24A-120 (7) BP-2022-0652
34 CALVIN TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-120-001 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-2022-0652 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 3000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2024
Use Group: Owner: TRUSTEES STULTZ RICHARD S &JOANNE
Lot Size (sq.ft.)
Zoning: URA Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON:06/07/2022
TO PERFORM THE FOLLOWING WORK:
REPLACEMENT OF ROOF SECTION
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 Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 3)Acia
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
The Commonwealth of Massaehit ettc II t
Q,...,)
Board of Building Regulations and S tndar s JUN - 7 2022 Ml'Ntt.'1 Al.0
Massachusetts State Building Code, 7 0 C R 11.
.2611
Building Permit Application"I o Construct,Repair, I t'ntt 4 F INC INSPECTIONS
rfi
One-or Two-Family Dwellin' N' TMAM,TON,MA Ot
This Section For Official Use Only
Building emit Number: &O' .2)-0 c).- i Date Applied:
1 !SIN l�� � L 7-za?Z
�.._ rite
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION ,
1.1 'ro erty Ad ress t _ T 1.2 Assessors Map& Parcel Numbers U
v II ,�f &4/i9 12 .
l.1• Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Timing District Proposed Use (.cat Area(sq ti) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard' Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.t,c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private tone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check ifyesO
SECTION 2: PROPERTY OWNERSHIP'
?tuitz` evoca `titling Trust Northampton, MA 01060
Name(Print) City.State,ZIP
34 Calvin Ter 650-804-8345 rick@zone425.com
No.and Street Telephone l::mail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Cl Owner-Occupied 0 Re•pairs(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 roof section with 30 year architect. rat roof system,ice and water shield.
synthetic felt.ridge vcnt_and cap.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official UseOnly
(Labor and Materials)-
1.Building S I. Building Permit Fee:S Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
•
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: S
4.Mechanical (HVAC) S List:
5.Mechanical (Fire $
Suppression) Total All Fees:S
Check No.4 heck Amount: Cash Amount:
6.Total Project Cost: S 10,0 0 0 µdid in Full 0 Outstanding Valance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 105743 01r2024
Shumway Services License Number Expiration bate
Name of CSI.Holder
P.O Box 522 List CS!. type(see below) 1'
No.and Street �.._..�.__.. T .I-YPe Description
Hadley MA 01035 t I'nre,trieted(Itui!dings up to 35,000 cu.ft.)
R Restricted l&2I.amity Dwelling
City/Town,State.71P ht Masonry
RC Roofing Covering
\\'S Window and Siding
SF Solid Fuel Burning Appliances
413-687-9400 shumwayservices@gmail.com I Insulation
Telephone Email address i) Demolition
5.2 Registered Home improvement Contractor(HIC) 178390 04/2024
Shumway Services
HIC Company Name or H1C Registrant Name HIC Registration Number Expiration Date
P.O Box 522 shurnwayservices kemail.com
No.and Street Email address
Hadley MA 01035 413-687-9400
C ity/Town,State,Z_IP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must he completed and submitted v lilt this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building pennit.
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.
f/4v-14S f 5-16-22
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this 1'cation is true and accurate to rt,A .of my knowledge and understanding.
5 /
Print Owner' or Atithorized Agent's Name(Electronic Signature) Date
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(111C)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important intbrmation on the 111C Program can be found at
www.mass.govroca Information on the Construction Supervisor License can be found at www.ntass.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. fl.) _ I labitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalL7baths
Type of beating system Number of decks/porches
Type of cooling system Fatclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
• Department of industrial Accilknts
1 Congress Street,Smite 100
Boston,MA 02114-2017
www.mass.govidia
Wasters'Compeosatiun Insurance AMU It:Builders/Contractors IIt(tm ians Plunibers.
TO BE FIELD WITH THE.PERM irrrsc Al:71101W 1
Applicant Information Please Print Letilits
Name Run- irwaniratioolndividualr Philip Shumway Inc. DBA Shumway Services
( ss t
Address: P.O Box 522
City/State/Zip: Hadley MA 01035 phone 413-687-9400
Are ysei aa=player?Cheek Ihe nppespriste hen:
T)pe of project(required):
aiI am a eursisr!a v ttb X trninuyten. fa Aram parl-heatl• 7 t,4 New construction
20 1 lot sok caorractor par.nervInp and hive nu rorkryeas working for me in 8 IN Remodeling
am)oquelt) Nu iv utters corm gavurame en.pnetaij
9 Demolition
301ain ats.iniii.i.sino doing&II laud.rsel,e11 INc...kotrlaitu comp Insurance tequirni j
10 c]Budding addition
4 0 am a Moavamtbn and%.• RN:tutu*ountractotx vunduct ail v.tel.on nt)jvnipett) v.111
mt:Ine thml oll 0u:rats:tun either have vutiers'..xxxipat*aum invuratude ut ire vole I a Electrical repairs or additions
pi-pi...mum wain no Lax•10)CC,*
2.0 Plumbing repairs or additions
SCV am a p-nevakualrat and I ha+t hard the sub-con tractors Wed the attached Ace,
13 gi Roof repairs
Thaw oub-rostrachost cerspia.area mei boa c wafters'wenn iwuranse.1
.
6.1j Wit WO a Cellpallitiall Ind ai ozitecn, r eiartsed Meat nvei sticscreptson per NIGL c. I 4 Other
I SZ 11(4).sad we hoar cso ernpluyeew rhiourariuns.camp awake mowed)
'An)appbscano that&cis boa II tmint all,.1W out dr*noon b kn.ahowmg thot workers'.umperatate.u.pdt,s miurrnatton
• 1k...improvers abo wham dist afriaaNg uttiv.ittng the+,are tieingai ataal.and da:n hoe outvvie contras:tart mug vuivnai ija% traluatung vu..11
:Curnriaturs that the..1.data hut.nu..vt itta..hrJ ‘bov.IttgI& naua aal ha.tub-....zutr....tar.in.1 tlat, riC Ot turf in."..:CAM tc-S
Cn171.,, thet maul pra..ah theu v.uttert"sump aL tit
I am an employer that is propiding worAers'compensation insurance for in ernpkrees. Below is the polics.and job site
Information.
Insurance Cornparly Name: Wesco
Policy#or Self-ins.Lic. WWC7569281 apingion Date: 02/2023
Job Site Address: City'State'Zip-
Attach a copy-of the starters'compensation policy declaration page(thou ing the petk? number and expiratioa date).
Failure to secure coverage as required under MOE c. 152.§25A is a criminal violation punishable by a ruse up to$I>500.00
and'or one-year imprisonment.as well as cis,' pen-does in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of tho statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage
I do hereby certify tinder the paint and penalties of perjury that the information provided above is true and correct.
5 Signature Date.
Phone c' 413-687-940Q
Official use only. Do not write In this area,to be completed by city or tows official
('its or Toisn: Permit/Llernse
Issuing Authority (circle ono:
I. Board of Health 2. Building Department 3.City Joys n Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
4
City of Northampton
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Pglir
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Illectitiampcza QS QdG .ja�l++r•
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION ANT)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
property licensed waste disposal facility,as defined by MGL c 111, S 1SQA_
The debris will be disposed of in:
Location of Faulty: Amherst Trucking or Private Damp Truck to Valley Recycling
The debris will be transported by:
Name of Haug: Amherst Trucking or Private Dump Truck to Valley Recycling
Signature of Applicant: Da