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32A-198 (2) 25 PHILLIPS PL BP-2018-1120 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 198 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:ROOF BUILDING PERMIT Permit# BP-2018-1120 Project# JS-2018-002012 Est Cost,$6050.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sa.R): 15594.48 Owner: HOFFMEISTER COLIN zomne: URC(100)/ Applicant. JAMES FLANNERY AT: 25 PHILLIPS PL Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:4/3012018 0:00:00 TO PERFORM THE FOLLOWING WORK.REMOVE EXISTING MAGTERIAL ON LARGE GARAGE, REPLACE WITH EPDM RUBBER 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 4/30/2018 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED _— 2U16 '' Oeperlmenl trH OMy �PA - City of Northampton IStatute at Permit .r Building Department Curb Cutrorlvrovay Permit CnONS 212 Main Street 'saxerlSaptis Avrrftbihty DET. a 1Wo Room 100 WalerMeN AveilebiIlly N Northampton, MA 01060 rwo sett N Stnwlurel Plant phone 413-587-1240 Fax 413-587-1272 PlobSne Plans _.-- Other Speldfy APPLICATION TO CONSTRUCT.ALTER,REPAIR,RENOVATE OR DEMOLISH A O6 10 OR TWO FAMILY y DWELLING SECTION 1 -SITE INFORMATION I `��•' 8-. ({ ZV 1.11 Proalift ddress: l This se tfich to be compptN�9/Q by oiRce K / h �j I/ll P$ 1 /Q G Pi Map_�t2t �...— Let-. t"1 O —Unit-- Zone Overlay District_,_ _ Elm St DiabM C110looe SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT — 2.1 Owner N Record: 0J;Ar_ 6 mwsl4� + --s _—raleasn-on«'P- h-d- `13-5--Nya�c NamaFmll C 1Meimg Aearess — lm L�12dL3/0 A -�e �- -- -1Hm?S S�rtllFxL ! __—�od�iLf�r _mea/SpP/Forr Aanc¢Ro��+nGilca76vA; ry lPnna — _ _ c I Mor,Ritess - - yl3 -2 03- 5-8 8 Sg Wro -- T I N1urrt SECTION a-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only _ _c.�kted by permit z Icznt I. Building ( nsDl b� (a)Building Permit Fee 2. Electrical hit S� hit Estimated Total Coat of onavm::u.fns. '6� 3. Plumbing Building Permit Fee qo 4. Mechanical(HVAC) 5.Fire Protection jq_�-y/�1__( 6. Total z(1 +2+3+4+51 T/JV-31 J,� Check Number r _ This Section For Official Use Only _ Date Building Permit Number .Lou Signature' Sa.ldng nemnspegnr of emlaings Lela Peoperkrmance-A" iy7GLcC, @ lmtill .[og� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING au informanoo Must Be Completed.permit can be owned Due to incomplete lemrmatlw Lnmm- pmp.d Acquired by Zonng Thi.culm,m la he Ri'a m In Lm Sim _ Frontline lnbaek. I m — — lair L: R: L R: Rem, Budding livighl BIdu.Squa a Furcu, (ml-ISP-111 TPootagu -- reM1 — sai ero minor IJ4¢a MvN ine A of Pnrk�,5 ace. Fill: lvnlnmc a Lamicit A. Has a Special Permit/Variance/Fi ding ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date Issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES 0 IF YES: enter Book Pageyyyy��satttt and/or Documentq B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O IF YES,has a permit been or need to be obtained from the Comet ation Commission? Needs to be obtained O Obtained O . Date Issued: C. Do any signs exist on the property? YES O NO IF YES,describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO ak— IF YES, describe size, type and location: E- WIJ the construetim activity disturb(Gsarng,ipad lAAA��— avat or Wang)over t urns or is it pan of a common plan that will disturb over 1 acre' YES O NO IF YES,than a Nonhampion Stortn Water Menagsment t from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORN 1 h k all a F bl t �— New House ❑ gtldition ❑ Replarament Windows �Altemtionls) ❑ Roofing Dr Doom ❑ Accessary Bldg. ❑ 1)...dean ❑ Naw Signs tp] Decks tq Skiing Olher(Cn Brief Description of Proposed wnrl,:$emo✓e xfsF,� material on lard lJkfat �ate wl'vFj F�DM �ubrbRR... Alteration of existing bedroom__ Yes_No Adding new beatnrom _Yes No Apsched Narrative Renovating did erhed basemen) _Yrs No Plans Attached Roll -Sheet ed it New house and or addition to existing houl complete the following UsoofbuJding:On.F.i Two Famlly_,_Othar_ b- NLmber of rooms In each famny uni[ _ Number of Bamrooms_ _ Is there a garage attached? __ d. Proposed Square footage of new comtructioa_ _ . Dimensions Number of stories? f. Method mhemag? Fireplaces or Wdods,oves Numbered each__ g. Energy Conservabdn Compliance. . Masscheck