Loading...
23A-083 (3) BP-2021-2292 15 MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-083-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2292 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: PEAK PERFORMANCE ROOFING Est.Cost: 4300 LLC CS-103061 Const.Class: Exp.Date:09/21/2022 Use Group: Owner: FATHALLAH MIRIAM& KATHLEEN HULTON Lot Size (sq.ft.) Zoning: GB Applicant: PEAK PERFORMANCE ROOFING LLC Applicant Address Phone: Insurance: 1 LOVEFIELD ST 4132035888 R2WC202869 EASTHAMPTON, MA 01027 ISSUED ON:12/15/2021 TO PERFORM THE FOLLOWING WORK: LOW SLOPE ROOF ONLY 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. Signature: 1644:14„.., X► - Cg,'� Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:F07166F6-059E-4573-91E4-5D6CB6B9E55C / I / NN,,CNI r The Commonwealth of Massachusetts if`;- ;�t .Board of Building Regulations and Standards "F 15`T FOR CIP Massachusetts State Building Code,780 CMR;�, 1 Mi litIPAL.ITY ;N Q USE Building Permit Application To Construct,Repair,Renovate Or;De�'m lish a (''RevisedMar 2011 0 ,aniill'Dwelling ' This Section .r Official Use Only Buildin Petmi umber: V Ai• .1q- Date Applied: !� • ,J /`i�VIiJ ors /� 12-ly-z0z1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property, Address: 1.2 Assessors Map&Parcel Numbers 15 Main St., Florence 23A-083-001 1.1 a Is this an accepted street?yes no Map Number Parcel 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 0 Private 0 Zone: Outside Flood Zone? — Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Miriam Fathallah Florence, MA 01062 Name(Print) City,State.ZIP 15 Main St. 508-615-6390 miriamfathallah@gmail.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building 11 Owner-Occupied 0 Repairs(s) I Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other liSpecify: Roofing. Brief Description of Proposed Work2: low slope roof section only: strip & re-roof with TPO SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 4,300.00 1. Building Permit Fee: $ Indicate bow fee is determined: 2.Electrical $ ElStandard City/Town Application Fee 0 Total Project Cost''(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fes: (11 Check NojUN Check Amount: Ill) Cash Amount: 6.Total Project Cost: $ 4,300.00 0 Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:F07166F6-059E-4573-91 E4-5D6CB6B9E55C SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2022 James J. Flannery License Number Expiration Date Name of CSL Holder UJI 4'1 , c1 j- List CSL Type(see below) U No.and Street t Type Description Holyoke, MA 01040 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 413-203-5888 SF Solid Fuel Burning Appliances peakperformanceroofingllc@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HTC) 183698 11/03/2023 Peak Performance Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 Lovefield St. peakperformanceroofingllc@gmail.com No.and Street Email address Easthampton, MA 01027 413-203-5888 City/Town, State,ZIP Telephone SECTION 6: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 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. DocuSigned by: Miriam Fathallah 12/10/2021 Print Owner's Name(Electronic Signature) Date 3E2E1732EA1A4AC... 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 • /0//d ,.,- / Print Owner's or Authorized Agent's Name I ecir.4,1'c Signatur)( 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 www.mass.govioca Information on the Construction Supervisor License can be found at uww.mass.govidps 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 half/baths 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:F07166F6-059E-4573-91 E4-5D6CB6B9E55C City of Northampton Massachusetts ��÷ _ Q�., ` �- w * lU t 4 4 ,, DEPARTMENT OF BUILDING INSPECTIONS y'; '. "` 212 Main Street • Municipal Building yJ a' ='' Northampton, MA 01060 b...1 �,0 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: Valley Recycling, 234 Easthampton Rd., Northampton MA 01060 The debris will be transported by: Name of Hauler: Aaron's Roll-Off Service Signature of Applicant: James J. Flannery Date: fL 10 1 wZ' The Commonwealth of Massachusetts Department of Industrial Accidents -.1 t= Office of Investigations I -I . I= ' 600 Washington Street f _Ai w:= 4' Boston, MA 02111 'x. ...i 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 Are an employer? Check the appropriate box: Type of project(required): 1. I am 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. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t 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.ErRoof 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. 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.#: R2WC202869 Expiration Date: 4/27/2022 Job Site Address: /S ni ii lU ST City/State/Zip: 00-r,edte Mfg D WI Z 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: f_ Phone#: Date: / a I I 0 7021 413-203-5888 Ca"."