17B-006 (13) 470 BRIDGE RD BP-2018-1061
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.Block: 17B-006 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-2018-1061
Project# JS-2018-001916
Est.Cost:$8500.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): 74052.00 Owner: PAYNE ANDREW C&LORETTA M KANE
Zonlne�RI(I00NRRn00)/ Applicant: JAMES FLANNERY
AT. 470 BRIDGE RD
Applicant Address: Phone. Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:4/18/2018 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SH INGLE 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: 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:
FeeType: Date Paid: Amount:
Building 4/18/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
vl t u I 62-CO C
Department use only 'f
City of Northampton Status of Pemxt:
Building Department Curb CuWriveri Permit
212 Main Street Serer/Septic Availability
( - Room 100 Water/Well Availability
Northampton, MA 01060 TWO Sets OfSwctura4pkns
phone 413-587-1240 Fax 413-587-1272Pbt/Sae Plains
Otl1er Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMIILLAY,DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address: This election to be completed
by office
MapR Lot QO`C Unit
I V Zone Overlay District
Elm at District CB Gunnell
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Loy-z4& KoNO- [3ridG2 ea , NorFln0.rn�� O/`I
Name(Pnm) Current Mailing Address:
Signature Telpfiy ? /' (L5
2.2 Autho a enL '"-fir (( O (q
-�RMES FLRNNEY2V Lovk+ �� � S� fEQS}�0.mpfDNMA010d4
Name(Print) Current Mailing Address:
X113 - 2-b 3- s VRS
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building b' SCb. bD (a)Building Penna Fee
2. Electrical 6 (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee �J'/--i/J(/J')�y T!„
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 -2+3.4 +5) Check Number
This Section For Official Use Only
Building Permit NumberDate
Issued.
Signa e:
AqAal
Building coals sioneeinspecor of Buildings Date
�¢AKPE{zFo14r1gNCE (-,,ODFIN(YLLC__ (al 6r1AIL, . CoM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
Now House ❑ Addition ❑ Replacement Windom Alteration(s) E] Roofing nal
Or Doors ❑
Accessory Bldg. El Demolition ❑ New Signs [0] Decks [❑ Siding[ZI] Other[
Brief Description pf Pro osetl 1
Work: R2mO�LnSlin5W- ldurfunis alnd (pU) sh1I)Qus, jlija V"
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.M New house and or addition to existing housing,complete the following:
a. Use of building:One Famli Two Family Other
to, Number of rooms to each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
C Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
It Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. Floodplain_Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
l Septic Tank_ City Sewer_ Private well City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. LOr e+}a, KANG ,as Owner of the subject
property
hereby authorize -3pMES FLANNEP-y -bbh PEPV, PEie—Fo2MANC� Poopw&
to act on my behalf, in all no ere relative to work a orized by this building permit ap licatio .
2
Signature of 0 Data
I, TAMESLRNNE" 6A ff AK �E RfD�IR NCt OCIDRI`06 LLL. as OvmenAuthorized
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.
-3RYNES FI-AtjMER /
Print Name
2
-SgnatW ofetlAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not/1Applicable ❑
Name of License Holder: -J S (.f4 fj ML ` j — ( b
License Number
1 Wil-Lill � I 4-ol,-IoK42 MA 016(40 9 2- - 0 , 3
Address Expiration Date
^�x�`�'P
Sgnat r - Telephone
8.Renistared I Improvement Contractor Not Applicable ❑
PC3K C6 P,00F(N(� Ll_C� 1 83 ,l
Company Name Registration Number
I L'wEFk�U7 �T I EAs r T p�oN NAR b (Oa} 11 �O3 �Zb ��1
Address (413) Expiration Date
Telephone 2.03— S gV?
SECTION 70-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(6))
Workers Compensation Insurance affidavit must be completed and submitted Wth this application. Failure to provide this affidavit will result
in the denial ofthe issuance ofthe building permit.
Signed Affidavit Attached Yes..... I No...... ❑
The Commonwealth of Massachusetts
Department of Industrial Accidents
- Office of Investigations
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/Orgmivadon/htdividuap: Peak Performance Roofing LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Areyouan employer? Check the appropriate box: Type of project(required):
E,
1. am a employer with 3 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).
s have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
9. E] Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions
1❑ 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 ]Roof repairs
insurance required.] r a 152, §1(4), and we have no
employees. [No workers' BE 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.
tConnacters 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.#: R2WC85146ff8nn II Expiration Date: 4/27/18
Job Site Address: City/State/Zip: Nor+�0.MPID�a4,
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 5250.00 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/pq�enalties of perjury that the information provided above is true and correct.
Sienatum 1i T—i � Dat : Lf/IZll�
Phone#: 413-203J5888
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: PermitUcense#
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 Commensation and Employer's Liability Policy
Berkshire Hathaway AmGUARD Insurance Company-AStock Co.
Y Policy Number R2WC811187
Insurance GUARD Companies �neYVaNCCI No.l of [21873].
Policy Information Page (AR)
[1]Named Insured and Mailing Address Agency
PEAR 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 00-1191951 Insured is Limited Liability Co. (LLC)
[2] Policy Period
From }7,04
p 12:01 AM,standard time at the Insuretl'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 Acddem-each acddem $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:
Sea Extension of Information Page -Schedule of Fortes
[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 diange by
audit. (Continued on another page)
Total Estimated Policy Premium ; 14,204
Total Surcharges/Asaessr nts 5 776.00
Total Estimated Cost 14 980.00
01m8MAL u8E 15 Page- 1 - Iriffiomatbne
M811 :R2WCa11187
61/28/2017 WC� �
Orp :
MANOIE
ISIVIR9 ORke: P.O.BM A-M,16&River Street,Wilkes-Barre,PA 167030020 s wwwAuardmom
Worker's Compensation and Emolover's Liability Policy
("Berkshire Hathaway AmGUARD Insurance Company -A Stock Co.
G UARD Com antes Policy NumNCCI No. [21873]
Insurance Renewal of R2WC811187
, � P
Policy Information Page (AR)
1]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVERELD STREET 8 NORTH KING STREET
EASTHAMPTON, MA 01027 Northampton, MA 01060
Agency Code: MAMAIN IS
Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC)
[2] Policy Period
From 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 WorkersCompensation
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 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/Assessments $ 606.00
Total Estimated Cost 14 256.00
101TERNAL USE XX Page- i - Info
rma8on Page '
MGA : R2WC'943835 rm000001A
Dare Ml"/2018 WC
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street,Wilkes-Barre, PA 18703-0020 •www.guard.mm
City of Northampton
s
Massachusetts
� s
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
0
NonNampton, . 01060 —.1
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:
` -io Rc1
(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:
E/,,S47a y✓t p to tv
Qaroris 12o1 (- oF{ , Z 100M15 Wav , mn
(Company Name and Address) O Oaf'
Signat re of Permit licant 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.
K Peak Performance Roofing LLC
PE Contract
PERF O R C E I Lovefield St Date C.Mr.W
Easthampton, MA 01027 4/12/2018 507
MA CSU#103061
MA MC# 183698 413-203-5888 peakperforn anceroofmglIc gnail.wm www.peakperfonomcerro6vgllc.com
Job Location Bill To
Loretta Kane Loretta K.
470 Bridge Rd. 470 Bridge Rd.
Northampton,MA 01062 Northampton,MA 01062
RevamarieQhomuil.mm Ro e.marie®hownil.com
Desctipbon Total
1.Remove the existing wal'shingles 8,500.00
2.Install six feet ofice and water shield at eaves and valleys, 12"around mof/wall intersections
3.Cover remaining mod with Certaintead"Roof Runner'synthetic underlayment(vapor barrier)
4.Install 8"aluminum drip edge on eaves and rake edges
5.Install Cartaintcad Flintlastic SA rolled reading on law slope areas(Color to match shingles)
6.lnstall amhitecmral shingles by Certain d -(Landrurk130yr sated shingle
https://www.certaintced.comhendmtud-mfing/pmductOwdnmW
Color Choice:
7.install ridge vent
S.Corvplete all necessary flashings including new pipe boots
Remove all debris from premises,and throughout the job,oontinoe cleanup and keep the premises undamaged
Toll area,$8,500
A deposit of I2 is due prior to the beginning of the job=$4,250
The balance of$4,250 shag be due upon completion,
Deposit Received On: / / Deposit E Check M
'We n re ssbefo ebrls m may fall into attic"
Cusm Sig Signature:
Contractor Signa TQa EB,500.00
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. Registration: 183898
1 LOVEFIELD ST. E>�ira0on: 11/03/2018
EASTHAMPTON,MA 01027
UpE Mdantl Realm CaM.
SCP1 10 17
l r}
.... s;' CS-103061
JAMES J FLANNERY
1 WILLIAMS S7
HOLYOKE MA 01//W``8
t-jZU (/A_
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