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38B-113 (2) DocuSlgn Envelope ID.ACA3D7CA-F8F2M1F-gEaF-D417008C5989 t Depa enuse use Doty City of North ni E C E IV[ 'of is ..Yjf Building Dep rtm Cut/ veway Permit__ 1. A 212 M810 tree r/Se 'c Availabfity Room 1 JUN 2 6 201 Wat r1we Availability Northampton, A 0 060 Two Sets f Structural Plana phone 413-587-1240 ax Is ane Ot:ADIIDINO INSPF 7�p�$3 NORTHAMPTON,PAA01 .rte}•^• APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWOFAMILY DWELLING SECTION 1 -SITE INFORMATION 60 fY/ �✓�� 1.1 Property Address: This section to be completed by otTc � '-3> e 43 Munroe St. Map �a/7 Loe�-�--Unit zone Ovel District- Elise SL Dkbkt CO Dishic SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Mary Ann Clawson 43 Munroe St., Northampton MA 01060 Nwne(PnM)© Aar"tea"Nnrey Current MaiFng Address:i Ali.u. Umers&1, Td'pll 413.695-8213 2.2 Authorind Apert: James J. Flannery 1 Lovefield St., Easthampton MA 01027 Name(Print) Owren WIN Address: 413-203-5888 Signature Teephww SECTION 3-ESTIMATED CON8TRUCTION COSTS Item Estimated Cost(Dollars)to be OMdd use Only completed by Permit applicant 1. Building $19,500.00 (a)Building Permit Rae 2. Electrical (b)Estimated!Total Cowl of Conebuclbn from S 3. Plumbing Building PermIt Fee 4. Mecham of(HVAC) 5.Fire Protection 6. Total=(1 -2*344.5) $19500.00 Check Number This Section For Official Use Only Building Permit NuDate mber Issued: Signature: Building Commissioner/Inspector of Buildings Digs peakperformanceroofingllc ®gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:ACA3D7CA-FBF2-441 F-9E8F-D41?0O8C5989 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Rooting Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs IDI Decks [[7 Siding[OI Other[E� Brief Description of Proposed Strip& re-shingle roof. Install or replace plywood as necessary. Work: Alteration of existing bedroom_Yes No Adding new bedroom_Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet ea.H Now house and or addltlon to exisOna housine comolab the 1bNowlnG, 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. Propoeed Square footage of new wnstruction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. Is construction within IDO ft.of wetlands? Yes _No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar goer below finished grade it. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank_ CitySevver Private well_ City water Supply SECTION Ta-OWNER AUTHOR17ATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. Mary Ann Clawson as owner of the subject property hereby authorize James J. Flannery/Peak Performance Roofing, LLC to act on my behae,in all matters relative to work authorized by Mia building permit application. pOLoew1p°" 6/24/2019 S' lure of Owner I I Date James J. Flannery I, ,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 tit pains and penalties of perjury. James J. Flannery Pont Name (4 lg6 11q netuw of Owner/Agent Dew DocuSlgn Envelope lD'ACA3D7CA-F8F2M1F-9E8F-D41700BC5989 SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name b Lt...NOMer'. CS-103061 Llcerne,Number James J. Flannery 09/21/2020 Address E ipaseon Dab 1 Williams St., Holyoke MA 01040 Signature � 413-20 413-203-5888 9.Rwlatsred Nome brmravelnsrN Comneta: Not Applicable ❑ Company Name Registration Number Peak Performance Roofing, LLC 183698 Address Expiration Dela 1 Lovefield St., Easthampton MA 01027 relepnone 413-203-5888 11/03/2019 SECTION /0-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L o.152,1251 Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit vn11 result in me denial of the issuance of the building permit. Signed Affidavit Attached Yes....... d No..... ❑ Docueign Envelope ID:ACA3D7CA-F8F2 4 lF-9E8F-W70p8C5989 City of Northampton Massachusetts A eD6PAATT6NT OF BUILDING INSPECTIONS 212 IL1n SCvaa[ Municipal Building Northampton, MA 0206p � 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: 43 Munroe St. (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: Aaron's Roll-Off, 1 Loomis Way, Easthampton MA 01027 (Company Name and Address) (�rasOR Signature of Permit Applicant 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. CocuSlgn Envelope In ACA3WCA FBF2441 F-9E8F-D41 7008C5989 Contract MFO E KE Peak Performance Roofing LLC P E R I Lovefield St °are com actlf Easthampton, MA 010276/19/2019 91z MA CSW 103061 413-203-5888 ak tmenccroof llc MA HIC# 103690 a p`TfO ®gmail.mm www.peakperformanceroofmgllc.wm Bill To Job Location Mary Ann Clawson Mary Ann Clawson 43 Munroe St. 43 Munroe St. Northampton,MA 01060 Northampton, MA 01060 413-695-8213 413-695-8213 mclawson@wesleym.edu mclawson@wesleym.edu Description Total 1. Remove the existing roof shingles 19.500.00 2.Remove existing chimney past roofline to attic floor and frame as needed 3.Install new 1/2 inch COX plywood over existing roof boards. ($60 per sheet installed over existing roof boards.$75 per sheet to remove old plywood and install new.) 4.Cover entire roof with Certainteed"Roof Runner"synthetic underlayment S. Install new 8"aluminum drip edge on all eaves and rake edges 6. Install architectural shingles by Certainteed(Landmark PRO 40yr) https://www.certainteed.wnVresidential-mofing/products/landmark-pro/ Color Choice: 7.No ridge vent is to be installed(due to existing insulation design.) 