23B-022 (5) 204 NORTH ELM ST BP-2019-0362
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-022 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cattery:roofing BUILDING PERMIT
Permit# BP-2019-0362
Project# JS-2019-000589
Est.Cost: $16250.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 183698
Lot Size(sa. ft.): 13198.68 Owner. RYAN.TAY&JUDITH SECTOR RYAN
Zoning: URB(100)/ Applicant: JAMES FLANNERY
AT. 204 NORTH ELM ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052
EASTHAMPTONMA01027 ISSUED ON.9/24/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & RE-ROOF SHINGLES; EPDM ON LOW
SLOPE PORTION
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: Oil: 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:
FeeType: Date Paid: Amount:
Building 9/24/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck--Building Commissioner
RECEIVED
Department use only
�of2JQrtt��to Status of Permit:
u``i�l''ding Depa me Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
DEPT OF BlR@��ht��TIONS Water/Well Availability
NORTHAM ,IN.P 010 0
Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION /- 3(a�
1.1 Property Address: � This section to be completed by ofte
(3011f ltl ALM S�.
Map l/)_";)L:�1 Lot 0 as Unit
Zone Overlay District
Elm St.Dlstrlct CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
hEyiAl y691\11 toy 1y F nrn Sf
Name(Print) Current Mailing Address:
i
Telephone �V
ignature
2.2 Authorized Anent:
1111"ES T, f-LIM)NEP,
Name(Print) Current Mailing Address: O JQ
5�?_-4LJ � — Y 13 - a®3 s�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 25/0VV, 60 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) `0 Ov
5. Fire Protection
6. Total=0 +2+3+4+5) / a �, " Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
i
��• ,i c,. •�� gra
s
U ECI t..
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House � Addition El Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[d] Other[d]
Wo _5h,./-73
Description of Proposed C fit , 0, E PI) (V oil l6e,eJ -51 ore-
rk: J r
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a:ff New house and or addition to existing housing, complete the following:
a. Use 4—building :One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. / `Masscheck Energy Compliance form attached?
h. Type of construction /
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor be:ow finished grade
k. Will building
,cerflorm to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Il
I, e✓ i''J ✓ L as Owner of the subject
property
hereby authorize TAm�S 'F Lf4N/U,&/2Y D614 OF14 K p 1 R F®R►' 4N C.6 K OD ICW G u
to act on my behalf, in all matters relative to work authorized by this building permit application.
lk 4 5 -('�'Zo r$
Signature of Owner Date
LA N A)£k y as Owner/Authorized
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.
--JamEs 7. F1_/4A/Ai R`/
Print Name
� y
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1� d� Not
Applicable 1❑
Name of License Holder: y�mES !�L-����^y C J - / 3o(moo
License Number
l Guillra � 5- , , 1-161 0 /Laa/ ,?
Address Expiration Date
q13 - d63 — 5 Y cF S
Signat��4�71 ure Telephone
9.Registered Home Improvement Contractor. Not Applicable ❑
PC1gX PC)? FoRmAav e-C 2v®FIruG, LLC /F 3 tea q
Company Name Registratio Number
Address (V13) Expiration Date
Telephone �0,3-54 7
SECTION 10-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....... C�t� No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS �'•
212 Main Street *Municipal Building
Northampton, MA 01060 f ` �j�10
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
Y Ail
(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 or leased from:
/Inions I�o�/D �, J CoomiS L� , ro_S4 !Amr6u 1)1)q
(Company Name and Address)
Signa re oY Permit Al6plicant 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.
P E K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St Date Contract#
O Easthampton, MA 01027 9/13/2018 662
MA CSL#103061
MA HIC# 183698 413-203-5888 peakperformanceroofingllc@gmail.com www.peakperfomtancerooftngllc.com
Bill To Job Location
Kevin Verni Kevin Verni
204 N Elm St. 204 N Elm St.
Northampton, MA 01060 Northampton, MA 01060
978-407-2017 978-407-2017
kevin.verni@gmail.com kevin.verni@gmail.com
Description Total
1.Remove the existing roof material and inspect sheathing or boards 16,250.00
2.Replace up to 64 square feet of plywood if necessary at no cost.Any additional plywood will be$60 per sheet
installed
3.Install six feet of ice and water shield at eaves and valleys, 12"around roof/wall intersections
4.Cover remaining roof with Certainteed"Roof Runner"synthetic underlayment
5.Install 8"aluminum drip edge on eaves and rake edges
6.Install architectural shingles by Certainteed(Landmark)30yr rated
https://www.certainteed.com/residential-roofing/products/landmark/
Color Choice:
7.Install ridge vent
8.Install new 1/2 inch polyisocyanurate insulation on low slope roof
9.Fasten using approved screws and plates
10.Install.060 EPDM rubber on low slope roof in compliance with manufacturer specification
11.Complete all necessary flashings including new pipe boots and new base flashing on chimney
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged.
Contractor will obtain building permit.
Total cost:Landmark shingles=$16,250
A deposit of$8125 is due at contract signing. The balance shall be due upon completion.
Accounts past due 30+days subject to 2%finance charge monthly.
*We are not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is removed.*
Total:
Contractor Signature: Customer Signature: Date:
Af /�— -Z $16,250.00
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 Leuibly
Name (Business/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Are you an employer?Check the appropriate box: Type of project(required):
1.VI am a employer with 4 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
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
workingfor me in an capacity. employees and have workers'
Y P h'• 9. E] Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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. If the sub-contractors 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.Lic.(#: R2WC943835 Expiration Date: 4//27/2019
Job Site Address: d b 7 S1
City/State/Zip: ���'�cQ rn��ti N,4 bvo�'eo
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 thepainq a d penalt'es of perjury that the information provided above i�re and correct.
Si nature: Date:
Phone#:
413-203-5898
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
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 '.f
■ Worker's Compensation and Emolo Wr's Liability Policy
Berkshire Hathaway AmGUARD Insurance Company - A Stock Co.
♦ 1 Policy Number R2WC943835
GUARDCompanies RenewalNCCI No.[Insurance 218 3]
Policy Information Page (AR)
[1]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIELD STREET 8 NORTH KING STREET
EASTHAMPTON, MA 01027 Northampton, MA 01060
Agency Code: MAMAIN15
Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC)
sJ`
[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)
t'
Total Estimated Policy Premium $ 13,650
Total Surcharges/Assessments $ 606.00
Total Estimated Cost 14 256.00
INTERNAL USE XX Page- 1 - Information Page
MGA : R2WC943835 WC 000001A
Date : 04/04/2018
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street,Wilkes-Barre, PA 18703-0020 0 www.guard.00m
Massachusetts Department of PubItc Safety �
801r,:� of gtOdmg Regulations r;
CS-103081
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 01040
i
,....::. 09/2112010
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: 183698
1 LOVEFIELD ST. Expiration: 11/03/2019
EASTHAMPTON, MA 01027
Update Address and Return Card.
23^A-05117
i
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