38B-096 (2) 30 MUNROE ST BP-2019-0407
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV.131ock: 38B-096 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-2019-0407
Project# JS-2019-000651
Est.Cost:$4850.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Qgnst.l lass, Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot SizeSsg ft.): 12763.08 Owner. KUROSE JAMES F&JULE J
Zoning:URB(100)/ Applicant: JAMES FLANNERY
AT. 30 MUNROE ST
Applicant Address: hone: Insurance:
1 LOVEFIELD ST (508) 294-44052 WC
EASTHAMPTONMA01027 ISSUED ON.101512018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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# Foundation:
Driveway Final:
Final; Final:
Rough Frame:
Gas: F Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smo : Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc nature:
FeehRe: Date f aid: &Mount•
P
Building 10/5/2018 0:00;00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587.1272
Louis Hasbrouck n Building Commissioner
RECEIVED t—
City of Northapton
OCT - 2 2
Building Depa enpornt
212 Main Str t
Room 10 DEPT OF BUILDING IN
Northampton, M ORTHAMPTON,M OG
phone 413-587-1240 Fax 413-587-1272 Ip ffil -
Oaw
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION U t'' 4 — /o?
1.1 Prooert►Address: Thhiis,section to be completed by office
Map I J Lotqj� Unit
Fun St.NoWd CB
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-JAMES /K U9 DSS 36 MvnPd e ,N�r l�arnp/z,h a/opo
Name(Print) Current Mailing Address:
Signaure Telephone X13 .� 3-7- 8'L1,5
2.2 Authorized Anent:
1)?mES T, sMAYnpfoN AN
Name(Print) Current Mailing Address: Q�Q
X13 - a63 - 5-F
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building �V 00 (a)Building Permit Fee
2. Electrical / (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) S 5-0, Check Number
This Section For Official Use Only
Builth Permit Number. Date
Building Issued:
Signature: L Il Y It
Building Commissioner/Inspector of Buildings Date
PC4KP&eF01`?M&V GER00F&95-11C. (a (�-rn lei L, JJt�J
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ FmMng
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [D Siding[p] Other[CQ
Brief WorkDescription of Proposed �4-glp + YP stung /-a, ��4ckv J C14 r-0-C -e e-60
Alteration of e)asbng bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ft-V MIt 6WAM UW Or MMOM tO Ub*W h MSI M.COf1 kft 1 B%%MO M:
a. Use of building:One Family Two Family Other
b. Nu r of rooms in each family unit Number of Bathrooms
c. Is there a ga attached?
d. Proposed Square footag ew construction. Dimensions-
a. Number of stories?
f. Method of heating? Fifeplaces or woodstoves Number of each
g. Energy Conservation Compliance. M eck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 ft. tlands? Yes No. Is construction wi 1"0 - floodplain Yes No
j. Depth of basemen cellar floor below finished grade
k. Will build' conform to the Building and Zoning regulations? Yes No. \
I. c Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Kw Q S E ,as Owner of the subject
property
here by authorize TAMES �'. FLAIV A)Qq-Y D&4 PE>3K PERF0Rm/9-IVC6 A0DF .)6 LL
to act on my behalf,in gllAefte relative to work authorized by this building permit pplication.
l
Signatu r Date
I pmrS -J. pw4f ulmy as Owner/Authorized
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.
-J,4ME s -J, FkAAJAJE9'/
Print Name Q
1
Date
Signature of Owner/Agent
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction SSupervisoor�: f� Not Applicable 10
Name of License Holder: V Am�J �J, /–L1��/N��y C s —
License Number
l Gyillram5 5-f, , 17161 ase rnJ4 016Y6
Address Expiration Date
y13 a6.3 59 4�E
Signature Telephone
Not Applicable ❑
p€aK P6"ie F6RM)91v c67 206Fltic5w, LLC l ' 3 6 9 Y
Company Name Registra7;72--olc7
r
/ G-0V-P*,4)Cj 5f Fa s fhQrr�,��� MAy���� ii
Address V 3Expiration Date
Telephone 203-58 YY
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.;25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yes....... 410"0' No...... ❑
City of Northampton
Massachusetts
EXPAR22SOM OF BUrZDING INSPECTIONS
212 Main Street •Municipal Building
4 Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, 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:
36 FYI va2�.-o s4,
(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:
'am ohs 4O&O W/ l Loomi S , �aS�f7�tYY1��/U
(Company Name and Address) d a
Sign re dY Permit Afplicant or Own6r Dat
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
IF 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
Awarn
u an employer?Check the appropriate box: Type of project(required):
1. a employer with 4 4. 0 I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.[1 1 am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
workingfor me in an capacity. employees and have workers'
y aP h'• 9. ❑Building addition
[No workers'comp.insurance comp.msurance.x 10.0 Electrical repairs or additions
required.] 5. We are a corporation and its
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.gRoof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must 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 must submit a new affidavit indicating such.
;Contractors 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.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Berkshire Hathaway Guard
Insurance Company Name:_
Policy#or Self-ins.Lic.# R2WC943835 Expiration Dated^ 4/27/2019
Job Site Address: 30 / /ryl ut7 r-o .5-1- City/State/Zip: /V MR0 fO&D
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 irr 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 and penalties of perjury that the information provided ab ve . tr cand correct.
Si ature: Date: 2 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#:
CS-103061
JAMS J FLANNERY
I W&LIAMS SY
HOLYOKE MA 9100
Nvu)
C��ie �pa�nm�n����� C�2�crQ�ac�.�►�
V208 >7
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. Expimfim: 11Registration. 183611/03/2019I LOVEFIELD ST.
EASTHAMPTON,MA 01027
Update Address and Retum Card.
SCA 1 20M4)6117
Worker's Compensation and Emoloyer's Liability Policy
Berkshire H ath a wa AmGUARD Insurance Company -A Stock Co.
y Policy Number R2WC943835
GUARDInsurance Renewal of R2WC811187
Companies NCCI No. [21873]
Policy Information Page(AR)
[1]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNEL L 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. Employees 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/Assemments 606.00
Total Estimated Cost 14 256.00
INTERNAL USE XX Page- 1 - Information Page
MGA :R2wC943835 WC 000001A
Date :04/04/2018
MANOTE
Issuing Office:P.O.Box A-H, 16 S.River Street,110kes-Barre,PA 18703-0020 a www.yuard.corn
P E K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St Date c°ntract#
• Easthampton, MA 01027 9/19/2018 676
MA CSL#103061 1 413-203-5888 peakperformanceroofmgllc@gmail.com www.peakperformanceroofinglic.com
MA HIC# 183698
Bill To Job Location
Jim Kurose Jim Kurose
30 Munroe St. 30 Munroe St.
Northampton,MA 01060 Northampton,MA 01060
413-537-8458 413-537-8458
Description Total
Detached Garage: 4,850.00
1.Remove the existing roof shingles and inspect sheathing or boards
2.Replace up to 64 square feet of plywood if necessary at no cost.Any additional plywood will be$60 per sheet
installed.
3.Cover entire roof with Certainteed"Roof Runner"synthetic underlayment
4.Install 8"aluminum drip edge on eaves and rake edges 4 . &JA;k
5.Install architectural shingles by Certainteed (Landmark)30yr rated
https://www.certainteed.com/residential-roofing/products/landmark/
Color Choice: Sit✓e-r 61'rch
6.Complete all necessary flashings
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged.
Contractor will obtain building permit.
Total cost:$4,850
A deposit of$2425 is due at contract signing. The balance shall be due upon completion.
Past due accounts subject to 2%finance charge monthly.
*We are not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is removed.* Total:
Contractor Signature: Gusto ature: Date:
/ $4,850.00