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23B-099 185 LOCUST ST BP-2017-1214 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-099 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1214 Project# JS-2017-002044 Est.Cost $10580.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PHILIP W SHUMWAY 105743 Lot siae(sq. ft.): 22041.36 Owner: LORENZO DANIELLE Zoning: SI(I001/ Applicant PHILIP W SHUMWAY AT: 185 LOCUST ST Applicant Address: Phone: Insurance: P O BOX 522 (413) 687-9400 HAD LEYMA01035 ISSUED ON:4/25/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE SHINGLES AND SKYLIGHT, INSTALL NEW SHINGLES 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/2520170:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1214 APPLICANT/CONTACT PERSON PHILIP W SHUMWAY ADDRESS/PHONE P O BOX 522 HADLEY (413)587-9400 PROPERTY LOCATION 185 LOCUST ST MAP 23B PARCEL 099 001 ZONE SI(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ThittLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Pai , f(_ tb Building Permit Filled out try Fee Paid Typeof Construction: REMOVE SHINGL ANDLIGHT, INSTALL.NEW SHINGLES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 105743 3 sets of Plans'Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:* Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit,,. Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management �,,rl n �- ay Si e of Bui ditto; icial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. l pa 2 4 Version) 7 Commercial Bui!din- Permit Ma 15,2000 Departme useen 1Aocu -- City of Northampton Status of Permit: ry02'HA'+iP Building Department Curb Cut/Driveway Permit - - 212 Main Street Sewer/Septic Awilabitty Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Savchual Plans phone 413-587-1240 Fax 413-587-1272 Ptot(Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address ` d M: This section to be completed b office (J5" Lotti y /)- C� Map Q� Lot 09 Unit Zone Overlay District 410 r+in—a no ita t.1 t trYI4- v1pc. d Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4. DcNie((e Cnre,Zo is ,4-4-I! er- Ail-Q t Socc-l-lia,...pitnrA+f1- Name(Print) nn Current Mailing Address: signature �, 0 f / ' r r Telephone Y(3- rz 7- 3 73.t( 2.2 Authori ed Aoent: nawa 5Cld ?'7 Inv/7d/,� 1L F 5kotni?) es Name(Print) Current Mailing Address: L 117 677tiN ao Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 0 $/� 6. Total=(1 +2+ 3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT / I, DQ Kid I.e Lorent O ,as Owner of the subject property hereby authorize $kV N Nir{`l 5 u 11 i' c to act on my behalf, in all matters relative towoaeerk authorized by this building permit application. I Sign ure 2tof Owner 6 � r ,Date A I, '4 wCQC(6 L4 re rat) ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 9ccnceLIc L-oC,P/IZo Print Name 4/rl /!7 S ature of Ovr gent Date SECTION 12-CONSTRUCTION SERVIC 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: CL 1Dhv2 P S� 7 � w 3 License /Dh7 1--11/na-1 sMo‘ r 1-142Itptii 4(a95 a1/19 Address Expiration Date L1 (7ayj0 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affldavi ust be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the bui ng permit. Signed Affidavit Attached Yes No O Shumway Services. Mass CSL#105743 General Contractor#22659 Shumway Services 27 Huntington Rd Hadley,MA 01035 (413)687-9400 TO: Florence Animal Clinic 185 Locust Street Northampton, MA 01060 Proposal (2/2/2017) Description Shumway Services will perform services as follows to all existing roof areas • Removal of existing shingles and low slope roof • Removal of skylight • Installation of new metal rakes and drip edge • Application of Palisades synthetic underlayment(Shingle section only) • Installation of Ice Barrier on eaves and valleys • All existing vent hoods will remain untouched • Installation of new pipe boot Flashings • Installation of Ice Bather on flat roof section • Installation of CertainTeed 30 year architectural shingles on main roof(color to be determined by Property owner) • Installation of hip and ridge cap • Install of ice and water shield rolled roof base on low slope section • Installation of Tarco rolled roofing on low slope section(Black in color) • All debris recycled or taken to Amherst Transfer Station • Magnetic sweeping will be utilized to clear any nail debris • This estimate is proceeding under expected conditions.Variable unforeseen items are additional cost to Property owner. Includes: • 5 Year written guarantee of workmanship from Shumway Services • Limited lifetime warranty from CcrtainTeed on CeratinTeed shingle area Terms • Total of$10,580.00 in 3 payments due to Shumway Services • Three payments due consist of S5,000.00 deposit,$1790.00 on first day of work and 2.790.00 upon completion of work within 7 seven days • Shumway Services will charge 550.00 late fee plus 1.5%monthly interest for outstanding balances. • Shumway Services reserves the right to stop work if payment schedule is not followed. Contractor Signature: /J Date: Property owner: Ow'Se G{eZ.P�/L�,i Date: 4/1,/i, r' From:Philip S humway Far_1aAa1 sI 0-0588 To: Fa:: 1415,557-1572 Pagu 2 o1304t25/B,e 17 11:51 AM The Commonwealth of Massachusetts Department of Industrial Accidents ie-}�'� Office of Investigations z1(1A 1 Congress Street,Suite 100 Boston,MA 02114-2 01 7 www.nta.ss.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name lBusiness:OrganizatioNlndividuap: vl Li"Ek Lin 5e te/te. 5 _ —' Address: t �VAZ City/State/Zi u L I E rn Phone it: L uz el.o _...... Arc you an employer? Check the appropriate box: Type of project(required): 1. lain a employer with 4. ❑ 1 am a genNtal contractor and 1 rmpJop (full aedfor)+rraiitnc).' have hired the sub-contractors 6. ( New mnr.mcuun 3,0 1 am a sole proprietor or partner- These on the attached sheet 7. j Remodeling ship and have no employees These soh connectors have g- 9 Demolition employees and have workers' /. 5 Building addition working for me in any capacity. c [No workers' comp.insurance c .inmt:mce= required.] 5. We are a corporation and its 10.0 Electrical repairs oraddhions officers have exercised their I I.5 PI ping repairs or additions 3.5 1 am a homeowner doing all work myself. [No workers' cont right of exemption per MGL > (I p- 12.2 Roof repairs insurance required.] c. 152,e 1(4),and we have no employees. (No workers' 13. Other comp.insurance required_] ',Any appneant that tlmeksbox#1 must also till out the section balmy shwrvn5lhelr workers'compensation policy inrprmotiml_ t lonissowners who i' this al d` ngthey am dmig all work and Ibe,hire n I£deeun suhima new affidavitindicating such. :Contactors Thal check this box mist attacked an additional vheei showing the mine of the subcontractors and slate whetleror nor thew entities have cmpiayocx IS tic soh-uonnacwrs hew uuployocs,Ilmo most pNvidc tcmr xor'ecrc'comp.policy Brinker I an,an employer that is providing workers'compensation insurance fsr my employees. Below is the poficyandjob site information. Insurance Company Name: Policy or Self-ins. Lie.#: _ Expiration Dale, Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure, to secure coverage as required under Section 25A ofMGl..e. 152 can lead to the imposition of criminal penalties of a tine up to St 500 00 and:orone-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcslieetionss of the WA for insurance coverage verification. I o hereby certifyunder the ins and penalties o perjury that the informationprovided above is true correct v Ivl y f t and Simetu - -' - Date: � _,;15,/ 1 Plume tr' Official use only. Do not write in this area,to be completed hr city or town official. City or Town: _ _Permit/Licenseit _ Issuing Authority(circle one): I, Board of Health 2.Building Department 3.City/down Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _ .... Contact Person: Phone n: Flom:Philip shumxay Fa<.188M 510-0388 To: Far: 1413,587-1272 Page 3 of 3 041251201711:3'1 AM City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: g5- intu5 ti .-)d The debris will be transported by: 51,,vr,w,1S pr,u,.. Je I rc-cP12 The debris will be received by: LPA I¢7 (l 4-ra f(-Cr �, alart Building permit number: Name of Permit Applicant 5i vr-i t✓K/ $ i cC; Date Sig ature of Permit Applicant