39A-054 (5) BP-2022-0749
74 LYMAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
39A-054-001 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-2022-0749 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 2009 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2024
Use Group: Owner: WAGLER GOLDENBERG, CAREY& WILLIAM
Lot Size (sq.ft.)
Zoning: URB Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:,
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON:06/22/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE 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: ! •
• ., '
•
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
6 (1?C h1 l GOht,n- excel
fi
1 he(.'t)mmonws:alth of Massa:1i efts t
Board of Building Regulations and , tanda•ds c/U C'tt+A .I I Y
VI Massachusetts State Building Code 7ftt) - It N (9i t1St: •
Or thmuliy� Rt. tset/ ' 'Ir 2t1t 1
Building Permit Application'l o Construct. Rcpa Rr a* 498
One-or Two-Family Dwell'', NOAfel
'This Section ForOfficial t lse Only 'M°'r /,‘Er i
p C
Building Pemtit Numtx ri(3P- .• ,.�.y ! Uatc Applied _.. Mq n„.
'l G zz 712
14 EV►N ' �e05S �.... ._...__ _. " Signature
late
Building Official(Print Name) 5
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2,,Asssesssodors Map& Parcel Numbers7 A......_ Parcel Nu ��
1.1 a is ttti s tan acceptedstreet?yes no Map Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use t..ot Area(sq ft) Frontage Oil
1.5 Building Setbacks(ft)
i n,ni Yard Side Yards Rear Yard
Required Provided Required 1 Provided Required Provided
1.6 Water Supply:(M.G.I.,c.40.§Sd) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: ,
Public 0 Private❑ Z.one: _,, Outside Municipal 0 On site disposal system ❑
Check iftes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
t., 6D 1 -ea4 Alt(��,� o�1\ l _a L 4
Name(Print) / City.State.ZIP �r �y
Na 1Strett I .M`"' t 1 C te� tl McC'telephone Lmai A dry
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition CI
Demolition 0 _Accessory Bldg.0 Number of Units _ Other ❑ Specify:
Brief Description of Proposed Work':
Replacement of roof section ' '
}- • 11 tee ccnE
v= t .. mat
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S. 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
❑'Total Project Cost'(item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (IIVAC) $ List:
5,Mechanical (Fire $
Suppression) Total All Fees:
Check No. IIN Check Amount: Cash Amount:
6.Total Project Cost: 1
(gyp.'7 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION
5.1 Construction Supervisor License(CSL) It1i?t3 t)I=2u24
Shuntway Services
License Number i.kpiplfatit7i bat,:
Name of CSL I k)lder
1'.C)13ox 522 I ist CS',•I We(sec below) t t ...........
No.and Street Tvpe Descriptions 1
I ladlcy MA 0I035 l- I nrestricted(Ituildtogs up to 35,000 cu. lt.)
Citytfown.State,ZIP R Restricted I&2 Family Dwelling
M Masonry _
RC Roiling Covering
WS Window and Siding -
SF Solid Fuel Burning Appliances
413-687-9400 shumwayservices'dgmail.com 1 Insulation
Telephone ,Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 178390 04t2()24
Shumway Services I IIC Registration Number Expiration fate
IJIC Company Name or I[IC Registrant Name
P.O Box 522 shumwayservices'ii'gmail.com
No.and Street Email address
Iladley MA 01035 413-687-9400
City;Fossn.Stale,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 ® No 0
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.
•(...ms. e
Print Own s Name(Electronic Signal ) ),it
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 a iication is true and accurate to owledge and understanding.
Print Own or Au ni• gent's Name(Electronic Signature) ate
NOTES:
I, 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(IllC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important inlbnnation on the IIIC Program can be found at
www.mass.gov'oca Information on the Construction Supervisor license can be tiiund at wwss.ntass•eovidps
2. When substantial work is planned,provide the information below:
Total floor area(sq. fl.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. fl.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number ofhalibaths
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
mr j"
Mac sachusettn 0-
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
7406ro.ne`...Tfr
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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:
Location of Facility: Amherst Trucking or Private Dump Truck to Valley Recycling
The debris will be transported by:
Name of Hauler: Amherst Trucking or Private Dump Truck to Valley Recycling
Signature of Applicant: Da
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
wwwmass.govidia
flutters'Compensation Insurance Affidavit:BuddertJContractors/EkciriciansiPlumbers.
1()BE FILED'SS ITU 1 HE PERMITTING AlYTHOltli 1.
Applicant Information Please Print Legibly
Philip Shumway Inc. DBA Shumway Services
Name tousineworpatzsatmvindividuali:
Addyess:
P.O Box 522
Hadley MA 01035
City/State/Zip: phone#: 413-687-9400
Art yes au et kph»,et?Check the apprtiptintr box:
T,s pc of project(required)
2;I atz. Cr:Soya%ail X eltzplo)v (lull and or part-I ante I• Vt New connIttJettaa
...r3 I aril tt le pilTrIld.C1 runnehdhp tk11:),t: employer6 working tor me tn S 0 Remodeling
wry L4pauly (No 66 otter,' matrantx raw.12[0.1
9 ICI am a hornwuner doing all la uria myself aorkeo"comp trexanance mou D Demolitionnt r
l 0 Building addition
4.0 I am a hothoou no and+a III hotns Luntractora to condu.:1 MI work on ray proputt) v.kil
enaurit that all contrnnora raisin hat,le%%Acta compruation ununtnet rxaxliOle LI
a Elt.Ttrical repairs or additions
isisiprici.*tth i,employcen
I 2 Plumbing rq:surs or additions
5C3 I am a Lrenaval contractor.and I hat lured the aub-eorstraetont haled on the attachod akteet
313 Roof repails
Thew Qab-contractor..hoot employee,and ha%e workers'wnip,taikairanCt:
14.C3Other
6 We Ilft a wepuratton and its 01114atev have exerened they ngla of excenptbon pet MU e-
1 52,I It 4),and we Iu ru centtloyets,[No wrtn comp inautance required]
'Any appitcant that eh.%It box g I mist also rill out the we-0ton billow shou thg their waders'come:wanton pokey taunt:owe
Ronan)*arm t,houtintut this attivir.tt tanit:ntinat the,ah:doing all v.orl.and then hate outwit:cunirselt.K.auhl submit a ni.' affidan it tralueatrag matia.
Conotaton.that check than hot rnuat altar-bed an taitistional short$hotaio tlaz name of the toth-euntractorti and*tate v./tether it not tlsow antales hatm
employees It the wh-euntraoast*have crript.dy eta.they mist provide their worker.'romp poh thanbet
I am an employer dim is providing sonsriers'compensation insurance for my employees. Below Is the policy and job site
Inforstadon.
Insurance Company Name: Wesco
Policy g or #: WWC7569281 Expiration Date: 02/2023
Job Site Address: (ityiStatelip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punilutble by a tine up to$.1.500.00
and'or one-year imprisomnenl as well as civil penalties in the farm uric STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Imei.tigatiuns of the DLA fur insurance
coverage ventication.
I do hereby certify under the pains and penalties of perjury that the inforntatkan provided above is true and correct.
t5'14. pti.„47 3140.40.44..*
Signature: Date:
Phone N: 413-687-9400
Official use only. Do not write in this area,to be completed by tit).or town official
City or Town: Permit/License N
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 0: