17A-279 (3) BP-2022-1453
63 OAK ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-279-001 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-2022-1453 PERMISSION IS HEREBY GRANT D TO:
Project# ROOF Contractor: License:
Est. Cost: 11000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date: 01/14/2024
NUTTELMAN KENNETH B &SHAR IN J KOEHLER
Use Group: Owner: & LISA A ROGALEWSKI &
Lot Size (sq.ft.)
Zoning: URB Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658 0 WWC3509999
HADLEY, MA 01035
ISSUED ON: 11/07/2022
TO PERFORM THE FOLLOWING WORK:
ROOF REPLACEMENT
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: ( Q)
.52
115/
Fees Paid: $80.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
R e J/P eiv'm V-
V �
The Commonwealth of Massa uset NOV
Board of Building Regulations a St.� rds 1 20� R
WMassachusetts State Building Co 71 1 vo, ' �� UN USE LI Y
ATy Komi
Building Permit Application To Construct,Repair,Renova k „ Revi ed Mar 2 11
One-or Two-Family Dwelling a ot�DNS l
This Section For Official Use Only --J
Buildin Permit Number:as
/I' 2 -/c/j' , Date Applied:
il'S?v Ir.J -Z� Z2 i � Z 11-7
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pfo)rtyOAd�dKess: �- 1.2 Assessors Map&Parcel Numb 79
I.1a 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(II)
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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 wner'of Record:
Name nt) I Cifa e,ZIP
63 D 4 k 16-
No.and Street Telephone Email Address
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 0
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
Replacement of roof section with 30 year architectural roof system.Ice and water field,
synthetic felt,ridge vent and cap. ta,.,. S1 �J.M id 1,14.�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. 11q heck Amount: 4° Cash Amount:
\
6.Total Project Cost: $ `\ C(\0 0 Paid in Full ElOutstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 105743 01/2024
Shumway Services License Number Expiration Date
Name of CSL Holder
P.O Box 522 List CSL Type(see below) U
No.and Street Type Description
Hadley MA 01035 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted I&2 Family Dwelling
M Masonry
RC Roofing Covering
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 Home Improvement Contractor(HIC) 178390 04/2024
Shumway Services HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O Box 522 shumwayservices@gmail.com
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.§ 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 IS► 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.
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 application is true and accurate to the best of my knowledge and understanding.
Print a s-ea uthorized Agent's Name(Electronic Signature) to
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
Massachusetts ' . `ce
t
i?(,,
DEPARTMENT OF BUILDING INSPECTIONS S
212 Main Street • Municipal Building �O> b
� � Northampton, MA 01060ky ‘�4�
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: i Date: 10,./P3 ILA:).__
The Commonwealth of Massachusetts
M
Department of Industrial Accidents
m, I Congress Street,Saite 10
.a4 tar
Roston,M4 02114 21 "
7;. www.mass.govidia
f+%'wtlters'Compeutatitta Insurance Affiidock:Bufkler C radon f; clantdPluathers.
to tot.FILED WITH THE PERMITIING Alrr OltwTV,
Applicant Information titan Please Print Legdhb
ame tltta t aticr India l II Philip Shumway Inc.DBA Shumway Services
Address:________P.O Box 522
HadleyMA 01035 ,
"it / t act tg Phone : 413-687 9400
Ate yen as orophrterl Chi the appropriate tr+aas: Ty pe of project trearlrairedl
t ei I ron a aroptever X_ ..,,artorloyeet it'atl and-or theirttera• 7 en New coast ocit rrt
2rj I sera A tole pooprioot or partarearp era have as erantrynes waking for me to S. D Remodetintr
wary r~a+paKity i a meatier*"comp,onsoortat maned i
30 t an it � �d a ail l aak �tl'.i ws cra te _
9., lk ttttiuort
t.
41,0 I s a#+ates ttra r arid area -aetorteta wades, trit stork as '. I l 0 I3tti iaeg i,se i
arum Oat ail ararraeront taker have t► kort*companatau etturana or art*An l l.0 Electrical repaint or addition
proptterat nob on anployettc
I2. 11utttbadditions
$.0 tarn a attend roar/taro ate!I bravo hired dretnissennationts Waders die otholate Auer I Roof re
shwa oltp-olototoom ii,ov ontOoyos end law a workers'nape austeiste.:
`a tr corporation era offta axe bate seen t d then note at Tern per l >4I<I, f —
t S .I Ito„.Ana at bash no enthirearets iNo workers'rs' r p ort e rtatoritil
applanert that chocks box a t roar ats=,s r"rli On tip saa,ta* Wow duo vs coonatateroo pa+tarn toloo aatvaarr..
tittausuvc nem who%LAMA the Oinks a raeaba:atta+they are stool ail work aril that Its eau&entarattart woe sat ac eta aft"atavet read' }I aooty
teentrattars that alai thus Itat sauna*at. nand an adattorals n tba moue salute ,,, ... *baba or not those, ins ti4Ver
tftpitrytv, if da Mast c.+satrau:ta tea s e+t ataHag etc.they tartan ttrrsk.`ida tiaatrworkers'u n+ mohair mamba
t air on employer that is providing*whew'` pensaat n insurance for my employers, Below is the policy and job site
information.
insurance Company tree Wesco
policy g or seig.inso Ls, ; WWC7569281 Expiration Date: 02/2023
Job Site Address: C"ity'Sta 7. p'�
Alttarh a copy of the workers'compensation policy gyration page(showing the policy number and et.pinili n date).
Failure to se tare coverage as retjuir l MOE c,IS2,l2SA is a criminal violation pttmsbabie by a line up to I,500 00
arakerrono-year imprisonment as well as civil penalties bt the form of a STOP WORK ORDER and a fine of up t $250.00 a
day against the violator.A copy of this Statentertt may be forwarded to the Office of tnscstt talons of the DIA for insurance
coverage venlica ion.
t tin hereby certify under the pa/ns dpenalth perjury that the informatonpro daboveAtrue (tweet
iore) 1/9,•)______
"tong 4: 413-687-9400
Official use oay. Do nit write in this area..to be completed by city or town official
City°orTown: Permit/Iicease ti
ii
Issuing Authority(circle one): ..n......
I.Board of health 2.Building Department 3.E.'tv,"I own Clerk 4.Electrical Inspector 'It.Plumbing Inspector
6.Other
Contact Person: Phone*: