12C-024 (2) BP-2024-1467
30 BURNCOLT RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
12C-024-001 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-2024-1467 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 9000 SHUMWAY SERVICES 105743
Const.Class: Exp.Date:01/14/2025
Use Group: Owner: CURRAN JOHNSON BARBARA J&EVAN N
Lot Size(sq.ft.)
Zoning: RI/WSP Applicant: SHUMWAY SERVICES
Applicant Address Phonez Insurance:
PO BOX 522 (413)549-4658 0 WWC7569281
HADLEY, MA 01035
ISSUED ON: 11/01/2024
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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 I)rivela) Final: 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.
Signature: / .7/Z
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
SEC
V
�C om oinwealth of Massachusetts
T 31 Board f Bu' ding Regulations and Standards FOR
Fp eafios . 'hus- State Building Code, 780 CMR MUNICIPALITY
r of USE
IVO1l 'd : ' ' mit A••lica on To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
�'°4:ANs'Pc`'0 r Cjne-or Two-Family Dwelling
�A 0, Ns This Section For Official Use Only
Building Permit Number& f' /'G 7 Date Applied:
STVi.0". igier r-i 7 N.. 4-AcL //• / - `Building Official(Print Name) Ignature Irate
SECTION 1:SITE INFORMATION
1.1yroperty Ad sus:f 1.2 Assessors Map& Parcel Numbers
I.1 a 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 CI Private❑ Zone: — Outside Flood Zone'? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ow er'of Record:
h 1'1kn Sew er ti �� /1 ��6
Name int) City,State,ZIP
YJ v(& C4 1 � l z $D,a_ / )-e 7-
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) 0 Alteration(s) 0 Addition 0
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
Estimated stunated Costs: Official Use Only
(Labor and Materials)
1. Building $ l op/I 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical $ 0 Total Project Cost3(Item 6)x multiplier x
3.Pltunbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees: ILIP
Suppression) L
Check No. `q Check Amount: Cash Amount:
6.Total Project Cost: $
oCQ ❑Paid in Full CI Outstanding Balance Due:
1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 105743 01/202f
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.)
12 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@gmail.com 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
178390 04/204.
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.§ 2 C(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 ® No D
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.
51AfcLl.t4
Print Owner'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 "s {aplication is true d accurate to the best of my knowledge and understanding.
Print Owner or Authorized Agent's Name(Electronic Signature) --464e
-11
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,fmished 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"
LZLL - bSZ - EIh
/9 tv14/ • 97/W)-PiJ
o
(-74
—/i / 6"1/146/ 1.14'71.((I -I-i- miti7-vvyrid
'290 o 4- o
777 urn-l_crq (e(rviy,woys
coa7uv7 /yowl 4,/ 1/1. 711 oy
00147�� z�7�'-
n
'xi2/ avu11-i- vN
The Commonwealth of Massachusetts
111—++ �!l. Department of Industrial Accidents
1 Congress Street,Suite 100
. l!t= Boston,MA 02114-2017
: Fo www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
'1'O BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print 1.eiibly
Name(13ustncsc tlrgamizatiunrindividual):
Philip Shumway Inc. DBA Shumway Services
Address: P.O Box 522
City/State/Zip: Hadley MA 01035 Phone #: 413-687-9400
Are you an employee?Check the apprpriate hex:
Type of project(required):
I.®I am:1 employer with X employees(full and'or pact-tins)_• 7. ®New construction
2.0 1 am a sok proprietor or partnership and have no employees wutkiag for rice in 8. ID Remodeling
any(-opacity.[No wutiten'camp.insurance required]
9. Demolition
0 1 sin a homeowner doing all work myself.[No workers'comp_insurance require d.]'
10 Q Building addition
4.0 I.nor a homeowner and will be hiring contractors to conduct all wink on my Imo/petty. 1 will n
ensure that all contractors either have workers'conic ettsoti n insurance or are sole 11.1_J Electrical repairs or additions
proprietor,with no employees. 12.0 Plumbing repairs or additions
50 I ant a general contractor and I have hired the sob-cuntractun listed on the attached sheet. 13i3 Roof repairs
These sub-contractors have employees and have workers'cuanp.insurance.:
h.a We an a corporation and its officers have exercised then nght of exemption per MtiL c. I 4.glOthet
152,¢l(4).and we haws no employees.[No workers'comp.insurance required.)
*Any applicant that chocks bpi Q1 must also fill out the section below showing their workers'compensation policy information.
+Ilonscownets who submit this affidavit indicating they arc doing all work and then hire oruside contractors mast submit a new affidavit indicating such.
:Contractor.that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees It t1s sub-contracar+ use employees.they must pins irk their porkers'cutup.pr Ile nuuiluc,
I ant an employer that is providing workers'compensation insurance,lor my employees. Below is the polio'and job site
iu%rntation.
Insurance Company Name: Wesco
Policy#or Self-ins.Lic.#: WWC7569281 Expiration Date: 02/2025—
Job Site Address: City.StateiZip:
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 51.500.00
and/or one-year imprisonment,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 sunder the pains and penalties of-perjury that the information provided above its t or and correct.
Signature: �Q���c'Q' Date: 1 H
Phone a*: 413-687-9400
Official use oil►`. Do not write in this area,to be completed by city or town official
City or Tossn: Permit/license#
Issuing:%uthority (circle one):
I. Board of Health 2.Building Department 3.('ityrluNn Clerk 4.Electrical Inspector 5. I'luuthine Inspector
6.Other
Contact Person: Phone 4:
City of Northampton
S`S' _ SIC'
/ ✓ Massachusetts ��?•'
14(
\SII-1 k.„;F DEPARTMENT OF BUILDING INSPECTIONS y; 4
.- i', ` 212 Main Street • Municipal Building vy..
Northampton, MA 01060x
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: /(2S2Date: [0