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25C-059 (10) BP-2022-0715 19 LINCOLN AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-059-001 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-2022-0715 PERMISSIONIS HEREBY GRANTED TO: Project# roof Contractor: License: Est. Cost: 7000 SHUMWAY SERVICES 105743 Const.Class: Exp.Date:01/14/2024 Use Group: Owner: M HEATH JEFFREY M& EDNA Lot Size (sq.ft.) Zoning: URB Applicant: SHUMWAY SERVICES Applicant Address Phone: Insurance: PO BOX 522 (413)549-4658 O WWC3509999 HADLEY, MA 01035 ISSUED ON:06/16/2022 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: >2 . TIT Fees Paid: $50.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / RC /I/ ...h The of ttd U ommonituseStanUN , ALrrY Massachusetts State Building Codb. 786 'in�T sUtinin, SE Building Permit Application To Construct,Repair,Renovate , s1s evise Mar 2011 One-or Two-Family Dwelling A44°10so Ns This Section For Official Use Only Buildin Permit Number: ea- )a P7/6 Date Applied: kluio 4.55 I & L-/L-ZOzZ BuildingOfficial Name Si Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbe�9, (4PI CUII h 0)5-G 1.1a 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(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: Jeffrey M. Heath Northampton, Mass, 01060 Name(Print) City,State,ZIP 19 Lincoln Ave. (413)586-2730 jeffhea@gmail.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) ❑ Alteration(s) 0 Addition 12 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 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 $ 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire H Suppression) $ Total All Fees: ''^^/ Check tlavl J�Check Amount: , Cash Amount: 6.Total Project Cost: $ 7 K ❑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 0 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�rii;gmail.com 1 Insulation T 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 MI 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.i � 1 — " ! r.l di Print Owner's Name(Ele Signature) ! ate 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 info ation contained in this lie on is true and accurate to the best of my knowledge and understanding. I Print Owner' r Agent's Name(Electronic Signature) Date 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" The lommonwetrIth of Massachusetts Department of industrial Accidents t'ongress Street.Suite 100 11:fre Boston, MA 02114-2017 www.mass.govidia afters'Cotttprrisation Insurance Affidavit: Builder (,7ontractorsiEletriciansiPlumbers. I NS tin i HE PERMUTING AUTHORITY. Applicant Information Please Print legibly, Philip Shumway Inc. DBA Shumway Services Name I Business/Organization/1 odividual P.O Box 522 CityiState/Zip: Hadley MA 01035 Phone#: 413-687-9400 Art WUan easpkryee Check tke appropriate tort: -1-„,pc of project(required): EN 1 ant employer with _X employees(run imilen pattionek* 7. 't New construction I Jiti It sole proprietor pertnennap and rai.:e V.1110.0)LC'S A'Ott:44 fir:me 0 Remodeling ety LAtreacity.No*Mums'comp.insUritlia. itspured,) 9. El Demolition 31:1 I ant a homeowner sluing all work myself,[No workers'comp misname reunited 1' I 0 El Building addition .40 I ant a homeowner and will be hiring ouritruchns to eoriduct all work on toy property. I will ("MUM that all connacions either have workers'conspen-satson inikonince of art sole 1 LC] Electrical repairs or additions propos:tors 15,ith no eniployees. I 2.1:1 Plumbing repairs or additions $C3 arri 4 general contractor and I lido e tined the Alb-contractor%listed an the anaehol sheer I 3123 Roof repairs Thew sub-contraciori.have employees and have workers'comp.insurance,: E]We am a corporation and its officer%have exercised then'nett or exaription per hIGL c, 14..30ther I Si, and wt has,e no employees.[No weaken eurnp.innuance required:I Any.applicant that checks hart 41 must also flit out the wenn;below sherng their Workers'compensation policy information Ilomeowners who solvitin this affidavit indscatang they arc Joon all work and then hire muridt contracteir*must solaria a new affirlas, medicating such. :t"untractors that chest this box must attached an 4daltit,0141 sitet:t showing the name of the sub,cuninwtori.mad stoic whether in not Mote imoties!taw clirlo:seci It!I..,,i3h,conhaLtors luv,e emplo,,ceN,they uuardelipfWelew workers'CiAttp,rttliCy 111.14i'ver. 1 am an employer that is providing rrorbers'compensadon insurance for my employees. Below is the policy and job site information. Insunince Company Name: WeSCO Policy#or Self-ins.Lie.