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38B-181
17 FORT ST BP-2021-1120 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B- 181 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-2021-1120 Project# JS-2021-001885 Est.Cost: $6350.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq. ft.): 4356.00 Owner: MACGILLIVRAY SCOTIA Zoning: URB(100)/ Applicant: JAMES FLANNERY AT: 17 FORT ST Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:4/5/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:PARTIAL 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: FeeTvpe: Date Paid: Amount: Building 4/5/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:3F9772FC-7598-4087-B623-C81505F807C9 1^ i t b C I v i,J '• APR - 5 2021 1 4 The Commonwealth of Massachusetts•------.._.-----•--w 1 FOR tfy Board of Building Regulations and Stand, ''�;�;'�; 'ocro_ .Massachusetts State Building Code,780 CMR MUNIUIPALITY -- — USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building JP rmit Number: 6,"off-�l d( ate Applied: u,04- ,, / w- 5-Zoz1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 17 Fort St. 38B-181-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSJJICP' 2.1 Owner'of Record: Scotia MacGillivray Northampton, MA 01060 Name(Print) City,State,ZIP 17 Fort St. 831-345-4472 sakot2000@hotmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building le Owner-Occupied 0 Repairs(s) 4 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other Ii Specify: Roofing. Brief Description of Proposed Work': Partial re-roof. Strip and replace asphalt shingles. (Excluding upper main slate section, and low slope section.) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6,350.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No.3Y-1/Check Amount: lif V Cash Amount: 6.Total Project Cost: $ 6,350.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:3F9772FC-7598-4087-B623-C81505F807C9 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2022 James J. Flannery License Number Expiration Date Name of CSL Holder W %IG,a- 5 5 l List CSL Type(see below) U No.and Street Type Description Holyoke, MA 01040 U Unrestricted Buildings up to 35,000 cu.ft.) y R Restricted 1&2 Family Dwelling City/Town.State,ZIP M Masonry RC Roofing Covering WS Window and Siding 413-203-5888 SF Solid Fuel Burning Appliances peakperformanceroofingllc@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 183698 11/03/2021 Peak Performance Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 Lovefield St. peakperformanceroofinglIc@gmail.com No.and Street Easthampton, MA 01027 413-203-5888 Email address City/Town,State,ZIP Telephone SECTION 6: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 .❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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: 3/31/2021 Scotia MacGillivray C M i(,(ivyr Date Print Owner's Name(Electronic Signature) 948970F9EEE0435... SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to e best of my knowledge and understanding. James J. Flannery `�(2,I UV Print Owner's or Authorized Agent's Name( ectro c Signature Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dus 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) _ (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system - Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DocuSign Envelope ID:3F9772FC-7598-4087-B623-C81505F807C9 City of Northampton O,, RMYJJam. S�5 ... SAC Massachusetts a� r G 3f' w' % � i ..ski;' DEPARTMENT OF BUILDING INSPECTIONS yJ bfi „ x 212 Main Street • Municipal Building 6. p ' "� r Northampton, MA 01060 f' SP0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Valley Recycling, 234 Easthampton Rd., Northampton MA 01060 The debris will be transported by: Name of Hauler: Aaron's Roll-Off Service Si nature of A licant: James J. FlanneryP1-7t-..1�� Date: `4i Z-f ib 24 g pp The Coininonwealth of Massachusetts Department of Industrial Accidents Office of Investigations = WM Lafayette City Center f 2 Avenue de Lafayette, Boston,MA 02111-1750 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 y an employer? Check the appropriate box: Type of project(required): 1. 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. ❑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.t 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lic. #: R2WC130849 Expiration Date:4/27/2021 l� Job Site Address: I 1 Ff t € City/State/Zip: Nord i0A, auk d ib(od 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 nains and penalties of perjury that the information provided a ove is true and correct. Signature: ni*I"1/4-4-3;1• Date: t{ qibti 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(check one): 10Board of Health 20 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Worker's Compensation and Employer's Liability Policy A�� AmGUARD Insurance Company - A Stock Co. �V Berkshire Hathaway Policy Number R2WC130849 61,' ARD Insurance Renewal of R2WCO21353 .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 I $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 DATE(MM/DD/YYYY) A Q® CERTIFICATE OF LIABILITY INSURANCE 7/10/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CT Adina Edgett Webber & Grinnell PHO (413)586-0111 FAX (A No): (413)586-6481 IA/C.NNEo,Extl: 8 North King Street E-MAIL : aedgett@webberandgrinnell.com ADDREINSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Admiral Ins Co/BRECK INSURED INSURER B:Plymouth Rock Assurance Peak Performance Roofing, LLC INsuRERc:WCAR- Berkshire Hathaway GUARD Attn: James Flannery INSURER D: 1 Lovefield Street INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 04/21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR EFF POLICY EXP TYPE OF INSURANCE INSD SUBRWVD POLICY NUMBER (MMIDDY LTR /YYYY) (MM/DD//YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES (Ea o currrrence) $ 300,000 CA00003521802 7/7/2020 7/7/2021 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: Employee Benefit Coverage Form $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED PRC00001007091 6/27/2020 6/27/2021 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) Medical payments $ 5,000 UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE R2WC130849 E.L.EACH ACCIDENT $ 500,000 OFFICERJMEMBER EXCLUDED? Y N I A C (Mandatory In NH) James Flannery is excluded 4/27/2020 4/27/2021 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below from WC coverage. E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /J � W Grinnell, CPC , C=C hi.it—� Y--�`+ I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2ot4o1) 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 iration: 11/03/2021 1 LOVEFIELD ST. EASTHAMPTON, MA 01027 Update Address and Return Card. SCA 1 0 20MM--05/17 V./4",o-riNJ.-/ii:/✓4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Exoiratlon 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 LOVEFIELD ST. .� L ';14 EASTHAMPTON,MA 01027 Undersecretary Not valid without gnature Commonwealth of Massachusetts Division of Professional Licensure Construction Supervisor Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain „n less than 35,000 cubic feet(991 cubic meters)of enclosed �(J space. CS-103061 Expires: 09/21,2 r JAMES J FLANNERY 411, 1 WILLIAMS ST HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts Cl". tate Building Code is cause for revocation of this license. Commissioner For information about this license Call(617)727-3200 or visit www.mass.gov/dpl DocuSign Envelope ID:3F9772FC-7598-4087-B623-C81505F807C9 Peak Performance Roofmg LLC 1 Lovefield St. P E Easthampton, MA 01027 P E R F O R C E 413-203-5888 peakperformanceroofingllc@gmail.com ROOFING MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10295 Scotia MacGillivray DATE 03/31/2021 17 Fort St. Northampton, MA 01060 ©©p\ft 831-345-4472 sakot2000@hotmail.com DESCRIPTION x , This contract excludes the upper main slate roof, and low slope section. Any carpentry work needed should be completed prior to the roofing. 1. Remove the existing roofing materials 2. Inspect the plywood/boards for any rot or deterioration. We will provide up to 64 square feet of plywood or board replacement at no cost. Any additional wood replacement will be $85 per sheet plywood or$2.65 per square foot of roofing boards . (Wood price subject to change). 3. Install six feet of ice and water shield on eaves and three feet in valleys/around all penetrations 4. Cover remaining roof with synthetic underlayment 5. Install new 8" aluminum drip edge on all eaves and rake edges 6. Install architectural shingles by CertainTeed (Landmark)http://www.certainteed.com/residential-roofing/products/landmark/ Color Choice: 7. Install Shingle Vent 11 ridge vent on peaks of roof http://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/shinglevent2 8. Complete all necessary flashings including new LIFETIME pipe boots and base flashing around chimney Includes CertainTeed Lifetime Limited Warranty with 10 year SureStart period. https://www.certainteed.com/resources/Asphalt_Warranty_CTR3782_1912_E.pdf 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 reasonable caution during the process; do not walk/drive under active work, or on areas of potential roofing debris. Peak Performance Roofing will obtain the building permit. Installations are weather permitting; long periods of inclement weather will cause scheduling delays. DocuSign Envelope ID:3F9772FC-7598-4087-B623-C81505F807C9 DESCRIPTION Total: $6,350 An initial deposit of$500 will secure contract/building permit/priority scheduling. A deposit of$2,675 will be due after building permit is approved, at time of material order and tentative scheduling (approx. 1-2 weeks prior to expected installation.) The balance shall be due Upon Completion, within 10 days of invoice date. Accounts outstanding after 10 days past final invoice date subject to 2% finance charge, compounded monthly. Warranty confirmation will be furnished upon final payment. TOTAL $6,350.00 Accepted By DoauSignedby: Accepted Date 3/31/2021 Sofia nAGitliwrai 948970F9EEE0435..,