23D-136 58 HINCKLEY ST BP-2018-1282
GIs#. COMMONWEALTH OF MASSACHUSETTS
Map-.Block:23D- 136 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categmv'ROOF BUILDING PERMIT
Permit# BP-2018-1282
Project# JS-2018-002283
Est Cost:$9250.00
Fee $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sp.ft.): 16073.64 Owner: BRAZEAU LOUIS R&JEANNINE
Zoning, URB(100)/ Applicant: JAMES FLANNERY
AT. 58 HINCKLEY ST
Applicant Address: Phone: Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMP-FONMA01027 ISSUED ON.61512018 0:00:00
TO PERFORM THE FOLLOWING WORIGSTRIP & SHINGLE 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 6/5/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
4phonCEIVED � crFF
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P 3 e6uifdin De rtment curd C�WMmolo wham
212 sin tr, SwvsdSeplb -
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rsM 01080 SSY413-587-1240 Fax 413-587-1272 Pbbmb Pletre
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION aP- l B -I 8i
1.7 ProaeM Addfxe:
This seeeon to M ownplated by aSke
5-8 H;nc)dp 3 Meg o73c> Lt 13 67 Unite
o re inGe�
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Fl
EYn SL D1e1110 CS DMbk-
SECTION 2-PROPERTY OWNERSHIPIAUTHORDED AGENT
2.7 Owner of Rasmd:
Lou;s Brazeau- St
Noma(Prim) Current Madng' Adweae: y/3 - 5-;3 q
Signahm Telepha
2.2 Aulhadod Aasrm
-JAMES T IPLAIVAleAV Sf, cj2 l-AampfonlMA
Name(Pend Cummt Meiling Address: OIO
'fl3 - a03 - S$? 8
swature Tmaphone
SECTION S-ESTIMATED CONSTRUCTION SQM
Item Estimated Cost(Dollars)to Be Oficial Um Only
comp]otetlby rmda limm
1. Building 9 a so, DD (a)Building Pennit Fee
2. Fkectrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building PermN Fee
4. Mechanical(HVAC) ,D
5.Fire Protection
6. Total=(1 +2+3+4+5) o7 Sd, Ghent Number ( Z
This Seceon Far OSlchi Use Only
SuiOirg Permg Nu Date
med:
Si rs: �O�Cj�/A
Cammlesbnerempector
of Bwldhgs DNp
➢eAK/�EI2FaI2l�gNfERDOFIN!>1t.C ® �mRit. eoM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION a•IMMUPTION OF PROPOSED WORN(check all applicable)
New Nouse ❑ Adtllllon ❑ RePlasament WI d0ws AM.U..(a) ❑ Roofing
Or Door O
Accessory Bldg. ❑ Demolition ❑ New Signs = Decks [C] Silting[[3] Other[[:q
Brief Description of Proposed slR it' t rl0 - rc,4 w/ C.Q.r�Vl T-Caj Sh,ZZ&S, 41( arujlorir
Work d x unrle�A4iKPA
Alteration of coasting bedmom_Yes_No Adding new bedroom Yes _No V
Attached Namidwe Renavating uMrniahed basement es No
Plane Attached Roll -Sheet
*L It Mw halve sul OF adAlm to siximWw hgWY1a.cOIDOMN the Movirlinat
a. Use of building:One Famity Taro Family Other
b. Number of rooms in each(amity unit: Numberof Bathrooms
C. Is there a garage attached?
d. Pmposed Square footage of new construction. Dimensions
e. Number of stories?
L Method of heating? Fireplaces or Woodsloves Number W each_
g. Energy Conservation Compliance. Masschack Energy Compliance form attached?
h. Type of msbucdon
1. Is construction within 100 0.of vm0ands?_Yes _No. Is construction within 100 yr. floodplain_Yea_No
I. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Sepfic Tank_ City Seger_ Private well_ City water Supply
SECTION 7a-OWNER AUTHORIZA710M-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 Lduis B ra zoa(/L as Owner of the subject
Property
herebyauthodw 741ME-5 71 "'q/V/UEI2y a64 PEAK PERF0Prn,4NCF AODFliu6 L[
to act on my behalf,in all maters relative to work authorized by this building permit application.
Signature of Orewr Date QIcS
I, �F1IY)ES I.RN Na12y as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application am true and aaurate,to the best of my knowledge
and belief.
Signed under the Paine and penalties of perjury.
'-JAMES 7. FIANN£k1/
Prem Name
say /8
Signature of Oaner/Agent V Date
SECTION 8-CONSTRUCTION SERVICES
0.1 Leen-Conolmdon Bupamhm Not Applicable Cl
Nam.al tJaomalt.Wx: 'JAMES 5 Pl—PM ER-Y Cs - 1030101
Limen.Number
J W //iaMs 5f, 1401VQ,ka !Y))4 0J04/6 a91a/ 1alb
Addmae IE*mfi^n om.
W3- a03 - 58��
s mmm Telephone
Not Applcable o
PERK P�RFoR/hRNLE RLOFl�u6 , LLC /S3 (o91?
Company Name Rep Number
( "ve-p-4)J 5+ as�harnp n� rnR a1a2 1� a3 /�ot9
Addmse (y,a� E prabon Data
Telephwre ab3-�888
SECTION 10.WORKERS COMPENSATION INSURANCE AFFIDAVIT(M.O.L a 162,1725C=($))
Wodters ComWsatm kmumnce affidavit must be mmpletetl and wbh Bas apphca#m Fa*jm to pmvtde to aft"it wN rmm
in the denial of the issuance of the building unit
SWmdAffidaAAaached Yes....... W No...... ❑
City of Northampton _
'x
Massachusetts
SP
DKIR or svr=EfiG r ZCTZOSS
212 win aena! •anninipnl su116inq
soneen.r„tcn, M0106
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 854, 1 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:
S8 /-/11 6k Ze c� S4 , F la r� n C-a—'
(Please print house num 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:
149"r?s INI-n '' Loomis way, MA'
(Company Name and Address)
Sign re or Permit A0plicant 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.
The Commonwealth of Massachusetts
Department oflndustrfal Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): Peak Performance Roofing LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Are u an employer? Check the appropriate bps:
Type of project(required):
L [am a employer with 4 4. ❑ 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. ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
workingfor mein an capacity. employees and have workers'
y P ty� 9. ❑ Building addition
[No workers' comp. insurance comp. insmance.l
required.] 5. ❑ We are a corporation and its 10.E] 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 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 NI must also fill out the section below showing their workers'compensation policy information.
I 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 most attached an additional sheet showing the name of the sub-contractors and state whether or not those entices have
employees. [fine subcomraclom 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.List. #: R2WC943835 Expiration Date: 4/27/2019
Job Site Address: City/State/Zip:
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 th}f+pwains, 'ratpnd penalties of perjury that the information provided ab�ve is n e and correct
Signature: Ile` Date S/ "g / e
Phone#: 413- 03-5888
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 S. Plumbing Inspector
6.Other
Contact Person: Phone#:
- Worker's Compensation and Employer's Liability Policy
11187
ija
rkshire Hathaway AmGUARD Insurance Company -A Stock Co.
Y Policy Number R2WC943835
,01
U A R DCompanies RenewalNCCI No.[218 3]
Policy Information Page (AR)
[3]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
From April 27, 2018 to April 27, 2019, 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 WC2003068
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
MW : R2WCWM35 WC 000001A
Dare : 04iwi2018
MANOTE
Issuing Omce: P.O. Box A-H, 16 S. River Street,Wilkes-Barre,PA 16703-0020 s www.guard.com
fie 9e ��-AWAarkoea
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. Regis=ortim: 183WB B
1 LOVEFIELD ST. E> llpn. 11/03Y2019
EASTHAMPTON,MA 01027
updM A&tr mi Realm Cert.
WWI 0 ]d.K 5117
5 SdC1`O3PfS5 93 E'n*_ 4 .'_"y
3os c' 3:.Jdi y 7e�} i io-. I ,ceras
i.cense CS-103061
JAMEL J FLANNERY
1 WILLIAMS 6T
NOLYOKE MA 0100
\zr, CA—
e,
A—e OA71R01t
MFO E K Peak Performance Roofing LLC
Contract
P E R CE 1 Lovefield St Data Contra au
Easthampton, MA 01027 5/24/2019 544
MA CSL#103061
MA HIC# 183698 413-203-5888 pcakperfom anccmofingllc@gmail.cmn www.peakperfomunceroofingllccom
Job Location Bill To
Louis Bnocent Louis Brexeau
58 Hinckley Sl. 58 Hinckley Sc
Florence,MA 01062 Florence,MA 01062
413-584-8565 413-584-8565
Description Total
We hereby propose to provide the labor and materials for the completion of the following work: 9,250.00
1.Remove the existing roof shingles and replace small section of wood on eve
2.Install six feel of ice and water shield at eaves and valleys, 12"around roof/ all intersections
3.Cover remaining roof with Certainteed"Roof Runner"synthetic anderlayment
4.Install 8"aluminum drip edge on eaves and rake edges
51nslall architecaual shingles by Certainumd-(Landmark PRO)40yr rated
httpsJ/www.ccrtaintmd.wm/residential-roofing/products wdmmk-pro/
Color choice:
BVeAk 5;e,- .
6.Install ridge vent
7.Complete all necessary Flashings including new pipe boots and new base flashing on chimney
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged
Total cost:=$9,250
A deposit of 54625 is due prior to the beginning of the job.
The balance of 54625 shall be dues upon completion. �/- c
Deposit Received On: (1W�/�/�0 Deposit S 7S; Check# a o a
*We are not responsible fm dirt/debris that may fall into snits
Customer Signature: �L
Contractor Si ,�� Total 59,250.00