29-504 (5) BP-4022-0775
10 MATTHEW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-504-001 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-2022-0775 PERMISSION IS HEREBY GRANTE TO:
Project# ROOF Contractor: License:
Est. Cost: 13000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2024
Use Group: Owner: CHOEDEN DOLMA TASHI& THUPTEN
Lot Size (sq.ft.)
Zoning: WSP Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON:06/30/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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:
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:
,ak_ . 4 . 11,
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
,
. , .
, cive i l ,
I___ 13, "Civ&
,,t)..
Z., The CommonI /
wealth of Massachusetts 2 9
tit/ Botud of Building Regulations and StandA .
Massachusetts State Building Code, 78S)CkftRop8,, 20,Z) Fo
M ICIP rry
Building Permit Application To Construct,Repair,Renovate 1/)554 ..,., '- item/ r 2011
• ci/oei;Olvs
One or ThaFaini e . ly Dwelling K4
. . ‘1 This Section ForofTiciiiiCise Only
Buildin Permit Number: , ei-A - 7 7 5 Date Applied:
I(e u it...) fiefiSs
j
//1,
ter'3 'Z022
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1
1 la\s this an acceptth 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
i Required Provided Required Provided Required Provided
1
1.6 Water Supply: (M.G.L c.40,§54) ' 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone' Outside Flood Zone? Munitipal 0 On site disposal system 0
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
1.J.. clw-grl of Recor4 ...,.r I r
'10.% 1)010AA 41,0 , '1, 6ttri(t filit- 0 1%7-
Na=(Print) City.Stale,LIP
i —1-D—Railkallt
413-qi3-10- k illfif iti I ttittlirgral_. BW:—
No.and Street Telephone E -it Add ,
SECTION 3:DESCRIPTION OF PROPOSED)VORK2 (cheek all that apply)
i New Construction 0 Existing Budding 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 Proposed Work2:
Replacement ofroof eeetiera with 30 year architectural roof system,Ice and water shield,
ityntheliciell ridge vent and cap.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
— ,
Estimated Costa
Item Mama' Official Use Only
(Labor and s)
I. Building $ 1. Building Pciiiiit Fee:S Indicate how fee is determined:
0 Standard Cityfrown Application Fee
2.Electrical S
0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4, Mechanical (HVAC) S List
5. Mechanical (Fire S
Suppression) Total All Fee, f
[ 11
iM
Check No. I 70 Check Amount:1401 Cash Amount
6.Total Project Cost S 1/,i
(frO 0 Paid in Full 0 Outstanding Balance Due:
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
105743 01/2024
Shumway Services C :: License Number }xplration Bata
Name of CSL tiolder �� ��
P.O Boa 522 List CSL Type(see below) U
No. and Street Type Description
Hadley MA 01035 U Unrestricted(Buildings up to 35,000 raJ.►t.)
Cityffossm,State ZIP R Restricted l&2 Family Dwelling
M Masonry .
RC hoofing Coveting,_
WS Window and Siding
SF Solid Fuel Burning Appliances
413-687-9400 shumwayservices@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Nome Improvement Contractor(111C) 178390 042024
Shumway Services HIC Registration Number Expiration Date
IBC Company Name or HIC Registrant Name
P.O Box 522 shumwayservices(,&lgmailecom
No,and Street — Email address
Hadley MA 01035 413-687-9400
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 2SC(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 mattersronic relative to work authorized by this building permit application.
ItitN',
P Name(Elc� ai aturc)i rly? �ji'� _ _ V
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 th' .''lication is true and accurate to the best of my knowledge and understanding.
�� ‘'/?( a
Print 0 ,'s or A vi1ii� d Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor 1 '
(not registered in the Home Improvement Contractor(111C)Program),will nor 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.Rov/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 hal f/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"
w„�.,
City of Northampton
k'�''" `� G k Massachusetts � _ J�C�i`
w
R`i �4-. DEPARTMENT OF BUILDING INSPECTIONS
1 ...� 212 Main Street s Municipal Building �� �
a: Northampton, HA 01060 yh; y
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:
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: ,..„/ Date: t!/
The Commonwealth of Massachusetts
Igateatiri•
Department of Ittt/ttstria!Accidents
_:• 1 I Congress Street,Suite 100
'=n Cr Boston, ,%fA 02114-2017
tvtvtv_niass.gor/dia
v1'„tker'Compensation Insurance Affidavit:BuilderiaC ontrae ,rslll:fectricianstl'lumbers.
TO BE FILED WITH Till:PE:RrMI'I'Ti(:AttfllOk l EV.
Annlicant Information Please Print Leeibis
Name{13ttsutcys!CSrZ;itnzation to tw idt,etl: Philip Shurnway Inc.DBA Shumway Services
Address: P.O Box 522
Ci /StateiZi Hadley MA 01035 #. 413-687-9400
ryr P� phone>r:
Are ton an trunk))or?Cluck the apprapchate boat Type of project(required):
1_®l ani a.onpto)a with X catylus ca atilt=tor part•tiut_1_• t.
10 I ant a wtk 7. � (`c w�construction
pcupractur a partncahip and hate no onikayt,a wutkiag for rra in N. 131 Remodeling
any capacuy.[Nu work, warp.inauraotx nqunall
3 ]1 a n v n+a cooYtka doing all work ruy.xlf.Nu wen►u 'cu
te.inatrrtnra reyuutall' 4- Demolition
o 1 ant a hotrr.c wnor and watt antara i.ra to cc=idoct all work un my r l 0 o Building addition
> �ty. l will
t-aaum that ail t+ustttaciurrc other hate coil•ra,*ttxrrr.-aubwt tnaurancv nr 2I•C MAC 1 i.o Elwri at repair or additions
pruprieursa Y tit no cr<tylbyara.
12.p Plumbing n irs or additions
5.Ci lain a a nacrsl contractor and cat c tonal the aub-cunu-actun lat.d un t!s auattttd alai t7.
Thcsc rub-contr a:um.Lase t c-u and tutu wwkcr..'c 13 I oof rCpatr5
.w comp.ia.urrnr.
tt,o A'c arr a corpoanura and rta oltic c a have t7tcrtvcj t.lwar rrgbt ofcacnption p.r MULL v. 1 .2 011tcr
l y'-.f 11.1,anti 'c has.nu t aptut.5crr.NU wtti.cta Warl%inaa-atur reyuindl
•Aay applicant that.kaLL.boa a1 snort atlu fill out the r.ctiorr ta:tuw allow inm taco wwLt s'cuortxnwtiuu policy isformatina.
t tlanaowaen who atabcul rlau arlotattr iadxn rns the)are<Lams all work and then Woe uutaidc contracts..moat.abwn a new atnlasx iaJit:rting:suck
Cunuacturs drat tea deli box accost atta:bod an aklitiarnal aAt mt sttaw*die aarnc of dre aubrcuntra.tara and acari w hither or nut dausr tstitica bus
onployca.-i. IftLe sub-cormac::rar Isa a employ cm.the)naua.prat We their v.tri km'kuanp.policy mots r.
I ont un employer that is providing iding►r'orhers•compensation insurance far my employees. Below is the policy and job.site
information.
Insurance Company Name: Weseo
Policy#or Self-'its.Lic w: W W C7569281 Expirution Date: 02/2023
Job Site Address: CityrStntc.:Zip:
Attach a copy of the workers'compensation policy declaration page(shotsing the polic) number and expiration date).
Failure to secure coverage as required under 1IOL c. t52,§25A is u cntninal violation punishable by a fine up to SI,500.00
andtor one-year impristxmlent.as well as civil penalties in the form of a 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 investigations of the DIA for insurance
coverage verification.
I do hereby certifj,under the pains and penalties of perjury that the information proaided'that Is true td correct.
ielature: 30 �� matte:
Phone#: 413-687-9400
Official use only. Do not write in this area,to Le completed by city or town official.
City,or Town: PermltiLirense%
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City'II'own Clerk 4.Electrical Inspector 5. Piuntbing inspector
6.Other
Contact Person: Phone#: