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29-224 (6) 136 ACREBROOK DR BP-2019-0840 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:29-224 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categor:ROOF BUILDING PERMIT Permit# BP-2019-0840 Proiect# JS-2019-001388 Est.Cost: $12650.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sa.ft.): 14897.52 Owner: HERNDON AUDREY&CHRISTOPHER Zoning: Applicant: JAMES FLANNERY AT: 136 ACREBROOK DR Applicant Address: Phone: Insurance: I LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON.112812019 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: Qit 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: FeeType: Date Paid: Amount: Building 1/28/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner pmf = Depertn"use"*y City of Northampton Status of Pwn*: `* Building Department Curb GuVDrkw*ayPemtit 212 Main Street Sewer/Sepdc Amy Room 100 WatedWelf Avafbibft Northampton, MA 01060 Two Sets of Structund Phns phone 413-587-1240 Fax 413-587-1272 PbvSft Plans OCCd�erSp[ecily APPLICATION TO CONSTRUCT,ALTER,REPAIR,JENOi.,_�__ FRA61kiDE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION JA ThIfs seal to completed by office 1.1 Property Address: of ��' DEP PPFCTIONS NiP 1,) ON.MA 01060 ay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: D a hl 13( rtcRAG�-P-6 c>k- D Q �k- Na rint) Cyr tMailingA dress_ 3a O� �Z 11i�'bb Cil b t o Telephone Signature 2.2 Authorized Atient: Inly)ES T, r-L1411)NFA y l Leve;e1c1 Sf, �a s1�-�tQ►rnpfoN M� Name(Print) Current Mailing Address: OIQ 61 l3 - 163 - Sy Signature v Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ,r Z �? 6- -� ' /` (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Feet'/ 4. Mechanical(HVAC) 5_Fire Protection 6. Total=(1 +2+3+4+5) /Z- 5 C- Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date p2AKp�l2For�rn�iycE�eaoF,�tiG-1-�-C � � mei c , Cr�l''I - EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoalicable) New House Addition [] Replacement Windows Alteration(*) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [E31 Decks [p Siding[0] Other[l7] Brief Description of Proposed Work:_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.if Now house and or addittbn to existing housing, complete the followirm: 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. Dirrteneions 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. 1. ptic 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, f-vt,b Pv;-t k# 2rr►D D N as Owner of the subject property hereby authorize �, F L,41VAJ Z/2 y j)&4 Pb/i K P[;R F D R►'► 1+1V CF R W F- U 6 LL tomy half,i at matters lative to work authorized by this building pe it application. 7n- 41—ignature JJ A of Date 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 Fl-RNNEK'-/1 Print Name Signature of Owner/Agent Date 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/Flectricians/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 Vu an employer?Check the appropriate box: Type of project(required): 1.pt( 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 ❑ New construction 2.❑ 1 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 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* 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 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.9 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 Seif-ins. Lic.#: R2WC943835 Expiration Date: 4/27/2019 Job Site Address: 136 Ar.P—4�-VOk �r7�'�'' C'it /State/zi T" �dr��� m4 0/b�a 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 cif perjury that the information provided above/is true and correct Suture: Datc,...._t / Phone#: 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#: Worker's Compensation and Employer's Liability Policy A Berkshire HathawayAmGUARD Insurance Company - A Stock Co. Policy Number R2WC943835 �A GUARDCompanies RenewalNCCI No. [218 3] Policy Information Page (AR) EI]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 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 9 www.guard.com 6; e 0/9��e� 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. Boration: 11/03/2019 EASTHAMPTON,MA 01027 Update Address and Retum Card. SCA i 4 2 » /✓ J Offles of Consumer Affairs i Bwirees Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the wq*@don date. N found ralum to: caltfrm Oflice or Consumer Af irs and Business Regulation ism 11/0302019 10 Park Plaza-Suite 5170 PEAK PERFORMANCE ROOFING,L.L.C. Boston,MA 02116 JAMES FLANNERY 1 LOVERELD ST. EASTHAMPTON.MA 01027 UnderaeCretary vldd to Nhout sIgimt ire Cm momyaalth of Massachusetts Division of Professional Licensure Board of Building RagWations and Standards Corkdruction Su Umastrided-Buildings of any use group which contain CS-103061F.tcplres:49/2112020 kss than 36,000 cubic feet(1191 cubic metas)of enclosed Specs- JAMES J FLANNERY � a 1 WLLU MS 37 HOLYOKE MA 01060 Commissioner C4- Failure to possess a current editiofr oithe Massadtusalts Stets Betiding Code is cause for revocation of this Ncw= For laftmution about this license CaN(617)7274200 or visit www.mass.gov/dpl P EICE K Peak Performance Roofing LLC Contract P E R F O R 1 Lovefield St Date c°ntrad# Easthampton, MA 01027 1/15/2019 755 MA CSU 103061 1 413-203-5888 peakperfomianceroofingllc@gmail.com www.peakperfonnanceroofinglic.com MA HIC# 183698 Bill To Job Location Christopher Herndon 1, Au&C.4-+ Christopher Herndon 1 "&Et ��— 136 Acrebrook Dr. 136 Acrebrook Dr. Florence,MA 01062 Florence,MA 01062 781-439-2088 781-439-2088 christopher herndon@gmail.com christophedhemdon@gmail.com Description Total 1.Remove the existing roof shingles 12,650.00 2.Install six feet of ice and water shield at eaves and three feet in all valleys,around pipes/chimneys 3.Cover remaining roof with Certainteed"Roof Runner"synthetic underlayment 4.Install new 8"alu ninum drip edge on all eaves and rake edges 5.Install architectural shingles by Certainteed(Landmark PRO 40yr) https://www.certainteed.com/residential-roofing/productsilandmark-pro/ Color Choice:Landmark PRO Max Definition Cobblestone Gray 6.Install new Certainteed ridge vent on peaks of roof 7.Complete all necessary flashings including new lifetime heavy duty pipe boots and new base flashing around 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 PRO shingles-412,650 Initial$500 deposit to secure contract and process building permit;with balance of deposit($5825)due prior to ordering materials/start of work. The balance shall be due upon completion. Accounts past due 14+days subject to 20/0 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: Customer Signature: Date: r t pl $12,650.00 City of Northampton Massachusetts :.' ZWAR2390 f' OF S=LDXAG XNSMC22GnPS 212 Main Street a Municipal B"ldinq I;D Northampton, Ms 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: (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: mons X01/-� -�' Zeoml.s �Layl ras�Aa.mrluv M19 (Company Name and Address) s f Sign re oY 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.