43-105 (2) 440 WESTHAMPTON RD BP-2019-0065
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43- 105 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeorv: ROOF BUILDING PERMIT
Permit# BP-2019-0065
Project# JS-2019-000099
Est.Cost:$2850.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(so.11): Owner. BURKE DANIEL&PENELOPE
zoning: Applicant: JAMES FLANNERY
AT. 440 WESTHAMPTON RD
Apin icantAddress: Phone. Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.711612018 0.00:00
TO PERFORM THE FOLLOWING WORIGPARTIAL RE-ROOF, SOUTH SIDE OF MAIN
HOUSE
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:
FeeTvve: Date Paid: Amount:
Building 7/1620180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
- pLot r
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City of rth mpton SYYrofPemaL.
JUL 1 3 ER"ng p ant CurbCS VIlveawar Pse
212 M in S eat MledBsoft , —,oar
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T OP ounoPE�T� n M 01060
NORIHFMP D *Mdftm
-1240 Fax 413-567-1272 P1911emPisrN -
SUedfY
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR))TWO F/
ORMA/MS.Y DWEWNG
SECTION i-SfTE INFATION eO/ l q—
1.1 Pmortr Atlerou: I q This Notion to be eomplelee oBk ,
"o W-# S+AaVYl��7olu led map Lot--�Unk
Zone O-ftDralce
EYn m.owda�_ CS DNmA
SECTION Z-PROPERTY OWNERSHIPIAUTHORUED AGENT
LI Owner of Record:
PFNe�oPE Bu2KE 4y0 tueslhampl�v �d !/or+harn�ifonl
Nemo(Pd Curem M.I g Maass:
B� TO"` 413 - 530 — -753(0
2.2 Auttorieed Agent:
719rnES T G[.ANNERt/ 5t EagAarnp;l*aMA
Nana(Print) Curent Meting Addnw:
y13 - ao3 - S8� g
Sigaaxe TeMpnaa
SECTION S-ESTIMATED CONSTRUCTION COSTS
sem Estimated Coat(Dollars)to be Official Use Only
com leisd by permitapplicant
1. Building O SD D D (a)Balldng Panne FN
2. Electrical O (b)Estimated Total Cat of
Con itruetion foam 8
3. Plumbing Bulitling Permit FN f'Y(. O
4. Mechanical(HVAC)
V
5.F'na Protection
6. Total=(1 +2+3+4+5) o Check Number qqq
This Section For lNBdal UN Only
BuiNing Palms Num Issued:Date
Sig B
missionedlnpwtar of Buldkgs Dap
➢P4Kp,El2FoRm&VeCPOOFlk6-LI-C , (>/11Rlt, C'U/1iJ
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 4 DESCRIPTION OF PROPOSED WORN(disc r all aonllesble)
New Howe ❑ Atltlltlon E' ReplacaMM Windows ANenationjy E] Roottng
Or DOOR O
Accessory Bldg. ❑ DemolNlon EDNew Signs M Declm [0 SidingD:31 Ottrer[EQ
Brief DeacnPtlon aFPrpppsep
Work VRRYI L 12E-RoyF, Sn,+h srds of MtU'/n hove . Sln,'P�r�/��Q r/,r✓hy(pS,
Alteration of existing bedroom_Yea No Adding new bedroom Yes No
Atmched Namedw Renovating unfinished basement Yea No
Plena Attached Roll -She&
IL N IISIN bqM Rlld or amildban to sxWm housiyaD-COrnpMb the foNOW1110
a. Ues of building:One Family 7vro FamilyOther
b. Number of rooms In each family unit Number of Bathrooms
a Is there a garage attached?
d. Proposed Square footage of naw construction. Dimensions
e. Number of stories?
E Method of heating? Fireplaces or Woodrmwes Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
L Is construction within 100 R of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yea_No
I. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yee_No.
I. Sepfic Tank_ City Sewer Private well_ City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. PEA)FI-OPE 3U2KE- as Owner of the subject
Property
hTHMES T FLF/VAJQZ)/ Dat? PEAK PERFORM41VCS f0DF1N6 L
to act my N,in gaffs\1�rsgg relative to work authorized by this building permit application.
alp L )-// - I't
Signaturit of Owmr Date
I, UPMES -J, FLgNN,E2y
.as beat of y knowledge Andra hereby declare that the statements and information on the foregoing application are We and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
'TAMES s, F1AA1AJ r9Y
Print Name
SiPalwe alOww/Apem Dare
SECTION S-CONSTRUCTION SERVICES
81 Licemad CaNbuetion Suoervhor. Not Applicable ❑
I�me of ilpM.Netder: -jwnES S PL-,1nuvEP Y C S - 1030101
LiceruteNumber
t LUilliaM5 5-k 1 1Lrokp m,4 01010 7/.a/ 42D1
Ewmion Date
1113- 0133 - S�BcF
siprolum relepinna
NotAppk" O
PEKPOf2MF3NLE 900F//U6 -1 /P3 (agg
Cempam Name ReOndna
Number
tave �lc1 f, �as�h,Ln4e&/,j MA a1Da� !r �3 /20 /T
Address (y13) 50rabon Date
Telephone ani-5
SECTION 10.WORKERS•COMPENSATION INSURANCE AFFIDAVIT(M.U.L a 152,§20C(S))
Wo*"Coetpe Tion Nmxance affsiavit must be Wm~and sWmitted with Ira appWmtiom.Fadum to reoriM ttus alfKWA VA man
in the denial of the issuance of dre building permit.
Signed AffidWtAttadmd Yes..._.. W tb_.... ❑
City of Northampton _
Massachusetts L
z
l�aal�mrr or sesrmssc zserecz:oss .
212 Main 6Greet a Wnicipal Buil6in
aorth�v wn, es 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:
11* mvslAampf-mi Rbac.
(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`5 Roll-oql zoomis i%, �asfl�am��n� i�lf1
(Comp
a
ny Name and Address) a �'
Sign re dr Permit Aftlicant 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 oflnvesligations
wi 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/Organintion/Individuap: Peak Performance Roofing LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
A,rree,/ypa an employer?Check the appropriate box: Type of project(required):
I.Ct i am a employer with 4 4. ❑ 1 am a general contractor and 1 6. New construction
employees(Poll 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 g, ❑ 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.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11,rr❑/Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t e. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
+Any applicant that checks box kl must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work moment hire outside contactors must submit n new affidavit indicating such.
iCmumwnm,that check this box..it attached an additional sheet showing the name of the sub-contrac ors and state whether or not those entities have
employees. If the sub-cunlactors have employees,they must provide their workers'camp.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.#: R2 W/0943835 p J Expiration Date: 4//2,7/20190 ,�,,n
Job Site Address: yN0 CU/sAo_.rnpp N 9 City/State/Zip: NO(ril[Lrnylo/V MA
V/6&0
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 aan�d penalties of perjury that the information provided gbovQ istrueand correct.
ure:
SignatDate:
Phone 4: 413-203-5888 ✓ V /J
Official use only. Do not write in this area, to be completed by city or town ojj ciat
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#:
Worker's Compensation and Employer's Uability Policy
Berkshire Hathawa AmGUARD Insurance Company -A Stock Co.
Y Policy Number R2WC943835
Insurance of G 11187
U A R D Compare es RenewaNCC1 No.[21873]
Policy Information Page (AR)
[I]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIELD STREET 8 NORTH KING STREET
EASTHAMPrON,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/Assessment 606.00
Total Estimated Cost 14 256.00
INTERNAL USE xx Page- 1 - Infomratlan Page
MW : R2WC943835 WC 000001A
DM : 04/04/2018
MANOTE
Issuing Office: P.O. Box A-N,16 S.River Street,Wllke lllz re, PA 18703-0020 www.guard.com
Joie �a�nma�e�clecc��li o�^�2ae�ccae�a
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: LLC
83698
PEAK PERFORMANCE ROOFING,LLC. Re xpira0dn. 11/03
1 LOVEFIELD ST. EgH'atian: 11/03/2019
EASTHAMPTON,MA 01027
UpdaM Ad,! p arM RNMm Card.
scn, O zwwr✓n
t , 2Y9 P1 . " . ACSi
Boa,,,
Qo'3udd "g ft¢g rp., ,n s cams
L.c $e CS-103067
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 010/0
(�..nn l/L_ Era, ar.or
�,e nm.as.o ne' 001210201/
PE K Peak Performance Roofing LLC Contract
P E R F O R (� E 1 Lovefield St °� c°""�""
Easthampton, MA 01027 6/14/2018 569
MA CSL!103061
MA HICH 183698 413-203-5888 peakperfromencemotingllefgmail.com www.peakpmformanceroohngllc.cem
BIII To Job Location
Pemry Burke Penny Burke
440 Westhampton Rd. 440 Westhampton Rd
Nonhampmn,Ma 01060 Northampton,MA 01060
psbu,ke@gmail.. psbmke@gmaifcom
413-530-7536 413-530-7536
Description Total
1.Remove the existing roof shingles 2,850.00
2.Install six feet of ice and water shield at eaves and 12"around mof/wall intersections
3.Cover remaining mof with Cerminteed"Roof Runner"synthetic underlayment
4.Install new 8"aluminum drip edge on all eaves and rake edges
5.Insult architectural shingles by Cerminteed (aadmark 30yr)
http://www.m minwed.com/msidential-mofiing/pmducts mndmuk/
Color Choice:
6.transit new Certainmed ridge vent
7.Complete all necessary flashings including new pipe boots
Remove all debris from premises,and throughout mejob,continue cleanup and keep the premises undamaged
Total cost
South side ofmain housa=S2,850
A deposit of$1425 is due prior to sun ofwork.
The balance of 51425 shall be due upon completion. (�
Deposit Received On: /�/ Deposit S l (.J Check 0 /30 1
*We ere trot responsible for dirt/debris that may fall into attic.Please check for debris altar dumpster is removed.•
Contlacbr Signature: Customer Si
Total sz.aso.o0