31B-030 43 SUMMER ST BP-2019-0381
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 B-030 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-2019-0381
Proiect# JS-2019-000620
Est.Cost: $9800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): 14287.68 Owner: CAINE THOMAS P
Zoning_URC(100)// Applicant: JAMES FLANNERY
AT: 43 SUMMER ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTON MA01 027 ISSUED ON.9/27/2018 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 Occupancy Sisnature:
FeeType: Date Paid: Amount:
Building 9/27/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
(gar
0 z Department use only
City of Northampton Status of Permit
W '* Building Department Curb Cut/Driveway Permit
�,i'" ' Q 212 Main Street SewerlSepticAvailability
WRoom 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
U phone 413-587-1240 Fax 413-587-1272 Plot/Site Pians
W °o Other Specify
AP LICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION �j�.�� '� ✓ l/
1.1 Property Address: This section to be completed by office
Map Lot Unit
�f 3
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
7
Name(Print) Current ,.tailing Address:
.-�a.•c E=J Telephone
Signature
2.2 Authorized Anent:
-InMES T. r-o-)1V J 15A'y l Lo v,9.4e ld 5f; Ea s Aa mp 161v Nq
Name(Print) Current Mailing Address:
_ Y13 - a03 - 5��3
Signature + Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / Y1^ 00 (a)Building Permit Fee
2. Electrical CJLI (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) _goo' Check Number
This Section For Official Use Only
Building Permit NumberDate
Issued:
Signature:
Buhding Commissioner/Inspector of Buildings Date
peAKPl59F0lern6N(6'A66F&6r 4L-C P G mil
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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SECTION!i-DESCRIPTION OF PROPOSED WORK(check a!1 applicable)
New House � Addition [] Replacement Windows Alterations) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks (❑ Siding(o] Other[CQ
Brief De�s�crippr]on of Pro osed ]
Work: STM t _tea Sof' ' 1IONS• 16"-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
fe-M New hous3dr akddltton to existlng housing comulete the foNoarinc�
a. Use of btilding:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Diniiinsions
e. Number of stories?
f. Method of heating? i'ireplaces or Woodstoves Number of each
g. Energy Conservation Compliance._ / Masscheck-Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 Jt..-of wetlands? Yes No. Is construction within 1t)Or. floodplain Yes No
j. Depth of basement o�lar floor below finished grade
s' \�k, Will building conform to the Building and Zoning regulations? Yes No.
1. Septic Tank City Sewer Private well City water Supply.1 X, __F
\�
`SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
7
S .�' //���
.as Owner of the subject
property
hereby authorize SAM F-S F L A1yA.)&t2 y D614 PF/4 X P[-R F o R m19-IV C6 R OD FIAy 6 u
to act on my be alf,in all matters relative to worts authorized by this building permit application...
Signature of Owner Date
I, IPMES U. C—t A N A)EPy as Owner/Authorized
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 the pains and penalties of perjury.
7R!'nES S. FL/qrvAJR -/
Print Name
Signature of towner/Agent Date
i
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction—Supervisor: Not Applicable 0
Name of License Holder: /-"LAlVA)EP,y C J --
License Number
l Gvil aM5 Sf, , fio/L10kQ
Address Expiration Date
LP3 - 063 5 k
Signature Telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
P€gK Lc'-(:!!. /?3 6 q S'
Company Name Registrabo Number
t-oV1-,Ci-Ped 5 ; Fa s �harnn�t� YYIA a/I �� /e 7Z o /y'
Address V 3) Expiration Date
Telephone 210>3_JTZ'YY
--]SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(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 permit.
Signed Affidavit Attached Yes....... 131,inNo...... ❑
City of Northampton
' Massachusetts
{.r
DEPARTMENT OF BUILDING INSPECTIONS D1.
212 Main Street a Municipal Building
Northampton, MA 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:
'-/ 3
(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:
'am b!9 S l 'O X 0 W/ / Lo®mi 3 1)L-1/; �as��i a rn�fvvn� //M)q
(Company Name and Address)
Z
Signa re oY Permit Al6plicant or Owner bate
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.
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
UV www.mass.gov/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 ypu an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4 4. E] I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]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 g• ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• 9. E] Building addition
[No workers' comp.insurance comp. insurance.$
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.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.VRoof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out 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 affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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.
Berkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.L/ic.#: R2WC943835 Expiration Date: 4/27/2019
Job Site Address: / Sl/�1r e i City/State/Zip: 1 yyL��� /14lq
d '-'/D(��
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 penalties of perjury that the information providedab ve is tr a and correct.
Si nature: Date:
Phone#:
413-203-5888
Official use only. Do not write in this area,to be completed by city or town offciaL
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#:
h l �A,7
1
A Worker's Compensation and Employer's Liability Policy
Berkshire Hathaway AmGUARD Insurance Company -A Stock Co.
y Policy Number R2WC943835
11187
GUARDCompanies RenewalNCCI No.[218 3]
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 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 Surdtarges/Assessment $ 606.00
Total Estimated Cost 14 256.00
INTERNAL USE XX Page- 1 - Information Page
MGA : R2WC943835 WC 000001A
Date :04/04/2018
MANOTE
Issuing Office: P.O. Box A-H, 16 S.River Street,Wilkes-Barre,PA 18703-0020 a www.guard.com
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License M103081 •
JAMES J FLAN WtY
1 ViLmMS By
HOLYOKE MA 01000 AJ to,,Jto
P-j.M (.A, Expir ior.
c0nrnission'er 09 /201
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. Registration: 183698
1 LOVEFIELD ST. Expiration: 11/03/2019
EASTHAMPTON,MA 01027
Update Address and Return Card.
sr_�i 20M-0e117
PEVjRn
Peak Performance Roofing LLC
Contract
P E R ' Lovefield St Cate Contract#
Easthampton, MA 01027 9119/2018 670
MA CSI.# 103061 413-203-5888
MAHIC# 183698 r+clxrl+�rm;�nccrx�timlle�igmail.cum «��u.pcakpertitnnancenwfingllc.com
Bill To Job Location
Caine Miller c/o Mauryne Van Dl15e11 Caine Mitter c/o Mauryne Van Dusen
43 Summer St., 2nd Floor 43 Summer St., 2nd Floor
Northampton, MA01060 Northampton. MA 01060
mvandusen�lcainemitter.com mvaiiduscii@caiiiemitter.com
413-586-1993 413-586-1993
Description Total
For section of roof on the far right end of the building adjacent to(lie parking lot.It includes the slope area as well as the 9.800.1x)
lo%v sloped portion on both sides of the ridge.
1.Rentove the existing roof materials including slate,wood shingles.rubber and roof materials beneath the rubber.
2.Remove rottedActeriorated wood. Install new half inch COX plywood over the existing beards.
Low slope roof sections:
3.Install half inch high density polyisocyanurate insulation with approved plates and screws.
4.Install Genflcx reinforced EPUNI Rool`Systenn.
http:Ngenflex.com,,wp-contenL,upin,id./201 .I l i('t307_GcnFlex-EPDi\1-Brochure_1014_web.pdf
Sloped roof sections:
i. Install 6 feet of ice and water shield at the low slope too steep slope transition.and install synthetic underlayment on
the remaining roof area.
6.Install CertainTeed Landmark Pro shingles
haps:/'www.certainteed.comiresidential-rooftng`preducts Iandnnark;
7.Prepare the ridge and install ridge vent
Remove all debris frons prernises.and throughout the job,continue cleanup and keep the premises undamaged.
Contractor will obtain building permit.
Cost: $9.800.00
A deposit of S4900 is due at contract signing. The balance shall be due upon completion.
Accounts past due 30+days subject to 2%finance charge monthly.
*We are not responsible for dirtidebris shut may fall into attic.Please check lbr debris slier dumps-ter is removed.*
Total:
Contractor Signature: Customer Signature: Date:
$9,800.00