38B-115 . ;14"r.._. ..
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21.070,:„:0 � t, r • Ataosachnsctts R _t.• •
1: ' DEPARTMENT OP BUILDWG INSPECTIONS • = -; 1 1=
• 212' Main Street 'Municipal $wilding
Northampton, Mass. 01060
•
WORX ER'S COMPENSATION INSURANCE A.FITDA.VTT
I, ' 'ori>71,477,
i ,- • , ,
• aiccnscdpermiticc) .
with a principal place of business/residence at: . -t9
i 457 f ' i / S @iT ST(phone #) 5 f 5`Ye
(s r...1/ci ty /staichi p)
do hereby certify, under the pains and penalties of perjury, that:
•( ) T am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
6 e k,, , F'Ltt'f�a/ 1 i'mer
c ontractori am a sole proprietor, general contractor or homeowner (circle one) and have hired
s listed below • who have the following worker's compensation policies:
(Nome of Contractor) ( Insurancc Company/Policy Number) ( Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) • (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(.tech additioml abbcci if neccaary to iadaile informarioc peroloing to all ma: oe.on)
!� b et•i•F/c ( P2 i ` tie r
Y� I and a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aw zc dui v biro bomcowoers Hbo eccploy pasom to do v• •-,. coas7udioo•or rcpairwork on a dtivaiag of
not mono than throe waits is which the homoownct mac' ce oa the grew-ads aplxutcawi thereto arc Cot Cana 000sidacd to be
cmploycro under tbo wockcex oompcns iZon Act (G L152,ss 1 (5)). appliallien by a boascownis for a Gococc er permit may cvidcooc the
I ego.' rtatoa of as employer uodar tiw W ocicola Compomaiion Act
I uoekrsuisel tb,d a Dopy *Min eta cco.cd clay be forx■rdad to th. Deportment of loduattial Aecadea& Onloe of loon a raooe for te •
covrngavecifieatioa sad that ally= to secure covaaso trader some. 25A 00.101.15 as lad to the' imposition of aimmal • : i .
oomizaug of a • roe of up to S 1,560.00 wd'or imtxnoa�t of tip to one y r and civil penalties in tic form of a Stop Work Ocda and a . .
Ciao o(5100.00 *sky against me: •
• For &p ealedaltt+a only
Permit Number
_ i( ` !i� .' i' Maps Lat - -
s•; 7. . . of Li.. ' c ruiner • Div '
Massachusetts - Dclrartment of Public Safct■
Bu ird of Building Rc , u latinn. and Standards
Construction Supervisor License
License: CS 13908
Restricted to: 00
ALAN R SHUMWAY xr
625 EAST PLEASANT ST
AMHERST, MA 01002
Expiration: 6/14/2012
( <unmi..imu•r Tr #: 26556
r� T%ie 6cm,r4oruoea/ o l_flaaoacJuiaet5
Board of Building Regulations and Standards License or registration valid for individul use only
n � €4
K=_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
1 Registration: 103721 = O
Board of Building Regulations and Standards
Expiration: 7/9/2010 Tr# 271850 One Ashburton Place Rm 1301
` � Boston, Ma. 02108
Type: Partnership
ALAN R. SHUMWAY ROOFING
Alan Shumway
625 E. Pleasant St.
Amherst, MA 01002 Administrator Not valid without signature
Alan R Shumway Proposal
625 East Pleasant St
Amherst, MA 01002 DATE Proposal #
(413) 549 -4658 5/20/2010 591
NAME / ADDRESS
Christian Campe
15A Park Ave
Northampton, Ma. 01060
TERMS LOCATION
On completion 152 So St
DESCRIPTION TOTAL
Scope of work: Provide all labor, materials and equipment to strip and reroof
front porch
Strip existing roofing
Repair rotten roof boards
Install #15 Felt
Install new .019 alumn. drips, rakes and all other related flashings
Install Certainteed shingles 30 yr woodscape - Pewterwood ( black)
All debris generated from job to be removed by contractor
Price includes permit to city of Northampton
Total: 2,460.00
•
All materials are guaranteed as specified and installed as per .
industry standards. '; ,460.00
CONTRA TOR SIGNATURE
OWNER SIGNATURE
, 4
- -. r, �}x rt { tiSB oniy
City of Northampton ' ' '''''%f Po'rrrttt�,
��i Building Department i%Gutt /ti4rt�t .+ �,t
P
z 211 M S t r ee t tr /S; tf- �, 0 qty
`�� � 1 ' o m 100 P t 5 ; - 04AgOi � l .-i _
Nor ampton, MA 01060 ,, 0 � 0 � `
phone 413 587 1240 Fax 413.587-127 2 � -�°
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
1
a ��
�,' t jg%
Map
Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
l
Name (Print) Current Mailing Address:
7 l L`he /IV/13k / Telephone
Signature
2.2 Authorized Agent:
Name (Pnnt)� Current Mailing Address:
I Sign ure Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
I
completed by permit applicant
1. Budding (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
1 3. Plumbing Building Permit Fee
4 Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Y r.t", el/ Check Number 535 3
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date J
. ; sr ` : BP- 2010 -1096
GIS #: COMMONWEALTH OF MASSACHUSETTS
,. • ;10ck: 38B 115 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1096
Project # JS- 2010- 001613
Est. Cost: $2460.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SHUMWAY ROOFING 013908
Lot Size(sq. ft.): 17075.52 Owner: CAMPE CHRISTIAN & JOANNA
Zoning: URB(100)/ Applicant: SHUMWAY ROOFING
AT: 152 SOUTH ST
Applicant Address: Phone: Insurance:
625 EAST PLEASANT ST (413) 549 - 4658 0
AM H E RSTMA01002 ISSUED ON: 6/3/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE PORCH ROOF
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 Signature:
FeeType: Date Paid: Amount:
Building 6/3/2010 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo