38B-181 (5) BP-2023-1567
17 FORT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-181-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1567 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
PEAK PERFORMANCE ROOFING
Est.Cost: 15490 LLC CS-103061
Const.Class: Exp.Date: 09/21/2024
Use Group: Owner: SCOTIA MACGILLIVRAY,
Lot Size (sq.ft.)
Zoning: URB Applicant: PEAK PERFORMANCE ROOFING LLC
Applicant Address Phone: Insurance:
1 LOVEFIELD ST 413-203-5888 R2WC342657
EASTHAMPTON, MA 01027
ISSUED ON:11/09/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
, ,
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
DocuSign Envelope ID: 1AAEC8B0-4872-4D90-9894-EA674F31862C
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The Commonwealth of M acYtty>�-=s 'rO
I Board of Building Regulations an' .S`tati:. `6?0 /
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PALITY
',ti, ` Massachusetts State Building Code,7gOcb, USE
Building Permit Application To Construct,Repair,Renovate Sr = ,,.. a Re-sed Mar 2011
One- or Two-Family Dwelling 07 so�ols
This Section For Official Use Only
Building Permit Number; 6P-. .3- /y'Q 7 Date Applied:
levio s 9 //-9 ZLZ3
Building Official(Print Name) Signature Date
SECTION 1; SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
I 17 Fort St. Northampton
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`Lone?
— Municipal 0 On site disposal system 0
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Northampton, MA
Scotia MacGillivray p
Name(Prim) City,State,ZIP
17 Fort St. 831-345-4472 sakot2000@hotmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition Ct Accessory Bldg.Cl Number of Units f Other )E Specify: Rooting
Brief Description of Proposed Work2: Strip and replace roof with
standing seam metal roofing
system.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building S 15490 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
E a Total Project Cost3(Item 6)x multiplier x
3.Plumbing S 2. Other Fees: S
4.Mechanical (I-IVAC) I S List
5.Mechanical (Fire
Suppression) Total All Fees:S
Check No. 4121Check Amount go Cash Amount:
6.Total Project Cost: $ 15490 ❑Paid in Full 0 Outstanding Balance Due:
DocuSign Envelope ID: 1AAEC8B0-4872-4D90-9894-EA674F31862C
'SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Superior License(CSL) • -
James J. Flannery
License Number Expiration Date
Name of CSL Holder i U
List CSL Type(see below)
No.and t F Type Description
Holyoke, MA 01040 U Unrestricted(Buildings up to 35,000 ca.ft.)
R . Restricted i&2 Family Dwelling
Cityfl'own,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
413-203-5888 peakperformanceroofinglIc@gmail.com SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address _ D Demolition
5.2 nKig, (HIC)Fe Veriormateootn , L 183698 11/03/2023
IIIC Registration Number Expiration Date
HIC CompV1 1 avia gsEic Registrant Name peakperformanceroofinglIc@gmail.com
No.and Streeet Easthampton, MA 01027 413-203-5888 Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION LNSURANCE 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 ❑
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 ail matters relative to work authorized by this building permit application.
p DocuSigned by:
S�efia M.dttai ivl''ait 11/1/2023
`—PPWtriwtie43%Name(Electronic Signature) Date
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 lotowledge and understanding.
James J. Flannery -ali^.es at\r,r 9/20/2023
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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.00vioca Information on the Construction Supervisor License can be found at www.mass.cov!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 half/baths
Type of hearing system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: 17 FORT ST.
The debris will be transported by: Aaron's 24/7 Towing and Roll-On
The debris will be received by: Valley Recycling
Building permit number:
Name of Permit Applicant Peak Performance Roofing LLC/James Flannery
11/2/2023 James Flannery aalikers ' ccrner
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
FX== _ IDepartment of Industrial Accidents
tr
i 1 Congress Street, Suite 100
eik_' -< Boston, MA 02114-2017
• v,>\tt
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): PEAK PERFORMANCE ROOFING, LLC
Address: 1 LOVEFIELD STREET
City/State/Zip:EASTHAMPTON, MA 01027 Phone #:413-203-5888
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 4 employees(full and/or part-time).* 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in S. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. El Demolition
10 ❑ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5 0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1;. Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
p
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
1-1.❑Other
152,§1(4),and we have no employees.[No workers'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.
1Contractors 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:04/27/2024
Job Site Address: 17 FORT ST. •City/State/Zip:NORTHAMPTON, MA
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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: James J Flannery Date: 11/2/2023
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#: