32A-078 (7) SGRAVESAVE BP-2019-0211
GIs#: COMMONWEALTH OF MASSACHUSETTS
May:Block: 32A-078 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: BuildinD DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categom REPAIR BUILDING PERMIT
Permit# BP-2019-0211
Project# JS-2019-000347
Est Cost: $4000.00
Fee $100.0 PERMISSION IS HEREBY GRANTED TO:
Const.class: Contractor: License:
Use Group: PHILIP W SHUMWAY 105743
Lot Size(sp ft Y Owner: HAMPSHIRE PROPERTY MANAGEMENT
Zoning: URC(100)/ Applicant. PHILIP W SHUMWAY
AT: 8 GRAVES AVE
Applicant Address: Phone: Insurance:
P O BOX 522 (413) 687-9400
HADLEYMA01035 ISSUED ON.8/1712018 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE DECKING, INCREASE SUPPORTS,
INCREASE DECK AREA
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 Occuoancv Signature:
FeeTvoe: Date Paid: Amount:
Building 8/17/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
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2018 CI of Northampton
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PION Sloepartmet
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12 in Stree
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�. Northampton, MA 01080
phone 413-587-1240 Fax 413-587-1272 -
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Progeny Addrese: ( r/ This section In beCoomplet�eQd by office
map,�� Let_0 -2r J` lnit
1 '1'yC 444b1 '-Lo, ZotW Ottertay District
am St.Dlslrtot CB DNMat
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT'
2.1 Or nisr of Record:
Name{ rt) Current.mail Address
"��
Telephone
sgneture
2.2 Authorized Agent
Name(Pool) Current Mailing Addl
Signature Telephone
SECTION S-ESTIMATED CONSTRUCTION CASTS
Item Estimated Cost(Drill to be, Offx$l Use Only
Complain, bypeomillapplicant
1. Budding ` (a)Building Permit Fee
2. Electrical { (b)Estimated Total Cost of
Construction from fi
3. Plumbing Building Permit Fee
4, Mechanical(HVAC)
5.Fire Protection
6. Total= 1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit undo Dete
Issusd.
S nature:
._�
Building Cm lon.ninclrectorof Buildings Oate
�UNtCANA SRrvlUSCo Mq,'I oi" -
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
LN 40
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DESCRIPTIONSECTION 6- PROPOSED
New House ❑ Addition ❑ Replacement Windows Anerallonhi) - Floating
or Doors
Accessory Bldg..❑ Demolition ❑ New Signs (0] Decks jbf Slding0l OthertCU
Brief Desertryary,of Propaeed
wok fr.11L ' n G�PaSi +-Il Pr;r]L.r �rr�tnl� .lock F/<n
Attached ofexisting bedroom_Yes;No Adding new bedroom
_Yee __No
Plans Attached
Rhed Flo Renovaling unfinished hassnient ;_Yes No
Piens Agaohea RPII Sheaf
Beo If NeW fi6l�e;S f�0ab5'6tfd(�}oliyfor�icY9fYHa+�ISYiuBlpl`$.Ltlif"nlet�tol�u"I�MnFi:.
a. Uae of building One Family _ Two Femlly Clher
b Number of rooms in each family Poll; Number of Bathrooms
c is there a garage attached?'
d. Proposed Square footage of new construction. Dimensions
e. Numberofstories?
I, Method of heating? Fireplaces or Woodstovee Number of each._
g. Energy Conservation Compliance, Masschack Energy Compliance form attached?
h Type.of conetnlatiall
I, Is consmidlon within 100 fl.of wetlands?—Yea_No. Is construction within 100 yrfloodpleln_Yes_No
J. Depth of basement or cellar floor below finished Wade
K Will building wnfomr lothe Building and Zoning regulators? __Yes No
I. Septic Tank_ Clty Sewer_ -PrNafswell.Cltywater Supply.
SECTION 7a OWNER AUTHORIZATION-TO BE COMPLETED WHEN
/i OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner ofthe subject
Mope
honor euthorize. ,,,,
toe o y behalf,m all kere relagv lowark eu 6. ihisbulltling permit epptimtloh.
I 44A
OwneNAUlhodzad
Agent hareb declare that ma'ssumoaeots one Intormatian on to foregoing application are We and aowreta,WNe heal of my lmnMedge
mni belief...
Signed under t¢epprIT penalties Of pe
POM Name
Sknalem of Oxner/Apmt Date
1
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction—Clyisor: Not Applicable 71
Name of License Holder
License Numbei�-
00 acX 5',1a k]a _ 14� ,�� 1 anon
Adm Expiration Date
0�— L-I ) 3 IZZa(-(an
Signatur Teleph n
9 Repiii Ngamo ft roVament Contol lor. Not Applicable ❑
Company Name Re is fion Number
L
Address Expiration ate
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
Workers Compensation Insurance alf civil 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...... ❑
I.SHUMWAY
ERVICES �� ' ' � aT
„ 'or All Your Property Maintenance Neads
Mailing Address: DATE OF QUOTE:JUNE 4,2019
PO Box 522
Hadley MA 01035 -
TQ ATTN:Sabrica-IIPMG
Grave Arcs Rear deck
15 Graves Ave
Northampton MA
Please find pricing for your requested service.
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North side decking repair project Numbers are an estimate,unforeseen circumstances are extra. .
Customer pays for any Permit fees
• 3 Ree first floor decks #8,16&20
• Decks done from start to finish and inspected by IIPMG before start of next project Estimated
• Decks will be expanded to approximately naice the size stretching to the back wall price of
• New footings will be installed $ r ni OU
Peeru t
• Deck support framed out of PT wood Total$
• Deck to be covered with nex decking,with low visibility screws, 13,800.00
• White vinyl railing system installed '..
• Any support of framing work done to second story deck system will be additional at$60.00/ man
hour
• Concrete work done on end unit by exit to be bill with estimated 48 in.hours
@60.00/ he I''�'�
Terms: t Oc
• Payment schedule due as follows:deposit of$2,000.00 per deck, and final payment of balance due within 7 days of
job completion date.
• If payment schedule is not followed,Shumway Services reserves the right to atop work uutll payment(s) ate received.
• Shumway Services will charge$50.00 monthly late fee plus 1.5%monthly interest for outstanding balances.
• This estimate is for proceeding under known conditions. At, unforeseen items are additional charge to Homeowner
and will be COtt s},nicated upon findings.
I-lomeon
wee Sign )
Date
i
1
�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
*Wmrkers'
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Compensation Insurance AtTidavf :Builders/Contractors/Electricions/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leasibly
Name(Business/Org(aanixationMndividuap: PM 1,,i NVQ(_
Ip
Address: LA7'—
City/State/Zip: Phone#: k''
Are you an employer?Check the apprp riate box: Type of project(required):
I.E]Iamaemployerwith__emplo,rzes(mllandmrpan-time`." 7. ❑New construction
2.❑Iamasolcpropriemrorpanneod,and M1xveno employees working far ricin g, ❑Remodeling
any capacity.[No workerseomp.issuance required.]
3❑1 am a homeowner,dui all wink myself No workers'can - d 9. ❑Demolition
ng yse [ p.inwrence require I'
4.1:1 1 am a hlam aces and will be hiring recharges to cumber all work on my property. twin 10❑Building addition
ensure that all contractors tither over workerscompensation insurance or arc sole II.❑Electrical repairs or additions
propriamrs with our employces. 12.E]Plumbing repairs or additions
5 I agcnarvl wnvacmr and l have hircdmo sub-wnvamms listed on a,,attached shoot.
[s[sub-comracgrshav,employces and hove workers camp inaumne: 13.ItLr'y�ll.Roofrcp1airs
weareacotpmmanand iu officershave exercised thclrright of exemption p[rMGL e. 14.1F.10[her&00 fjjjr
152,&10),and we haven employees.[No workers'wrap.instrance required)
•Any applicant that checks box 41 must also fill out the section below showing noir workers'mmpe ration policy Information.
Bmers
oeownwho submit this and evit indicating they are doing all work and then hire rune&conformists most submit a new affidavit indicating such.
:Cmarecme,that check mis box most attached an additional sheer showing the name of the sub-contractors and slate whether or not these entities have
employees if themb-eentracma have employees,they must provide Heir x arkers lamp.pcliry 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:
Policy#or Self-ins.Lie.#: _ Expiration Date:
Job Site Address: Cuy/Stete/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 bIGL a 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 farm 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.
1 do hereby certify under the pains andpenalties of perjury that the information provided abooJve/rs and corzec4
Si N Date // N 1�
Ph #
Official use only. IM 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 N:
City of Northampton
Massachusetts
( 4
L
t DEPBBTMENT OF BUILDING INSPECTZONS
212 rain Street •xwiripal Building C�
xartnampton, erP 01060 s yji
Debris Disposal Affidavit
In accordance of the provisions of MGL c40, 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:
1 < h . Uc1 —
(Pleas print house number and street name)
Is to be disposed of at:
yaa1, , lea,cfc�nk's
(PI ase print amease print an�of facility)facility)
Or it be disposed of in a dumpster onsite rented or leased from:
a
CName
M Le0.���I VK, �
Company Na a and Address)
7Igl g
Signaturulf
Pdr6t 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.
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