24A-072 (7) BP-2023-1199
50 RIDGEWOOD TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24A-072-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Penn it# BP-2023-1199 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 9000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date: 01/14/2024
Use Group: Owner: CHAPMAN ROSALIND & LISA WEREMEICHIK
Lot Size (sq.ft.)
Zoning: URA Applicant: SHUMWAY SERVICES
Applicant Address phone: Insurance:
PO BOX 522 (413)549-4658 0 WWC3509999
HADLEY, MA 01035
ISSUED ON: 09/01/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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:
• $1• y9 .
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f_....,. ,G....,,
00 . 0-ifa.d /--? -c
&, The Commonwealth of Massachu tts 1106
Board of Building Regulations and S n 3 �� IC ALITY
W Massachusetts State Building Code, 80 N oFn E
Building Permit Application To Construct,Repair,Renova o )zti 9 vise Mar 2011
One-or Two-Family Dwelling "N.Mq 0 cr0 Ic)NS
Thiltion For Official Use Only
Building ermit Number: �j�-a 3 - )1 ti
Building A plied:
-UiU a s / // q-/-2)Z3
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Propeas rod 1.2 Assessors Map&Parcel Numbers
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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Northampton, MA 01060
Rosalind Chapman & Lisa Weremeichik p
Name(Print) City,State,ZIP
50 Ridgewood Terrace 413-313-3018 rozchapman@hotmail.com
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 0 Specify:
Brief Description of Proposed Work':
Replacement of roof section with 30 year architectural roof system.Ice and water shield,
synthetic felt,ridge vent and cap.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ *6,0,-i. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) S List:
5.Mechanical (Fire $
Suppression) Total All Feey10 4 1-A 0
Check No. 13 Check Amount: g Cash Amount:
6.Total Project Cost: `; 1�t A 0 Paid in Full 0 Outstanding 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.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP 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 El 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 f,in all matters relative to work authorized by this building permit application.
08/19/2023
Print Ow 's ame(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 . e and accurate to the best of my knowledge and understanding.
Print Own t', • ed Agent's Name(Electronic Signature) D e
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,fmished 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
o<n 'Po ,g "' s
Massachusetts 4'�?f .�
(41
DEPARTMENT OF BUILDING INSPECTIONS **4
\' 212 Main Street • Municipal Building yeti. D�
x •r4*' .''1 ," Northampton, MA 01060 S ..• .10.
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:
The Commonwealth of Massachusetts
FA= -- Department of Industrial Accidents
•' = AMIN
:a1= j( 1 Congress Street,Suite 100
=;1 a'Op' Boston,MA 02114-2017
www.mass.gov/dia
- 1%urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMIT1'IN(:Ali l'HOltl'1'Y.
Applicant Information Please Print Leeibls
Name it;u,tnccss(hgamuttwnrindrwduall:_ Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
City/State/Zip: Hadley MA 01035 Phone#: 413-687-9400
Are vuu an employ rr?Cheek the appropriate boa: Type of project(required):
I.®I and a cinpLi er with,,__X_employees employees(full and/or part-tirns:0 7_ ®New construction
1 ant a suk pnipnetur or part nershiii and have nu employees woiking fur me in t{. 1]Remodeling
any capacity.[No workers'eoinp.insurance regmnd.)
9. ❑Demolition
30 I an,a homeowner doing all work myself.(No workers'comp.insurance requited.)'
I 0 Q Building addition
4.0 1 am a homeowner and will be hiring axrtaractors to conduct all work on my property_ I will
ensure that all contractors either hose workers'r.-unyicruatiuti insurance or'are sulc I I a Electrical repairs or additions
prupnetun with no employees. 12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13E3 Roof repairs
These sub-contractors have employees and have workers'coop.insurance.;
6.0 We a a corporation and its otlicers have exercised then night of exemption per M(iL c. 14.[Othe1
n
11,1.§1t41.and we have no cmpluyres.[Nu workers'cone.insurance required.)
*Any applicant that chucks box el inner also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must subnut a new atfsdav it indicating such.
;Contractors that check this box must attached an addrtiunal sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-cumracturs have employees.they must provide their workers'arnp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name: Wesco
Policy#or Self-ins.Lic.#: WWC7569281 Expiration Date: 02/2023
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation polity 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 SI,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a tine 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 DR for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Sus manor: 5 �Q/!.iCAe. '�2 0.0„
iihomc 4: 413-687-9400
Official use only. Do not write in this area.to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.('ityflown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: