43-105 (3) 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 c.142A)
Cateeorv' ROOF BUILDING PERMIT
Permit# BP-2019-0065
Project ft 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(sq.ft.): OWner: BURKE DANIEL&PENELOPE
Zoning, Applicant. JAMES FLANNERY
AT: 440 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
I LOVEFIELD ST (508)294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.711612018 0.00:00
TO PERFORM THE FOLLOWING WOM'PARTIAL 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 FireplacetChimney:
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:
FeeTyoe: Date Paid: Amount:
Building 7/16/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
4NORTHAMP
_ --,City of rth mpton a(PemRJUL 1 34=l ,g ment ClaboaaDAiwwryPlw"a
212 M in eet ewwN9glMlim1T OF ntIILOIYCv�NiPECTI On M 01060TTC1�VfRlNN
D. -1240 Fax 413587-1272 WeMBfieP111m. -
>�y
APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY
FORMATION DWEWNG
SECTION 1 -SITE INISO- l q_ N
1.1 ProoartV This section to M Bono~ oflla
'��o W-esAaryipirAj IM- map Lot Unit
zoite OYway Dkbkt _
Son SL OWrk( co wAmck
SECTION 2-PROPERTY OWNFRSHIPIAUTHORDED AGENT
2.1 Owner of Rewrtl:
P, ENELOPE aU2KEyyo tuesMo-mpF°,u /,�d, Nor+Glarr�fanJ
Nemo(Hi Current Mailing Redress:
ySignaki � Te""'��LTe""' '413 - 530 — 753!,
2.2 AumorWa Aaent
791nES T 0 09VNER1/ EetsAAy)1p101v/NA
Nome(Pmwo Current Meiling Address: O�Q
11/3 - PO-3
Signe um Telaphore
SECTION 3-ESTIMATED OMMUCTION COSTS
Hem Fsbmated Cwt(Dollam)to be Oftel Use Only
complebecl by bennit apolioant
1 Bulbm 12 F 50, DO (a)Sulliling Permit Fee
2. Electrical (b)(b)Estinated Total Cost o1
ConWelion from 6
3. Plumbing BWNMtp Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
S. Total=(1 +2+3+4+5) o2$SOr °L Check Number I q
This Section For ORktat Ute Only
BugdHp Pemvt Date
Issued:
Sq
B keloriarAmpecEorNBultligs Dew
p¢gK/e�i2FolemF}NCERooFln/GttC GmRic, eoM
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S.DESCRIPTION OF PROPOSED WORN(cheek all aoollceblal
Naw Howe ❑ Addition Replacement Windows Albration(s) ❑ Rooflnp
Or Doom ❑
AccessoryBldg. ❑ Demolition ❑ New Sign [01 Decks [O SitlinS[OI Ddmr[[:o
Brief Description of Proposed
Work: ?aR-nn Re-f?WP' Sr'.�h sid-c oF' ma.fn hiviv . Shs.'P???? -i C"P/a o S1L'k1g S-'
Aserabon of existing bedroom_Yea No Adding new,bedroom Yes No
Allached Narrative Renovating unfinished basement Yes No
Plan Attached Roll .Sheet
t a Net biguse wAor Bdditn to 10 t6 hauWa.comol616 Mt6 foftiodo :
a. Use of building:On Family Two Famiy Other
b. Number of rooms in each family unit Number of Bathmmr
c. Is there a garage attsched?
d. Proposed Square footage of new,construction. Dimensions
e. Number of stones?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Enrgy Canseratkm Compliance. Masscleck Energy Compliance form attached?
h. Type of construction
p. Is construction within 100 ft.of wetlands?—Yes No. Is construction within 100 yr. floodplain_Yes_No
1. Depth of basement or caller floor below finished grade
k. Will building oonbm to the Building and Zoning regulation? Yea No.
I. Septic Tank_ City Sewer_ Private well_ City water Supply
SECTION To-OWNER AUTHOR17ATION-TO BE COMPLETED WREN
OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT
I. pcly ELOPE 802KC as Ower of the subject
properly
h JAMES 7. FLRNAI&9Y D6A PEAK PERFORMANCE RDOFIA)6 LL
Wact my If,in��I\gym relative to work authorized by this building permit application.
'' nalu� Date
I, U.4m cs -J. F(-AN 1UEAY 'as OwnedAwen:ed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
—JAMES S, F1ANN£91/
Print Name
SiereNeMOvmx/PaeM Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Cwstrue8w Suserviwr. Not Applicable ❑
N..,tLlran..Nae. : J,9MES J F1-19ivNERy OS - /03010/
DGeneE Number
l GuilliaM5 5+, l{alyoko mA 01011,0 09/a/lao/8
Address I Fxphatkm Dale
W3- a63 - 5-8SS
Sprlemre telephone
Not Appltcable ❑
PERK PERPofLrY7HNCE RUDFI1ufr, LLG /k'3 (aL
Com"M Name Regatraf Number
I 4ove-l;-ld 54, FasfharnP4Dni MA a�ba� �I �U3/2o /9
Address Cyl3� Expiration Date
Telephone aol3-5 FFY
SECTION 70-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L m 152.9 28C(S))
Workers Compensation Insurance affidavit must be completed and submitted with tics application. Failure to provide this alfa9vit will result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yes....... w inNO...... ❑
City of Northampton0
(i)Massachusetts
n�aaa6®rr or eoranrav rsapxczrosa .
212 min atuat o Wnicipal sailding
North' ton, M 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:
LI'ID Roa-CL
(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:
'amonrs 6&W, Lodm;s u) ' �asfhamp�i� n!�
(Company Name and Address) c� a
Signaldre dT Permit Aoplicant 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 ofMassaehuselts
Department of Industrial Accidents
Office of Investiganons
91 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizationnndividuap: Peak Performance Roofing LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888
A,rre/ypa an employer?Check the appropriate box: Type of project(required):
1.[y [am a employer with 4 4. ❑ I am a general contractor and I 6. LJ New construction
employees(full and/or part-time).* have hired the sub-contractors
❑ 1 am a sole proprietor or parmer- 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.E] Plumbingrepairs or additions
myself. [No workers' comp. right of exemption per MGL 12 u 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 cheeks box WI most also NI ore the section below showing their workers'compensation policy information.
'Homeowners who submit this affdavit indicating they aredoing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractom that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entitles have
employees. If the sub-eammators have employees,they must provide their workers'camp,policy number.
1 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.#: R2WC943835 / Expiration Date: 4�/2�"7/2019L� ,.�,,�1
Joh Site Address: yyo �(l/.$fl,0.tyL lt/ ��l City/State/Zip: /V6f PhLYyL k0/U //fr7
0/J&o
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.
Ida hereby certify under thepains(a�nrdpenarlllddess of p/el rjury that the information provided gbovq is
true and correct.
Signature' ]f !- --[�[I Date: �l 0
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(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 Liability Policy
Berkshire Hathaway AmGUARD Insurance Company - A Stock Co.
Y Policy Number R2WC943835
Insurance 11187
XVG U A R DCompanies Renew NCCI No.d 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. 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 polity 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
IMERNAL USE xx Page- 1 - Information Page
MGA :R2WC943835 WC 000001A
Date : 04/04/2018
MANOTE
Imuing OMM: P.O.Box A-M, 16 S. River street,Wilkes-Barre, PA 16703-0020 •www.guard.Com
J. (�a�nmonu�ea�t�z a��%UGaa�ac�uael
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. Registration: 111095
FreOon. 11/
1 LOVEFIELD ST. 03/2019
EASTHAMPrON,MA 01027
upaata AaOraea rM FIMM Cera.
su, a �17
RC3 .O, ?u.IQ
�:a•nsa CS-103061 '
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 61000
r-j.N, CA._ .,.•,
09/211201.
PE K Peak Performance Roofing LLC Contract
P E R F O R (+ E 1 Lovefield St Dale contraa0
Easthampton, MA 01027 6/14/2018 568
MA CSI#103061
MA HIC0 183698 413-203-5888 peakperfommnceroofinglk,ftnail.com www.peakperformuncemoMgllc.com
Bill To Job Location
penny Burke penny Burke
"0 Westhampton Rd. 440 WesWempton Rd
Northampton,Me 01060 Northampton,MA 01060
psburke@,snal.mm psburkoagmaiLcom
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 roof/wall imersections
3.Cover remaining mo(with Certainteed"Roof Runner"synthetic underlayment
4.Install new 8"aluminum drip edge on all eaves and rake edges
5.Install m 1 ikclural shingles by Cenainteed (Landmark 30yr)
http:/Aw .certaintmd.mm/residential-mofing/pmducL-Amdmuk/
Color Choice:
6.Install new Cenainteed ridge vent
7.Complete all necessary Bushings including new pipe boots
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged
Total msn
South side of man lux sed2,850
A deposit of 51425 is due prior to start of work.
The balance of 1425 shall be due//upon completion. 7 [� Z
Deposit Received 0n: /�/ Deposit S lf'-( (-� Checks /Jb l
'Wearc na responsible for dirl/debrls that m_ Ul iota attic.please check for debris after dumpswr is removed.•
G
Contractor Signature: Customer Si re:
Total sz,aso.0a