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17C-006 (13) 24 LAKE ST BP-2020-1129 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-006 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-2020-1129 Proiect# JS-2020-001890 Est.Cost: $2400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq. ft.): 9539.64 Owner: WAGMAN ALEXANDRA S Zoning: URB(100)/ Applicant: JAMES FLANNERY AT. 24 LAKE ST Applicant Address: Phone: Insurance: 1 LOVEFIELD ST _ (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:511512020 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ON BACK PORCH ONLY 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 Si¢nature: FeeType: Date Paid: Amount: Building 5/15/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:38619B1A-OE23-439A-9C53-558E81003E82 Department use only City of Northampton ' Vitus of Permit: % Building Department curb-Cut/Driveway Permit _ 212 Main Street qy Sewdr/Septic Availability Room 100, ti��� S Watefl,WellAvq:ilability Northampton, MA 0166 �„ Twots of Structural Plans phone 413-587-1240 Fax 413= / , Plgesite Plans ti2,gsO�ccther Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA4;O6EMQLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office 24 Lake St, Florence Map_ ec Lot Unit Zone Overlay District_ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Alexandra Wagman 24 Lake St, Florence MA 01062 Name(Print)I—:,— usigned by: Current Mailing Address: Telephone 413-548-0853 Signature 1421F6E304c541E_. 2.2 Authorized Agent: James J. Flannery 1 Lovefield St., Easthampton MA 01027 Name(Print) Current Mailing Address: Lq 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 $2,400.00 (a)Building Permit Fee 7 Electrical h) ESti;r.?!eH Tptgl r•ncT of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) T 5. Fire Protection 41 6. Total= 0 +2+ 3+4 + 5) $2,400.00 Check Number �jJThis Section For Official Use Only Building Permit Number: ('/1- '���114/ Date /f Issued: Signature: L 5' ZO& Building Commissionerilnspector of Buildings Date peakperformanceroofingllc (a) gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:38619B1A-OE23-439A-9C53-558E81003E82 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ TRoofing Or Doors F-1 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks (CJ Siding[O] Other[p] Brief Description of Proposed remove existing roofing material on back porch roof only, replace with rolled roofing 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 FarnT _ 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 It. 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 r Alexandra Wagman as Owner of rhe subject property hereby authorize James J. Flannery / Peak Performance Roofing, LLC to act n y b Vlf, in all matters relative to work authorized by this building permit application. 5/6/2020 F .— Sig yatu 6 AP441 r 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 ¢ s&/2-6 2-0 Signature of Owner/Agent Date , DocuSign Envelope ID:38619B1A-OE23-439A-9C53-558E81003E82 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:-- _^ CS-103061 License Number James J. Flannery 09/21/2020 Aedress Expiration Date Holyoke, MA 01040 Signaturew� Telephone 413-203-5888 9. Registered Home Improvement Contractor: Not Applicable ❑ Com�anyNameName Registration Number Peak Performance Roofing, LLC 183698 Address Expiration Date 1 Lovefield St., Easthampton MA 01027 Telephone 413-203-5888 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....... I/ No-.... ❑ DocuSign Envelope ID:38619B1A-OE23-439A-9C53-558E81003E82 _ City of Northampton •>t�� � Massachusetts G°y A �# � fy ; ,` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building t Northampton, MA 01060rYjy � 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: 24 Lake St, Florence _ (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) 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. • 1 'f A y. ,. The Commonwealth of Massachusetts y Department of Industrial Accidents }` Office of Investigations ' 600 Washington Street .•r 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 Are,/you an employer? Check the appropriate box: Type of project(required): 1.L� I 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. F] New 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 8. ❑ 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 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.gRoof 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. $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.#: R2WC130849 Expiration Date: 4/27/2021 -( Job Site Address: a L&�4p SC. City/State/Zip: F-/60P«_ mfi 0/6 2 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above 's true and correct Si nature: Date: 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#: y_• ,r..:.. .... ....� �.c`•...�,.: �.....:_.. .,.,...y.M.':...:... .a. �:..:..:.... . ...a :.' �.r..� .. ...,.....,.. .. ..... ... !.-.a,.......,,. ....,a.. ....k.... ...a.eu.ut..d a i.-i.�r�-.'N`aa..SYil1 r n , ? Pf t. 4r 'R.•W A!.�•� � zpi., i•Y- h.... - *9;#-: ..n' .s '.py..._, y i A Worker's Compensation and Employer's Liability Policy !�Berkshire Hathaway AmGUARD Insurance Company - A Stock Co. eve( y Policy Number R2WC130849 `' Insurance Renewal of R2WCO21353 G U A R D °A 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 LOVEFIELD STREET 8 NORTH KING STREET EASTHAMPTON, MA 01027 Northampton, MA 01060 Agency Code: MAMAIN15 Federal Employer's ID XX-XXX1951 Insured is Limited Liability Co. (LLC) [2] Policy Period From April 27, 2020 to April 27, 2021, 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 $ 25,108 Total Surcharges/Assessments $ $867.00 Total Estimated Cost $25,975.00 INTERNAL USE XX Page - 1 - Information Page MGA : R2WC130849 WC 000001A Date : 04/07/2020 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square,Wilkes-Barre, PA 18703-0020 • www.guard.com :. . , . ��.: . i z,; � ! Y6r �'.Q _ f>� � � Wit. �. i '?, _ _. ...W .. .,. ... .d..... ..- -r .. .. 4, _ \ -. _ ,'�«.v� s.' ..ea:1"` .a.r.34,hk�.r 9 i a at' .c 4.mS s�' .:'����,5�.. �i��•.a �r-'�-�: - Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC PEAK PERFORMANCE ROOFING,LLC. Registration: 183698 Expiration: 11/03!2021 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Update Address and Return Card. SCA 1 L3 20'&0507 _7/11 S!�i vi riiii•�iil/fi V. Office of Consumer Affairs b Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 183698 11/03/2021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY 1 LOVERELD ST. EASTHAMPTON,MA 01027 Undersecretary No' without 'gnature Commonwealth of Massachusetts 19 Division of Professional Licensure Construction Supervisor Board of Building Regulations and Standards Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. CS-103061 Expires.:09,2112020 JAMES J FLANNERY 1 WILLIAMS ST HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner CAC— For information about this license Call(617)727-3200 or visit www-mass.gov/dpi DocuSign Envelope ID:38619B1A-OE23-439A-9C53-558E81003E82 Peak Performance Roofing LLC 1 Lovefield St. Easthampton,MA 01027 413-203-5888 P E R F O R C E peakperformanceroofingllc@gmail.com • • MA HIC#183698 MA CS0103061 Contract ADDRESS CONTRACT# 10074 Alexandra Wagman DATE 04/17/2020 24 Lake Street Florence,MA 01062 awagman@hcc.edu 413-548-0853 JOB LOCATION 24 Lake Street, Florence TESCRII'TI(j1T AMfU1�iT -This contract is for the back porch roof only- 2,400.00 1. Remove the existing roof material 2. Inspect plywood sheathing for rot or deterioration 3. Replace up to 64 square feet of CDX plywood if necessary at no cost. Any additional plywood will be $75 per sheet installed 4. Install new 8" aluminum drip edge on all eaves and rake edges 5. Install new Flintlastic SA rolled roofing by Certainteed Color Choice: 6. Complete all necessary flashings Remove all debris from premises, and throughout the job, continue cleanup and keep the premises undamaged. 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. Total cost: Back porch roof=$2,400 A deposit of$1,200 is due at contract signing. The balance shall be due upon completion. Accounts outstanding 10 days past final invoice date subject to 2%finance charge, compounded monthly. TOTAL $29400.00 Accepted ByoeeuSigneaby: Accepted Date 5/6/2020 C E304C541E .