30B-089 (2) 80 FEDERAL ST BP-2019-0106
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:30B-089 CITY OF NORTHAMPTON
of -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:ROOF BUILDING PERMIT
ermit# BP-2019-0106
Protect# JS-2019-000171
Est Cost: $3950.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: JAMES FLANNERY 183698
Lot Size(sa.ft.): 46217.16 Owner: CARPENTER THOMAS D&GAIL S
zonine7 URB(1IoyWP(74)/FFR(I)/RR(N/ Applicant: JAMES FLANNERY
AT. 80 FEDERAL ST
ApplicantAddress: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.712512018 0:00:00
TO PERFORM THE FOLLOWING WORIGSTRIP & SHINGLE ROOF 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# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 2k 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:
FeeTvoe: 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
gor
aw
City of Northampton SWACIPwisit
Building Department /5AR7a4mWft"W
212 Main Sheet sawnwilaspillaAriMl—I
Room 100
Northampton, A-7"M! Plw
phone 413587-1240 ax
APPLICATION TO CONSTRUCT,ALTE ,RE IR, NWbE LIBA ONE OR TWOO FAMLLY DWELLING
SECTIONI -SITE INFORMATION DEPT OF BUILDING INSPECTIONS (JIFAi�^lO�
1.1 Property Addroaa: PERT In to M
Map �JO X Lafq UWI_
Bo Fedo-ral Sf. 2DDa OV*wY
Elm at.Dlwlcr CO DWOW
SECTION 2-PROPERTY OWNERBNIP/AUTHORMD AGENT
2.1 OWW of Rword:
7homi5 w 6-61 ('a'r '0 a h il-P, Sb F-P (jaro 5-t
Nam mt Cummi Mellkg Addles..
1 ' V`
BlgrmWre T6w," q/3- 5gv- o.7
2.2 Aulborized Agent
w9mES T FcANNERy l LovR,< z/d St, Eas��tarn�lnNMA
wne(P" CuLem MehIg Addinn;:
Y13 - ;los - 5858
sgn.ea. Telagnne
SECTION 2-ESTIMATED CONSTRUCTION COSTS
Item Eetimeted Coes(Dollars)to be Oficial Use Only
completed bv gamuticant
1. Building �• d. co (a)Building PermitFee
2. Elecbiral (b)Estimated Thai Cog of
Construction ffonl B
3. Plumbing Building ParmN Fw 7�77
4. Mechanical(HVAC)
5.Fire Protection
S. Total=(1 +2+3+4+5) Check Number
This Section For Olflcbl Use Only
Building PernOt Number Date
Iswetl: � / 6
v✓ �G/
Building Impactor of Bum pale
pergKp>��Fo�erngvcE,eooElv��.�-c 6mr�ic, �M
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S-DESCRIPTION OF PROPOSED WORK Ichwk all applicable
New Nouse ❑ Addition ❑ D Powm orrdgwa Alterawn(a) ❑ Rooling
Acceawry Blrig. ❑ Demolition ❑ Nev,Signs IA] Decks [p SidinOB:31 OIMr[q
�
�ofPrOWled s/> +
Alteration of existing bedroom_Yes No Adding ratw tremmm Yea No
Attached Narrative Renovating unfinished basemand Yes No
Prone Attached Roll -Sheet
Is.r Nw 601M andor att5OH to wdsd O bovalm QORaakft VIS,1foNow[RO:
a. Use of building:One Famiy Tao Family Omer /
b. Number of mons in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new mnsbucgon. Dime ' ns
e. Number of stories?
f. Method of heating? Fireplaces or Woudsmves Number of each
g. Energy Coremvation Compliance. Masscheck Energy Conplmnm form attached?
h. Type Mconstructlm
I. Is construction within 100 R ends?_Yes _No. Is consWction within 100 yr. floodplain_Yes No
j. Depth or base lar floor below finished grade
k. Will Wil " conform m the Building and Zoning regulations? Yes No.
L 'c Tank_ City Serer_ Private well_ City water Supply
SECTIONTa-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLES FOR BURRING PERMIT
1, lkp rK�t's -/��'F�1//L as Owner of the subject
Property
here a j.AME-5 7. F /LFHVAJQZ Dae PEAK PFRFORM4N66 KODOW u
m o be 77masers 've m work authorized by this building ti application.
7 Z3 I
ig atom of rTvnar Dies
1. UpMES �, FLANAJEAY .as Ovmer/Authonzad
Agent hemby declare that the statements and information on the foregoing application are true and amurete,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
—JAMES T F4AA/A1gK`/
Print Name p �j
Siprebes of OwndAgenr v Pel
SECTION s-CONSTRUCTION SERVICES
61 L cam ed Conshucdm Supervisor. Not Applicable ❑
BEIR011.1,14wa.r: -JAMES S PL-9A11LJERy 1030101
liOerlee Number
l Gyilham5 51 l�olyokp M)4 OIDyO A2 0/
Atltlms �� Expiration Dme
yl3 - a03 - 5888
Slims Telephone
Not Applicable ❑
PERK PERFoR/YiRNGE 2voFln��, LLC 1?3 (a9b'
Cornpam,Name Regi Number
i lovt� �JrJ 5h� Fasfham 4Z)fj YEA 51aa_ 7710 3/zol�
Address (y/3) Borabon Doss
Telephone a�3-.SPBJ
SECTION 76 WORKERS'COMPENSATION INSURANCE AFFIDAWT(M.O.L c 184,5 2SC(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 it.
ng perm
Signed Affidavit Attached Yes....... ty'inNo...... ❑
City of Northampton _
Massachusetts �-
x
laaa4smar as eoraarxa rrapicrrolas
414 Win abet a Wnicipal enildin0
aortho ton, re 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:
61�0 Fo d-o,-nt/ 5 f,
(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:
'amonrs zoomis uJf��, �asfham��n� mil
(Company Name and Address) Q a
Sign reafd oT Pehnit Aillplicant 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 ofMassaehusetts
Department oflndustrial Accidents
Office ofinvestWashington
Strons
eet k1i 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricions/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 ypu an employer?Check the appropriate box: Type of project(required):
I. I am a employer with 4 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
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 me in an capacity. employees and have workers'
Y P tY 9. E] Building addition
workers' comp. insurance Weare
insurance.,
required.] 5. ❑ We arc a corporation and its 10.❑ 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 u Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicanuhat cheeks box til must also pilots the section below showing their workers'compensation policy information.
,Homeowners who submit this smatter,indicating they arc doing all work and then hire oulaide wntmaors must submit anew alidmit inducting such.
[Contractors that check this box must handed an additional sheet showing the name of the sub-contractors and state whether or not hose entities have
employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
Into 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. Lie#:�^R2,JW�C9�4338(35 Expiration Date: 4/27/2019
Job Site Address: Fd Fe de (.l-f City/State/Zip: j'(p.Q�LQ /M offil
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 penalneyll-perju that the information provided aboveis t ue and correct
Sia m - Date 7le_'37
Phone#: 413-203-5888 ✓✓✓✓
vi
Oficial 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 AmGUARD Insurance Company- A Stock Co.
Y Policy Number R2WC943835
AlInsurance G UA RD Companies Renew N CI No.l of [21873]
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: 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 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
INIERNIIL 115E xx Page - 1 - Infomwtion Page
MGA :R2WC943835 WC 000001A
Date :04/04/2018
MANOTE
Issuing Office: P.O.Box A-M, 16 S.Rlrer Street,Wilker8erre,PA 18703-0020 r www.guard.cem
671-w wammonalea iX t/2c & jac1m,6jeffJ
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: LLC
MB
PEAK PERFORMANCE ROOFING,LLC. Re xpiraMm: 11/03
1 LOVEFIELD ST. Ei�ira0on: 11/03/2019
EASTHAMPTON,MA 01027
Upa AG Imw wW RMCN.
SCP1 IpA4p5Hi
iy$i a5CIS5 tl^' L i Q
Boi n o Re P_uda� q Req mss }m 'Dams
i,iensa CS-103051
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 010"
r jZ;:; (_A_ pC.'tYOC
•,cmnss:a"^ 09171/2011
MFO E K Peak Performance Roofing LLC
Contract
P E R 'SCE 1 Lovefield St Date com ac0e
Easthampton, MA 01027 7119/2018 601
MA CSW 103061
MANIC# 183698 413-203-5888 peakperformenceraofingllc@gmeil.com w .peakperformencemoti�llawm
Joh Location Bill To
Thomas&Gail Carpenter Thomas&Gail Carpenter
80 Federal St 80 Federal St.
Florence,MA 01062 Florence,MA 01062
413-584-0779 413-584-0779
Cwpmg@comea t.net Carptng@comcwLnm
Description Total
Detached Garage(both the front and back of the shingled slopes): 3,950.00
1.Remove the existing roof shingles
2.Cover entire roof with Cerlainteed"Roof Runner"synthetic underlayment
3.Install 8"aluminum drip edge on eaves and rake edges
4.Install architectural shingles by Certainteed -(Landmark)30yr rated
httpst//www.cerminteed-wmlmidential-roofing/pmductsAmdmuk/
Color Choice:—(''";G( S(nk
S.Complete all necessary flashings
6.Reinforce damaged racers
We will replace up to 100 square feet of plywood if necessary at no cost.Any additional plywood will be
$50 per sheet installed.
Remove all debris from premises,and throughout thejob,continue cleanup and keep the premises
undamaged.
A deposit of$1975 is due at contract signing.
The balance of$1975 shall be due upon completion. 1
Deposit Received On: 7 /—/-E— Deposit$ /4 75 Check# 55
We ere not responsible for dirt/debris that may fall into anic.Please check for debris after dumpsur is removed.• TO`^I,
Contractor Signature: sm rgn D tr: Total:
.
$3,950.00