29-507 (3) BP-2024-1466
38 MATTHEW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-507-001 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-I466 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est.Cost: 6800 SHUMWAY SERVICES 105743
Const.Class: Exp.Date: 01/14/2025
Use Group: Owner: SOK ER CHANBONA &KIMCHOU
Lot Size (sq.ft.)
Zoning: WSP Applicant: SHUM WAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658 0 WWC7569281
HADLEY, MA 01035
ISSUED ON: 11/01/2024
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 Drivetiway Final: 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.
Signature: 4°./7
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
art
The Commonwealth of Mass thus tts 3 1 2024
Board of Building Regulations a d St dards FOR
*+U i Massachusetts State Building Co e, NoRrH ttnrNG rNSp ICIPALITYSE
a rr
Building Permit Application To Construct,Repair,Reno r Mht �Ns R vised Mar 2011
One-or Two-Family Dwelling
This Section/ For Official Use Only
Building Permit Number: �19'AO�- 1'10 0 Date Applied:
`� /jt
Building Official(Print Name) Si ture Dat
SECTION 1:SITE INFORMATION
1.1 Iriperty- ddres L� �`� � 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❑ —Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'ncr'of RGcor11: .\ FlerfAA
/t°1
Name(Print) City,State,ZIP
CA-ct4Att L/' °r- Oet wfriorr_A44,444,04,4,
No.and S reef Telephone Email AdoWEis
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 0 Specify:
Brief Description of Proposed Work':
Replacement of roofseetion 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 $ 6I 00 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 Fees:
Check No.,O I Check Amount: Cash Amount:
6.Total Project Cost: S F ,0 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 105743 01/2026
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 04P026.
Shumway Services
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
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........... ❑
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.
fc L C.41 �� 7 a
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION r
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this a lication is true and accurate to the best of my knowledge and understanding.
Print O er's or uthorized Agent's Name(Electronic Signature) VAt
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 he found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov"dns
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
YHAM
?�. -ti S•S•...7.sic,
�'' Massachusetts 44'. ,<.
;4 '.I • DEPARTMENT OF BUILDING INSPECTIONS It ;;
y
s - I`' 212 Main Street is Municipal Building J6•.,• a
��il Northampton, MA 01060 � iY..ii;j`1C
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: erst -ivate Dump Truck to Valley Recycling
The debris will be transported by: )
L' �v/1 `1
Name of Hauler: or Private Dump Truck to Valley Recycling
Signature of Applicant: 2
Date: "--)
The Commonwealth of Massachusetts
• Department of Industrial Accidents
_ _ I Congress Street,Suite 100
t. �„ 1— Boston.MA 02114-2017
www:nnass.gov/dia
ma 11 kcr.' Compensation Insurance Affidavit:BuilderJContractorslEkctricians/Pluinhers.
TO BE FILED%%1 fH 111E PERMITiIEG AtlTHORITV.
.Anl►licant Information Please Print Legihh
blame I Business Organization Indt%idual►:_
Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
City/State/Zip: Hadley MA 01035 phone#: 413-687-9400
Are)N an enmpkwer!('peek the appropriate(hot:
"I'y err of project(required):
®I am a employer with X enipioyecs i full molar pat-limit-' 7- ®New construction
2 LJ I am a sole morns-tor ut purtncidup and have no employees working for me in 8. [2g Remodeling
any capacity.(No workers'comp.insurance requited] v
y. Demolition
tfij I am a&maxim,nu doing,all work myself.(No worker: comp.irtaura ee requited.]'
it]I am a}utmeuwnti,a nt nd will be hiring aira.lors to conduct till work on my property. I will 10 O Building addition
ensure that all contractors either have workers'compensation insurance or an sole I I.0 Electrical repairs or additions
pniprietoas with no employees.
12.0 Plumbing repairs or additions
t^I am a general contractor and I have hired the sub{oinuaetors listed on the attached sheet 13®Roof repairs
l J Thew sub-contractors tease employees and have workers'comp.mn.utanec.
6.0 We are a commotion and its officer.have eneteised their ngh t of exemption per Alt,l 4. 1 3.( t)thty
152. 1i41.and we have no smplo}ees.[No workers'comp.insurance requited.[
'Any applicant that dtecks bus nl must also till out the section below showing their winters'compensation policy information.
t Ikiowowners who submit thus affidavit indicating thc-y are doing all woik and then hire outside contractors must submit a new atYidav it indicating such.
:Contractors that cheek this hot must attaclwd an additional sheet show ing the name of the sut*coanr-acturs and state w huthcr or not those unities lave
cmpluyc,: lithe,ub-r.,ntr.,et.os lu,.cnq,losces.they inu,t ern v ikr their workers'comp 1 .Itev number.
/am tin employer that is providing workers'compensation insurance for my employees. Below is the police'and job site
information.
Insurance Company Name:Wesco _
Policy#or Self-ins.Lie.#:_ WWC7569281 Expiration Date: 02/202r
Job Site Address: CityState'Zip:
Attach a cope of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 15?.*25A is a criminal violation punishable by a tine up to SI.500.00
anti+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 infTrmatlni provided^ correct abase is Ira and
Sibnaturc: �Q�L �L Date: 1n/a- 1
Phone g: 413-687-9400 l
Official use only. Do not write in this area.to be completed by city or lawn ofcial
City or Tossn: Permit/License b
Issuing.tuthorits (circle one):
I. Board of Health 2. Building Department 3.('it%/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
• multi static] ,try,.
• �Mani eed Landmark or I kO th nas
•
• �.'
•
• \i" deh:r.}lauied away to itpptopnate wa
k+erprnc to clear nail debris -
I tit`est,-torte t,proceeding under expected conditions
u . . 1
•
• \less tree rooting equipment used to catch debris for a dean iohstte
Near oilikmanshtp guarantee from Shumwas Sox ices
Limited 1-itclime Warrant) from('ertatnteed or IKO
. . - Shumway Sen.ices Plus an% extra,
2 pax ments due consist of S2.500.00 deposit. and balance upon completion of wo
If more than 2 : u o „r' •
Sh u m wa s serx• •
• Price to s a lad for 7 da