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17A-045 (5) 180 BRIDGE RD BP-2019-0127 GIs#: COMMONWEALTH OF MASSACHUSETTS MaR.Block: 17A-045 CITY OF NORTHAMPTON Lot,-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeow ROOF BUILDING PERMIT ermit# BP-2019-0127 Proiect# JS-2019-000205 Est.Cost,$9650.0 Fee $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(so. ft.): 11238.48 Owner: Brooke Norton zoninw Rl(100)/(7RA(100)/ Applicant. JAMES FLANNERY AT: 180 BRIDGE RD ApplicantAddress: Phone: Insurance: I LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON.•81212018 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF & REPLACE SKYLIGHTS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: O�1• Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTVpe: Date Paid: Amount: Building 8/22018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner M413-587-1240 D Map Veselsy rth mpt nea rtm t taabq WDilsyt ermn reel Sedriea/fewd~MWA 01 0 SSYdegurift" q ^ ;,Fax 413587-1272 IhoV9BeaIMIB. - QrSBsaBI�_ APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -BITE INFORMATION /q-/a 7 1.1 ProeeUe AddraN: ile! ,!� This"Won to be Completed by v / YO !3)ei c��Q /1C� Map j 7d Let D Z15 um Zone OaMq DwwcL Ban SL aYIkY CB Oisbk! SECTION 2-PROPERTY OWNERSHIPIAUTHORIM AGENT 2.1 Owner of Record: gwoo/w / opR wj /3k,d6a deal• Name(Prinl) Currenl muiliig Mdress: Tela — 1-113 - , W3 - 99 /35 21 Audwrind Anent 7FIm£S 7, GLANNERt/ / Lov¢ 'z/c� S+, Eas�LlarnPf�NMA Name(Price) Current timing Mdress: OID2� 1113 - P63 - 5-sa8 Signature Tebgiwe SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Ooty com letad Dentrit applicant 1. Bu71din9 /�S�- &ZJ (a)Building Perrrlx Fee 2. Electrical C. (b)Estimated Total Coat of C rnstmction from e 3. Plumbing Building Penult FM // 4. Mechanical(HVAC) `/C1 5.Fire Protaubon 6. Total=(1+2+3+4+5) (0577, Check Number This Section For OlRclal Use Only Suading Permit Number Date bauad: Slgnatu BWdrg nspeclur of BuMugs C'E, pe4Kpf9FoRrng1 (6'A&6F11y6-LJ-e A 6mr+i<, co" EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION i DESCRIPTION OF PROPOSED WORK(check all assllwbNl New Nouns ❑ Addition ❑ Replacement Windows Allurements) ❑ Itooflng Or Dons ❑ Morsel Bldg. ❑ Demolition ❑ New Signs 0:3] Docks [0 Siding RZ3l Other lt:j &ie/Desrripfion of Proposed Work J � Alteration of meeting bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plane Attached Roll -Sheet M.N NB1B�BIM Q BOOR�B1I�110[tOWMB.fa1NNO[Bb fytB fONOWNIB: a. Use of building:One Famiry Two Famiy Omer b. Number of more in each family uniC Number of Bathrooms c. Is them a garage atiadled? d. Proposed Square footage of new construction. Dimensions i e. Number of stories? I. Method of heating? Firaplacss or Woodstowrs Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 R of ends?_Yea _No. Is construction within 100 yr. floodplain_Yes_No j. Depth of basement or ar floor below finished grade k. Will building rm to the Building and Zoning regulations? Yes No. I. Be enk_ City Sewer_ Pnvelu well_ City water Supply_ SECTION 7Y-OWNER AUTHORIZATION-TO BE CONPLEfED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMR ,, BROOKE /VV0,(7U1✓ as Owner of the subject property harebytumbitS, JAmFS 7. FL,41mj& Zy 2)6A PFAK PERFORmfNVCF R0OF1iu6 u to as on my bgppgjg.S m relative to work authonzed by this building perm"epppceYgn. S1 nature of Owner Dale I, 7amES -J, FLANMERy as OwnenAuthonzed Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 7HYr)ES T FLANN£K`/ Print Name 7 � Signature ofOenedAgerd UDate SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructim SuoeMeor.. f— Not Applicable 0 Nemeer Lm,,Hmdw: JAMES T PL- 91VNEI-Y C s — /030&1 Licorwe Number l Willlam5 51" MA 010y0 09b/1a0/8 Addmro ENarelbn Date y13 - a03 - 588 sgrNwe TNepberw S.Anditlared Hasse brawarewasid Container. Not Applicable ❑ PERK PE12POR/YIHNGE RvoF/iu6 , LCG /b�3 �o �I� Comoom Nome Rsgisbati Number 1 "V1.9XId 5+ Fasfh& )ztJ M.4 Nb. 1109/20 /9 Addroas (q)3) Expiration Gate Telephone do3-.';-P YY SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 183,¢26C(8)) Workere Compensation Imurence 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 AfBdavb Atteched Yes....... ly'inNo...... ❑ City of Northampton Massachusetts i o rsa+ura�rr az eorasras rsspsaioars 212 Nein Street •Nunicipol NnildinN NorN npien, M 01D60 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 1 acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a property licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: l �,D KId, (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented of leased from: /baton`s Ro/%o��; Loomis tya�, �asfham� l�� (Company Name and Address) d a r'Date a Sign re Permit Applicant or Owner�Date If, for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(easiness/OrganiaatioWIndivtduap: Peak Performance Roofing LLC Address: 1 Lovefeld St. City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888 Aan employer?Cheek the appropriate box: Are of project(required): L am a employer with 4 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers'comp. insurance comp. insurance., required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I and a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 u Roofrepairs insurance required.]t c. 152, ¢7(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information. t Bam momm. who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. rContmemrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not hose entities have employees. If the sub-contactors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Berkshire Hathaway Guard Insurance Company Name: Policy#or Self-ins. Lia.#: /�R2WCC9438355 Expiration Date:: 4/27/2019 Job Site Address: /9'0 breid .Q /C� City/Statc/Zip: /"/OLE/KQ M//�7 Ofd,0Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 fine of up to$250.00 a day against the violator. Be advised that 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 ofperhnoy,that the information provided above is true and correc6 Sie am �T Date -7 Phone it: 413-203-5888 Official use only. Do not write in this area,to be completed by city or town offichd City or Town: Permit/License it Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f Worker's Compensation and Employer's Liability Policy S Berkshire Hathaway AmGUARD Insurance Company - A Stock Co. y Policy Number R2WC943835 GUARDInsurance Renewal of R2WC811187 Companies NCCI No. [21873] Policy Information Page (AR) [1]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC. 1 LOVERELD STREET 8 NORTH KING STREET EASTHAMPrON, MA 01027 Northampton, MA 01060 Agency Code: MAMAIN15 Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC) [2] Policy Period From April 27, 2018 to April 27, 2019, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3)A. The limits of our liability under Part Two are: Bodily Injury by Accident- each accident $100,000 Bodily Injury by Disease - each employee $100,000 Bodily Injury by Disease - policy limit $500,000 C. Refer to Residual Market Limited Other States Insurance WC200306B Endorsement- D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and,therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium 13,650 Total Surcharges/Assessments $ 606.00 Total Estimated Cost 14 256.00 WERNAL USE xx Page - 1 - Information Page MGA : R2WC943835 WC 000001A Date : 04/04/2018 MANOTE Issuing Office: P.O.Boz A-M, 16 S. Rwer street,Wllkes-Barm, PA 18703-0020 a www.guard.com Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: LLC PEAK PERFORMANCE ROOFING,LLC. Registration: 183898 1 LOVEFIELD ST. Expiration: 11/03/2019 EASTHAMPTON.MA 01027 Update A&Ire nM Ra .CW. sw O .17 ® 6dti1`Ysttts O cM b Vi.`.} aOb 4'iuJdi �Ct] J60s 'AG.4 ..cenca M103061 JAMES J FLANNERY 1 WLLLAMS B7 HOLYOKE MA 01818 o1n1aX121,2018 o18 K Peak Performance Roofing LLC P E Contract PERF O R (` E 1 Lovefield St Data Contracts Easthampton, MA 01027 7/242018 6n MA CSL#103061 MA HIC 9 183698 413-203-5888 peekperformenceroofingllcQgmail.wm www.peakperformencemofmgllacem Bill To Job Location Brooke Norton Brooke Norton 180 Bridge Rd. 180 Bridge Rd. Florence,MA 01062 Florence,MA 01062 413-230-9935 413-230-9935 brookenorton@gmail.com brookenorton@gmail.com Description Total 1.Remove the existing roof shingles 9,650.00 2.Remove and replace two skylights with Velux manual vented 3.Install six&et of ice and water shield at eaves and valleys, 12"around roof/wall intersections 4.Cover remaining roofwith Certainteed'Roof Runner"synthetic underlayment 5.Install 8"aluminum drip edge on eaves and rake edges 6.Install architectural shingles by Cerminteed -(Landmark)30yr rated https,J/www.certainteed.wnVmsidential-mfing/pmdwtsAmdmark/ Color Choice: 7.Install ridge vent S.Complete all necessary flashings including new pipe boots and new base flashing on chimney Remove all debris from premises,and throughout thejob,continue cleanup and keep the premises undamaged. Landmark shinglcs$7,950 Value skylights and installation=2 @S850 each=$1700 Total war—59650 A deposit of$4825 is due at contract signing. The balance of$4825 shall be due upon completion. ((�/�''��/� Deposit Received On: 7 / 26 / I b Deposit S� Check# 13 Yj *We see not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is mmovcd.' Total,. Contractor Signature: CuM. S' Date: 1 7/618' $9,650.00