23B-099 185 LOCUST ST BP-2017-1214
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-099 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-2017-1214
Project# JS-2017-002044
Est.Cost $10580.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PHILIP W SHUMWAY 105743
Lot siae(sq. ft.): 22041.36 Owner: LORENZO DANIELLE
Zoning: SI(I001/ Applicant PHILIP W SHUMWAY
AT: 185 LOCUST ST
Applicant Address: Phone: Insurance:
P O BOX 522 (413) 687-9400
HAD LEYMA01035 ISSUED ON:4/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE SHINGLES AND SKYLIGHT, INSTALL
NEW SHINGLES
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 4/2520170:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1214
APPLICANT/CONTACT PERSON PHILIP W SHUMWAY
ADDRESS/PHONE P O BOX 522 HADLEY (413)587-9400
PROPERTY LOCATION 185 LOCUST ST
MAP 23B PARCEL 099 001 ZONE SI(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ThittLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Pai , f(_
tb
Building Permit Filled out try
Fee Paid
Typeof Construction: REMOVE SHINGL ANDLIGHT, INSTALL.NEW SHINGLES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105743
3 sets of Plans'Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:*
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit,,. Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
�,,rl n �- ay
Si e of Bui ditto; icial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
l pa 2 4
Version) 7 Commercial Bui!din- Permit Ma 15,2000
Departme useen 1Aocu --
City of Northampton Status of Permit:
ry02'HA'+iP
Building Department Curb Cut/Driveway Permit - -
212 Main Street Sewer/Septic Awilabitty
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Savchual Plans
phone 413-587-1240 Fax 413-587-1272 Ptot(Site Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address
` d M: This section to be completed b office
(J5" Lotti y /)- C� Map Q� Lot 09 Unit
Zone Overlay District
410 r+in—a no ita t.1 t trYI4- v1pc. d
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
4.
DcNie((e Cnre,Zo is ,4-4-I! er- Ail-Q t Socc-l-lia,...pitnrA+f1-
Name(Print) nn Current Mailing Address:
signature �, 0 f / ' r r Telephone Y(3- rz 7- 3 73.t(
2.2 Authori ed Aoent:
nawa 5Cld ?'7 Inv/7d/,� 1L F
5kotni?) es
Name(Print) Current Mailing Address:
L 117 677tiN ao
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection 0 $/�
6. Total=(1 +2+ 3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/ I, DQ Kid I.e Lorent O ,as Owner of the subject property
hereby authorize $kV N Nir{`l 5 u 11 i' c to
act on my
behalf, in all matters relative towoaeerk authorized by this building permit application.
I
Sign ure 2tof Owner 6 � r ,Date
A I, '4 wCQC(6 L4 re rat) ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
9ccnceLIc L-oC,P/IZo
Print Name
4/rl /!7
S ature of Ovr gent Date
SECTION 12-CONSTRUCTION SERVIC
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: CL 1Dhv2
P S� 7 � w 3
License
/Dh7 1--11/na-1 sMo‘ r 1-142Itptii 4(a95 a1/19
Address Expiration Date
L1 (7ayj0
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affldavi ust be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the bui ng permit.
Signed Affidavit Attached Yes No O
Shumway Services. Mass CSL#105743 General Contractor#22659
Shumway Services
27 Huntington Rd
Hadley,MA 01035
(413)687-9400
TO: Florence Animal Clinic
185 Locust Street
Northampton, MA 01060
Proposal (2/2/2017)
Description
Shumway Services will perform services as follows to all existing roof areas
• Removal of existing shingles and low slope roof
• Removal of skylight
• Installation of new metal rakes and drip edge
• Application of Palisades synthetic underlayment(Shingle section only)
• Installation of Ice Barrier on eaves and valleys
• All existing vent hoods will remain untouched
• Installation of new pipe boot Flashings
• Installation of Ice Bather on flat roof section
• Installation of CertainTeed 30 year architectural shingles on main roof(color to be determined by Property
owner)
• Installation of hip and ridge cap
• Install of ice and water shield rolled roof base on low slope section
• Installation of Tarco rolled roofing on low slope section(Black in color)
• All debris recycled or taken to Amherst Transfer Station
• Magnetic sweeping will be utilized to clear any nail debris
• This estimate is proceeding under expected conditions.Variable unforeseen items are additional cost to
Property owner.
Includes:
• 5 Year written guarantee of workmanship from Shumway Services
• Limited lifetime warranty from CcrtainTeed on CeratinTeed shingle area
Terms
• Total of$10,580.00 in 3 payments due to Shumway Services
• Three payments due consist of S5,000.00 deposit,$1790.00 on first day of work and 2.790.00 upon completion
of work within 7 seven days
• Shumway Services will charge 550.00 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: /J Date:
Property owner: Ow'Se G{eZ.P�/L�,i Date: 4/1,/i,
r'
From:Philip S humway Far_1aAa1 sI 0-0588 To: Fa:: 1415,557-1572 Pagu 2 o1304t25/B,e 17 11:51 AM
The Commonwealth of Massachusetts
Department of Industrial Accidents
ie-}�'� Office of Investigations
z1(1A 1 Congress Street,Suite 100
Boston,MA 02114-2 01 7
www.nta.ss.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name lBusiness:OrganizatioNlndividuap: vl Li"Ek Lin 5e te/te. 5 _
—'
Address: t �VAZ
City/State/Zi u L I E rn Phone it: L uz el.o _......
Arc you an employer? Check the appropriate box: Type of project(required):
1. lain a employer with 4. ❑ 1 am a genNtal contractor and 1
rmpJop (full aedfor)+rraiitnc).' have hired the sub-contractors 6. ( New mnr.mcuun
3,0 1 am a sole proprietor or partner-
These
on the attached sheet 7. j Remodeling
ship and have no employees These soh connectors have g- 9 Demolition
employees and have workers'
/. 5 Building addition
working for me in any capacity. c
[No workers' comp.insurance c .inmt:mce=
required.] 5. We are a corporation and its 10.0 Electrical repairs oraddhions
officers have exercised their I I.5 PI ping repairs or additions
3.5 1 am a homeowner doing all work
myself. [No workers' cont right of exemption per MGL
> (I p- 12.2 Roof repairs
insurance required.] c. 152,e 1(4),and we have no
employees. (No workers' 13. Other
comp.insurance required_]
',Any appneant that tlmeksbox#1 must also till out the section balmy shwrvn5lhelr workers'compensation policy inrprmotiml_
t lonissowners who i' this al d` ngthey am dmig all work and Ibe,hire n I£deeun suhima new affidavitindicating such.
:Contactors Thal check this box mist attacked an additional vheei showing the mine of the subcontractors and slate whetleror nor thew entities have
cmpiayocx IS tic soh-uonnacwrs hew uuployocs,Ilmo most pNvidc tcmr xor'ecrc'comp.policy Brinker
I an,an employer that is providing workers'compensation insurance fsr my employees. Below is the poficyandjob site
information.
Insurance Company Name:
Policy or Self-ins. Lie.#: _ Expiration Dale,
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 ofMGl..e. 152 can lead to the imposition of criminal penalties of a
tine up to St 500 00 and:orone-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Invcslieetionss of the WA for insurance coverage verification.
I o hereby certifyunder the ins and penalties o perjury that the informationprovided above is true correct
v Ivl y f t and
Simetu
- -' - Date: � _,;15,/ 1
Plume tr'
Official use only. Do not write in this area,to be completed hr city or town official.
City or Town: _ _Permit/Licenseit _
Issuing Authority(circle one):
I, Board of Health 2.Building Department 3.City/down Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other _ ....
Contact Person: Phone n:
Flom:Philip shumxay Fa<.188M 510-0388 To: Far: 1413,587-1272 Page 3 of 3 041251201711:3'1 AM
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: g5- intu5 ti .-)d
The debris will be transported by: 51,,vr,w,1S pr,u,..
Je I rc-cP12
The debris will be received by: LPA I¢7 (l 4-ra f(-Cr �, alart
Building permit number:
Name of Permit Applicant 5i vr-i t✓K/ $ i cC;
Date Sig ature of Permit Applicant