12C-067 (9) BP-► 022-0942
23 HAROLD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
12C-067-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0942 PERMISSIONIS HEREBY GRANTE I TO:
Project# REPAIRS Contractor: License:
Est. Cost: 15000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2024
Use Group: Owner: HARRINGTON MARGARET L
Lot Size (sq.ft.)
Zoning: RI/WSP Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON:08/10/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE SIDING AND ROOFING ON GARAGE, REBUILD SHED
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 VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I 1 � .II�.o • • 3- ,
I
Fees Paid: $98.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildins Commissioner
AUG - 8 E2O22 /
nFPT.OF 6UILf)!N�!tiS°ECTlON3 oonTHAMPTpN MA 01060
--- The Commonwealth of Massachusetts
W Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
E
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
"Isis ection For Official Use Only
Building Permit Number: 614 A),r Date Applied:
/Cetn,c..) a55 ✓/& e-IO-2o2Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
�1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.la Is this an ace d street? no Map Number Parcel Number
P yes
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:
1A ovei' 1—. `}4-circ 1 ri.tair� PLrat'e ' i V(1 A- Q i aba.
Name(min) Nov) d,t`941�'�--1"u C_(A City,State,ZIP
023 -�-lb l A 1)3.5 - [ 'f0 redly.0 Lrirk (A h'l4 SS•&L it.
No.and Street Telephone V Email Adds
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' 'R{-n kit 3i-aTi 0A 9c r
Replacement of roof section with 30 year architectura roof system.tce and water shield, 1
synthetic felt,ridge vent and cap. n n 94. R.c/4v'1� 5
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
i
1.Building $ 1 5000 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ I ❑Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: —
5.Mechanical (Fire $ Total All Fees $ 46
Suppression) /�
` �� Check No.13,"I Check Amount: Cash Amount:6.Total Project Cost: $ \ f 1 0 Paid in Full ❑Outstanding Balance Due:
y �L`
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 18t2 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 my behalf,in all matters relative to work authorized by this building permit application.
jlr a
Pri �' Name(Elect nic S ture)�{ y / Date
-�prridl` Y
SECTION 7 :OWNER1 R AUTHORIZED AG�CLARATION
By entering my name below,1 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 knowledge and understanding.
Print or Authorized Agent's Name(Electronic Signature) /VI "Date
NOTES:
I. 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
m,
\(1)1
SIDE YARD
SIDE YARD
1 1
FRONT SETBACK_
FRONTAGE
City of Northampton
... ..SIC
yt�• , Massachusetts 4.1
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,14 .k I DEPARTMENT OF BUILDING INSPECTIONS
*14 212 Main Street • Municipal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
in accordance of the provisions of MGL c 40, 554, 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: ±' 0))/C --
•
The Commonwealth of Massachusetts
Ill. fl. Department of Industrial Accidents
1 Congress Street.Suite 100
+ r Boston, MA 02114-2017
www.mass.gov/dia
1114kers-( onlpt•n.aliun Insurance A(fidasit:Builderu'Contractors,EtectriciausPlumbers.
10 Hi.1.11E0'%flit"flit:PEitMflfl\(:At*itioRtt .
Applicant Information Please Print Le ribl+
Name 1l3usirtcs. :, antlattualnrll+t,tttaq: Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
City/Slate/Zip: Hadley MA 01035 pie#: 413-687-9400
Are”Ni No employer?(Mebane appru, lair boa: r Ty pe of project(required):
1.71 lam a emphwr.T u eth— X —_-empluyce.(full and or part-time t• 7. ID New construction
'.D I am a sulk pruprmor or partnership and hose no curpkn yes kinking ng leer me in 8. ® Remodeling
airy capacity.[Nu uurLna?comp.insurance mgwnd.l
9. ❑Demolition
z. 1 ant a luonow ru.T cluing all taint myself.(No sicken'Guar.insurance napari:d.)'
t.�J- lam a bur n t.net and lc ill be hiring o ntratura to conduct all++oak on my pmrra.-ter. I%ell
10a Building addition
er+sure that all contractors either rtaoa workers•Cur pensatsun insurance or an sole 1142 Electrical repairs or additions
prupriclurs u ith nu unpluyccs.
12.0 Plumbing repairs or additions
I am a auroral contractor and I list hired the sub-contractors listed on the attached Stteet-
13123 Roof repairs
Thcsc sub-contractors base employ-co,and fuse our►en'carp.insurance.;
6.0 N c arc a curpvrratrtm and its oflreen has c exercised deco ngln of caenq•tiat per S1tiL c.
14.[ Other
Ili§II41.and s,e have no emplus'ces.[No u.akrn'..wnp.tmreantc requited.[
'Any applicant that elrcxiks bus n i mtnr also till out the lacteal beluu slim rng their uta<S.compensation pulley information.
tlunxum rwrs oho sulnntt clue atftdasrt utdreatm:thcs are doing all Mork and then hue uutsrdc contractors maid submit a neu attlidasit/nlrcatiurr such.
tt'untraetun Ilul check this boas must atta.lwed an additional shttt shim uoj the name of du:sub-cactractun and stoic N1alhcr to not those entitles lust
esrpluyces. lithe sub-umtr.icritr la_y..rirq^L•.ces.tlrey must pro.ide their uorken'ramp.policy number.
I ant 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-sirs.Lic.#: W WC7569281 Expiration Date: 02/2023
lob Site Address: CitytState Zip:_
Attach a copy of the corkers'compensation policy declaration page %bossing the policy number and expires n date).
Failure to secure coverage as required under MM(eL c. 152,§25A is a criminal violation punishable by a fine up to SI.500.00
and,er one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for i • ce
coverage%critication.
I do hereby certify antler the pains and penalties ofper%urh that the information provided above is true and correct.
Sir"+n:tR�n: � �� Q Date:: r { 4
Monk:... 413-687-9400
Official use talk Do not orrice in this area,to be completer)by city or town officiaL
('it+ or Town: PermiULicense#
Issuing authority lcirele one):
I. Board of health 2.Building Department 3.('ify/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.0111er
( intact Person: Phone#:
City of Northampton
,0N`M
"r Massachusetts
I r r�i J
� DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building • IS\ •C'�
Northampton, MA 01060 4,•, �0
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born (insert month,
day, year),hereby depose and state the following:
1. 1 am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a
parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption,
does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or
is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two-year period shall not be
considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for
and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any
provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my
parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of ,20_.
(Signature)
23 Harold St Florence
Replace garage roof and siding,
Remove shingles install ice and water shield , synthetic felt and 30 yr arch. Shingles
Remove siding, install Tyvek, install vinyl siding
Demo and rebuild shed attached to garage ( less than 200 sq feet) vinyl siding and roof tie into garage