43-063 (9) BP-2024-0773
40 DUNPHY DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-063-001 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-2024-0773 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 7000 PHILIP SHUMWAY 105743
Const.Class: Exp.Date: 01/14/2025
Use Group: Owner: MCELROY PATRICIA L
Lot Size (sq.ft.)
Zoning: WSP Applicant: PHILIP SHUM WAY
Applicant Address Phone: Insurance:
P O BOX 522 (413)687-9400
FIADLEY, MA 01035
ISSUED ON: 06/14/2024
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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: 6/2.
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massa uset . �i V
Board of Building Regulations a • Sta. ��
a OR
W
Massachusetts State Building C.de, 7*T CMR / UN USE IPALITY
Building Permit Application To Construct,Repair, ' - ti it Demolish a Re sed Mar 2011
One- or Two-Family Dwelling yq' ,./0"1:bvs.,
` This Section For Official Use Only ' O7°619"
ft
Building Permit Number: (/ )h � /3 Date Applied:
/1CUIv (2,5 1//2 C: Iw 2o2y
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 PropeertyjAdd rek:, 1.2 Assessors Map&Parcel Numbers
1.1 a 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 0 Zone: Outside Flood Zone?
_ Municipal 0 On site disposal system 0
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
tt‘
Name Pri t) City,State,ZIP
0� I
No.and Street i velephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) li Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': .
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 $ '# 70,el) 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier_ _ x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All FeeQ W(Check No.(WDb Check Amount: ! - Cash Amount:
6. Total Project Cost: $
-7 orq ❑Paid in Full 0 Outstanding Balance Due:
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.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
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 HIC 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 El 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.
‘ q
Print Owner's Nam Electronic Signature) D e
SE ION 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.
014r \ 5LAfhttt 4o /III ti
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"
_� The Commonwealth of Massachusetts
1*_- Department ofIndustrial Accidents
= 1 Congress Street,Suite 100
•` : : ' Boston,MA 02114-2017
1%1-4' wow mass.gov/dia
% orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE fll.t:D WITH'fHE I't:RMl7Tl4G AIITHORlT1'.
Applicant Information Please Print Legibly
Name(l3usituss[hgatttzautm Individual):
Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
Hadley MA 01035 413-687-9400
City/State/Zip: Phone#:
krt.)nu an employer?Cheek the appngrriate hot: Type of project(required):
I g I am a employer with X employees(full and'ur pat-tire)-' 7. ®New construction
20 1 am a sole proprietor of partnership and have nu etuployem winking for me in $. ®Remodeling
any capacity.[Nu v.otkers'comp.utsurme remnred_I
9. p Demolition
.1C1 I am a humans doing all Hint myself.[No wtrkas comp,'romance Requited.]'
10 O Building addition
4.0 I am a homeowner and will be hiring onntrataun to conduct all work on my property. I will
acute that all amt[ra--tots citbet knee workers'compensator nrutance or arc!wit: I I.p Electrical repairs or additions
prupnetcros w ith no crnploytat.
12.0 Plumbing repairs or additions
50 I am a gan-raI contractor and I Isere hired the sub-cunttactuu listed on the attached sheet. 13.13 Roof repairs
These sub-contractors have employees and hate waiters'coup.insurance.;
6.0 We are a corporation
and its officers have Criticised theirright of exemption per MCI\. 14.nOther
152,*It41.and we hate no eviployeesr.[No winters'comp.insurance required.]
*Any applicant that chucks boa#1 must also fill out the section below showing their waiters'compensation policy infotnation-
*Ikaneowners who subin t this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tfontracturs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hate
employees. II"rb:.ub-cun[ractcas lase employees.they must ptuv idc their workers'tang,.tx,li:t aunt..
I ant an employer that is providing workers'compensation insurance Or my employees. Below is the policy and Job site
information.
Insurance Company Name: Wesco
Policy#or Self-ins.Lie.#: WWC756928 I Expiration Date: 02/2023
Job Site Address: City/State/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 MGL c. 152,§25A is a criminal violation punishable by a tine up to S1.500.0(1
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 under the pains and penalties of perjury that the information provided above is t e and correct
Signature: 7 �Q2 lA-GC'P'tZ Date: �p "y t `/
Phone#: 413-687-9400 //
Official use only. Do not write in this urea. to be completed by city or town official
City or Toss n: Permit/License#
Issuing Authority(circle one):
1. Board of(Health 2.Building Department 3.COI-town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone 0:
_ _ __ City of Northampton
°a '4 °+ SAS S,�
Massachusetts Af '
`z -
•. (` i DEPARTMENT OF BUILDING INSPECTIONS
\; 4' 212 Main Street • Municipal Building yJti CDC
Northampton, MA 01060 f�W..3+��^`S
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: VI