38B-239 (2) 25 OLIVE ST BP-2019-0188
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map,Block: 38B-239 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category' ROOF BUILDING PERMIT
Permit# BP-2019-0188
Proiect# JS-2019-000311
Est.Cost: $1580.00
Fee: S40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sc.rt.): 11935.44 Owner: SCHLICHTING KERRY
Zoning:URB000)/ Applicant: JAMES FLANNERY
AT. 26 OLIVE ST
Applicant Address: Phone: Insurance:
1 LOVERELD ST (508)294-4052 WC
EASTHAMPTON MA01 027 ISSUED ON:8/15/2018 0:00:00
TO PERFORM THE FOLLOWING WORKSTRIP & 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 Signature:
FeeTvpe: Date Paid: Amount:
Building 8/1520180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
of Northampton 81wM atPlRat
1 L. ding Department CMbf]NOW&AWPwmit
2018 12 Main Sheet SwAdGepBc MddabIMT
Room 100 VVAwMW Avdobft
c.,e 1,spotsortf
mpton, MA 01060 TYm Seb ofBtriciIraI PWM
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.4 517-1240 Fax413-587-1272 Pbb%ib PWM
Cow Bparlly
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR Two FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 ProuaNbr Addrw is 0. to be complew by offh:.
alo Ol. ue S+. � 3 lLa —�M
Zone Oa.rlay District
Elm at DlWd CE Olaelct
SECTION 3-PROPERTY OWNERBHIPIAUTHORIZfO AGENT
2.1 Owned of Raaord:
� Sri t. a R sk,N -y' 6lax Nacti���. MA oto66
N ( cmrem N.a.g aaerea.. ao3 6(0 3335
Telophom
Sgnm
2.2 Authorized Among
7q/YIES T CbVVA1FAY l LcvR�'z/cl Sf, Eas�llarnplaNMA
Name(Ford) Current Meiiig Addreee:
Y13 - a63 - 583 8
agnature Tekphons
SECTION+-ESTIMATED CONSTRUCTION COSTS
IWn ESdmtdad Coat(DollaM)to be OIIicud tics Only
Dompleted by pennit e Vicent
1. Building 1 SO d- p0 (a)Building Penna Fee
2. Electrical O (h)Estimated Total Cost of
Construction from 8
3. Plumbing Building P.rmB Fee �7
4. Mechanical(HVAC) pr C/C-//
5.Fire Propcaon
6. Total=(1 +2+3+4+5) O. Chadic Number
This SNMM Fa ORklal Use Only
D .
Building Permit Num Isaued:
S' re:
Building bd mdIMspedo1-Ev1digs Date
peAl(�tlZForernNNc ROOFING-�-C� �/)'IR%G, GO/1i/
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 11-DE
SCRIPTION7E:1NTmSigns
(checkNapplicable)
Now Nape eOndowa Alpmfion(s) Q Roofing
Or Accase ryeMg. w1 Docks f0 / SICIng S71 OdprtCV
Briewodc
f Deecdpson of lk°toot°° +e ip + /3 Q S (.0 1'7?Al!-F pot$cfi�.
Nleration of e>osfing bedroom_Ves_No Adding now bedroom Yes No
Atfached Narpfive
Plans Attached Roll -Sheet Renovating unfinished Casement _Yes No
Ba.IP NBW hours well Or BddlOon to e:ietlna housing,COBbIBaa the followlgD'
a. Use of butiding:One Family Two Family Other
b. Number of mans in each family,unit Number of Bathrooms
c. is there a garage attached?
it. Proposed Square footage of rpw construonon. Dime s
e. Number of stories?
f. Method of heading? 'replaces or Woodstmai; Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. lands?_Ven _No. Is construction within 100 yr. floodplain_Yes_No
I. Depth of baseme w9ar fioor below finished great
Ic Will build oontorm to the Building and Zoning regulators? Yes_No.
I. cTank_ City Sewer_ Pdvate"11_ City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
AGENT OR CONTRACTOR\ ( APPLIIES FOR BUILDING PERMIT
1 & &"— k �s'v,n as Orwpr of the subject
property
hembyauth0M JAMES T F«/VQ7,Y 2)6A PEAK pERF0PM1}NCF 40DFI%U6 U
1 ct o my behe ,in all modem work N/p/pn,ma by this building permit application.
f0gewfuladOem, Daa
'JAn')ES �'. FLANAJ,EAY as Omr/Authonzed
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 tip pains and penakles of perjury.
-JAMES -J. FLANN;R`/
Pmt Name c
6
Signature of Garner/Agent Dille
SECTION 8•CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nernsaf Ucenselfolder: '-JAMES S FLAAVNEAY OS - 103010/
License Number
l Williams 51,E 461yoke rnKl 01.0W 09&a1laai8
Address ' Expiration Data
y13 - 903 - 5-88g
Sprvitum TelepMrie
Not Applicable ❑
PEAK P£RFoR/hANGE 2voFJn�Fr, LLC /F369Y
Comnsm Name Registrae Number
I Lova-i-P)J 5+ Fasfharr��on� MA DMD23, i/ 7;3/zo /9
Address (yf3) FViretion Date
telephone aD3-5-BN'F!
SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.
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 panni.
Signed Affidavit Attached Yes....... winNo...... ❑
City of Northampton
Massachusetts L"
w
>aasasana� or sorxozsc sss+acrzoss
212 Main etsest or niciPnl euiloinq :
Northn ton, 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:
.,)& to Ava- Sf,
(Please prim house number and street name)
Is to be disposed of at:
Vaffu Reeaj,'n6l r&s4a1���Ifff1��w'�� X� -2J,
(Please print name and location of facility) /1JOY
Or will be disposed of in a dumpster onsite rented or leased from:
r
o Mi GU { f�
(Company Name and Address) a
plJ� Q� g� � 8
Signalere a Permitplicant 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 oflindustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
US 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
Are u an employer?Check the appropriate box: Type of project(required):
L am a employer with 4 4. ❑ I am a general contractor and 1
employees(full and/or part-time)." have hired the sub-contractors 6. F] Rem New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ emodeling
ship and have no employees These sub-contractors have 8, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P Y 9. E] Building addition
req workers'comp. insurance comp. a corporal
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 LE] Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12 u Roof repaim
insurance required.] t c. 152, §I(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their werkers'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 iderit indicating such.
lCm nacmrs that check this box mind attached an additional sheet showing the name of the subcontractorsand state whether or not those entities 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.fLii��,.#: R/2WC943835 Expiration Date: 4/27/2019
Job Site Address: , D`tV.e. City/State/Zip: 4l°r4J M,0Anf MA
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expir4tion dZate). 0/0&0
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 maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of fs rjury that the information provided above is true and correct.
Sianinum Q- �C� n Date'
Phone#: 413-203-5888 UA t
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#:
C�,� �a�ramanuRsa�l�e a�'�'G�>/uusseCza
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: LLC
Regwout n: 163896
PEAK PERFORMANCE ROOFING,LLC. Expiradw: 11/04M019
1 LOVEFIELD ST.
EASTHAMPTON,MA 01027
UpO AeOrass an0 RM CW&
SCAT 0 2aAa'J�l
1t.msacr„carts epo ` ea v a`n:',
5caa ar a,<,bx i g Regu+a'er t .rvaorns
L.<:t•rsa G8-749067
JAMES J FLANNERY
HOL(Y'O✓KE MA 0110/.400
Worker's Compensation and Employer's Liability Policy
Berkshire Hathaway AmGUARD Insurance Company - A Stock Co.
Y Policy Number R2WC943835
Insurance 11187
,tiGUARD Companies Renew N CI No.l of [218 3]
Polity 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: 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 WC2003068
Endorsement-
D. This polity 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 j 13,650
Total Surcharges/Assessments $ 606.00
Total Estimated Cost 14 256.00
INTERNAL USE xx Page- 1 - Information Page
MGA :112WOMM35 WC 000001A
Dale :04/04/2018
MANOTE
Issuing Office: P.O.aux A-N, 16 S. River Street,Wllkes-Ram,,PA 18703-0020 a www.guard c
K Peak Performance Rooting LLC
PE Contract
I Lovefield St Date Dantracl0
P E R F O R C E Easthampton. MA 01027 s•gema 628
• . .
MA C5111 103061
MAHIC# ISM98 413-203-5888 peakperlimmanccruolingllcagmailcum .�u...peakperl'ummncemoang0ccum
Bill To Job Location
Kem Schlichting Kerry Schlichting
26 Olive St. 26 Olive St.
Northampton.MA 01060 Northampton. MA 01060
kerrv.schlichting:agmail.com kern.schlichting:agmail.com
203-610-3335 203-610-3335
Description Total
Front Porch Roof 1,580D0
1.Remove the existing roof shingles and inspect sheathing or boards
2.Replace up to 64 square fret of plywood if necessan at no cost.Any additional plywood will be 560 pn sheet
installed
3.lasrall ice and water shield on entire porch roof
3.Install 8"aluminum drip edge on eaves and take edges
5.Install architectural shingles by Cenainteed -(Landmark PRO)40yr rated
https:- www.certainteedcom'residential-roofing products landmark-pro
Color Choice:6ebblasmaa I0AuJJg.PLt3oChk
6.Complete all necessary flashings
Remove all debris from premises,and throughout the job.continue cleanup and keep the premises undamaged.
Contractor will obtain building permit
Total cost:
From porch roof
1Landnrark PRO shingles H 1.580
A deposit of 5790 is due prior to start of work. The balance shall be due upon completion. 7 n
Deposit Received On: ! ._/� Deposits 7- l.D_ _ Check a�'12 0
"N<are nm responsible for diro'dalrcis tl�at map fall into anir.Pleas neck ILr J<hri.u0a dmnpstcr i.mnmaJ." Total:
ComtWor Signature: C .etomcr Signature: Dew:
6— y ate, $1,580.00