13-082 (6) BP-2023-1583
89 MARIAN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
13-082-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1583 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 11000 PHILIP SHUMWAY 105743
Const.Class: Exp.Date: 01/14/2024
Use Group: Owner: GRAHAM MOGA STEVEN &LEIGH T
Lot Size (sq.ft.)
Zoning: RI/SR/WP Applicant: PHILIP SHUMWAY
Applicant Address Phone: insurance:
P O BOX 522 (413)687-9400
HADLEY, MA 01035
ISSUED ON: 11/09/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF SECTION
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:
• r.• y9 . c / •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
7 R
Th Commonwealth of Massachusetts
MA a 8 oard of Building Regulations and Standards FOR
e as husetts State Building Code, 780 CMR MUNICIPALITY
o USE
' 4u,i Per t Ap lication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
No O T"a'•n7o f 741AFCTIONs. One-or Two-Family Dwelling
- This Section For Official Use Only
Building Permit Number: -1--3•i5 f' Date Applied:
/Littio...)��5 _� n cl 2dz3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Prope, A res '�a c 1.2 Assessors Map&Parcel Numbers
J `
•
1.la Is this an accepted street?yes 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 ID _Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Northampton, MA 01060
Leigh Graham and Steven Moga City,State,ZIP
89 Marian Street 617-894-1855; leigh.t.graham@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other tt Specify:
Brief Description of Proposed Work2:
Replacement of roof section with 30 year architectural roof system.Ice and water shield.
synthetic felt.ridge vent and cap.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ kk\DGCN
1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: (JO n Check No. Check Amount: Cash Amount:
6.Total Project Cost: $
`\Way\ 0 Paid in Full 0 Outstanding Balance Due:
4.
City of Northampton
Massachusetts
a �
f DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building �VjwS b�
Northampton, MA 01060 ` aro
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new / replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 105743 01/2024
Shumway Services License Number Expiration Date
Name of CSL Holder
P.O Box 522 List CSL Type(see below) U
No.and Street Type Description
Hadley MA 01035 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M' Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-687-9400 shumwayservices@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
178390 04/2024
Shumway Services HE Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O Box 522 shumwayservices@gmail.com
No.and Street Email address
Hadley MA 01035 413-687-9400
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 .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 Shumway Services
to(act on my behalf,in all matters relative to work authorized by this building permit application.
Steven 7.Moga „_q_pg
Print Owner's Name(Electronic Sigilature 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 ' 's application is true and accurate to the best of my knowledge and understanding.
Print U n(r's or Authorized Agent's Name(Electronic Signature) D e
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"
CITY OF NORTHAMPTON
SE :ACK ' AN
MAP: OT:
LOT SIZ :
REAR LOT DIMENSI 6 :
AR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
3 Massachusetts �4, l�
:c
• yMllrf , DEPARTMENT OF BUILDING INSPECTIONS s. j '
212 Main Street • Municipal Building w� 1.
F` '� �': Northampton, MA 01060 f-44 g,j 0C
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: Amherst Trucking or Private Dump Truck to Valley Recycling
The debris will be transported by:
Name of Hauler: Amherst Trucking or Private Dump Truck to Valley Recycling
Signature of Applicant: Date: \., c'' A3
The Commonwealth of Massachusetts
h_=y l� Department of Industrial A ccidents
1 Congress Street, Suite 100
='= t'— Boston, MA 02114-2017
wwlw.�nnss.go►'/dia
1%urkers' ('ompensatlon Insurance Affidavit: Builders/ContractorsiEkctricianslPlumbers.
To BE FILED 11 ITH THE PERMITTING AI!THORJT1'.
Applicant Information Please Print Leeibls
Name(Business[Irgantzntton:Indtv'duall:
Philip Shumway Inc. DBA Shumway Services
Address:
P.O Box 522
Hadley MA 01035 413-687-9400
City/State/Zip: Phone :
Are pm ea employer?Cheek the appropriate box: Type of project(required):
1.® m lava with ._._X____ employees ifull andlor part-time s-• 7. ® New construction
2.0I am a ante proprietor ur partnership and hair..:no employees working fur me in S. r i Remodeling
Silly capacity_[No worsen'comp.uuunrnce required.) t._77
301 am a homeownerdoing all work myself.[No%odors'comp.immunise requi al)`
9. ❑ Demolition
u lain a homeowner and will be hiring contractors to conduct all work on my property. I will I U❑ Building addition
�—+ensure that all contractors either have wvrrkers'compensation insurance or ass sole I I a Electrical repairs or additions
prupneton with no employees.
12.0 Plumbing repairs or additions
Sin I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.3 Roof repairs
These sub-contractors have employees and have workers'carp.insurance.:
6.0 we are a corporation and its ufficen have exercised their nght of exemption per MGL c. 14. Other
IS,f 1(4),and we have no employees.[Nu workers'comp.insurance requited.]
•Any applicant that checks box al must also fill out the section below showing their workers'compensation policy infurnation-
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidav it indicating such.
=Contractors that check this box must attached an adtional sheer showing the name of die sib-contractors and state whether or nut those entities have
employees- If the sub-contractors have employees.they must pray idc their workers'oommp.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: Wesco
Policy#or Self-ins. Lie. #:_ WWC7569281 Expiration Date: 02/2023
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the paltry 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 tine 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
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above true d correct.
:;:
um. �� Data:r:: 413-687-9400
7
Official use only. Do not write in this area. to he completed h,l'city or town official
('it► or Town: Permit/License#
Issuing.\uthorit (circle one):
I. Board of Health 2. Building Department 3.Ckyfi'titannClerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#: