35-291 (7) 117 WOODLAND DR BP-2019-0894
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-291 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2019-0894
Proiect# JS-2019-001480
Est. Cost: $19650.00
Fee: $40,00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): 33149.16 Owner: GREEMAN DAVID&AMY
Zoning: Applicant: JAMES FLANNERY
AT: 117 WOODLAND DR
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508)294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:2/14/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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 2/14/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
City of Northam ton FEB 1 3
Building Departent
212 Main Stre t
Room 1000 DEPT OF BUILDING I
Northampton, MA 101060_ NORTHAfWPTON. �
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION g�- ( q-
1.1 Property Address: section
/ Q. This too be com
ll wood 1n ) G�Y ! by�
,D Ri 1/� Map 3b Lot Um
Zone Overlay DhAdat
Elm St.District CB
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
,q (57A4 0- !1-7 Wood lan d bksy
(Pn Current Mailing Address:
Tel '7 �T7
Signature ephOrie ��3 — 37 — Ci,3
2.2 Authorized Anent:
-IRMES T, 4CL-/91V/4jCt2 y LoYR e/c� Sf, 67a s /mN lytq
Name(Print) Current Mailing Address: O1D14-4
9t44"-.1 ai Y 13 - P 3 - SS 8
Signature 11 V Telephone
im
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by peffnit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number 7 7
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature: 2 - 1 y -ZD i q
Building Commissionedlnspector of Buildings Date
p�xp�I2Fo�rn�iv���ooF�ivG-�� �
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House E3 Addition El Replacement Windows Alterations) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks IQ Siding PD] Other[i7]
Brief Description of Proposed (l��/ 4- /Q
Work: J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ili °'ISY N ba4m WW or ackMim to 600no housing,con kilt tto foilkwlE1'l:
a. Use of 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. Dimens'
e. Number of stories?
f. Method of heating? eplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. "ends?
Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of baseme cellar floor below finished grade
k. Will bui ' conform to the Building and Zoning regulations? Yes No.
1. ptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l 2),4 V/'
as Owner of the subject
property
here authorize �Am�s 7, F Lf A/Aj&/2y MA PEAK P E R FD R m14N CC R OD r-M 6 u
to
a o my half,' a matters relative to work authorized by this building permit application.
aignatuib or owner Date
I, -JqM ES u• F-LAN NE7! 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 T Ft-A1V v>=R'/
Print Name
Signature of Owner/AgentDate
SECTION 8-CONSTRUCTION SERVICES
8.1 Llcensetl Construction Suoervlsor: Not Applicable ❑
Name of LIcum Holder: 7JRMFS S P L-91VJV 6-f,,! e S — l 0 3010/
License Number
l Zvi/barns Sf, , /-/olVOkQ rn)4 016LlD 9la/-aa
Address I Expiration Date
`/13- 063 -- 5-9.Y
Signature Telephone
G Not Applicable ❑
pFA4K Pt-i2Fo�emRiv
Company Name RegistraZ017
mber
i Lave-ri-ocj 5 , Fa s -1�arn,���1 1`ylA a/ba9- �l ?-0 /,7
Address (q)3) Expiration Date
Telephone 203-57
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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....... Iyr No...... 0
City of Northampton
Massachusetts
DSPAR22IMT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building s'
Northampton, MA 01060
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:
(Please print house number and street name)
Is to be disposed of at:
ll 7 GUood la,"d
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
'amon'5 Z46mi-S wou '5-0SAAMVY6U M/9
(Company Name and Address) d a
Sign re dY Permit l6plicant 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/Flectricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zi : Easthampton, MA 01027 Phone #: 413-203-5888
Are Vu an employer?Check the appropriate box: Type of project(required):
1.Vl am a employer with 4 4. ❑ I am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.L3 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 any capacity. employees and have workers'
Y P Y + 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
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 I l.❑ Plumbing repairs or additions
myself. [No workers' camp. right of exemption per MGL 12.gRoof repairs
insurance required.] t c. 152, §1(4),and we have no 13.❑ Other
employees. [No workers'
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 afi`idavit 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 protide their workers'comp.policy number.
1 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. Lie.#: R2WC943835 Expiration Date: / 4/27/2019
Job Site Address: //� G�C►0d/4-nd D6 V a— City/State/Zip: r4y: 1u " o/O& z
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 of perjury that the information provided above i.*true and correct.
Sign,_alure: Date. _02 /
/3,.
Phone#: 413-203-5888
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 M
Worker's Compensation and Employer's Liability Policy
A Berkshire HathawayAmGUARD Insurance Company - A Stock Co.
Policy Number R2WC943835
GUARDCompaniesInsurance Renewal of R2WC811187
NCCI No. [21873]
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)
[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
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 9 www.guard.com
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02106
Home Improvement Contractor Registration
Type: LLC
PEAK PERFORMANCE ROOFING,LLC. Registration: 183696
1 LOVEFIELD ST. Expiration: 11/03/2019
EASTHAMPTON,MA 01027
Update Address and Return Card.
SCM O 20M4)6117 ,+
ri(P`IoJMt.Mollu�a//.6 ref"/r`a tta.�a;.+�l.
ONioe of Conauerar Affairs i euakwas Repnsatlon
HOME IMPROVEMENT CONTRACTOR Recon valid tar Individual use only
TYPE:LLC before the expiration date. If found return to:
BMANNOW f2mbom Oflles of Corwu nw Affairs and Business Regulation
lam 11/03/2019 10 Park Pim-Suite 5170
PEAK PERFORMANCE ROOFING.LLC. Boston,MA 02116
JAMES FLANNERY � --
1 LOVEFIELD ST. \ - ?H���
EASTHAMPTON.MA 01027 V� fly V811d without si9neWre
Conunonvfeafth of Massachusetts
Division of Professional Licensure
Board of Building Rapdafions and Standards
Supervisor
Unrestricted-Buildings of any use group wixich contain
CS-103061 Expires:09/21/2020 less than 36,000 cubic feet(891 cubic meters)Of enclosed
spaCe.
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 01080
Commissioner CLFa(filre to possess a current edition of the Massadwsa6ts
Shue Building Code is cause for revocation of this license.
For Uufomwdm about this license
Cali(617)727-3260 or visit www.mass.yov/dpl
PE K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St Date c°ntract#
ag MCI Easthampton, MA 01027 2/7/2019 768
MA CS"103061 1 413-203-5888 peakperformanceroofmgllc@gmail.com www.peakperfi)rmanceroofingllc.com
MA HIC# 183698
Bill To Job Location
David Greeman David Greenman
117 Woodland Dr. 117 Woodland Dr.
Florence,MA 01062 Florence, MA 01062
413-237-6377 413-237-6377
Description Total
We hereby propose to provide the labor and materials for the completion of the following work: 19,650.00
We mill provide up to 64 square feet of CDX plywood if necessary at no cost.Any additional plywood will be$60 per
sheet installed over roof boards.If there is existing plywood that needs replacement,$75 per sheet applies
1.Remove the existing roof shingles
2.Install six feet of ice and water shield at eaves and three feet in all valleys and around pipes
3.Cover remaining roof with Certainteed'Roof Runner"synthetic underlayment
4.Install new 8"aluminum drip edge on all eaves and rake edges
5.Install architectural shingles by Certainteed(please choose)
(Landmark 30yr)http://w`ww.certainteed.com/residential-roofing/products/landmark/
Color Choice: (]_WA 6 w C� n n-} rA-p I a u d-
6.Install new Certainteed ridge vent on peaks of roof
7.Complete all necessary flashings including new lifetime heavy duty pipe boots and new base flashing around 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=$19,650 (included$500 neighbor discount)
A deposit of$9825 is due at contract signing. The balance shall be due upon completion. Accounts past due 14+days
subject to 2%finance charge monthly.
Me are not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is removed.'
Total:
Contractor Signature: Cu er igna Date:
2' / $19,650.00