8.Complete all necessary flashing Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged. Please use caution during the process and after dumpster is removed;do not walk/drive over areas of potential roofing debris.Contractor will obtain building permit. Installations are weather permitting. Landmark PRO shingles=$15,500 Plywood cost Add$4,000 Total replacement cost=$19,500 A deposit of$9750 is due at contract signing/prior to start of work. The balance shall be due upon completion. Accounts outstanding over 10 days post-completion subject to 2%finance charge, compounded monthly. Conlmctor Signamree Customer Signature: ,4 p„ Date: 6/24/2019 Total: """1 Q41bt. Lww566t. eEmsaramee.er $19,500.00 Ali The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations vi 600 Washington Street Boston, AIA 01111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letfibly Name(Business/OrganvatioMndividlad): Peak Performance Roofing, LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888 Areu an employer?Check the appropriate box: Type of project(required): 1.�f I am a employer with 4 4. ❑ 1 am a general contractor and I employees(full and/or part-time)." have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P b 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 I LC] Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12, Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] aAny,applicunt that checks box#1 must also fill out the section below showing their workers'compemation policy information, t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside connecters must submit a new affidavit indicating such. $corset...that duck this hox most attached an additional sheet showing the name of the sub-eontractori and slate whether or not hose entities have employee. If the sub-convectors have employers,they must provide their workers comppolio 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.Lie.#: R2WCO21353 Expiration Date: 4/27/2020 Job Sitc Address: 1� PAMrOG 3-}- City/State/Zip: nIl' Q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to seem 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. 1 do hereby cerdip under the points and penalties ofperjury that the Information provided above is!me and correct Sienature, 'Jy 1- Date: (01'.15101 Phone#: 413-203-5888 Oficial 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.Citylfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Worker's Compensation and Employer's Liability Policy � AmGUARD Insurance Company - A Stock Co. NIV Berkshire Hathaway Policy Number R2WCO21353 61!NhARD Insurance Renewal of R2WC943835 31 Companies NCCI No. [21873] Policy Information Page (AR) [I]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC. 1 LOYEFIELD STREET 8 NORTH KING STREET EASTHAMPTON, MA 01027 Northampton, MA 01060 Agency Code: MAMAIN15 Federal Employers ID 00-1191951 Insured 16 Limited Liability Co. (LLC) [2] Policy Period From April 27, 2019 to April 27, 2020, 12:01 AM, standard time at the Insured's mailing address. [3] Coyeril A. Workers'Compensation Insunince - Part One of this policy applies to the Workers'Compensation Law of the following states: Massachusetts 8. 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 Endorsement-WC2003068 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 Pans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 31,202 Total Surcharges/Assessments $ $1,181.00 Total Estimated Cost $34383.00 'mF°M• Mr xx Page- 1 - Informaeon Page MGA :R2WCO21353 WC 000001A Den '.01/01/2019 MANOTE Issuing OMM: P.O.sox A-M, 16 S.River Street,Wilkes-Barre,PA 18703-0020 a www.guard.com C�fie �a�n�zo-nusea�,li o�C� ac`iccaelt.G Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: LLC 3898 PEAK PERFORMANCE ROOFING,LLC. FiegLvWSW:balm: 111021 1 LOVEFELD ST. E�hetbn: 11N3/2019 EAS7HAMPTON,MA 01027 tIPBMs Addrpe end ROWm Cad. sul O 8ar6'17 �.1.'7rs.wnvmw//.{ryl'^%(aivm.{r:.✓/: tAne.ac.e..11.Algln•n,.e�Itnalaallon IIOYEIMRIOENCOMTRACTOtt RaplW�lm valM ler mueldalwany TYPE:LLC Mpe1Ms@Mbn date. OWurtl raW t18wrlMm Eakism 6 Cr AOisdBRSplsb 1168 IIAKN1g 10PAm-SN510 PEAK PERFORMANCE ROOFING,LLC. 90ala%MA W16 JAMES FIANNERY EASTHAMPTON,MA 01027 Undersecretary W&Valid WIthOUf signature Cgeicrmea0h 01 Muaactluae0s Divison d Vmkssioml Licenmre BOON of euilmng Regulations ii N Sta11GNs COIIMrlretlon super~ . . . Uleeaetcted-BUBdings of any use Irma,which a M&M CS-107061EAplrea;QB/2112020 was than 16,000 orbic feet)801 cubic meters)of end sed SpiCl. JAMESJFLANNERY 1 WILLIAMS S7 HOLYOKE MA 0100 COmmissiow Cj' FaSumtopoesessacm tedi oftheMmuchuxlW slate Building Code is emas far revocation of mis Ihalse. For inbrrrlation iib A Ove heellae Cao(811)7W4200 a visN vrww.rnu.gw/tlpl 43 MUNROE ST BP-2019-1501 GIS#, COMMONWEALTH OF MASSACHUSETTS MamBlock:398- 113 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeom ROOF BUILDING PERMIT Permit# BP-2019-1501 Project# JS-2019-002431 Est.Cost:$19500.00 Fee:S40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sa.ft.): 7318.08 Owner: CLAWSON MARY ANN Zoning:URB(100 Applicant. JAMES FLANNERY AT: 43 MUNROE ST Applicant Address: Phone: Insurance: 1 LOVEFHELD ST (508)294-4052 WC EASTHAMPTONMA01027 ISSUED ON:612 712019 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspectorof Plumbing Inspector or Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House It 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 Occuoancv signature: FeeTvpe: Date Paid: Amount: Building 6/17/20190:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner