29-035 (2) 48 PIONEER KNLS BP-2018-1205
GIs 4: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:29-035 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-2018-1205
Proiect4 JS-2018-002152
Est Cost$9950.00
Fee $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: JAMES FLANNERY 103061
Lot Size(sp.R.): 11979.00 Owner: LOVELESS JOAN S
Zori= Applicant. JAMES FLANNERY
AT. 48 PIONEER KNLS
Applicant Address: Phone: Insurance.,
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:5/1612018 0:00:00
TO PERFORM THE FOLLOWING WORKSTRIP & 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$0 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:
Feel*pe: Date Paid: Amount:
Building 5/16/20180:00:00 540.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
a.
City of Northam on arp*m t -
g�1iI�i�tjj9g�a rt ant
CutiBdurrngPtmd
212`M51Haatr t SwA*d5M4oAwv1Sb tr
Room 106 -
gEPT OB Said dLiYrriM W�iiR,,,,
7-1272 PIeM,.T,_
OMarSNirdfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR OEMOLISM A ONE OR TWO FAINLY DWELLING
SECTION 1-SITE INFORMATION
pp_ ) $ -l1UtS
This taction tD bewmpl ad bye
1.1 ProtsntYAtldmt:
6fg Piot �Rf� �YJO�� LMP 29 Lot 2j501 Unn
/0 r-"-) Own"n'D"'""
IBM ft vw k CA District
SECTION 2.PROPERTY O W NERSHIPlAUTNORI2EDAGENT
2.1 Owner oIR cw0 f
70/4/vLOUELOSS y8 P%On1� KM611s ,rinrao
Nwna(Prkq Current NaMin9
Tekplwne
Bignaare
2.2 Acaw*
3RMES S LLAN1{t,RY 1 Lout eJct� S�, QS��2Am��aNMf�
Name(Pring Current Nailing Address: Q�Q
q13 - a03- 58B 8
Slgrmwre Talepinna
SECTION 3-EISTINA ED CONSTRUCTION COSTS
them Ealimetad Cost(13010m)to be, Oi5d8l use Orgy
co *ted by p2mvitApplicant
1. Bwwft 9 9 5-0, 00 (a)Building Parma Fee
2, Electrical _/ (b)Eatimetad Total Cost of
Coiwtrnxdion fran
3. Plumbing BulNSng Permit Foe
4. Ltactienical(HVAC) `
5.I"Pmt*cwn
S. Total-(I -2.3+4+5) Crack Number
This Socibn FwOfficii Uoo Only
Det*
Buldng Perms N igae�;
Bupwo of BwkNgs Dere
pe4K,PfgFORmRNCERObF/N6-LI-Cg i /mMG, Z)N
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 6 DESCWP M OF PROPOSED WORK(check all applica )
New Nowa ❑ Addition ❑ p Doors Mk+r M(s) Q 8.11.9
Accessory Bldg. ❑ Demolition ❑ New Signs M DerAs [I7 Siding M] Oti
Brief Desotpaon M Pmpmed
wont: Revnavr -exis�,na s�;n >c,, i�s�f� 1� l��C�er�iWrn>nf,�, 4/1z4,Vt�!'s, ,L�f�1
Alteration of meeting bedroom_Yes_No Adding new bedroom_Yes No
Attached Narrative Renovating unfinished basement Yes No
Plan AtmCled Roll -Sheet
M.y" M hwim eye of smftn to timum h[nuhn.COMaku int foftwbm
a. Use of building:One Famity Two Family Omar
b. Numberof rooms in each family unit Number of Bathrooms
G Is there a garage arched?
d. Proposed Square footage of new construction. Dimensions
e. Number of stones?
I. Method of heading? Fireplaces or Woodskrves Number of each_
g. Energy Consemgon Compliance. Meascheck Energy Compliance form attached?
h. Type of wnstructton
I. Is construction within 100 fl.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yee_No
I. Depth of basement or teller floor below finished grade
k. Will building conform to the Building and Zoning regulabi Yes No.
I. Septic Tenk_ Cly Sewer_ Private well_ City water Supply_
SECTION To-OWNER AVINORVA7M-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BONDING PERMR
l �Orlly Lb as Owner of the subject
Property
nerebyauthodm JgMES J. FLfiNN�y2)/ Dt33A PEAK pERFORMI+NCF A00ilill6 UC
to act�o�n�my behalf,in a'111 matters rate#"to work authorized by this building pens application.
sig re of Ovmar Dere
I, -JAMES -J. P(ANA)ERY .as OwnedAuthodzed
Agent hereby declare that the statements and Infonn6on on the foregoing application ars true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
-JAMES T FLF}NNERL/
Print Name
Signature of OwneriAgent Da e
SECTION 6-CONSTRUCTION SERVICES
3.1 I-lamed Construction Suoervbor. Nm Applicable 0
m.,rumm,lwlda,:_ J,9MES S FLANNEI2y Cs - 1030101
licenao Number
l Uvilliam5 5- , /Jo/yok8 rn14 016go i 1,2 0/
Addie I radm Dale
1113- 903 - SPBFr
Signature Telepmne
Not Applicable 0
PERK PERFoR/hHNGE g00F/ruG, LLC /?3698
Commm Name Registiatio Number
i "ve-;.end 5+, EQ s fhamp�oN YwA a/a�� a �;3 /2o 19
Address /y13� F-Virstion Date
Telephom dD3-.�88�
SECTION 10.WORMERS'COMPENSATION INSURANCE AFFIDAVIT(6.O.L c.1162,126C(6))
Workers Compensation Imurence affidavit must be completed and submitted with Nis application.Failure to provide this alfidevit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... winNo...... 0
The Commonwealth of Massachusetts
Department oflndustrial Accidents
Office oflnvestigations
vi 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
Areypu an employer? Check the appropriate box: Type of project(required):
1.E21I am a employer with 4 4. ❑ I am a general contractor and 1 6. F1 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have R. ❑ Demolition
working for me in any capacity. employees and have workers' y ❑ Building addition
[No workers' comp. insurance comp. inamance3
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 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.yRoof 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 bl must also fill oat the section below showing tbeir workers'compensation policy information.
r Homeowners who mbmit this i f idavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contactors 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.#: /RJ2WC943835 Expiration Date,:./ 4/27/2019
Job Site Address: y ' PiOr)-e�P, /1 {70//S City/State/Zip: f/Oaw rvv 016 ;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.
Ido hereby certify tunder
_th�e aims and,penalties of perjury that the information provided above is true and correct.
Sienamre' Yt Dalc'
Phoneie: 413-2 5 8� 8
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):
t.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Worker's Compensation and Employer's Liability Policy
11187
ka
rkshire Hathaway AmGUARD Insurance Company- AStock Co.
Y Policy Number R2WC943835
Insurance UARD Companies Renew N CI No.l of [218 3]
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, 2018 to April 27, 2019, 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. Employers 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 WC200306B
Endorsement-
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 13,650
Total Surcharges/Assessments j 606.00
Total Estimated Cost 14 256.00
IWERNAL USE xr Page- 1 - Information Page
MGA : UWC 3835 WC 000001A
Date :04/0/2018
MANOTE
Issuing Once: P.O. Bou A-H, 16 S.River Street,Wilkes-Barre,PA 18703-0020 •www.guard.am
City of Northampton
Massachusetts 4.
Is
DfPANOfRNl' or aDZLDIDO IRSPECTION5
212 w5n Street ma ipal Suilainp
up
Nnrtbtcn'nn, hA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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:
'f8 P'onz,ere �no��s
(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:
,4mon`s Roll-n , / Loomis a) , �as�tiamp PM
(Company Name and Address)
-5/O� �
Sign o re Permit plicant or Owner Date
If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Departrnent as to the location where the debris will be disposed.
�tte �ammanu��a,�� o�C> cce�uaeC�
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. Re xpiMUM: 11/0=
E�glira0on: 11/03/2010
1 LOVERESTHAM ST.
T
EASTHAMPfON,MA 01027
UpdM*Aeenaa e�RS mCMe.
un, o mwavn
®
B..'d" Ba l a n s R
artl 0 o,`9uJRegi atrc.os to a=as:as
Lena? CS-107061
At—311111
JAMEY J FLANNERY
10YLL11AM6 87
HOLYOKE MA 01//010.�
,n,ss,urnr OW2112010
K Peak Performance Roofing LLC
Contract
P E
1 Lovefield St Date Contrec8l
P E R F OFROM R C' E Easthampton, MA 01027 5/9/2018 547
MA CSM 103061
MA HICM 183698 413-203-5888 peakperformanceroofingllc@gmail.com www.peakperfonnenceroofingllc.com
Job Location Bill To
Joan Loveless Joan Loveless
48 Pioneer Knolls. 48 Pioneer Knolls.
Florence,MA Florence,MA
413-584-6522 413-584-6522
joanloveless@yahoo.com jmmIoveless@yahoo.com
Description Total
We hereby propose to provide the labor and materials for the completion of the following works 9,950.00
1.Remove the existing roof shingles
2.Install Fimilastic SA rolled roofing on low slope section
3.Install six feet of ice and water shield at eaves and valleys
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 Certaintecd (Landmark PRO 40yr)
httpsJtwww.cmtaintced.conVuesidential-roofing/pmducMmdmmk-pro/
Color Choice:
7.Install new Cenainteed ridge vent
S.Complete all necessary lashings including new pipe boos and new base flashing around chimney
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged
Total cost:=$9,950
A deposit of$4975 is due prior to start of work
The balance of$4975 shall be due upon completion.
*We are not responsible for dirt/debris that may fall into attic*
Customer Signature: •y.,r„ J JoAkP�
Contractor Si