39A-066 12 HAMPTON TER BP-2019-0105
GIs;#: . COMMONWEALTH OF MASSACHUSETTS
a :Bio k:39A-Obb CITY OF NORTHAMPTON
a:-0(11 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Q' t�eorr ROOF BUILDING PERMIT
Permit N BP-2019-0105
Proiect# JS-2019-OG017a
Est Cost $320000
EMS49-00 PERMLSSIONIS HEREBY GRANTED TO:
ns[.(,Mass: Contractor: License.,
tJse Groin JAMES FLANNERY 103061
Lot zetsa.Q-, 13111.58 OWner, BARCLAY DAVID H ar LYNN z
Zonine: URBf 106)! Applicant: JAMES FLANNERY
AT: 12 HAMPTON TER
ApplicantAddress: Phone. Insurance:
1 LOVEFIELD ST _ 508 294,-4052 WC
EASTHAMPTONMA01027 ISSUED 0A`.-712512018 0.00.ao
TO PERFORM THE FOLLOWING WORK.•STRIP & SHINGLE ROOF OF GARAGE 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 a 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 7/25/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
a413-587.124O
ED 6?-M
t�.
JULNprtPain IT AWS VvAk~tammltAlikMAO 060 7YTr8eMMd8tedeeelPlMte240 Fax413tsal-1272 PNML ,_„_,r
APPLICATION TO CONSTRUALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TYPO FAMILY DWELLING
SECTION 1 •SITE INFORMATION ry q19- 'I oc
1.1 p. i ( plnass � < 77 T7 LM"Otimo��MkA
t2 tfamp�On� -T.a-�en�acc� t"�--
zonis Over4YDI.trIct
FAn eL dmeg CS orglq
SECTION 2-PROPERTY OWNERSHIPtAUTHORDED AGENT
2.1 Owrwr oT Rewrtl:
�)/ ID 641Qt- +y 12 1 rno om 7op(wg, tUor4Aryb,
Cmam MIAV Addms:
Taw" C113 -3 26 - 9 510
2.2 Aumodred Agent:
-1Am'CS 3, GIANN�Ry / Lov2z/d St, as�l2ampfilrwMA
Name(Pdm) Curom Marna Addnss: OIQ�
IY13 - a63 - s8x8
SlgMtae TGWI
SEMpN 2•ESTIMATED CONSTRUCTION COSTS
Item Eslmatall Cost(DOMas)to be Oficial Use Only
com~bv cannit amiCant
t. 'J 00 (a)Suli Pednst Fee
2. Electrical (h)Emanated Triad Cast of
Construction kiln
3. Plumbing Beading Permit Fee [/
4. Mechanical(HVAC) (7JQ
5.In Protection
S. TOM=(I -2+3+4+5) 3zoo, ° Chadc Numhar
This Section For Official UpgOnly
Building POW&Numten Date
issued:
S _
Burg ofeuadfpe Dam
�egXptry2Fo)2InRNtERbOFINGI-�-C� �iYtF}l[, (?v/uJ
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION b DESCRIPTION OF PROPOSED WORK(check all asotloabta)
Now Nowa ❑ AddWM ❑ ReploeamaM Windows Aheradon(s) p z;--g
Or Doom ❑
Accessory Bldg. ❑ DemolWon
New Sign [131 Dec. ks IM Sldingit:3l
Olherjrj
Brief Description N ProposWork: ed dtk6od 6mavCcLM s1,1,, bs
�
Alteration of scaling bedroom---Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ga.9NIsm.Emm i o dor addEw to suYWem howhm.Dolnigh to Ow 1ONOWIlllla:
e. Use of buikkng:One FamilyTwo Family Otlmr
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed SQwm footage of new construction. imensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodshries Number of won
g. Energy Conservation Compliance- Massclmck Energy Compliance form attadmd?
h. Type of construction
I. Is construction within 100 wetlands?_Yes _No. Is construction within too yr. floodplain_Yes No
j. Depth of Dasa r cellar floor below finished grade
k. Will buildi conform to the Building and Zoning regulations? -Yes-No.
I. cTank_ City Sewer_ Privatswall_ Caywater Supply_
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT
1, 2>/4 v,b 614 P,C LAy .as Owner of the subject
MOP"
henstryntho ize 7gl»ES 7. FLRNNEl2y t7BA PEAK pbRFOR7YIF}N CF Roo Fi%u6 u
to act behal,i all matters rela0ve to work aut horged by this building permit application.
S' o Date
JAMES T FI.ANN6ky ,as OwneNAuthonzed
Agenthereby declare that the statements and information on the foregoing application am true and accurate,th the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
-JAMES 7, FLANN£Ky
Prim Nang
SonaWro of DhwturAgem
Ddus
SECTION 8-CONSTRUCTION SERVICES
8.1 Llesnesd Construction Suenviwr: Not Applicable O
Num of Lkamettslder: jgrnES J PLA1vNs2y CS - /0301D/
LlWae Number
l luillrams Si, l�olyokp Mj4 OI,OyO 09/a1�aa/8
AddRu �� EWrallon Dale
y13 - a03 - S88£
SIQIIeWR Talephene
Not Applicable ❑
PERK PEKPolZMHNGE 2v6r11v6-, LLC /?3699
Cornea"Name Regisba8s Numbe
i Lovt� �lrJ 64, EISA&!2304-6Al YYIA Nbda4 �l �pM617
Addnaw (y/3) Expiration Date
Telephone 1Q3-5887
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L c.181,f 26C(e))
WorkeR Compensation Insurance affidavit must be completed and submitted with this application.Failum to proAde this aSgevit Will result
in the denial of the nuance of the building permit
Signed Atfidavtt Attached Yes....... yr No...... ❑
City of Northampton S MassachusettsDEE?" 60gP1 cr B=1urW XW7ZCSICae212 Win tsnata Wniaipal Building
ao:th u on, M 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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:
iz 1 �ti7�a�.
(Please print hou a number and street name)
Is to be disposed of at:
(Please prim name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
/�a�ean`s !2o/%oFF; zoomis wad, �asfl�aYn��N M19
(Company Name and Address) 0 a
6�1� � /X
Sign re Permit Ailliplicant 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 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/Organizadun/hadividuap: Peak Performance Roofing LLC
Address: 1 Lovefeld St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Aan employer? Check the appropriate box:
Are of project(required):
1. 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 constmetion
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' y ❑ Building addition
[No workers' comp. insurance comp.insurance.l
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.E] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 u Roof repairs
insurance required.] r c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 most also fill out the section below showing their workers'compcnsation policy information.
I Homeowners who submit this affidavit indicating they are doing at l work and then hire outside contractors must submit a new affidavit indicating such,
�comwemrs that check this box must attached an additional sheet showing the time of the subcontractors and state whether or not those elides 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.Li,.#:J �R�2WC94/3835 Expiration Date:p , 4/27/2019 L' ,
Job Site Address:—/,? /7`tC 171-/�7�/t-j !-E � �-� City/State/Zip: /1/�/ )
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 penal[' s otf pe/r- ry that the information provided ab ve is tr a IF correct.
Signature: X` Date 7 / Z 3 / O
Phone#:
413-203-5888 of -
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
11187
kshire Hathaway AmGUARDInsuranceCompany -A Stock Co.
Y Policy Number R2WC943835
AlInsurance G UA RD Compan es �n°t" NCCI No.al of [219 3]
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: MAMAINIS
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 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 111 14 256.00
Int RAAL.USE xx Page- 1 -R Information Page
MGA : WC943835 WC 000001A
Date :04/04/2018
MANOTE
Issuing Once: P.O. Box A-N, 16 S.silver Street,Wilkes-Barre,PA 18703-0020 a www.guard.com
/ (GO?72491,0�72LleP,ll'�-Gf2 0���� LLCP. 6
l2�Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Types LLC
PEAK PERFORMANCE ROOFING,LLC. RSE)pirpIraafilim:bon: 163698
wl: 11/03/2019
EASTHAMPTON,MA 01027
UOda A Imw and Ra mCW.
.1 O 2w 117
® "ssa nusets .<P�"mea 3a+cy
dca +c. SuJtl n.� Rego-marro 'rm � a:�ca:as
.cense CS-103061
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 016"
�an CA— Er onanc^
a,ommssore^ ON111201f
P E K Peak Performance Roofing LLC
Contract
1 Lovefield St Dab contrae#
P E R F O R C E Easthampton, MA 01027 7/11,203589
. .
MA CSI#10:3061
MA HIC01936" 413-203-5888 pdakperformanamofmgllc(r4anail,com www.peekperfomumceroofingllc.com
Job Location Bill To
David Barclay David Barclay
12 Hampton Terrace. 12 Hampton Terrace.
Northampton,MA 01060 Northampton,MA 01060
413-320.4510 413-320-9510
davidbamlay100@hotmaii.com davidirmlayi0O@hototaii.cam -
Description Total
Detached Garage: 3,200.00
1.Remove the existing roof shingles
I batt raw 112 inch CDX plywood on`Neon to"section
3.Cover entire mf with Certainteed"Roof Rumcer'synthetic underlaymem
4.Install naw 8"aluminum drip edge on all eaves and rake edges
5.Install amhitectural shingles by Certainteed (Landmark PRO 40yr)
hW:I/www.certainteed.mm/msidential.mofing/pmducts/landmark-pro/
Color Choice:
6.Comphdc all necessary flashings
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises
umlemaged
Total corn$3,7A0
A deposit of$1600 is due at contract signing.
The balance of$1600 shall be due upon completion.
Deposit Received On: 7 / !- / �OrDeposit$ A&60 Check 4 00
rla,7 _7120
'We ars mtrespoasibkfordaddebrisrhatmayfailinm c.Pkm.,aforde atter psrcrisrimwd.' Total:
Contractor Signanue: Cnsmme ignalure: Date: