31A-189 (4) 61 WASHINGTON AVE BP-2019-0010
GIs 9, COMMONWEALTH OF MASSACHUSETTS
Map.Block: 31A- 189 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-2019-0010
Project# JS-2019-000012
Est.Cost:$1700.00
Fee'$40.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot size(sp ft.): 11891.88 Owner: GRYSKA MARK J&ELLEN HIRSCHBERG
Zorn=URB(I00V Applicant. JAMES FLANNERY
AT: 61 WASHINGTON AVE
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:7/5/2018 0:00:00
TO PERFORM THE FOLLOWING WORK RE-ROOF SMALL SECTION 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 7/5/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department,..
City of Northampton Sinus of Permit
Building Department Curb Cn+HtMvaway PWM
212 Main Street Sewmrl
Room 100 WabrANell AvdaWIjr ,
Northampton, MA 01060 Tian Sete of 8Maelural Ptaavk-
phone 413-567-1240 Fax 413-567-1272 PWSite Rana
08verapeaty
APPLICATION TO CONSTRUCT,ALTER,REPAIR.RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION w� ��e 10
1.1 Proeerty Addross 1111118 SeCdOn LO be castellated by office
Map a(-/T Lot_ ^Unit
l Zona Overlay District
_ Elm at olswin CB Dlstdct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner!of Record; --
f(/Ere
Name(Print) Current Mailing Add,.. ---^�—
_ Telephone
Signature
2.2 Authorized Anent: f
J,gtnES 3, FLANgl�}��`— 1 LoyRtl'e/c� Sff cayhAt NIMA
Name(PnN) Current Mauling Adav ii. Q�Q
/3 - ao3
Signature Telephone
SECTION S-ESTIMATM CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed rmit avoiliwin
1_ Building y� rn (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
i Gun:rn:,•i'.+n G;x:� '.^,1 : _ ._�
3. Plumbing Building Permit Fee W
4. Mechanical(HVAC) q"
5.Fire ProteMn
6.
Total=(1 +2+3+4+5) / ('/', �` Check Number
This Section For Official Use Onl
Data
Building Permit Number: Issued'.
Building Commissbnsrllnspeclor of Buildings Date
PeAXn{/2FoRrngN�6k66FIN6- L-1-Gf& 6mRiL : �tlM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
PEAKK Peak Performance Roofing LLC.
Contract
P E R F O R - CE ' Loo efleld st Dale contraiorn
�. Easthampton. MA 010'_7
41A CSLd 103061
N9 HIC N 183698 11;-0nt-iR66 p"l," 11.nnen.uv,.li,gI I- , ,..o.n nv„-paa6peni,nn;nnenu.lintalecom
Bin To Job Location
hhun Ilin.hhorcA?I:uh t,n.ke LH...I hj-,,hIl&31ark Or,aka
I,I N",I".aill,A,u. nI U,l,hin.Inn 1,e.
N wfia,npl.,n. %IA"1116” Ao nhanlploR 51A nlunu
111-584-68S" I I?-ifi 1-1.%So
,hr ,iI he nim„n.lnvllI o in, chinchbemrn a hmmad .,.m
Description Total
I R,tll ev,rl a nwl namrinl, I'uu no
lb"heamine.
maahawaa? tagcncd ':-Ligh l ,r - Inl;hn- al ole uilh app -,Lwm.=,:uuiAlt ,-
4 {dham I Inr1 n,inl,l,n1 YDAI ruhh,r roof.,cI n
11 alumGmai drip dp:....pe'1nne111
,It I,, mmap'J Till",dans c.It/1111/111 A11 dc'oG.'Ill ho raa.o.e,l trmn 111 LI' �.
L 1,1 5170
,A dcpa.6 nt,Rill i,mqulrcd prior m g,In"I
1 hr balanm of SniII.hall he due trim eom..I'l u.
!4'M•d Nsaivd 1 e, Dap.,:" c _ r had.
,.II m:d it tl.hr,I hl I ' ln, I'11 11L IIILski JnLalis l - pr sn,.neJP -
l'nit , t rC1_namm � ( ,g, n._1i-19ur .
Total vL I.1,1..
SEC4ON 6 DESCRIPTION OF PROPOSED WORK Ichack■B applicable)
New Housa Addison ❑ Replxement Windows Alteratlon(s) Roofing Er
Or Ooore ❑
Accessory Bldg, ❑ Darrow. ❑ New Signa [p] Decks [q Sidfnq 0Z7] Od w'[C]
wwil.`�paonmProp a /7C _Ra0F S)I) 11 seejcn' w�+Gl EiiD`bf tc
Aeerabon of existing bedroom`Yes_ No Adding new bedroom Yes No
Attached Nanaave Renovating unfinished basement Yes No
Plans Attached RON -Sheet
Se.N Now Rowe end or BOOM to sxM m houshm, comps to the followlna:
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 stones?
I. Method of hosting? Fireplagas0r Woodstoves Number of each
g. Energy Conservation Compliance. ."Masscheck Energy Compliance form attached?
h. Type of construction
i. Is wnstruction within 100 If of wetlands?_Yes _No. Is consWdfon within 100 yr. floodplain_Vex_No
j. Depth of besormud or cellar floor below finished grade
k. Will building conformTa'Ore Building and Zoning regulations? Yes`No.
1. Septic Tank City Sauer_ Private well_ City water Supply_
SECTION TY-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR AP�^1PUES FOR BUILDING PERMIT
I L� as Owner of the subject
Property
hereby authorize SAM Fs FL1+N1UZA>' (76x'1 PS-14K PIRFORMANC.F ROD F111)6 LL
�y to ad on my behalf,in all matters relative to work authorized by this building permit application.
i - —
S' natuwolo Dale
-Jq(oEs -J, FwgN/UUP-y as Owner/Authonzed
Agent hereby declare that the statements acid'nformation On the foregoing application are true and accurate, to the best Of my knowledge
and belief
Signed under the pains and penalties of perjury
7ArnES J. FLANN£R`/
Print Name
Signature of Owner/Agenl UDale
SECTIONS-CONSTRUCTION SERVICES
8.1 LfceruM Conatruetlen Susimi�--c:: Not Applicable 13
Namef LimmMolder: -J,9MES J PLPIVNEKy CS - /0301x/
LkenBe Numbef
/ Guilliam5 5i, /lo%okp rn><l WQY,0 09/ai/. a
Address —T EVMMM Dale
yl3 - x03 - 588
SldnaaWre TelopnM.
Not Applicable 0
PERK PEKr-0P'l ,glVGE Lee- 1?3698
Comoary Name Registra' Numbe/
Love-/;-lcl 5f, Fasfharn�foN YAR aiaa� /l70r; Zo /g
Address Ct/f 3Expiration Date
Telephone a103-588�
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 162.5 25C(S))
Workers Compensation lmurence affidavit must be Mmplated and submitted with this application.Failure to provide this affidavit will reaus
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... lV' No...... ❑
City of Northampton _
Massachusetts G
t�asa+®rr
OF eczaozao rs�acrzoss .
212 Win 61cu*t a Wnicipal auilan0 '• '
eonthe ton, W 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 property licensed solid waste disposal facility, as defined by MGL c 111. S 150A.
The debris from construction work being performed at:
til rvash;n&1-0ti 4U� ,
(Please print house number and street name)
Is to be disposed of at:
Vatby RJe y(GnG , 73y CJ-S � a tie" 12d, )i1014bantpkyo
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
0
(Company Name end Address) ���a'
Sign re Permit Mplicant 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
U1F www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organiz tiennndividuap: Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 phone #: 413-203-5888
A,rree/ypu an employer? Check the appropriate box: Type of project(required):
1.Lel 1 am a employer with 4 4. ❑ I am a general contractor and I 6. E] New construction(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 S, ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.l
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 Lm❑]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 u Roof repairs
insurance required.] t a 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box NI most 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 most submit a new affidavit indicating such.
lConlractors that check this box must attached m additional sheet showing the name of the sub-couuacma and state whether or not those entities have
employees. If the sub-contactors 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. Lia#: R2WC943835 Expiration Date: 4/27/2019
Job Site Addressdp/ 6UCtS/1- n 40 AVf2— City/State/Zip: lVo(il{i[6U ekin MR
Attach a copy of the workers' co pensrtion policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL a 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 to=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 and penalties of perjury that the information provided above is true and correct.
Silmaturc i� te
Phone#: Da
413-203-5888
Official use only. Do not write in this area,to be completed by city or town ojjicia2
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityfYown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
A Worker's Compensation and Employer's Liability Polley
Berkshire Hathaway AnIGUARD Insurance Company-A Stock Co.
11187
Y Policy Number R2WC943835
GUARDCOmpan es RenewalNCCI No.[218 3]
Policy Information Page (AR)
[I]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 L.OVEFIELD 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. 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 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 $ 606.00
Total Estimated Cast 14 256.00
INTEitNAL USE xx Page- 1 - Information Page
MGA : R2WC 3835 WC 000001A
Dee : 04/04/2018
MANOTE
Issuing Once: P.O. Box A-N, 16 S. River Street,Wilkes-Barre, PA 18703-0010 s www.guard.mm
-9fze 0/0- 4&sackaeffd
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 pimbon: 11 099
1 LAVEFIELD ST. Exgtlre0an: 11//03/2019
EASTHAMPTON,MA 01027
UpeMeA iwI,BM RIMIRI Cede.
.GN O .11
® +i5$dL n,+5tn5 OJ E+1! 4 rd�itj
3oac m' 9uAd 19 Rego +.ham. io 3 nnros
�.anse CS-103061
JAMEOJFLANNERY
I W011AM607
HOLYO(E MA 0100`10
MMA EaPinPon
:oinm,�5A,1N 091712010
'- CSE Peak Performance Roofing LLC
Contract
P E F Q 1 Lovefield St Date Contract#
Easthampton. MA 010'_7 618'_018 5,n
MA CSL#103061
MA RIC# 183698 41?--'n3-5888 peaLperli nmanc<nwlingll......Lmm a..a.penkprlonnnncrmulingllc.oam
Bill To Job Location
bllen I lir.chheR,,k MnA[ic,ka [Alen Hincthe,&]Ink[in>ka
61 A ashinetan Art, 61 R achar ewn A,,,
Nonhampwa.Jl 40 Inlet Ynnhampton.M A 0 l ao
313.584-66311 413-584-6850
ehir,ehbereme hmmailcum eliinchheremolun9lail qnm- _ -. _ — _—
Description Total
1.R.mmo eai.enE nmI malmiA, 170100
2.Ibspett fhe.healbing.
3.Imall mc<hanicuh5 fantlud'dhigh densis rarN isncyvuvak r°ith apraeatd xnras:0d plums.
4.Adhere IIM1II scialin.it[PDM mbher rnai asrrm.
5 1n.rlall aluminum drip edge on l,crimeter of roil:
I'roam rail]be pmroelol(arm damage at all time, Ah debris mill be rcam: cd Ihnn the pranisc,
[oal •$11110
A dopbeil of S950 required prior n:Hartal'uorA.
I he balance n158511 shs]I M1e due brain nnnplewn.
!Iep—a N.:cci<d on Depovn< [heck' _-
'\\, annul res7vmsiM1le for dirt dehri>Ihm nen 611 inm;:nia_plea, hh
'cA f,dthrls afi rT-psrr a monno-l.' '
Contractor Sienamn: � Ij lu.fomtr SiennOrc o1J!/�f'A