Energy Compliance form afteched7 It Type of cd,atruction Is construction within 100 itof wetlands'+__Yes Noa construction within 100 yr. floodplam_Yes--NO t. Depth of basement or cellar floor holo.finished gratle _ k, Will building conform to the Building and Zoning regulations? _ Yes—_.No I. Septic Tank_— City Sewer_ Private wall_ City..lot Supply SECTION to-OWNER AUTHORIZATION.7O BE COMPLETED WHEN \ OWNERS AGENT OR CONTRA TOR APPLIES FOR BUILDING PERMIT Y IIre pt r`lI n` _/` /' �8 as Owner of the subject hereby add, tie / eQn fort"lail r— R6 ()fln& U—L/ Ip dao hall all Malt.rs ralerrvemwork euthorizetlh this holding permit applicationjpvagki�- NI . L umn uete lames '� ��arutfR M9 PaKki-f6emaniRil, LL0--a10wnerrAuhmd,al Agan,herahy declareIna)the statements and information on the foregoing appTeathat are We and accurate,to the best M my knowledge and belle) Signed under the pains and penalties of perjury Fir,Name � Sgnature /Owr adern Dele _. _. SECTION S-CONSTRUCTION SERVICES B t Llca aa,d Construction --S}}uuat rvlaa, Not Applicable ❑ Namaeflicema Halle, as Number r jJTiL(arns s / g�z i8 _ Ade EAPnafo at. 519n TelePFone S.Ra ikila nal Hama Imoro and Comraclor. Not Applicable ❑ Comlunv Name rem / R369S �� y p Retismahon Numner PC eat QQ1 mQ/Ai4 I�p.1 r-mb, -d 1( 3�zoJ"4J Aatlress --11 L t ) �,, \ / Fxpsatmo ate _SI i CLf..gh fPNV TeIePhone (O.Z.rJ.s [p —Y —MfF n/L1d�} SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.153,§2SC(6)) Workers Compensation Insurance affidavit must be completed and spbtnetsd vitt this application Far.,.to p,.ad,this affidavit vill result In the denial of the Issuance of the building permit. Signed ARidevit Attacnetl Yes..._ Nd_..... �L\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UIF www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatiowtndividaaB: Peak Performance Roofing LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888 A,r_ey7.ou an employer? Check the appropriate box: Type of project(required): 1.Ly lama 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 g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.-* 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 gRoofrepairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box FI must also fill out the section below showing their workers'compensation policy information. Hameowners who submit this affidavit indicating they are doing all work and then hire outside wrnmctors must submit a new afndm it indicating such. tContracmrs that check this box must attached an additional sheet showing the name of the sub-emnnnetors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workerscomp_policy number. I am an employer that is providing workers'compensanion insurance for my employees. Below is the policy and joh site information. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lia#. R2WC943835 ,. _ Expiration Date: 4/27/2019 Job Site Address: o_5 /OA///I;OS P/a Ce City/State/Zip: �/Of>I-�?QYYIfJfo/J p D�j� 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 andpenalties of per/j,ury that the information provided above is true and correct. Shimaturm Date: y oZs Phone#: 413-203-5888 ✓ V )f` 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#: City of Northampton Massachusetts A _ z D212 Min S OF 6UILnici INSPECTIONS 212 Main street n.' it ni aaildtng }�y Noaauepcon, MA OI060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building pemlit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a property licensed solid waste disposal facility. as defined by MGL c 111.S 150A. The debris from construction work being performed at P511 uupmmbbeer e lnP , ,Uori�t a mP{�vt1 and sheet 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: Cga"'J //-©('r' / Loomis AbV, /yh4 (Company Name and Address) Q lea�- SignaiSignai rof ermit Applicant o� r 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. Odie (Foin monrweae6 olOW awackoe& Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: LLC PEAK PERFORMANCE ROOFING,LLC. Regxprald : 183898 1 LOVEFIELD ST. E1�ira0wan: 11/03(2019 EASTHAMFTON,MA 01027 Update Address antl Ra .Card. su, O sw�osm 3 „ic a cq o•n: s:. CS-109081 JAMB J FLANNERY 1 WLLGAM8 ST HOLYOKE MA 010010 , . zzn l� - aon�ao�e