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38B-047-005 (2)
9 LYMAN RD BP-2021-0115 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-047 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-2021-0115 Proiect# JS-2021-000185 Est.Cost: $3050.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sg. ft.): 5183.64 Owner: NAVARRO SANDRA Zoning. URB Applicant: JAMES FLANNERY AT. 9 LYMAN RD Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON.7/29/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:MISC ROOF REPAIRS 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: FeeTvpe: Date Paid: Amount: Building 7/29/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:CE0035F9-4046-49FE-A041-EAA949B49F08 � l g� The Commonwealth of Massachusettts,, 9 R r- Board of Building Regulations and Stand y�, �(J� CSA Ty ' t Massachusetts State Building Code,780 C USF Building Permit Application To Construct,Repair,Renovate Or evised ar 2011 One- or 7bvo-Fancily Dwelling T�, This Swtion For Official Use Only Buil ' g Permit Number: 10 Date Applied: �v►ti1 os5 - -7-Z9-ZOZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& cel Numbers Sandra Navarro 38B-047-005 Lla Is this an accepted street?yes no Map Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Sandra Navarro Northampton, MA 01060 Name(Print) City,State,ZIP 9 Lyman Rd. 770-500-7157 navarrosand@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building ar Owner-Occupied ❑ I Repairs(s) 4 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other specify: Roofing. Brief Description of Proposed Work': Misc. Roofinq repairs(cap&ridge, damaged shingles chimney lead replace pipe vent&coliars) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor aMaterials) 1.Building ( 3r and d 0 1. Building Permit Fee: $ indicate bow fee is determined: 2.Electrical $ El Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S S ression) Total All FeeS Check No7�_Check Amount: Cash Amount; 6.Total Project Cost: $ 3,050.00 El Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:CE0035F9-4046-49FE-A041-EAA949B49F08 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2020 James J. Flannery License Number Expiration Date Name of CSL Holder U �'/i A-(n � �� List CSL Type(see below) (1 1 Type Description No.and Street _Holyoke, MA 01040 U Unrestricted(Buildings u to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-203-5888 peakperformanceroofingllc@gmail.co m I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 183698 11/03/2021 Peak Performance Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 Lovefield St. peakperformanceroofingiic@gmail.com No.and Street Easthampton, MA 01027 413-203-5888 Email address Ci /Town,State,ZIP Telephone SECTION 6:WORMERS'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.......... No...........0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize James J. Flannery/Peak Performance Roofing LLC to act on my behalf,in all matters relative to work authorized by this building permit application. Sandra Navarro DocuSlpned by: 7/23/2020 /� C b� 1Ud�bl�l�y"— Print Owner's Name(Electronic Signature) 7EA64FDate 82AAAo�`�B4DE,.. SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. James J. Flannery 7 7 Z6-j-e Print Owner's or Authorized Agent's Nam lectr is Signatu Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at wwtv.mass..,ov/oca Information on the Construction Supervisor License can be found at tx vsnv.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of haWbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DocuSign Envelope ID:CE0035F9-4046-49FE-A041-EAA949B49F08 City of Northampton � � . X5,5..-�• S%,� r Massachusetts ¢ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 P CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: Aaron's Roll-Off, 1 Loomis Way, Easthampton MA 01027 Signature of Applicant: Date: -7 �`� ?bj-D The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 kwil, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): Peak Performance Roofing, LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888 Are/you an employer?Check the appropriate box: Type of project(required): 1.LI am a employer with 4 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or pan-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 8. ❑ Demolition workers'h employees and wo working for me in any capacity. 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. lg/ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ 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. I am 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.#: R2WC130849 Expiration Date: 4/27/2021 Job Site Address: g lma n + ` City/State/Zip: 66 k d—mo IM �Uv 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 and penalties of perjury that the information provided above is true and correct. Signature: Date: wv—� 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#: A Worker's Compensation and Employer's Liability Policy �!�Berkshire Hathaway AmGUARD Insurance Company - A Stock Co. ♦ y Policy Number R2WC130849 tz�� Insurance Renewal of R2WCO21353 iA" GUARDCompanies NCCI No. [21873] 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 XX-XXX1951 Insured is Limited Liability Co. (LLC) [2] Policy Period From April 27, 2020 to April 27, 2021, 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 Endorsement-WC200306B 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 $ 25,108 Total Surcharges/Assessments $ $867.00 Total Estimated Cost $25,975.00 INTERNAL USE XX Page - 1 - Information Page MGA : R2WC130849 WC 000001A Date : 04/07/2020 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 o www.guard.com Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC PEAK PERFORMANCE ROOFING,LLC. Registration: 183698 Expiration: 11/03/2021 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Update Address and Return Card. SCR 1 ® 20M-0507 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: ,RmistrlaUon Expiration Office of Consumer Affairs and Business Regulation 183898 11/0312021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Noq Valid without 'gnature Undersecretary ,/J i Commonwealth of Massachusetts Division of Professional Licensure Construction Supervisor Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. CS-103061 Expires.: 09/2112020 JAMES J FLANNERY 1 WILUAMS ST HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner For information about this license Call(617)727-3200 or visit www.mass.gov/dpi A�® CERTIFICATE OF LIABILITY INSURANCE DATTE 1MMIDD 20 NYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Adina Edgett Webber & Grinnell PHONE (413)586-0111 FAx (413)586-6481 Exti; aC, No: 8 North King Street E-MAIL ADDRESS: aedgett@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Admiral Ins Co/BRECK INSURED INSURER B:Plymouth Rock Assurance Peak Performance Roofing, LLC INSURERC:WCAR- Berkshire Hathaway GUARD Attn: James Flannery INSURER D: 1 Lovefield Street INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 04/21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FOOCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ CA00003521802 7/7/2020 7/7/2021 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefit Coverage Form $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ 20,000 B ALL OWNED SCHEDULED AUTOS X AUTOS PRC00001007091 6/27/2020 6/27/2021 BODILY INJURY(Per accident) $ 40,000 NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED 7 1 RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVER2WC130849 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? y❑N I A C (Mandatory in NH) James Flannery is excluded 4/27/2020 4/27/2021 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below from WC coverage. E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /J W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) DocuSign Envelope ID:CE0035F9-4046-49FE-A041-EAA949B49F08 Peak Performance Roofing LLC 1 Lovefield St. PE � Easthampton,MA 01027 413-203-5888 PERF O R C E peakperformanceroofingllc@gmail.com • MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10146 Sandra Navarro DATE 07/23/2020 9 Lyman Rd Northampton, MA 01060 0 Navarrosand@gmail.com 770-500-7157 DESCRIPTION AMOUNT 1. Install new shingles on small area missing shingles= $300 3,050.00 2. Remove and replace all shingles on hips and peaks of roof(Includes installing new ridge vents at all applicable peaks) = $1,800 3. Install new lead flashing at base of chimney= $550 4. Remove and replace vent and install new pipe boot collars over pipes = $400 Remove all debris from premises, and throughout the job, continue cleanup and keep the premises undamaged. We are not responsible for debris that may fall into the attic/interior. Please use caution during the process; do not walk/drive under active work or on areas of potential roofing debris. Peak Performance will obtain building permit. Installations are weather permitting; long periods of inclement weather will cause scheduling delays. Total: $3,050 A deposit of$1,525 is due prior to the beginning of the job. The balance will be due upon completion. Accounts outstanding over 30 days past final invoice date subject to 2% finance charge monthly. TOTAL $39050.00 Accepted By DcouSignedby: Accepted Date 7/23/2020 a vJ►ra Na"vv'o 57EA64F82AAAB4DE...