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24a-241
58 TERRACE LN BP-2017-0666 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-241 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2017-0666 Project# JS-2017-001089 Est.Cost: $9195.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Group: PHILIP W SHUMWAY 105743 Lot Size(sq.ft.): 14941.08 Owner: SHAW ANDREW T&KARYN 0 zoning: URB(100)/ Applicant: PHILIP W SHUMWAY AT: 58 TERRACE LN Applicant Address: Phone: Insurance: P O BOX 522 (413) 687-9400 HADLEYMA01035 ISSUED ON:11/16/2016 0:00:00 TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE 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 11/16/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner e meatus@nit ii• NQS ► 4 - City of Northampton 2p 'ttp of Pempf ,� i =uilding Department orb CutiDrwetgarPmrd e `, 212 Main Street .A t vailsity r �- w' �- Room 700 WagN+ell Avaflabflit�y Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Pia i,. Other Sp.d r` ,_- APPLICATION TO CONSTRUCT,ALTER, RgEP/AAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION C7Y- / 7 �`� 1.1 Property This section to be completed by office it 'JT<(fCC / Gam Map Lot Unit Zone Overlay District Elm St.Distrlpt CB District -,,,,_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 _ n15 S1,1"' P lC� Name(P nq Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 11t.nLig.? 5Qrkts Name(�) t Current Mairng Adddrress: t 6/(J�l q Lit)r; Signature Telephone SECTION 3•ESTIMATED CONSTRUCTION COSTA Item Estimated Cost(Dollars)to be Olficiat Use Only completed by permit applicant 1. Building 1 I q (a)Budding Permit Fee 2. Electrical i I 5 (b)Estimated Total Cost of Construction from(61 _ 3. Plumbing Building Permit Fee — 4. Mechanical(HVAC) 5.Fire Protection i 6. Total=(i +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: //�' �- _ Signatures /f/ •f/ /� Buil•mg Commissioner/Inspector `// /v.1 of buildings Date 5lwtvtu tt1S vIet5j-) 5snn + Lent/, Shumway Services. Mass CSL#105743 General Contractor#22659 Shumway Services 27 Huntington Rd Hadley,MA 01035 (413) 687-9400 TO: Andy Shaw 58 Terrace Lane Northampton, Ma Proposal (10/15/2016) Description Shumway Services will perform services as follows to the main house roof. • Removal of existing shingles • Installation of new metal rakes and drip edge • Install of new pipe boots and flushings(commercial vent hoods excluded) • Application of synthetic underlayment(palisades) • Installation of Ice Bather on eaves and valleys • Installation of CertainTeed 30 year architectural shingles (color to be determined by Homeowner) • Installation of hip and ridge cap • All debris recycled or taken to Amherst or Valley Transfer Station • Magnetic sweeping to clear any nail debris • This estimate is proceeding under expected conditions, Variable unforeseen items are additional cost to homeowner. Includes: • 5 Year written guarantee of workmanship from Shumway Services • Limited Lifetime Warranty from CertainTeed Terms • Total of$9,195.00 in 3 payments due to Shumway Services • Three payments due consist of$3,065.00 deposit, $3,065 upon first day of work and 3,065.00 upon completion of work within 7 seven days • Shumway Services will charge$50.00 late fee plus 1.5% monthly interest for outstanding balances. • Shumway Services reserves the right to stop work if payment schedule is not followed. Contractor Signature: Date: r Homeowner: A , __. . ,; ►�'1/44„,JV Date: j( t\Q. S Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ._. _._.. _. .. Frontage .._ .. . Setbacks Front Side L: It L: . . R: Rear Building Height Bldg.Square Footage Open Space Footage / (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION Si.DESCRIPTION OF PROPOSED WORK(check all applicable) / New House n Addition ❑ Replacement Windows Alteration(s) n Roofing I..J Or Doors C Accessory Bldg. ❑ Demolition ❑ New Signs (C} Decks [q Siding[Cij Other(fl Brief Descriptir of Proposed t' Work: QH0.c.ar . . Jn. t) .i✓ Lk' 11 1 411 i ' Alteration of existing bedroom Ye. No Adding new oedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing, complete the following: a. Use of building:One Family _ Two Family Other b. Number f rooms in each family unit; Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction, i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,as Owner of the subject PrOPeny hereby authorize _ to act on my behal all matters lative to work authorized by this building permit application. Signature of Owner Date ('‘' ` A. )„�M'i,t / ,as Owner/Authorized Agent hereby ceclare that the sta mens and infohpation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Punt Name p/�//� (/�/( ' )19 4 / �-- .. Signature MOwne gent ... Date SECTION S.CONSTRUCTION SERVICES / a;/ "?‘-73 8.1 Licensed Construction Supervisor ) Not Applicable CI Name of License Holder; P4 ) 1o�' )(1 U/hL/"r ) i t;� 7Li 3 �7 license b>' 'II 4 .� A..... d e1 f / )Q Address Expiration Date Sign.fee cTelephone S.Re%istered Horne lmprvw¢ment Contractor, Not Applicable J �� I S Company Name Registration Number : 2/2 ' Address Expiration Daiihi t Telephone SECTION 10-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 11. -Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1$8.3.5.1. Definition of Homeowner:Person(s)who own a parcel of and on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling.attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one Immo in a two-veer period shall net be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall he res,, sible I rat such work .erformed under the buil.in. i ermit. As acting Construction Supervisor your presence on f he.ioh site will be required from time to time,during and upon completion oldie work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under ibis permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 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. Address of the work: J /7iy Q / c--, The debris will be transported by: The debris will be received by: AriLtt5 , n( Vel 4r5A , h Building permit number: Name of Permit Applicant Ph,) 5 k✓nvu y Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents l _-, — t �6 Office of Investigations � Y " I Congress Street, Suite 100 Boston, MA 02114-2017 -taw, www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: I.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees (MI and/or part-time).* have hired the sub-contractors 6. IE New construction 2.❑ I am a sole proprietor or listed on the attached sheet. 7. El Remodeling partner- shipand have no employees These sub-contractors have $ ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance c . insurance.[ 9. El Building addition required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ tubing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t e. 152, §1(4),and we have no 12. Roof repairs employees. [No workers' 13.0 Other _ comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.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: Policy#or Self-ins. Lic.#: _ Expiration Date: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify and, the pains and penalties of perjury that the information provided above is true and correct Si mature: / Date: 1 7 9 / ib _ Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: