23D-133 59 HINCKLEY ST BP-2020-0049
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D- 133 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# 13P-2020-0049
Proiect# JS-2020-000080
Est.Cost:$10950.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq. ft.): 10628.64 Owner: CLUFF CHERI L
toning. URB(100)/ Applicant. JAMES FLANNERY
AT. 59 HINCKLEY ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.7/18/2019 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 Sidnature:
FeeType: Date Paid: Amount:
Building 7/18/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
DocuSign Envelope ID:F5947F4B-CA22-4819-875E-9A5171 BB27D8
Department use only
- City of Northam t mit:
oma' Building Depa mere EC E I V uUDr eway Permit
212 Main St eet Sewe Septi Availability
Room 10 V�later ell vailability
Northampton, M 01060 JUL Two S is of tructural Plans
phone 413-587-1240 Fa 4131-587-1272 Plot/s�Pl
a sIt.DINc INS eci
iHAMP?ON.NAI
APPLICATION TO CONSTRUCT,ALTER, E LSH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6,0— J `
1.1 Property Address. This section to be completed by office
Map �J D Lot / J Unit
59 Hinckley St.
Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Cheri Cluff 59 Hinckley St., Florence MA 01062
Name(Print) DocuSigned by Current Mailing Address.
Telephone 413-335-7568
Signature
2.2 Authorized Agent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Print) Current Mailing Address:
413-203-5888
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $ 10 950.00 (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 = 0 +2+ 3+4 + 5) $10,950.00 Check Number 1
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Buildin Commissioner/Inspector of Buildings Date
peakperformanceroofingllc C� gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
,
DocuSign Envelope ID:F5947F4B-CA22-4819-875E-9A5171BB27D8
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 54
Or Doors F-1
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding [0] Other[O]
Brief Description of Proposed Strip & re-shingle roof.
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes _ No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
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. 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 below finished grade
k. Will building conform 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
Cheri Cluff as Owner of the subject
property
hereby authorize James J. Flannery / Peak Performance Roofing, LLC
to act on my behalf, in all matters relative to work authorized by this building permit application.
Docusigned by: 7/10/2019
Signature of Owner Date
James J. Flannery
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 J. Flannery
Print Name `
Signature of Owner/Agent Date
DocuSign Envelope ID:F5947F4B-CA22-4819-875E-9A5171BB27D8
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of Llcense Holder: CS-103061
License Number
James J. Flannery 09/21/2020
Address Expiration Date
1 Williams St., Holyoke MA 01040
Signature1� f Telephone
J_( 413-203-5888
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Peak Performance Roofing, LLC 183698
Address Expiration Date
1 Lovefield St., Easthampton MA 01027 Telephone 413-203-5888 11/03/2019
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....... L/ No...... ❑
DocuSign Envelope ID:F5947F4B-CA22-4819-875E-9A5171BB27D8
City of Northampton
Oro!
Massachusetts tea? <<
A c
� 3
N
DEPARTMENT OF BUILDING INSPECTIONS r
m
212 Main Street •Municipal Building
Northampton, MA 01060 sbyY ��
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:
59 Hinckley St.
(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:
Aaron's Roll-Off, 1 Loomis Way, Easthampton MA 01027
(Company Name and Address)
7
Signature of 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 FTashington Street
j Boston, MA 02111
wlvr.,.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organizationandividual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 phone #: 413-203-5888
Aan employer?Check the appropriate box:
Are of project(required):
1. am a employer with 4 _ 4. ❑ I an i general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees The�e sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
y p �'• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.T
required.] 5. ❑ We ai e a corporation and its 10.❑ Electrical repairs or additions
3.1:11 am a homeowner doing all work off:crs have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.gRoof repairs
insurance required.] t c. 1 S'?, §1(4),and we have no
emp.oyees. [No workers' 13.❑ Other
comp. insurance required.]
"Any applicant that checks box#1 must also fill out the section below,howing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all .c(A 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'compenswion insurance for my employees. Below is the policy and job site
information.
Berkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.Lic.#: R2WCO21353 __ Expiration Date: 4/27/2020
N o r-Nn ti YY1�
Job Site Address: rJ i(1GK 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 Section 25:% :)f 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 viell 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 Ihat 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 is true and correct
1
Sienature: Date: —7/1
Phone#:
413-203-5888
Oficial use only. Do not write in this area,to be ce,-.4eted by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.Cite/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
X/M (Pommon"WaltX OIC-416wac"a
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts' 02108
Home Improvement Contractor Registration
Type: LLC
PEAK PERFORMANCE ROOFING,LLRegistration: 183698C.
1 LOVEFIELD ST. Expiration: 11/03/2019
EASTHAMPTON,MA 01027
SCA I 20M-W17 Update Address and Return Card.
4
Office of Consumer Affairs 8 Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:LLC before the expiration date. If found return to:
B1 Wration Office of Consumer Affairs and Business Regulation
183088 11/032019 10 Park Plaza-Suite 5170
PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02116
JAMES FLANNERY
1 LOVEFIELD ST. � � — ti�� � —
EASTHAMPTON,MA 01027 Undersecretary t valid without signature
® Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
Unrestricted-Buildings of any use group which contain
CS-103061 Expires: QW2112020 less than 36,000 cubic feet(991 cubic meters)of enclosed
space.
JAMES J FL./WNERY 4.
1 WILLIAMS ST
HOLYOKE MA 010+0
Commissioner CL
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
Far information about this license
Call(617)727-3200 or visit www.mass-gov/dpl
w Worker's Compensation and Employer's Liability Policy
v/. AmGUARD Insurance Company - A Stock Co.
erkshire Hathaway Policy Number R2WCO21353
Insurance Renewal of R2WC943835
tiArl" GUARD (Zompanies 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, 2019 to April 27, 2020, 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 Endorsement-WC200306B
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 31,202
Total Surcharges/Assessments $ $1,181.00
Total Estimated Cost $32,383.00
INTERNAL USE XX Page - 1 - Information Page
MGA R2WCO21353 WC 000001A
Date 04/01/2019
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street,Wilkes-Barre, PA 18703-0020 • www.guard.com
DocuSign Envelope ID:F5947F4B-CA22-4819-875E-9A5171BB27D8
PE K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St Date Contract#
Easthampton, MA 01027 6/27/2019 931
MA CSL#103061 1 413-203-5888 peakperfomianceroofingllc@gmail.com www.peakperformanceroofingllc.com
MA HIC# 183698
Bill To Job Location
Cheri Cluff Cheri Cluff
59 Hinckley St. 59 Hinckley St.
Florence, MA 01062 Florence, MA 01062
413-335-7568 413-335-7568
cicluff@yahoo.com cicluff@yahoo.com
Description Total
1. Remove the existing shingles and inspect plywood for rot/deterioration 10,950.00
2.We will install up to 64 square feet of plywood at no cost.Any additional plywood will be$75 per sheet
installed
3. Install six feet of ice and water shield at eaves and three feet in all valleys,around pipes and chimneys
4. Cover remaining roof with Certainteed"Roof Runner" synthetic underlayment
5. Install new 8"aluminum drip edge on all eaves and rake edges
6. Install architectural shingles by Certainteed (Landmark PRO 40yr)
https://www.certainteed.com/residential-roofing/products/landmark-pro/
Color Choice:
7.Install new Certainteed ridge vent on peaks of roof
8.Complete all necessary flashings including new pipe boots and new base flashing around chimney
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises
undamaged.We are not responsible for debris that may fall into attic. Please use caution during the process
and after dumpster is removed;do not walk/drive over areas of potential roofing debris. Contractor will obtain
building permit. Installations are weather permitting.
Total: Landmark PRO shingles=$10,950
A deposit of$5475 is due at contract signing. The balance shall be due upon completion. Accounts
outstanding over 10 days post-completion subject to 2%finance charge,compounded monthly.
Contractor Signature: Customer Signature: DocuSigned by Date: 7/10/2019 Total:
[� $10,950.00
5776170laA1M7...