23D-026 (3) 480 ELM ST BP-2020-0966
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23D-026 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-2020-0966
Project# JS-2020-001643
Est.Cost:$10500.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sa. ft.): 8015.04_ Owner: JENNIFER L JAKOWSKI
Zoning: URB(100)/ Applicant: JAMES FLANNERY
AT. 480 ELM ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:2/27/2020 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:
Footin-s:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Dmartment 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:
FeeTyue: Date Paid: Amount:
Building 2/27/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
DocuSign Envelope ID: E4AC6CE6-3237-4C7A-9786-AFA6F49F7435
Department use only
City of Northampton i' tatus of Permit:
�. Building Departreii# -,INrb Cut/Driveway Permit
212 Main Stre6f po er/Septic Availability
Room 100 ��'� c� r/Well Availability
Northampton, MA 01 � 15 7wn;, ets of Structural Plans
phone 413-587-1240 Fax 413 12.7205 Plans
O Oecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, A DEMOLISH A ONE OR TWO FAMILY DWELLING
N
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot 0.�& Unit
480 Elm Street
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Jennifer Jakowski 480 Elm St, Northampton
Name(Print Docusignedby: Current Mailing Address: 413-273-3131
Telephone
Signature 661A132DF0D6F4C2..
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 $10,500.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee ,
4. Mechanical(HVAC) V
5.Fire Protection
6. Total=0 +2+3+4+5) $10,500.00 Check Number
O /� /� This Section For Official Use Only
6qb�Building Permit Number: ,0 a" 1 Date
Issued:
Signature: ' _ Z' 21,-ZOZD
Building Commissioner/Inspector of Buildings Date
peakperformanceroofingllc (& gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
DocuSign Envelope ID:E4AC6CE6-3237-4C7A-9786-AFA6F49F7435
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 13
Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [O Siding[C3] Other(ol
Brief Description of Proposed Strip and replace architectural shingles
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.
1. 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
Jennifer Jakowski
I. , as Owner of the subject
property
hereby authorize James J. Flannery / Peak Performance Roofing, LLC
to act on m behalf ip,all matters relative to work authorized by this building permit application.
Docu igndd y:
2/25/2020
0 Signatur o Date
James J. Flannery
I, 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
B
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
UJt111 4_ff) St, Holyoke MA 01040
Signature o Telephone
r—`t - 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 413-203-5888
Telephone 11/03/2021
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....... No...... ❑
City of Northampton
Massachusetts
i .A c
N
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building yJy Cs
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:
480 Elm Street, Northampton
(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)
) �_,�>j_x'
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 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888
A;71
u an employer?Check the appropriate box: Type of project(required):
1. 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. EJNew construction
2.❑ I 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. E] Building addition
[No workers' comp. insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.VRoof 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#1 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.
lContractors 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.#: R2WCO21353 Expiration Date: 4/27/2020
�4?0 F 1 fn ,_x� +ho_ n 0-on
Job Site Address: Q��� City/State/Zip: 1 )pr Q 10(00
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 andpena 'es ofperjury that the information provided above is true and correct
Signature: Date:
Phone#: 413-203-5888 V if
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#:
Worker's Comoensation and Emolavees L-ability Policy
Berkshire Hathawa AmOUMD Insurance Many-A `Co.
Policy Number R2WCO21353
GUARD Insurance Renewal of R2WC903635
Companies NCCCI No. [21673]
i(
Pofty tnfonnintlon Page(AR)
[1]Named Insured and Nailing Address Agency
PEAK PERFORMANCE ROOFING LLMC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIEI.D 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) i!
fi
t
j
[2] Policy Perlod
From April 27, 2019 to April 27,2020, 12:01 AM,standard time at the insured's mailing address.
[3] Coverage
1
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 i
Bodily Injury by Disease-policy limit $500,000
C. Refer to Residual Market Limited Other Stages Insurance Endorsement-WC200306B
w
D. This policy Includes these endorsements and schedules:
See Extension of Information Page-Schedule of Fortes j
[4] Premium
i'
The Premium Basis and,therefore,the premium will be determined by our Manual of Rules,
Classifications,Rates,and Rating Pians. All required information is subject to verification and change by
Page) E'
audit. (Continued on another e
Total Esdmabi Polley Premium 31,202
Tool Mwdmroes/Assassmenb $1,181.00
Total Esdmsbsd Cost 6 $32.383AO
WERNAL USE XX Page- 1- Inkmotion Page
MGA :RZWCD21353 WC 000001A
Date :OgOIM19
MANOTE
Unuing Ounce:P.O.sox A-%16 S.River Sbw*e WIC PA 18703-0020 0 wwwAwrdA=n
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
Registration: 183698
PEAK PERFORMANCE ROOFING,LLC. Expiration: 11/03/2021
1 LOVEFIELD ST.
EASTHAMPTON,MA 01027
Update Address and Return Card.
SCA 1 O 2OM-05//117
.�� rilYlN//!Y!//Y7�1�/'� �LMaiJI/�N/31✓�'3
Offles of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. K found return to:
ffilgishybort Eoration Office of Consumer Affairs and Business Regulation
183668 11//03/2021 1000 Washington Street -Suite 710
PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118
JAMES FLANNERY
1 LOVEFIELD ST. ri'L illc
EASTHAMPTON,MA 01027 Undersecretary No valid withoutgnature
i
Commonwealth of Massachusetts .
Division of Professional Licensure Construction Supe
Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(881 cubic meters)of enclosed
space.
CS-103061 Eatpirm 091211=
JAMES J FLANNERY -
1 WIWAMS ST
HOLYOKE MA 01050 w
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
Commissioner For information about this license
Call(617)7273200 or visit www.mass gov/dpi
DocuSign Envelope ID:E4AC6CE6-3237-4C7A-9786-AFA6F49F7435
Peak Performance Roofing LLC
1 Lovefield St. MF
E K
Easthampton,MA 01027
413-203-5888 P E R C E
peakperformanceroofingllc@gmail.com • •
MA HIC#183698 MA CSL#103061
Contract
ADDRESS CONTRACT# 10033
Jen Jakowski DATE 02/24/2020
480 Elm Street
Northampton,MA 01060
jennifer.jakowski@gmail.co
in
JOB LOCATION
480 Elm St,Northampton
3► �TO1*1 AMOUNT
1.Remove the existing roofing shingles 10,500.00
2. Inspect the plywood for any rot or deterioration. We will provide 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 on eaves and three feet around pipes(low slope roof
will receive full ice and water shield)
4. Cover remaining roof with synthetic underlayment
5. Install,new 8" aluminum drip edge on all eaves and rake edges
6.Install Landmark architectural shingles by Certainteed(please choose)
http://www.certainteed.com/residential-roofing/products/landmark/
Color Choice;
7. Install ridge vent on peaks of roof
8. Complete all necessary flashings including new pipe boots and 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 ANY DEBRIS THAT MAY
FALL INTO ATTIC.Please use caution during the process;do not walk/drive under active
work or on areas of potential roofing debris. Contractor will obtain building permit.
Installations are weather permitting.Long periods of inclement weather will cause scheduling
delays.
DocuSign Envelope ID:E4ACBCE8-3237-4C7A-9788-AFA6F49F7435
DERI AMOUNT
Landmark shingles=$10,500
A deposit of$5,250 is due at contract signing. The balance shall be due upon completion.
Accounts outstanding over 10 days past final invoice date subject to 2%finance charge,
compounded monthly.
TOTAL $109500.00
Accepted By Accepted Date 2/25/2020
C86IAB2DF0D6F4C2..