38C-040 358 SOUTH ST BP-2019-0389
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C-040 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-2019-0389
Proiect# JS-2019-000629
Est.Cost: $4775.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groo: JAMES FLANNERY 103061
Lot Size(sq. ft.): 6011.28 Owner: ILLINGSWORTH EARL
Zoning: URB(100)/ Applicant: JAMES FLANNERY
AT. 358 SOUTH ST
Applicant Address: Phone: Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:10/1/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF BACK HALF OF
HOUSE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Melon
Footings:
:bough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Cas: Fire C?epartinert Fireplace/Chimney:
Rough: 01l Insulation:
Final: Smoke: Final:
`t'HIS PERMTT MAY BE REVOKED BY THE C'IT'Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certifi ate of Occugancy Signgtipre:
FeeType: Date Paid: ALnount:
Building 10/l/20180:00:00 $40.40
212 Main Street,Phone(413)587.1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED I pm
Department use only
City of Nor ham ton S s 4Permit:
Building DE partr ienfiEP 2 7 2018 Erb Gu riveway Permit
212 Maid Stre
It ptic Availability
Room 100DEPT OF BUILDI IG INSPEC erN4�ell Availability
Northampton AMPTON.PAA 010i ' wa43ab of StrUCtural Plans
phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6P-t!jJ 30va
1.1 Property Address: This section to be completed by office
}� Map 1c, Lot v Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,674P-L l-i/y7N 35? Scu-L i S-t
Name(Print) Current Mailing Address:
Signature S
g 4,'_ Telephone / 3 r_- 0 _. a a�C
�- J
2.2 Authorized Anent:
zy'qm1rS T, 4CLI) VNFt2 `f ! L�Y��;�/c� Sf, �as�lt�rnpfaiyl�l�4
Name(Print) Current Mailing Address: O�Q�
4113 - dO3 - S-F
Signature U Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 7775-
775` (JCS (a)Building Permit Fee
2. Electrical �T (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee �
4. Mechanical(HVAC) (�
5. Fire Protection
6. Total=0 +2+3+4+5) y O O Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
��� ✓/�-(.e�r� !0 C I
Building Commissioner/inspector of Buildings Date
p e4X P,F9 Fot2M6A1CC-A&0F&6-1-1-610 (� rn 6 4
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
` .._.. .:
M f^
3
♦....�-J .. r..
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition 0 Replacement Windows Alteration(s) Q Roofing
Or Doors ❑
Accessory Bldg. Q Demolition 0 New Signs [EJ] Decks Siding[p] Other[a
Brief Work Description of Proposed I p .+ RO _5 a& �et/ �7L7Z),re ,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes o
Plans Attached Roll -Sheet
es.If New house and or addition to existing housing, complete the following:
a. Use uilding:One Family Two Family Other j
b. Number of room ' each family unit: Number of Bathrooms
c. Is there a garage attache .
d. Proposed Square footage of new cons ion. Dimensions
e. Number of stories?
f. Method of heating? Fir ces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck rgy Compliance form attached?
h. Type of construction
i. Is construction within 1 of wetlands? Yes No. Is construction within 10 floodplain Yes No
j. Depth of base nt or cellar floor below finished grade
k. Will b " ing conform to the Building and Zoning regulations? Yes No.
I. eptic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize SAMES �', FLf41V/U&/2y !713/3 PFi3K PERF®P M4N CC AODF1%y6 L
to act on my behalf,in all matters relative to work authorized by this building permit application.
---
Signature of Owner Date
I, pfres -J. F-i'AN/L)Ek/ 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 -J, F4A1vA1E9V -
Print Name
47,5
Signature of Owner/AgentDa e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not
Applicable 1❑ ) _ J
Name of License Holder: '—JAMES ES J- P L�1VA)EP,y C., S -- / Q 3Q(a
License Number
luilla/n5 5 , , !-710%0kQ MA 01oL16 _ 9La���d
Address Expiration Date
1113 - 063 -- 5-,?S�
Signature Telephone
9.Realstemd Home Improvement Contractor. Not Applicable ❑
POM PC2 FoP,mRov e_C 206F11L)6-, LLC /?r 3 ( 0
Company Name Registratio Number
Address V /Vj3Expiration Date
Telephone 203_.57 YX
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....... W, No...... ❑
City of Northampton
Massachusetts
F•: G
w: L
DEPARTMENT OF BUILDING INSPECTIONS y,
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:
3 �5_� Scr-L,)t,�? S
(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:
s /�o�l-o IV / Looms
(Company Name and Address) o ai
c� 5
Signa re o Permit plicant 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/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888
.;7yl u an employer? Check the appropriate box: Type of project(required):
1. ama employer with 4 4. ❑ 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. [:1 Building addition
[No workers' comp.insurance comp.insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.[:11 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 Roof 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#I 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.Liic.#: R(2`WCf9f4,3835 Expiration Date: 4/27/2019 y, e 1 ,� n
Job Site Address: J 5 c JL�r� City/State/Zip: �Dr /�v 14i 0
vica�O
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 istr a and correct.
Si nature: Date: lb
S
Phone#:
413-203-5888
Official use only. Do not write in this area,to be completed by city or town ofciaL
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#:
.. s �
��
Worker's Compensation and Employer's Liability Pol'�
Berkshire Hathaway AmGUARD Insurance Company-A Stock Co.
y Policy Number R2WCMWS
UARD Insurance Renewal of R2WC811187
GCompanies NCCI No. [21873]
k,
Policy Infornmoon Page(AR)
[i]Named Insured and Nailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIEt-D 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 - Pert 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)
:1
E
tirrrated PolkV Premium $ 13,650
rclmrges/Assessments $ 606.00
timated Cost 14 256.00
INTERNAL USE roc Page- 1- InfOr ration Page
MGA :R2WC943835 WC 000001A
Date :04/04/2018
MANOTE
Issuing Offlm:P.O.Box A-H,16 S.River gb et�Wilkes-Jerre,PA 18708-0020 a www.gmrdA=m
Massachusetts Department of Putat.c Safety
Board of Building Regulations and Standards
License. CS-109061
JAMES J FLANNERY
I WILLIAMS ST
HOLYOKE MA 01010
..ti, Com. Corr o a 21 12D
112018
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.
,-Al 0 20M-05117
P ELICE
Peak Performance Roofing LLC
Contract
P E R F O R I Lovefield St Date Contract#
Easthampton, MA 01027 9/25/2018 615
MA CSL#103061 413-203-5888 peakperformanceroofingllc@gmail.cwm www.peakperformanceroofinglic.com
MA HIC# 183698
Bill To Job Location
Earl Illingsworth Earl Illingsworth
358 South St. 358 South St.
Northampton, MA 01060 Northampton,MA 01060
413-530-2008 413-530-2008
Description Total
1.Remove the existing roof shingles 2,387.50
2.Install six feet of ice and water shield at eaves and valleys, 12"around roof/wall intersections
3.Cover remaining roof with Certainteed"Roof Runner"synthetic underlayment
4.Install 8"aluminum drip edge on eaves and rake edges
5.Install architectural shingles by Certainteed -(Landmark PRO)40yr rated
https://www.certainteed.com/residential-roofing/products/landmark-pro/
a It K 6v n df' {/a.f d/eek,
Color Choice: VM [I pj/6�9
6.Install ridge vent
7.Complete all necessary flashings including new pipe boots and new base flashing on chimney.
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 the job,continue cleanup and keep the premises undamaged.
Total cost:
Back half of h4
A deposit of$2387.50 is due at contract signing. The balance shall be due upon completion.
*We are not responsible for dirt/debris that may fall into attic.Please check for debris after dumpster is removed.*
Total:
Contractor Signature: Customer Signature: Date:
r
ag
/� $2,387.50