#: WWC7569281 Expinition Date 02/2023 Job Site Address: - Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCA c. 152. §2,5A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line 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 certify under the pains and penalties of perjury tluu the information provided above is true and correct. Signature! Date' Phone#: 413-687-9400 Official use only. Do not wile In this area.to be completed kr city or town official lily or Town: Permitel.icenle Issuing Authority(circle one): I. Board of Health 2.Building department 3.Cityfrowu Clerk 4.Ekrtrical inspector S. Plumbing inspector 6.Other 3 Contact Person: Phone tt: City of Northampton Maszachusetts (%1; r 41- DEPARTMENT OF BUILDING INSPECTIONS r 411%; 212 Main Street IP Municipal Building „ Northampton, MA 01060 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: Da • C, The Commonwealth of Massachusetts =Iv; Deportment of Industrial Accidents 7 1 Congress Street,Suite 100 1.-:*17-41111— Boston. MA 02114-2017 wwwmass.goWdia fl token Compensation Insurance Affidas it:Builders/(ontractorsiElectriciantiPlumbers TO BE FILED 111111 1 ItE PERNIFEIING Air!Ii()R11 1. Annlkant Information Please Print Legibly Name(Buiuc nuunlri8niduat : Philip Shumway Inc. DBA Shumway Services Address: P.O Box 522 MA 01035 City/State/Zip: Hadley phone#: 413-687-9400 Are yrs ea mph»re Check the appropriate lorai Type of project(required) X 1 lair.a employer oith employee% ull wilco part.tunel 7 New Construction I4171 u Froprictotor postrier.hip and litoeniensploynci working for me m c3 Remodeling area saleastly.Nv*utters'vamp.Itftsuran retprirod 30 tarn a buns:ovine:%km'all iron.myself (No winters'comp insuronce too:raj' 0 Demolition 10 0 Building addition 40 lam a hom000.nor and humg sunhat:tors to veridu.A.all work on roy property. 1 van noun that all contractors either he workers'1...XIINTLS.A7011 LlItttiftlaCe Elf hole sole 110 Electrical repairs or additions propnciors a no:lapis/cr.. I 2,0 Plumbing repairs or additions 5.0 1 am a priori!contractor and I haa r bated the sub.corittoeicirs.hided on the anachol%heel Thew%tab-contractor%base employees and haat*utters'eiarrp nisainmee.: 3.0 Roof repairs 2i60 We arc a corporation and its officvni hove est:a:lard[Iwo rtgla orictnptioti per MU e. 14 t ()titer _ 152.4114).and sir have no employees,(No woricni`Win) ifnainifiCe requireill "Any applicant that dirk box PI mz thy IrU out the wion brio*showing their winters'compeers:awn policy inform:hoe Hotheowners who 61.161:114 this affitlasit inchcatang they arc doing all oink and then hire outwit contractor%now sutittui a nt At&IV%it inethating 1.1.101- IContraeturs that cheek this hei must;eta.hied alekuunal sbiet%boo tag the name of the sub-suntractors arid state w hether or not those cantles haw employixs If the euta-curitra.tora bait.cmplosets.they must provide their wortas'comp member ea — I am an employer that is providing workers'compensation insaronee far my employees. Below ii the;whew'and job site Informatkut Insurance Company Name: Wesco Policy or Self-ins.Lk.#: WWC7569281 Expiration Date: 02/2023 Job Sitc Address: CityStaterlip: Attach copy of the workers'compensation policy declaration page(shouing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, k25A is a criminal violation punishable by a fine up to$1,500,00 anctior one-year imprisomnent„as well as civil penalties in the form ors STOP WORK ORDER and a fuse of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Otitsv of Investigations of the DIA fur insurance coverage verification. I do hereby cent&under the pains and penalties of prrJary that the information provided above is true and correct. Signature: 54411.44,7 ..5,7„2.4../...c.44...• Date: Phone 0: 413-687-9400 Official use on Do not write in this area,to be completed by thy or town official. City or Town: Permit/License N Issuios Authority(circle one): I.Board of Health 2.Building Department 3.(14 II ossn Clerk 4.Electrical Inspector 5. Plumbing Inspector G.Other Contact Person: Phone#: