24D-155 BP-2021-2285
11 CARPENTER AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-155-001 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-2021-2285 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 10000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2022
Use Group: Owner: SHUMWAY PROPERTIES LLC
Lot Size (sq.ft.)
Zoning: URC Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON:12/14/2021
TO PERFORM THE FOLLO WING WORK:
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.
Signature: I Qs-,
.)I
• a >2 -
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Fees Paid: $40.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
I RECEIVED
�- I� DEC 1 0 2021
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The Co onweal - assachusetts r)FPT OF SU WING IN�P TIONS
NORTHAh4�TpN,�iTI
Board of Building egulations and Standards
1 I
MUNICI1'ALT1 Y
Massachusetts State Building Code, 780 CMR USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
n. This ection For Official Use Only
Builtui
Permit Number: 5d i A'vS Date Applied:
I� I Joss _ /L '12 i2-I3-zzzi
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Ad ress: 1.2 Assessors Map&Parcel Nunij
4Car -t-k-- � R yn 1
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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Rec rd:
2,40.t ,� �j� -,),,y5 i .L t-ACa 1 t- ei A IA -3
N e(Print) City,State,ZIP
cN ''' C)'' 413 6g colt'
and r t Telephone Email Address
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 Prop - ,I.„.
osed Work2: (( pit i' 0 2 Ct E—
5 r1/ J-C l l-)- '12 C t-► c i 1it
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
i 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ �(
Suppression) Total All fees: C
Check No.1u� Check Amount: qo
6.Total Project Cost: $ 0 a ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) a �� — -=—�P�
�U�(,✓Lt,S ccry� S License Number' Expiration Date
Nai.
of CSL Holdef , /
�ag?8/17List CSL Type(see below) �/No.and StY Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
a G�I C¶ R Restricted 1&2 Family Dwelling
City wn,State, IP M Masonry
RC Rooting Covering
WS Window and Siding
`��C� SF Solid Fuel Burning Appliances
'\` G$1 I Insulation
Telep on Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) A (A /7 S39? -, 4144,,
�� H1CRegisttation Number Expiration Date (/
HIC Company Name or IC Registrant Name
No.and Street Email address
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 0 No .0 (1/I -Pi_.,(
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 51,1,1,,,A(...,ct � "f if/L.( /
to act on my behalf,in all matters relative to work authorized by this building ldermit plication.
Print n r s Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information
contained in ' a ication is true and a curate to the best of my knowledge and understanding.
lcf?/ 1
Print Ow is o uthorized Agent's Name(Electronic Signature) ate
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"
City of Northampton
oµ, 0 \. 3In
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1Massachusetts ' - ''�
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4. , DEPARTMENT OF BUILDING INSPECTIONS
a.- * 4 212 Main Street • Municipal Building 0 .t
< 4t5G,21 Northampton, MA 01060 444% 3r-,)e
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:
I Location of Facility: A it- fed)-- T rk,L 1 _ ,
'A/
The debris will be transported by:
Name of Hauler: V (7 is C `, L i ',_
Signature of Applicant: Date: 1 v 0
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The Commonwealth of Afassaehusetts
AismArl,iam:e Department of Industrial,-lecidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
WWW.no/0540'1/4/1a
11 orkers Compensation Insurance Affidavit:Builders/ContraetorsiElectricions1Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
.4orilicant Information Please Print Legibly
Name(BUS mess'OrganizattotV Individual): 4 ,.6..6,14 vte...e i
Address: 0 Clek 5 A --• „....
c ityiState/Zi p: Phone #:
_ ..____ ... -
Art.' tnagibaytr?Clerk ruprialt bon:e th app irk
Type of project(required):
i. i ani II'employer nocifi \ ernpiltlytei Olin Indio/paivtiinel.• 7. 0 New construction
2[3 I ern a wit pruptictoe Of garncrship and have no trioyer..^a working tar woe iti h. ED Remodeling
any capacity_No*Awn,'camp.ineuntrun ictiolirtaq
9. 0 Demolition
10 i Alt 3 InniknArner doing all Auet sayaell.Nu unfit...an'cdeint.irtnararter requital.)•
i 0 0 Building addition
4.0 I am a hinnedwrer and will Ewe hiring onto:at:tura to cdnduct all Wunk.on my rupttrty. I will
'cumin:ilia all torraractiara either hate KY.116:0;CAJETSKti%vison inattramcie do ate Wit II I:3 Electrical repairs or additions
prOpnctins With CM eltIplWyttla,,
I 2.0 Pi ing repairs or additions
I am a gcnimal contractor;and I have hired the sath”contractor,listed Uri the annehtel thee. -
II RtiOt repairs
ilicse huh-cuiltnittOri,laii...0 chipluyihrs and have markers'COMP.inaurance.;
14.tj°thin
6.0 we Luc a conForatiun and ikv officer;hanatenertiand itseir rigbi of etcrrapanni peir hiGL c. -
1..S.2,§1(41,and wc han't nu empluyveit.[Nia wenkera'encem,inikurance required.J
*Any applicant'Nit&mks.hen n1 ulnat alai fig out the 1..e-ctaan beluav shoe.ins thee vi orkero:compensation pulley information,
t lidatienwner,who aiihicie dui'affidavit unbeattug they are anaug all Nkviic and then hire oatoade einttractuta nand aubinot a nev,atlidan it indicating awls,.
4:Emir:a:tors that chuck Ili,bui.must at tazhed lin 311419iional sheet%bowing thi.!namu of the aills•comnactor,and',taw whohce m nut dose...ntitics have
eatmluyec,. It the%uh-ci,ntrachin,hkivt.irinphoyise.i,die} MUM rim ILL:iiicir %4!Irk cr,'cortip pulk:y number
I am an employer that ii providing workers'compensation insurance for my employees. Belo W is the policy and job alit'
information.
Insurance Company Name: •,•,C, C 1) _____ /
Policy#or Self-ins.Lic.;: ,s./Lf' C. 3 5o qi4, Expiration Date:
Job Site Address: 4 (Cr( 1)-er a 4.A., I City/State/Zip: a to 6 g
Attach a copy oldie 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$1,500.00
and:Ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tint of up to 5250.00 a
day against the violator_A copy of this statement may be forwarded to the 01Iii:e of investigations of the DIA kir insurance
coverage verification.
Jibo hereby certify under tl • :win intil penalties iif perjury that the information provided above is tjue and correct
Signature: Date: I
Phone#:
Official sise only. Do not write in this area,to be completed by city or town offkittL
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#: