39A-052 (5) BP-2024-0710
86 LYMAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
39A-052-001 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-2024-0710 PERMISSION IS HEREBY GRANTED TO:
Project# REPLACE DECKS 2024 Contractor: License:
Est Cost: 40000 PHILIP SHUMWAY 105743
Const.Class: Exp.Date: 01/14/2025
Use Group: Owner: L ARNOLD KENNETH D& WENDY
Lot Size (sq.ft.)
Zoning: SC/URB Applicant: PHILIP SHUMWAY
Applicant Address Phone: Insurance:
P O BOX 522 (413)687-9400
HADLEY, MA 01035
ISSUED ON: 06/05/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE STAIRS
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. i�
Signature: ����C:�.--..
Fees Paid: S280.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
\ -v-A-E---6-E1VED
_ The Commonwealth of Magsac us s_ A i024
.. lift 7.L_ ;, Office of Public Safety and Insecti s I 1
Massachusetts State Building Code( 0 C R) 1
Building Permit Application for any Building other than On l P c t ng II
(This Section For Official Use Only)
DF'No THAtiy•ON.e�__ 1
Building Permit Numbero7/' 7/Q Date Applied: Building Official:4 /(
SECTION 1:LOCATION 615121
It 1 �yiv% rl N•c r4-1,c-.,j) C k oc
No.and Street City/Town Zip Code • Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2 PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair Alteration 0 Addition❑ Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑
Is an Independent Structural Engineering Peer Revi uired? Yes 0 No � —
Brief Description of Pro s d Work: G 4 e_C.14/ Sort �per•)
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) O
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ 1-3❑ 1-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IB 0 HA IIB ❑ MA IIIB0 IV 0 VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Sup, Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public Check if outside Flood Zone U Indicate municipal ® A trench w}H not be Licensed Disposal Site Id-
Private El or indentify Zone: or on site system 0 required NI or trench or specify �13 /-J
permit is enclosed❑
Railroad right-of-w Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review compl d?
or Consent to Build enclosed 0 Yes 0 or No Yes 0 No II
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Wcn2 /,MII 7 S 1��)-1 cr far 12 fie-)
Name(Prifit) No.and Street City/Town Zip
Property Owner Contact Information:
4w n cr _ _ _ _ VA//'d !2 I' 3C 4F41k1"—
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owne hereb authorizes:
S,area
Name Street Address City/Town ,State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 1.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
5 Its* li l't4 I ..ree 01, .A.con
Name(Registrant) Telephone No. e-mail ddress Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
4wi"t�aj çervi -r
Compan ame
.\ vM CSC - v
Namebf Person Responsible foi Construction License No. and Type if Applicable
6arcA — HaeI e k MI - .
Street Address City/Town State Zip
== — '\1't- 4?- 44on
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the' suaiice of the building permit.
Is a signed Affidavit submitted with this application? Yes No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ i�1Q t� Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ _(contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ LA Li!¢ol) (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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.
ciA it{L Ct 44'1a/4 -____-
Please print and sign name Title Telephone No. Date
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: C t S fs h ra;�t a—
6l� �1
t'u /
Name late
sS
1\\ I
CITY OF NORTHAMPTON
VSETBACK PLAN
MAP: LOT:
CI
k3'1. LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
?iaYr1Arnr,o\
Massachusetts ��?` '�
t111011
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DEPARTMENT OF BUILDING INSPECTIONS °. I.°
212 Main Street • Municipal Building yJy Cm
\,. 1.07:1�i. :,. O
"'t Northampton, MA 01060 i -. �^
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:
nil 4 1
k r
Location of Facility: 1. f\\75
The debris will be transported by:
tA \Name of Hauler:
(/ 5�k�
Signature of Applicant: Date: 1 `'�
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Amdavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Annlicant Informatkoo Please Print Levibly
Name(Business/Organization/Individual): Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
City/State/Zip: Hadley MA 01035 phone#: 413-687-9400
Are y.e es employer!Cheek the appe.prlate bar Type of project(required):
1241 am a eeepbya wNh X employees(Adl and'or parttime).• 7. ®New construction
20 I am a sole proprietor or paeonetabip and have no employees workma for me m 8. m Remodeling
any capacity.(No workers'comp.'nominee mooed.)
30 1 am a homeowner dome all wu t myself.(No workers'comp.mn a uuoe re uered.)
9. ❑Demolition
ILO ass a homeowner and will be hiring coatroom bnd conduct all work on my propriety. I will
10 O Building addition
ensure thn all contractors either have mikes'compensation ire rase r or are sole 1 I a Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5 I am s general contractor and I have hated the sub-contractors hated on the attached sheet
Thew aubaantmctoes lose employees and have trotters' ro ters'comp,enwunce.t 13{3 Roof repairs
Th
6.0 we a a caporaraon and its officers hove exercised their of exesaptaoo M per GL c. 14.BOdler
an
1(4).and wK have no employees.[No workers'comp.insurance required.]
'Any applicant der checks boa a I mint also fill out the section below shame their waders'compensation policy informatim.
Honseowwers who sinew this st1'riacst indscatina they arc dome all work and then hire outside cattractaas mot submit a mew affidavit indicating such.
tCoau:tws that cheek the box must attached an additional sheet showing the name of the sub•contnctors and state whether a not those entities have
erm'loyom It the subaaatractors have employees,they maW provide their waters'comp.policy number.
l ass an employer that!s providing writers'compensation Insurance for uiy employees. Below is the policy and job site
inforstads&
Insurance Company Name: Wesco
Policy#or Self ins.Lic.tt: WWC7569281 Expiration Date: 02/2023
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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisoemtent,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
coverage verification.
I do hereby certify under the pains and penalties of perfrry that Ike information provided above is erne and correct
cior�lure: :
Phone tt: 413-6B7-9400
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License M
Inning Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 0:
Initial Construction Control Document
? lit rt To be submitted with the building permit application by a
s \ { �.l �e Registered Design Professional
for work per the ninth edition of the
''._..-., Massachusetts State Building Code, Y80 CMR, Section 10Y
Project Title: Exterior Egress Replacement Date:01.09.2024
Property Address: 86 Lyman Rd,Northampton,MA 01301
Project: Check(x) one or both as applicable: New construction (X) Existing Construction
Project description:
I,Seth D Wilschutz MA Registration Number:952505 Expiration date:08/31/2024,am a registered design
professional,and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerningl:
X-Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'.
Enter in the space to the right a"wet"or �S .00ARC*
electronic signature and seal: N N
•
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'
iiir
• 61441OFMpSyP
Phone number:413-489-1951 Email:seth@seth.design
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is
chosen,provide a description.
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