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06-045 (3)
217 HAYDENVILLE RD-Route 9 BP-2018-1071 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:06-045 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Categorv:ROOF BUILDING PERMIT Permit BP-2018-1071 Project# JS-2018-001934 Est Cost $10650.0 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sn.fl.): 64904.40 Owner: CRAIG PAUL R&KAREN A zoning: RI(100)/SR(100)/ Applicant. JAMES FLANNERY AT: 217 HAYDENVILLE RD - Route 9 ApplicantAddress: Phone: Insurance: I LOVEFIELD ST (508)294-4052 WC EASTHAMPTONMA01027 ISSUED ON.•4/19/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING SHINGLES, INSTALL PLYWOOD, NEW SHINGLES, RIDGE VENT 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 4/19/20180:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner LA DepertnleM use only City of North mp c n += Stow of Permit: ,r Building Dep Curb Cut/Driveway,Permit 212 Main Street SeweNSeplic Availability Room 100 Water/Well Awilabdq Northampton, MA 01060 Two Seta of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Sfte Plans Other Specity APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH ONE OR TWO FAMILY DWELLING ��II SECTION t -SITE INFORMATION ^Pp (g- t0 '7"/ 1.1 P]rooeM'A/tltlress-rr / gjtlspec1lon to be compl,�by office '1 / 7 7 hili vJ-Q h vI //e. ✓�O ZMapone pV1//ll/Y/Y1/-- Lot ��/�Distrr Unit L-42,o—.J,5 IS Zone Overlay District GP Elm St.District CS DlsMcl SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: KAPFN 01-7 146kydenv1'11eWd11eed5 016,53 Name(Print) Current Mailing Atltlress'. v13- 749 - 3yy3 Telephone Signature i 2.2 Authorized ADent: Gwe �'e(d St ,TAMES Fd/}NN D)ai PIRK PC2Fo/c 44AWC AOOF/A16 �A57Nh7YnpTo/U 1"tt] 0/63� Name(Pont) Current Mailing Address: Sign re V Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 10 JTZ Ob (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee :;(✓//c'.�/ 4. Mechanical(HVAC) ff G 5. Fire Protection 6. Total=(1 +2+3+4+5) E �� r �J/,5 b0 Check Number a2 This Section For Official Use Only Date Building Permit Number: Issued' Signature: Building Com issionehlhspe of Buntings pate PE"AKPEP,FDKMANLF 00F-W6 LLC 6,1l,44iL. Ci9M EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Allenlion(s) ❑ Roofing Or Doors O Accessory Bldg_ ❑ Demolition ❑ New Signs [O] Decks [p Siding[O] Other[E3] Brief Description of Proposed work: RnrnoV_ .RX(S><inU C17, 171ps, in_ S/zt�� P��tubOC�� NPGU S11i,r/IJIPS( ri�P Uz!'1t Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet as.N New house and or addition to existing housina. complete the following: a. Use of building:One Fari Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance tone attached? h. Type of construction i. Is construction within 100 R.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 as Owner of the subject property *n herebyauthorize JA/?7FS r—LANN�Ly b6A P64K FEKF012M,1AJi7F 1tZ66r1 )& LL-G to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Data I JAMES FLlfNIJE.ey 7)U PEhk OLF(aMUCt /,600,U6 LLC , 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 the pains and penalties of perjury. Jigil FGANNEX Print Name SignatureOwn (Agent Date Section 4. ZONING All Information Must ae Completed.Permit Can ae Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Departmert Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved kin #ofParking Spaces Fill: volume&Location A. Has a Special Permit/Variance/finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 8.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Namepf License Holder: JA-M�5 s FLA-n1u67/211C S _ 1636�/4, � License Number wlC ,arns 5+ , lblyokp MR o/oho ��z1,s Address Expiration Date �� (I X13 - 203 51'FrY §igna(i}e Telephone 8.Registered Home Improvement Contactor: Not Applicable ❑ PEAK RODPW6 Li / F 3 & gg Company NameRegistration Number Lw.P��ld 5-E , EAST/4AMP7UA/ Mil- olOd� l3�20/y^ Address L//3 Expiration Date Telephone 263 5`d kF SECTION 70.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 162,§26C(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...._. 2 Na..._ ❑ The Commonwealth of Massachusetts Department of Industrial Accidents Ogee 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/Organization/Individual): Peak Performance Roofing LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888 Areyou an employer? Check the appropriate box: Type of project(required): & 1. '1 am a employer with 3 4. ❑ 1 am a general contractor and I employees (full and/or pap-time). have hired the sub-contractors 6. ❑ New construction 2.