37-069 (2) 705 FLORENCE RD BP-2019-0128
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block:37-069 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-2019-0128
Protect JS-2019-000206
Est.Cost-$11950.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: JAMES FLANNERY 103061
Lot Size(sg. R): 63597.60 Owner: THOMPSON JOHN R&MARGARET E
Zoning, Applicant: JAMES FLANNERY
AT. 705 FLORENCE RD
Applicant Address: Phone: Insurance.,
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:8/2/2018 0.00:00
TO PERFORM THE FOLLOWING WORK:STRIP & 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 Occuoancv Sie ature:
FeeType: Date Paid: Amount:
Building 8/2/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
:phone
EIVED (� W
Deperbsent�U*
Cjty ort am on �atP.mrt
I De art nt Curt,000i9awrgrift
212 Main r
UILDING IN 90 WMedWe3
Oso TWet3Maofftu*Miflal3_- �..
413-587-1240 Fax 413-587-1272 PWAIM Ptd_
APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION 0v /q /,)
1.1 Prooerte AddGM: This aeatlon W be carllPAted by office
GS F/DRLr�C� �Cf, NeP3— Lot�fp U..t--
Zonia Olerisy DM61et
San SL M.e1ct CS Mmrq
SECTION 2-PRROPICIM OWNERSHIPIAUTHORRED AGENT
2.1 Owner of Record:
MAR64tZET e 10if-N 74017))Q5 AJ wS Flounc) e ICfl .
Name M) Cutin Meaft,Addnaa:
Telephone yl3 — A 70 109
S nature
2.2 AUMoMd Anent;
7Am><S T, GLANNEl2y l LovR 'z/d St Fasf�arn�lnNMA
Nemo(Pint) Current Meng Addncc:
IV13 - ao3- s8B8
slsmwa rateplbna
SECTION S-ESTIMATED CONSTRUCTION COSTS
Item Estimated Coat(Dollars)to be Official Use Only
caro eistlbY D91TGft 11110liCent
1. Building ll/ 95a 00 (a)Bulking Permit Fee
2. ElecMcal (b)Estimated Total Cost of
Construcdon from S
3. Plumbing Building Perml Fee
4. Mechanical(HVAC) �(J
5.Fire Protection
6. Total=(1 +2+3+4+5) l SU. Check Number
This Section For OMcial the Only
Building Pemm Number: Dela
ISRIed:
S re:
BU109 Impactor M BUIdIngs pets
pe4KpFI2FoRrn6NCER00FlN6-Ld-C ® 6MM1 , C'_vOM
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5,DESCRIPTION OF PROPOSED WORK(check all aesg eM)
New Nouse ❑ Addmo ❑ F eDp mom Windows Aherabon(s) L] Roofing
0r Deaa ❑
Accasuory Bldg. ❑ Demolition ❑,�j " New Signs M Decks (O Siding]O] OMer ICT]
Brief Description of Proposed
Work: �Sfwe f
Aneration ofeps0ng bedroom_Yas_No Adding new bedroom_Yes No
Attached Namefive Renovating unfinished basement Yea No
Plana Attached Roll -Sheet
Ss,If New NOYN and or BdaMbB to BS)Sl m 11ot ldmi.coBMNBES NM Womilm ,
a. Use of building:One Family Tao Family Omer
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
a. Numbaofstories?
I. Method of Meting? Fireplaces or Woodshnes Number of each
g. Energy Conservation Compliance. Aiassrhec k Energy Compliance form attached?
h. Type of ounsWctio
1. is construction within 100 S.of wetlands Yes _No. Is construction within 100 yr. floodplain_Yes_No
j. Depth of basement a cellar low finished grade
k. Will building conform a Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer_ Private well_ citywater Supply_
8E 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
AGENT ORCONTRACTORAPPLES FOR BUHMM PERMIT
I.�/— {✓ K - /it D/��G J7� ,as Owner of the subject
propsM
herebyauthodze TAMES 7. l7G4 PE14K pbRFoR/i7t+NC.F RODPW LC
ro act on hag,in all matters reiabve to work authorized"is building permit application.
Signature of / ?Z e%
OF—
I, 7amEs U. FLAN/USRy as OwnerAuthonzed
Agent hereby declare that the statements and information on the foregoing application am We and accurate,m the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
-JAMES 7. FLANNFR`/
Print Name
Sgneuse of Owner!pentClete
SECTION 8-CONSTRUCTION SERVICES
8.1 Lkanwd Cordettuction SupeMenr: Not Applicable O
Name of License Notch.: -j4n?ES S PI- 9/VNERY C S — /0301,/
Litenee Number
/ william5 5- , 40/yokg MJ4 OIDy� 0 ;/Q Z2t7i8
nmmas � I Egllmtlon Dale
y13 - a63 - 5888
8lpreaae Telephone
Not Applicable ❑
PERK PEKFOiz/I�HNGE RvoF/iuG, LLC /�3 (a9�
Company Name Registm Number
1 Love-;tic) 5f FAslharr��ON Yv1A aiba� i17a3 /?-
Address /vj3� Expiration Date
Telephone aD3-.EBFJ
SECTION 10.YYOMRS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.a.162.¢26C(8))
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....... I' No...... ❑
City of Northampton S Massachusettsa�aaaaQrs or asizszsc zaarurzoss
212 win etr«t .I ci"l milium,
aortbavptoe, M 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 property licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
-405 F1090OU (2d.
(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:
amons 6//-0/V/ / Loomis bOaq, mA
(Company Name and Address) 0 a
Signat
firePermit Applicant 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/Organintion/Individuap: Peak Performance Roofing LLC
Address: 1 Lovefeld St.
City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888
A,r�e/ypu an employer?Check the appropriate box: Type ofproject (required):
I. 1LS 1 am a employer with 4 4. ❑ I am a general contractor and I 6. E]New construction
employees(full
a nd/orpart-time).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8, ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp, insurance camp. insurall
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions
myself. [No workers'comp. right ofexemption per MGL 12.&fRoofrepairs
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 hot 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 of iduot indicating such
TConuuctors that check this box must aruched an additional sheet showing the name of the sub-contractors and one whether or not those entities have
employees. lithe sub-contractors have employees,they most 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.she
information.
Insurance Company Name: Berkshire Hathaway Guard
Policy#or Self-ins.Lic.#: R2WC943835 // Expiration Date:: 4/27/2019
Job Site Address: 70,5 Elorona A-1-d— City/State : {'/Zip0/.Q Vrn010bz
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
foe 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 penalfies of perjury that the information provided above is true and correct.
Sig_nattlM Date'
Phone#:
413-203-5888
Ojftcial 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#:
671-w 6) G--A sackoe&
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. Regietra = 183898
SOW=1 LOVERELD ST. E11/03/2018
EASTHAMPTON,MA 01027
Update Address and FIMM COM.
SCAT O :awsrn
ossa- �u Id',,,)
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Baa t a• Budi6nR Req � on o a Cams
ecen,e M103061
JAMB JFLAUMMY
1 WILLIAMS O7
HOLYOKE MA 010"
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011I21=2
Worker's Compensation and Employer's Liability Polley
Berkshire Hathaway AmGUARD Insurance Company -A Stock Co.
Y Policy Number R2WC943835
GUARDInsurance Renewal of R2.WC811187
Companies NCCI No. [21873]
Policy Information Page (AR)
1]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 i5 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
INTERNAL m5E XX Page- 1 - Information Page
MGA :R2WC943835 WC 000001A
Date :04/04/2016
MANOTE
Issuing Once: P.O.Box A-N, 16 S.River Street,Wilkes-Barre,PA 18703-0020 s www.guard.com
P E K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St Dare Conlracue
Easthampton, MA 01027 7/24/2019 606
MA CSUt 107061
MA nIC 8 187698 413-203-5888 peekperformenrtroafingllc(dgnaiLwm www.peekperfommncemofmgllc.com
Job Location Bill To
Peggy&John Thompson Peggy&John Thompson
705 Florence Rd. 705 Florence Rd.
Florence,MA DIO&Z Florence, MA
413-270-1091 413-270-1091
noho93@comcast.net noho93@commt.net
Description Total
I.Remove the existing roof shingles 11,950.00
2.Install six feel of ice and water shield at eaves and 12"around roof/wall intersections
3.Cover remaining roof with Certainteed"Roof Runner"synthetic underlaymem
4.Install 8"aluminum drip edge on eaves and rake edges
5JnsmII architectural shingles by Certainteed(Landmark PRO)40yr rated
hupsl/www.cenainteed.wmlmidmtial-roofing/products/landmark-pro/
Color Choice:
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 thejob,continue cleanup and keep the premises
undamaged
Total cost=$11,950.00
A deposit of$5975 is due at contract signing.
The balance of$5975 shall be duel upon completion. 7
Deposit Reb
Received On: f / Nv l 8 Deposit$ 5915 Check# .SO
*We are not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is removed.' Total:
Comrstar Signature: Costumer Signature: Date:
$11,950.00