32C-207 (5) •
BP-2024-0016
81 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-207-001 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-2024-0016 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 RENO Contractor: License:
Est. Cost: 500 SHUMWAY SERVICES 105743
Const.Class: Exp.Date: 01/14/2024
Use Group: Owner: RUTH FRANCIS,
Lot Size (sq.ft.)
Zoning: URC Applicant: SHUMWAY SERVICES
Applicant Address Phone: Insurance:
PO BOX 522 (413)549-4658() WWC3509999
HADLEY, MA 01035
ISSUED ON: 01/04/2024
TO PERFORM THE FOLLOWING WORK:
DELETE BATHROOM WINDOW, INSTALL STUDS SHEATHING UNDERLAYMENT AND TIE INTO SIDING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Sere ice: 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:
14 • cs-,
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/ 1)A,
\\w0\y�� T�,r�
The Conmtomsralth of Massachusetts O^, Nsp
>w1 M` Fc
ilk), I, Board of Building Regulations and Standards •o70 ,o,,,,, (PAt.I'fY
`'u. Massachusetts State Building Code. 780 C"MR 1SE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Tito-Tinnily Dwelling
This Section For Official Use Only
Building Permit Number: 1f __... .. Date Applied:
1... .. I .
I to
Building Official(Print-Nan-ICI _. _. _.. ._Na c) Signature
SECTION I:SITE INFORMATION
1.1 Prwerty Address: 1.2 Assessors Map& Parcel Numbers
tl►"KL_.5 -------- —
I.la 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.ci.t,c.40.§54)^ 1,7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private❑ Zone: ___ Outside)food tone" Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.kow R
_rc.n_ S 1\)Ot'- -^ �1-DyN MA- O (060
Name(Print)
City.State.!IP ,
$L1 I0,I4,> S_S\-ee t— 413 ttt Li 5cl 3q rush 1e-F@3matl,
No.and Street Telephone Email Address Career
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑/ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other uj Specify:
Brief Description of Proposed Work:
Delete bathroom window —
Install proper studs sheathing underlayment and tie into siding —
SECTION 4:ESTIMATED CONSTRUCTW COSTS
Item Estimated Costs: Official Use Only
(Labor and Material)
1. Building S Sao 1. Building Permit Fee:S Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical S 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire f�
Suppression)
$ Total All Fees:$ #1
Check No.VI I I Check Amount. Cash Amount:
6.Total Project Cost: $ 5 ^/� Paid in Full 0 Outstanding Balance Due:
SECTION S: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
105743 01/2024
Shumway Services license Number Expiration Date
-
Name of CSI.Holder
P.O Box 522 List CSE 1 ype(see below) _1.1
. n.a_._.._......__._ _..__......_................_____......_..___..__.____..._ __ _._._.............._.___ i.vpc Description
Nod Street
Hadley MA 010351l Unrestricted(Buildings up to 35,000 cu.IL)
R Restricted 1/k2 Family Dwelling
C.itvTow•n.State.7.1P M Masonry
Rt.' Roofing Covering
-- ------ - WS Window and Siding
SF Solid Fuel Burning Appliances
413-6R7-940(1 shumwaysery ices p gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 178390 04/2024
Shurnwa> Services 91IC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O Box 522 shumwayservicesugmaii.com
No.and Street Email address
Hadley MA 01035 413.687-9400
Citv.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 m 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 on 'behalf, in all matters relative to work authorized by this building permit application.
FramAn. ()cc IS 2.023
Print()aaner'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 Owner's or Authorized 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. I42A.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.bov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.IL) _ (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
.‘otAMP.3 e ss sic
s• Massachusetts At! C.- 'e{
r<- �: �f
N
4` h DEPARTMENT OF BUILDING INSPECTIONS Z
212 Main Street • Municipal Building v •..
;tr Northampton, MA 01060 A
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION ANI) 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.
0-41 /
0 C/I)ri'S - -(-6\/A A-0 N-ri
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 Common tvr alth of a tfas•sac°husetts
t �'� Department of Industrial Accidents
tl�t
•• '—= 1 Congress Street.Suite 100
Boston. iVA 0211.1-2017
► rvattnacs.gor/Ilia
Workers'Compensation Insurance.%ftidasit: lloildert'Cr►ntrartttr+tElretriristns'Pinmhcrs.
10 Kt:t ILla)1t I III 111E 1110111 I I\t: Al 11101011.
Antillean*Information Pirate Print l,esibltr
Name lNu,ox+�tir�¢amtatr.,n�ntit�r.htai> _ Philip Shumway Inc. DBA Shumway Services _+
Addt +s: P.O Box 522
C ityr'StateiZip: Hadley MA 01035 Phone : 413-687-9400
Art rani era rumprsyer!t lark the app sprWe hos:
i'tpr of project(required)
t 1 air stair•. er wNb X ,a'mg u (full and or pat•hmet' 7, ®New construction
_Q t am pcw* r ar pram r.tnp and ham no cmplpn cc*%mkaag tut me an S. in Remodeling
anti a;a(uady i.0 ts.rka'r.'.amp.tantalum' nymphal
i `I. 1.-1 Dcmohtst tt
j I ant a hx€a..owmt alonig all utak nn'wlf.l no/Len'war 'murmur miasma I"
1(I O Building addition
a I am a hatnsaturm and w It!be[arms tooparamaurt mu avndua all a tok am rn)*pro rcrty I a all
<Yam that all vi nt Xittr%tither lint moot t% soetitpar.,tsNrrt na.UtanaL at art Mr147 I I.a Elecin cal repairs or additions
ptopr euttrm /ith no emnpluya¢a
12.0 Plumbing repairs or additions
"3113 I am a rt'm call ammonite and 1 tut[bard the tub.,-atrttta.tun.hued on the attr.had13121Roof[['pairs
The .tole cuattactute hates etriployem and hate warier.'.amp unur u�.r.
N'r an a a.xp.•rattOn and its officers hat r tiva>.-ased then nem of ttamprtrua per raK.:t t. 14.0 er
131 41141.and mt hate no ett;.luy>cts.IS o%triers'eitntp.insurance:Nutted.'
"Any appinamt that a}e.iks Not r I aunt alum till out du*lama hekrw.hateu mg their%mie t'eompetuation policy wdarmateun
l'ionatiJnurn%t Imo%alums thn allitla.rt a tt atang they ate doing all nod.and then Curt musrde contractors meg animist a new altattvit asdia:itng stick.
:+C'untiactut%that auras thmti bola anus[attached an xklitta>rtal abet[shim mg the named the wbvatueractura slut stria*fritter or not those[sinus[Issue
en triomar, 1t r1% ut-ivntr.r,r,n Ir:a.•,rtrl,nevs,tsar.must pm.edrthctr worker. unrtp £allay number
1 am an emplot er that is providing,carters'compensation insurance for my.employees. Below is the policy and job site
in formations.
In.urattce Company Name: Wesco
Paalit% -or Self=ins.Lac.i:: WWC7569281 Expiration Date: 02/2023
Job Site Address: City/State'Zip:
Attach a cop,,of the worlce+rs'compensation policy declaration page(showing the policy assaber 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
andtor one-year impnsoarnent.as well as civil penalties in the form of a STOP WORK ORDER and a fine 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
c*wcrag!e verification.
do hereby certify Nader the pains and penalties of perjary that the Information provided above is true and correct �—
Sitnattlrrre: c5¢�.lC,g4_ Date:
Phone sr: 413-6B7-9400
Official use wily. Do mat write la tilt area,to be completed by city or team official
City or Town: Permit/License it
lowing Authority(brass owe):
I.Board of Health 2.Building Department 3.City/limn Clerk 4.Electrical Inspector S.Plumbing Intpetter
6.Other
Contact Person: Phone I: