29-513 (2) 21 TARA CIR BP-2019-0369
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-513 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2019-0369
Proiect# JS-2019-000598
Est.Cost: $7950.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: JAMES FLANNERY 183698
Lot Size(sq. ft.): 9713.88 Owner., GATTI ELIZABETH M&NANCY E FAMIGLETTI
Zoning: Applicant. JAMES FLANNERY
AT. 21 TARA CIR
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.9/24/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & RESHINGLE ROOF, REPLACE 1
SKYLIGHT
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 Deuartment 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:
FeeTvue: Date Paid: Amount:
Building 9/24/2018 0:00:00 $40.00
212 Main Street,Phone(413)587.1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
DepartmieVuse oMy
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability.
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 F I" s
APPLICATION TO CONSTRUCT,ALTER, EPA ,RENOVATE OR DEMO ISH ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION3U 9
1.1 Property Address: DEPT.OF BUILDING INSPE a on to be completed by office
NORTHAMPTON.MA 01080 j
'21 TCL r�a C//e C /c, ap Lot �/� Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
c3ETip C1iOTTi MH
Na Print) Current Mailing Address:
Sgnatu / Telephone '-J/3 - 32-0
2.2 Authorized Anent:
,g1)9F.3 T. f-LIM)AIF2y Loye,e/c� Sf, �asfllarnpf�NMI4
Name(Print) Current Mailing Address. �JQ
L:21 I X13 - PO -5-F? F
Signature ' Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 'Z 9 5G}, C7 0 (a)Building Permit Fee
2. Electrical T / (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee L40,
('
4. Mechanical(HVAC) V v
5. Fire Protection
6. Total=(1 +2+3+4+5) 9 50, c Check Number
This Section For Official Use Only
BuildingPermit Number: Date
Issued:
Signature: '4 �✓
Building Commissioner/Inspector of Buildings Date
PMKFOf2i7ft E"�00F/N G- 4-4-C 0 Ir(V 4 ,
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
....�_... 3.lOi7 �.a1C:4' t'k1li��cN,'(
i'F'h1 Lig Eltlii i.ilYK.'t!�'s:b�l:�il(j{�
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��.� 4 � J�
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. :�.�..._...w .._
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alterations) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[0] Other[EA
Brief Description of Proposed 1 1- r,(� �jhr/7�-�� ) /
Work: P I C�G� f�� �P�a civ `� u L�y l�t
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.ff New house and or addition to existing housing,complete the following-
a. Use of building :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. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction /
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,
1 I TP 6 T f4 C` 0 f To as Owner of the subject
property
hereby authorize SAM F"S T F LF}/VIU&t2)/ Z16t4 OFi4K P V R FO R M/4N GE A OD FW 6 u
to a n my behalf,in all ry�Iters relative to work authorized by this building permit application.
Signature of Owner Date
JAM E$ _J. PLA/U/U Qy 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.
__JAMES T F`/4/VAJ R`I
Print Name
Signature of Owner/Agent UDate
r __.
. .. _
.Y _, _
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction—SSupervisor: f— Not
Applicable 1030&1
❑
Name of License Holder: V Am ES 3- !'�Lfi1V/N 6A y (... S -- / 0 3Q&1
License Number
/ GUd aM5 51, 4 0 16 L16
Address Expiration Date
L113 - a43 --- .5.?4� Val 42,6 2 e)
Signature Telephone (6ulwj
9.Registered Home Improvement Contractor: Not Applicable ❑
P€RK /F3 & 9 S
Company Name Registratio Number
"V11 ;-p 1 5-! , Fa s h a r�� DAJ M)qy�� a� lir 7Z. 2-0 /7
Address V (V13) Expiration Date
Telephone
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....... No...... ❑
City of Northampton
Massachusetts
Fi
�G
DEPARTMENT OF BUILDING INSPECTIONS
S.
212 Main Street •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:
,;� / AARP n'/-� c /c- , On reyx_a 01/Y
(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:
�Mon'5 6/%O�;/; J Z-oomis b0 M19
(Company Name and Address)
/ Z/ O
Signa re o Permit Afplicant 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.
Aassachusetts Department of Public Safety
Scard, of Su�fcing Regulations and Standards
Lzcense CS-103061
JAMES J FLANNERY
I WVJUAMS ST
HOLYOKE MA 010" A)EGLJ
-C&A'
P
1220
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.
A 1 2CM-05/17
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ofo Office of Investigations
'y 600 Washington Street
` Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leuibly
Name(Business/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Are you an employer?Check the appropriate box: Type of project(required):
1. 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 �' EJ 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 8• ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P h 9. ❑ 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 11.0 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' 13.0 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.
$Contractors 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.Lic.#: R2WC943835 Expiration Date: 4/27/2019
Job Site Address: pC 011'.rCCity/State/Zip:
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 provided above ytue and correct.
Sisznature: & Date: /
Phone#:
413-209584
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#:
i(4 Worker's Compensation and Employer's Liability Police
Berkshire Hathawa AmGUARD Insurance Company - A Stock Co.
Y Policy Number R2WC943835
11187
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: MAMAINI5
Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC)
s,
[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 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 e www.guard.com
P E K Peak Performance Roofing LLC
Contract
1 Lovefield St Date Contract#
P E R F O R C E Easthampton, MA 01027 9 1.2 2018 661
• • •
MA CSL# 103061
NIA HIC# 183698 411-103,-5888 peakperfurmancernnHingllcitgntail.com .%%%%.peakpertimianceruolinglic.com
Bill To Job Location
Elizabeth Gatti Elizabeth Gatti
21 Tara Circle. 21 Tara Circle.
Florence. MA 01062 Florence. MA 01062
bethnsierra:iraol.com bethnsierra«aol.com
413-320-1286 -113-320-1286
Description Total
Contract for the main hoose and front of garage roof: 7.950.00
1. Remove the existing roof shingles and inspect sheathing or boards
'_.Replace up to 64 square feet of ply wood if necessary at no cost.Any additional ply%rood%vill be S60 per sheet
installed
3.Install six feet of ice and water shield at ea%es
4.Cover remaining roof%vith Certainteed"Roof Runner"synthetic underlayment
5.Install 8"aluminum drip edge on ea%es and rake edges
6. Install architectural shingles by Certainteed (Landmark)0yr rated
https: www.eertainteed_eotn residential-rooting.products landmark
Color Choice:Colonial Slate
7. Install ridge%ent
8.Remove and replace sky light(I%lodel C04"fixed")
9.Complete all necessary flashings including new pipe boots
Remove all debris from premises.and throughout the job,continue cleanup and keep the premises undamaged.
Contractor%%ill obtain building permit.
Landmark Shingles:$7.:00
Skylight Replacement: $650
Total cost: 57950
A deposit of S'975 is due at contract signing. The balance shall be due upon completion. accounts past due 30+days
subject to 20o finance charge monthly.
'V a are not responsibl.:for dirt'debris that ma% fall into attic.Please check for debris after duntpster is renamed.'
Total:
Contractor Signature: Date:
` .']. 111-1 la 57,950.00