5. Plumbing inspector
6.Other
Contact Person: Phone#: __
City of Northampton
oa H M o �S Si
r••',[`� Massachusetts ��?`' .;-- c>s
raii
`I y «' DEPARTMENT OF BUILDING INSPECTIONS
'!v 4, 7 �i 212 Main Street •• Municipal Building vd., I,
- Northampton, MA 01060 s' j��0
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: vqi I E 'I Rec'/c Li NG / paote-n.11m Pi-onl
The debris will be transported by:
Name of Hauler: BrzAmucc I cow sr c-r1o*1
c `
Signature of Applicant: Date: (/zt/z/