-l't 1 -1--LliC11- 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 AmGUARD Insurance Company - A Stock Co. I; Berkshire Hathaway Policy Number R2WC202869 Worker's 0,41 GuARD Insurance Renewal of R2WC130849 Companies NCCI No. [21873] Policy Information Page(AR) 1[1]Named Insured and Mailing Address Agency 1 PEAK PERFORMANCE ROOFING LLC WEBBER &GRINNELL INSURANCE AGENCY, INC. I 1 Lovefield St 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, 2021 to April 27, 2022, 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 $500,000 Bodily Injury by Disease - each employee $500,000 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 i [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) 0 , 1 n i t 3 Total Estimated Policy Premium �aR 27,082 Total Surcharges/Assessments $ $926.00 t Total Estimated Cost 28 008.00 INTERNAL USE XX Page- 1 - Information Page MGA :R2WC202869 WC 000001A Date :03/23/2021 MANOTE Issuing Office: P.O. Box AH, 39 Public Square,Wilkes-Barre, PA 18703-0020 •www.guard.com Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) 05/12/2021 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 have ADDITIONAL INSURED provisions or 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 Adina Edgett,CISR Webber&Grinnell PA/C. Ext): (413)586-0111 FAX No): (413)586-6481 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Admiral Ins Co/BRECK INSURED Plymouth Rock Assurance INSURER B: y Peak Performance Roofing,LLC INSURER C: WCAR-Berkshire Hathaway GUARD Attn:James Flannery INSURER O: 1 Lovefield Street INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 06/2022 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. INSRTR AUULThULIH POLICY TYPE OF INSURANCE N M/ E YYY POLICY EXP SD WVD POLICY NUMBER MDD/Y X COMMERCIAL GENERAL LIABILITY ( ) (MM/DDNYYY) LIMITS 1 OOO,OOO EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A CA00003521803 07/07/2021 07/07/2022 PERSONAL&ADV INJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $ 2,000.000 PRO -COMP/OP $L I PRO- LOC 2,000,000 X POLICY PRODUCTS OTHER: Employee Benefit $ 2,000,000 AUTOMOBILE LIABILITY GOMBMIEEYSIN©EE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED PRC00001007091 06/27/2021 06/27/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED %,/ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ - _ DED RETENTION$ $ WORKERS COMPENSATION X MUTE EMPLOYERS'LIABILITY STATUTE ER Y N C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA R2WC202869 04/27/2021 04/27/2022 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 500,000 WC:James Flannery is excluded i DESCRIPTION OF OPERATIONS/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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • K4921072-0Aeliea I G f,0CZ'riieSaC4l.C,✓ k 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 1 LOVEFIELD ST. Expiration: 11/03/2023 EASTHAMPTON,MA 01027 Update Address and Return Card. SCA 1 0 20M-05/1717 Ofrfce of onsumer Arrairsa& uslness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 183698 11/03/2023 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY LOVEFIELDLD ST.ST• �� , i{ � ; k r EASTHAMPTON,MA 01027 Undersecretary Not valid without signature 111 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor 1:U�st i.ctio^ Supervisor s�or Unrestricted-Buildings of any use group which contain ri'- a� � less than 36,000 cubic feet(991 cubic meters)of enclosed space. CS-103061 Expires: 09/211 JAMES J FLANNERY •• 1 WILLIAMS ST HOLYOKE MA 01040 • n D Failure to possess a current edition of the Massachusetts Commissioner �w State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl .Iz,(VLw c cQ a cA-vs ( I . S � � c pA& j wU-\n S DocuSign Envelope ID:F07166F6-059E-4573-91 E4-5D6CB6B9E55C Peak Performance Roofing LLC 1 Lovefield St. P E K Easthampton, MA 01027 413-203-5888 P E R F O R CE peakperformanceroofingllc@gmail.com ROOFING MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10524 Miriam Fathallah DATE 12/10/2021 15 Main St. ©ID Florence, MA 01062 miriamfathallah@gmail.com 508-615-6390 DESCRIPTION -This contract is for the replacement of the 400 ft low-slope roof only- 1. Remove the existing roofing materials. 2. Mechanically fasten 1" polyisocyanurate insulation with approved screws and plates 3. Install Genflex fully adhered TPO roof system including all necessary flashings and accessories http://genflex.com/wp-content/uploads/2014/11/CB04_GenFlex-TPO-Brochure_1014_web.pdf 4. Fabricate and install .032 gauge white aluminum drip edge on the perimeter 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 attic. Please use reasonable caution during the installation; do not walk or drive under active work, or on areas of potential roofing debris. Peak Performance Roofing will obtain the building permit. Installations are weather permitting; inclement weather will cause scheduling delays. Total =$4,300.00 A 1/3 deposit of$1,400 will secure contract/material order/permitting/priority scheduling. The balance shall be due Upon Completion, within 10 days of invoice. Accounts past due 30+days subject to 2% finance charge on the oustanding balance, compounded monthly. TOTAL $4,300.00 Accepted By DocuSigned by: Accepted Date 12/10/2021 3E2E1732EA1A4AC_.