29-096 (4) BP-2023-1124
24 HOLLY CT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-096-001 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-2023-1124 PERMISSION IS HEREBY GRANTED TO:
Project# SIDING 2023 Contractor: License:
Est. Cost: 8000 BRAMUCCI CONSTRUCTION 110834
Const.Class: Exp.Date: 09/03/2024
Use Group: Owner: A FIL THOMAS S &GINNY
Lot Size (sq.ft.)
Zoning: WSP Applicant: BRAMUCCI CONSTRUCTION
Applicant Address Phone: Insurance:
17 MT WARNER RD (413)221-3942 656OUB1K70974321
HADLEY, MA 01035
ISSUED ON: 08/17/2023
TO PERFORM THE FOLLOWING WORK:
NEW VINYL SIDING
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:
• V 6 ).2 . TAIT
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
*Ema(/ klit,11 ��61�
The Commonwealth of Massachus tts RECEIVED
W Board of Building Regulations and Sta dar F R
Massachusetts State Building Code, 78 C M ,NICI•ALITY
IIII 11 77 U'E
Building Permit Application To Construct,Repair,R ova Otggmdli$h?t023 Revised ar 2011
One-or Two-Family Dwelling
This Section For Official Use On1PEPT OF BUILDING INSPECTIONS
A� NORTHAMPTON.MA 01060
Building ZrD-s
it Number: Z)"r /041 Date A lied: -
` IZs //f/Z--- 617
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
2q lJaLty C7
1.la Is this an accepted street?yes k no Map Number Parcel Number
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 Owner'of Record:
G.1 r.o4 Y I t LA._ S3? orciAL--04 I4A D LE Y mA o / 0 3 S
Name(Print) City,State,ZIP
127 wQ.3r ST- 413 - 520 - 7776 Tuac3$2(k4 1/I-IO0, col)
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) IR- Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other fa Specify:X 1 D I N 6-
Brief Description of Proposed Work2: i ru S.r A d.-L Ai E tid V 11)V L. S I b/ M&
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ rd 000 . 00 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 0( 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee
Check No.0'\ Check Amount v Cash Amount:
6.Total Project Cost: S 8 0 0 0 . 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS 110 $31 °j/ S f 3 0 Z
15 R4 reit U C C t License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
i 64-T. W A I'2 N E e. RD •No.and Street Type Description
Unrestricted(Buildings up to 35,000 cu.ft.)
114 D L e Y M a 01 b 3 S R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
6 R a rn V c C i C o N sT/e.)C'r u I Grin 1 L, � Window
a S RC Roofing Covering
B ��► WS Window and Siding
SF Solid Fuel Burning Appliances
913- 221 ' 3 4 2 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/ 50 4 06 4- 25"-20Zf
g4,da n tJ L'CI C.o NS'7 J v C'7 S 0 N Z.LC. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
/7 .v1 . 10•4A NE/C a',. 84._4_11,QCC/ CoAiST lb)c l o' 4#74/C.
No.and Street Email address c O poi
OJA'D/.- i'MA DI 03r 4/3 -22/ -394Z
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFI1DAVIT(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 l No 0
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 O C t- &(I )rn u cc/
to act on my behalf,in all matters relative to work authorized by this building permit application.
(./ NN v / C.L 8 - 14 • ; 0 2-
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 the best of my knowledge and understanding.
f2t /3'ZQ,i 7 dcC / 8 -I4 - 2_0z3
Print Owner's or Authorized 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"
"i1d1"� The Commonwealth of Massachusetts
il
.. . i1,1 Department of Industrial Accidents
ut 1 Congress Street,Suite 100
`� � Boston,MA 02114-2017
-1 a %- ww»:mass.gov/dia
%%us kers'Compensation Insurance Affidavit:Builders!ContractorsfElectriciansIPlumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Annlicant Information Please Print l e ibiv
Name(Busittcs.s orl anvatioa Indio idual►: 3?u C C.1 CO hK?X.11 t'i ►01.1 _ ._._w._
Address: 1'1 yy-r wAle.lvt;Y. RA) -
City/State/Zip:tiAb L EN r-tA al Olv Phone#: 4 L3 - Ze l - 3q 412
Are inn an emplinrr?Check the appruprnate hot: .L,e pe of project(required):
a c e7 f
3 XI.iuIn lrlpto) .till .,._1_,_.. l'rp4u/cca(kW andot pnrytirn:)'' 7. 0 New construction
20 I am a suk proprietor or puutnrrship and haws nu cmptoyixs winking for cm:in $. 0 Remodeling
any capacity.(No workers'comp.insurance requiem)
9.
30 I am a humaw corms,.insurance
nnrr doing all work myself.(No workers`cor insuce requital' ❑Demolition
4.0 I am a huts owner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all cwmramors either haws workers"contpc"t►xaiwn insurance or arc sole i I.Q Electrical repairs or additions
proprietors with no crrtp►uyeaa.
12.0 Plumbing repairs or additions
5Ci I am a general contractor and I have hired the sub-contractors listed on the attached Acct..
T or bow
'These sub-contractors ha employees and hair workers'comp.imuracur.t 130 Roof repairs
Es
6.0 W`c are a corporation and its officers have exercised their righ*of exemption per MGL c. 1 . Other s ID t N
152,¢i(41.and is e have no employees.(No workers'comp.insurance required.(
*Any applicant that chocks box'I must shu fill out the section below showing their workers'compensation policy information.
r Homey%nen who submit dos atT.dtvit indicating they are doing all work and then hire outside contractors must sirborit a new affda%it indicating such.
:Conuactor%that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
onpluw cc-, If the nub-conirJ tLYrs lie c onrIke.cc>.thew must mot ilk thicir o urkc&comp.policy number.
I am an employer that is providing tt.`orllers'compensation insurance for my employees,. Below is the policy and job site
information.
Insurance Company Nam:: -rt.tE tlA RTFo R 1 ,-_
Policy#or Self•ins.Lic.N: 656 0 U B 1 IL7 o 9 7 t32 2 Expiration Date: tt/t G /to 2 3
Job Site Address:21 go LLY CT. City/StatelZip:FL b g e N C 6 414 CPO 6?
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 against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
co\erase w enliration.
I do hereby certify under the ins and penalties ofperjury that the information provided uboi c is true`and correct.
Si'nature: Date: $ - 14 - z oZ3
Phone : 413 . 22 I - 39 42
Official use only. Do not'mite in thiss area.to be completed by city or town official
City or Town: Permit/License b
Issuing Authority(circle one):
I. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other ,
Contact Person: Phone#:
City of Northampton _
/c
F Massachusetts 44 --. 'e.,
* �t
i- DEPARTMENT OF BUILDING INSPECTIONS it-, p+ M
s, 1
212 Main Street • Municipal Building vh c'
Northampton, MA 01060 'r'j V 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: ALA-c4 Q ecYcc.I N (7 zsi Eos-r1.14m Pro N ST
NoQ AWIpTVN) 01.41 OIO (, O
The debris will be transported by:
Name of Hauler: 13QgmJcei cows-rrevc-r ' orJ
Signature of Applicant: Date: 8 - 14 - 2023