23B-003 (2) 15 SUMNER AVE BP-2020-1082
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-003 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2020-1082
Proiect# JS-2020-001828
Est.Cost: $86000.00
Fee: $559.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRAMUCCI CONSTRUCTION 110834
Lot Size(sa.ft.): 4312.44 Owner: CHRISTOP14ERSON CLAIRE
Zoning:URB000)/ Applicant. BRAMUCCI CONSTRUCTION
AT. 15 SUMNER AVE
Applicant Address: Phone: Insurance:
17 MT WARNER RD (413) 221-3942 WC
HADLEYMA01035 ISSUED ON.51812 02 0 0:00:00
TO PERFORM THE FOLLOWING WORK:RENO KITCHEN AND 2ND FL BATH, NEW
WINDOWS, NEW DOOR
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 Si(_Ynatnre:
FeeType: Date Paid: Amount:
Building 5/8/2020 0:00:00 $559.00
212 Main Street,.Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-1082
APPLICANT/CONTACT PERSON BRAMUCCI CONSTRUCTION
ADDRESS/PHONE 17 MT WARNER RD HADLEY (413)221-3942
PROPERTY LOCATION 15 SUMNER AVE
MAP 23B PARCEL 003 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSE REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENO KITCHEN AND?` ATH,NEW WINDOWS,NEW DOOR AND ADD
+e12-DECJ> DFeK RZKOvX- R-Q�k ;PRO 1rCj-
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License 110834
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD.PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
5AIa
Sigoature of Building Official U0 Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Department use only
`llVOT 'rf,# s City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION --
1.1 Property Address This section to be completed by office
►S s�mNEK aJE -
APR 2 Map^, � Lot U �-,> unit
i=c
OR C N C E MA 010 b 7- �: �^� �n20Zon Overlay District
�0'c
. St.D*r at CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT /
2.1 Owner of Record:
«-At2F C0Ri5ToP0r-2Sbf4 rs surnNiek AyE
Name(Print) Current Mailing Address:
, � /per LX �° ._.l 413 • 2sto - +0,q I 8
Telephone
Signature
2.2 Authorized Agent:
RiCPARD BRArn7JCC1 /7 Mr. w4/2MER 0. HAD 4.E`/ rnA 6/03-5-
Name
/n3SName(Print Current Mailing Address:
913 - 121 - 3942
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (oz-"Foo (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
3500 Construction from 6
3. Plumbing 03000 Building Permit Fee
4. Mechanical (HVAC) 11 1700,0
5. Fire Protection
6. Total = 0 +2 +3+4+5) ►� g(o, 000 00 Check Number �-
l This Section For Official Use Only
BuildingPermit Number: Ato— v�� `���' Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
89,AMoceI ce5"S?'AvCT1ON @ GPAA IL . Corn
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:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at theRe istry of Deeds?
NO O DON'T KNOW YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q 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:
E. Will the construction activity disturb(clearing, grading,expavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement�ndows Alteration(s) EJ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition New Signs [O] Decks [[?ISiding [p] Other[a
Brief Description of Proposed
WOrk:lZeNti tiiTehIEN ANS 2FL. BATAaooM/N9W ftF_PLACEMENT WINDeuJS /NEW 000A AND
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓/ No 'DOCK
Attached Narrative Renovating unfinished basement Yes NoF(Z0t& �Rc�EcT-
Plans Attached ROTI -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family I/ 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
i. Is construction within 100 ft. of 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 .
1. 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, ct-a►RE t s-roPIAF-Rsen) as Owner of the subject
property
hereby authorize Rte-0AR.D I3RArY1�eC
to act on my behalf, in all manals1relative to work authorized by this building permit application.
• / 20 0
Signature of Owner Date
I, R,CdAAD 894MUCC/ segmuccl e o N s-m vc7/oy as Owner/Authorized
Agent hereby declare that the staterfients and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
RIC.4geD BRA M JCCI
Print Name
- A• I$ - 2020
Sign wn r gent Date
SECTION 8 -CONSTRUCTION SERVICES—7
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: $Zir- BARD 6RA rA VCC 1 C-6 - 1 1 0 83
License Number
MY• WARNER RD- AbL-EY MA 01035 9 - 3 - Z020
Address Expiration Date
A IS - ZZI B 9 4 2
gnature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
BRA(Y)Ur-Cl c 0" sTQyC i 1 bN 15-0,408
Company Name Registration Number
1-7 nA-r . viot2NGR 2A' S - /7 • 2OZ-1
Address Expiration Date
0A•D t-9,/ MFl 61 6 35- Telephone 913. 2ZI 39 4 Z
SECTION 10-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....... X No...... ❑
--a City of Northampton
SSS SSC
Massachusetts
At DEPARTMENT OF BUILDING INSPECTIONS p%
212 Main Street *Municipal Building
Northampton, MA 01060 rsy.^�.j<�0
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:
1S 5QMNJCR_ aJC, E�LQFENCC,, Nl/A
(Please print house number and street name)
Is to be disposed of at:
VA L L C-1 R e c y e L 1 N 6 / 2 3� CAST 4A rnPrd fJ ZD
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Q• 20 0
Signa ure 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.
The Commonwealth of Massachusetts•
Department of Industrial Accidents
> I Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Anulicant Information Please Print Legibly
Name (Business/Organization/Individual):BRA M0CCI CONS-rROCT1QKJ / RtCOARD 5RAMOCC1
Address: ri m-r• w4anlca an.
City/State/Zip: 0 AID L6-4 tAA 01035' Phone#: 913 • 221 39 42
Are ou an employer?Check the appropriate box: Type of project(required):
1.Z I am a employer with Z employees(full and/or part-time).' 7. New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 0 Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOf repairs
These sub-contractors have employees and have workers'comp.insurance?
6,❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: IlAaT Fo Ro umoeAwRiTERs t N S u(ZAtdCE
Policy#or Self-ins.Lic.#: lc S(0 009 - 1 k-10974 Expiration Date: ll• t t. - 2 o 2 0
Job Site Address: I S 5 u m N E 2 Ayre • City/State1Zip:F&.oe¢Nt E MA OI 0 b2
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$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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify and ains and penalties of perjury that the information provided above is true and correct.
Signature: L�2 Date: ► . 2
Phone#• 413- Z21 - a94L
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
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#:
City of Northampton
•�'' Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 'P
212 Main Street • Municipal Building
Northampton, MA 01060
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.If the homeowner has contracted with a corporation or LLC, that entity must he registered
Type of Work: R c N p Est.Cost: 6(o, va o .
Address of Work: iS surnNER. AM. Fc.oaWcE AAA gra 2.
Date of Permit Application: 4• i s • 20 20
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:
I hereby apply for a building permit as the agent of the owner:
4• is • ze2e 8,QgrnUCC I COrvsToe0C-r- r/ 15-04os
Date Contractor Namc HIC Registration No.
OR:
'Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
'1 [10 Ito
Date Owner Name and Signa e