22D-075 (2) 56 FLORENCE RD BP-2019-0408
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22D-075 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-2019-0408
Proiect# JS-2019-000652
Est.Cost: $9950.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): 21780.00 Owner: SHARP JANET&WILLIAM HILL SHARP
Zoning:URA(100)/WSP(100) Applicant. JAMES FLANNERY
AT. 56 FLORENCE RD
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508)294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.10/5/2018 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: M Insulation:
Final: S� ► ;, Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/5/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
n
(Low 5ff#t�
City of Northampton ,C(
Building Department
212 Main Street SpA
Room 100 ;
Northampton, MA 01060 ,
phone 413-587-1240 Fax 413-587-1272 P
APPLICATION TO CONSTRUCT,ALTER,R OLI H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION OCT _ 2 2018
1.1 Property Address: ThI4 sect /,ction to be Completed by office
DEPT.OF BUILDINGMSPECTIONS 1/ Lot V � Unk
'/ F7�( C NORTHAMPTON,MA 0106
(� r ► J Zone Owrley DilsMct
Elm St. CS
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.JA-NET S 4ag P S& Fl oy2-0-nt- IeJ Floy-"(Q rn,4
Na a Tint) _ 77 Current Mailing Address:
>,-/.0"'e / 0, Aa-
Telephone 1/3 - 336
-
Si n' `/7
2.2 Authorized AsreM:
IRMES T, f-l-aNNeAY l �ov� �/c� '5:1, �as�-l�avnpIONM!�
Name(Print) Current Mailing Address:
�r4
1113 - ao 3 - S8 8
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Q bb (a)Building Permit Fee
2. Electrical / (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) 5-n I Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: to ILI to
Building Commissioner/Inspector of Buildings Date
Pe4K pfi2F01er)?4NeERooF/Nt6-
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoollcable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing Er
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[p] Other[Co
Brief Description of Proposed R e o � Luo od �2 i�1 d CQ/)2P f?), —tkp O Cke C -
Worts: S?f2l-p � ►2�Q. �'S�.�l� t• �bYYtQ p U
Alteration of e)asting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Off: aratirl,or addWm to exlstll M 11OU81M.CoMphift the Wowhw
of building:One Family Two Family Other
b. Number of ro in each family unit: Number of Bathrooms
c. Is there a garage attache _
d. Proposed Square footage of new cons Dimensions
e. Number of stories?
f. Method of heating? Fir Woodstoves Number of each
g. Energy Conservation Compliance. asscheck y Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetia Yes No. Is construction within 100 yr. plain Yes No
j. Depth of basement or cella r below finished grade
k. Will building con to the Building and Zoning regulations? Yes No.
I. Septic T City Sewer Private well City water Supply
SEV&N 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR-CONTRACTOR APPLIES FOR BUILDING PERMIT
I, JAL& /-7S)4"4 2-fp ,as Owner of the subject
property
hereby authorize J_.9MFS T FLf4/VA)QZY !7!3/4 PE/4K PERF0Rm14NCF AODFlb6 Li
to act behalf,in all ma rs relative to work authorized by this building permit application.
- cam. l �- �Gi.-i✓
Signa re of Pmer Date q-
1 JPMES T F1,AA1 A)EA1 as Owner/Authorized
Agent hereby der-Aare 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 pedury.
J',qmL=S -,T.
Print Name c
A� 0
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nam.of License Holder: DAMES J-, PL-MVA)Ff2 y e S -- 1 D.301 I
License Number
l Gyillral�s Sf, , fio/yokQ MJ4 6I6L16 9/a/ Z0
Address I Expiration Date
y13 - 063 - 5-9 S9
Signature Telephone
Not Applicable ❑
PFRK PFR.r-40P1 YiRN cE &06,C11L)6-, LLC /?3694Y
Company Name Registratio Number
r "V-1�t;Cj ��, �Q sfharn,�}nnl YYIA a/�� /170-3 201y'
Address 3Expiration Date
Telephone A0,3-57
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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....... M"' No...... ❑
City of Northampton
Massachusetts
:a
Z"ARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
Northampton, 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 properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
s6 F1da-'P-hu iek
(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:
(Company Name and Address)
Sign re OY Permit ftiicant 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 Invesfigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Aoolicant Information Please Print Legibly
Name(Businessiorgm&Ation/inatvidui i): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone M 413-203-5888
Are u an employer?Check the appropriate box: Type of project(required):
1.
Are
a 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. E]Building addition
[No workers'comp.insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ P
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. Roof 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-contractor;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.Licc.--#: R2WC943835 Expiration Date: 4/27/2019
Job Site Address: J�y� Fl or-p /`�-�-au City/State/Zip: r r ore ou Mf
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 is 7trand correct
Signature: Date. L
Phone M 413-203-5888
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#:
CS-103061
C'm y
JAMES J FLANNERY �-
1 WILLIAMS ST
HOL.YOKE MA 9100
90WWiaxwea- x
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. mon. 1 /W
1 LOVEFIELD ST. F-xp�� 1111/W=19
EAST HAMPTON,MA 01027
Update Address and Return Card.
SCA 1 p 20M-W17
Workmen Cwn EmilknMeA Liability
Berkshire Hathaway Ain6""ND Iesunume Company-A Stock Co.
y Policy Number R2WC943835
kGUARDCmaneMMC[18737
Pocky Information Papa(AR)
[i]Named insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY,INC.
EASTHAMPTON1027 Northampton, MA 01060
Agency Code: MAMAINIS
Federal Employer's ID 00-1191951 Insured In Umited Liability Co. (LLC)
[2] 1
From April 27,2018 to April 27, 2019, 12:01 AM,standard time at the insured's mailing address.
[3] Covers"
A. Workers'Compensation Insurance-Part One of this policy applies to the Workers'Compensatlon
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 $1001000
Bodily Iryury by Disease-each employee $100,000
Bodily Injury by Disease-policy limit $5001000
C. Refer to Residual Market Limited Other States Insurance WC2003065
Endorsement
D. This policy Includes these endorsements and schedules:
See Extension of Information Page-Schedule of Forms
[41 Pr+arnium
The Premium Basis and,therefore,the premium will be determined by our Manual of Rules,
C7assMcatlorhs,Rates,and Rating Plans. All required Information is subject to verification and change by
audit (Continued on another Rage)
Total Estlmsted Palm Pnamium $ 13,650
Total Sodunles/Ass 606.00
Total Eodnuftd Cost 14625&00
NUERNAL USE hoc Page- 1- Information Pape
MMA :RZ C94383g WC 000001A
DNA :04/04/2018
MANOTE
land"Oilloe:P.O.tsar[A-%16 S.Rhror Stn+eat,WNlaaa-Ilarre.PA 187084020 a www.owrdAmn
P E K Peak Performance Roofing LLC
Contract
P E R F O R C E I Lovefield St °ate co"tract#
Easthampton, MA 01027 9/25/2018 679
MA CSL#103061 413-203-5888 peakperformanceroofingllc@gmail.aom www.peakperforTnancemofingllc.com
MA RIC# 183698
Bill To Job Location
Janet Sharp Janet Sharp
56 Florence Rd. 56 Florence Rd.
Florence,MA 01062 Florence, MA 01062
413-336-1181 413-336-1181
sharpj 123@comcast.net sharp]123@comcast.net
Description Total
1.Remove the existing roof shingles and inspect sheathing 9,950.00
2.Install new 1/2 inch CDX plywood over boards on slopes above the kitchen
3.Replace up to 64 square feet of plywood if necessary at no cost.Any additional plywood will be$60 per sheet
installed
4.Install six feet of ice and water shield at eaves and 12"around roof/wall intersections
5.Cover remaining roof with Certainteed"Roof Runner"synthetic underlayment
6.Install 8"aluminum drip edge on eaves and rake edges
7.Install architectural shingles by Certainteed(Landmark)30yr rated
https J/www.certainteed.com/residential-roofing/productsAandmark/
Color Choice:
8.Install ridge vent
9.Complete all necessary flashings including new pipe boots and new base flashing on chimney
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises undamaged.
Contractor will obtain building permit.
Total cost:
(Landmark shingles)=$9,950
A deposit of$4975 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 dirt/debris that may fall into attic.Please check for debris after dumpster is removed.*
Total:
Contractor Signature: ustomer Signature: Date:
, 2Li c 2 q' d6-1 $9,950.00