❑ t 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' [No workers' comp. insurance comp. insurance-( 9. E] Building addition required.] S. ❑ We are a corporation and its 10.EJ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑-,/Plumbing repairs or additions myself. [No workers' camp. right of exemption per MGL 12.6 Roof 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 Pill 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. iCoovectore that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees- If the sub-contractom have employees,they must provide their workers comp.policy number_ I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lie.#: /IR-2WC8514//68 Expiration Date: 4/27/18 Job Site Address: al;' /1{aVdl PP Ill(_Q KQ City/State/Zip: kffQS Mq -'1 0-5-3 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 e. 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. Ido hereby certify under tthe�p¢afn�s an�dlpenalties of perjury that the information provided¢(love if true and correct SS>mature: 71" -b t I Yl Date: c1711 /f aJ Phone#: 413-201'588'8 n 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#: Workers Comoemsation and Emolover's Liability Policy *83UARDCompariles rkshire Hathaway AmGUARD Insurance Company-A Stock Co. Y Policy Number R2WC011187 RenewalNCCI No.[21873]. Paley Into:mstlon Pape (AR) [3]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC W EBBER&GRINNELL INSURANCE AGENCY, INC. 1 LOVEFIELD STREET 8 NORTH KING STREET EASTHA WfON, MA 01027 Northampton, MA 01060 Agency Code: MAMAINSS Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC) [2] Poll Period From 'A la=AOM!7`, ®, 12:01 AM,standard time at the Imured'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 acddent $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 indudes these endorsements and schedules: See E#ereion of Information Page -Schedule of Forms [4] Premium The Premium Basis and,therefore,the premium will be determined by our Manual of Rules, CassiBrations, Rates,and Rating Mans. All required Information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium ; 14,204 Total Surchnges/Assessments $ 776.00 Total Estimated Cost 14 980.00 INTERIUL USE is Page- 1 - bADmnatiOn Page MW :R2wra1119] M/26/2017 WC 000001A Data : MNIOTE Iming Omp:P.O.Box A-M,15 S.River Street,WNker-Barre,PA 18703.0020 a w .puard.mm ia Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company -A Stock Co. rkshire Hathaway Policy NumberR2WC943835 Insurance UARD Companies of N CI No.[218 3] Policy Information Page (AR) [I]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 00-1191951 Insured is Limited Liability Co. (LLC) [2] Policy Period Fros '8.9 M8,279 ilio, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this polity 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 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 INTERNAL USE xx Page- 1 - Information Page MGA R2WC943835 Dare :09/04/2018 WC OOOOOlA MANOTE Issuing office: P.O. Boa A-H, 16 S. River Street,Wilkes-Barre,PA 18703-0020 •www.guard.mm City of Northampton . . Massachusetts DEPARTMENT OF BUILDING INSPECTIONS pp 212 Main Street 4Municipal 0vilding Zj; Chi• Northampton, MA 01060 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: alb 96tyceny lb W weds AM G/093 (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: � arDns moll 1)9, / h©mf1 U�a� 'raS4,10-�Pkti (Company Name and Address) Signature of Permit Applicant or Ownef 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. MFO E KE Peak performance Roofing LLC Contract 1 Lovefield St Dabs °onh� P E R Easthampton, MA 01027 4/11/2018 506 MA CSM 103061 MA NIC 8 183698 413-203-5888 peakpertorm.wxmofingllc@grnmLcom www.peakperfomunmoofinglle.com Job Location Bill To Karen Craig Karen Craig 217 Haydenville Rd. 217 Haydenville Rd. Leeds,MA 01053 Leech MA 01053 413-779-2443 413-779-2443 prc217@wmcastnet prc217Qmmc l.net Description Total I.Remove the existing roof shingles and install 1/2 inch CDX plywood 10,650.00 2.Install six feet of ice and water shield m eaves and valleys,IN around roof/wall intersections 3.Cover remaining mofwith Cermivteed"Roof Rumarr"synthetic underly ment 4.Install new 8"aluminum drip edge na all eaves and cake edges 5.1resal architectural shingles by Communed (Landmmk 30yr) httpd/www.wmirneed,cremdentW-roofhng/pmduc&landmorld Cob,Choice: 6.boded new Cerminteed ridge vent 7.Complete all necessary Flashings including new pipe boom and new base flashing around chimney Remove all debris fimn premises,and throughout the job,continue cleanup and keep the premises undamaged Total cost: Landmark shivglea=$10,650 A 50%deposit is required prior to start ofwork=$5325 The balance of$5325 shall be due upon completion. fkpoem Rocsived On: 't l lS/ S Deposit$ S3a5 Cheek R�� •We are not responsible for dirUdebris the 1' Customer Sigrature: Contractor Signa Total SI0,650.00 C/fze oln/na)eul" .91fa c djaCk(Je& 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: 1838 1 LOVEFIELD ST. Expiration: 11/0312019 EASTHAMPTON.MA 01027 UpO AOOrece rM Re m Crd. SCA1 O pM-0S1] 3C5 J 3 f� T 04 _ _.. . CS•103061 JAMES J FLANNERY 1 WU.UAM6 SS HOLYOKE MA 01000 r-jz�7 CA- -. s_ .. OW 112010