31A-135 78FORBESAVE BP-2019-1036
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block:31A- 135 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-2019-1036
Project# JS-2019-001693
Est C st $10950 00
Fee--$40 00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Groin JAMES FLANNERY 103061
Lot Size(sp. fit): 5967.72 Owner: PATTNOSH JOSEPH&JOHN
zonine, URBn00y Applicant. JAMES FLANNERY
AT. 78 FORBES AVE
Applicant Address: Phone: Insurance:
I LOVEFIELD ST (5 081 294-405 2 WC
EASTHAMPTONMA01027 ISSUED ON:312112019 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: 2ik 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 3,21/20190:00:00 540.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Lio-f=-
Depardnent Use only...
City of Northampton Stade of permit: -
Q,
Building Department curb CUUDdvwmw Perms
212 Main Street SomfinSsprk Availability
Room 100 Water/Well Avallabil
Northampton, MA 01060 Two Sats of Structural Plana
phone 413-587-1240 Fax 413-587-1272 PIuVShe Plana
�' ;' a
Other Sperm'
APPLICATION TO CONSTRUCT A MOLISH A ONE OR TWO FAMILY
DWELLING
SECTION t -SITE INFORMATION
1.1 ProoerN Address: MAA - 0 2019 This section to be completed by office
78 Forbes Ave. nMap 3A Lot
� Unit
F � Overlay
District
Elm SL District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
John Pattnosh 78 Forbes Ave., Northampton MA 01060
Name(prop Current Malting Address:
Telephone 617-529-3518
Signature
2.2 Authorized Aaenl:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Print) CurrentMeiling Address:
413-3-203-5888
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 65b CSD (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) 5-0. Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: 4 ILI3-7�-z0)R
Building Commission.0inspectm of Buildings Data
peakperformanceroofingllc �gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ Now Signs I01 Decks tM Siding IOi Other I"
Brief Description of Proposed Strip & shingle
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 New house and or addition to existina housing complete the followinim
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?
I. 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 fl. 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 CftySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
John Pattnosh ,as Owner of the subject
property
hereby authorizeJames J. Flannery/ Peak Performance Roof ng, LLC
to act on lative to work authorized by this building permit application.
3 Ib
Signature of er Date
I,
James J. Flannery as owner/Autmodzed
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. Flannery
Prins Name
03/15/19
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable ❑
Name of Lleense Holder: CS-103061
Limnse Number
James J. Flannery 09/21/2020
Address Expiration Date
1 Williams St., Holyoke MA 01040
Signature Telephone
413-203-5888
9 Realaterad Ham Immovement ContractorNot Applicable ❑
Company Name Registration Number
Peak Performance Roofing, LLC 183698
Address Expiration Date
1 Lovefield St., Easthampton MA 01027 Telephone 413-203-5888 11/03/2019
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted wth this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Af0davit Attached Yes....... d No...... ❑
_ City of Northampton
C."71
Massachusetts �P?�
�
DBPARTM¢NT OF BUILDING INSPECTIONS i
212 1 in etraat •Nunicipal Building
17 NorNa ton, MA 01060 6
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, 1 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:
78 Forbes Ave.
(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:
Aaron's Roll-Off, 1 Loomis Way, Easthampton MA 01027
(Company Name and Address)
�_I� 03/15/19
Signature of Permit Applicant 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
lip wwrumass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/F.lectricisns/Plumbers
Amolicant Information Please Print Legibly
Name tBnsinea ligan adnnflnaix;auan: Peak Performance Roofing LLC
Address: 1 Lovefield St.
City/State/Zip; Easthampton, MA 01027 Phone#: 413-203-5888
A,rree,7ypa an employer"Check the appropriate box: Type of project(required):
1.pd I am a employer with 4 3. ❑ I am a general contractor and 1 6 ❑ New construction
employees(full and/or part-timet.. have hired the sub-contracmrs
�.❑ 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
xnrking for me in any capacity. employees and have worker: 9 ❑ Building addition
[No workers'comp.insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I and,a homeowner doing all work officers have exercised their I1.❑ Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12 YRoof repairs
insurance required.]t c. 152.S 1(4).and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
`Any applicant Nae checks box*I mull also fill nut the section below showing their worker'entatusetion pal icy information.
t Ham xho same Nis uRdarn ind'¢mlay they are doing all work and Nen hire nmside contractors must.uMnit a new amiboa indicating such
K'omranor that check this box must aoaelled an additional shun nhuwing the now of the sub-cuntrucmr and cute x hefec en nut those entities hoe
crddayas. If Ne sub-eomrwrors have employees.they mum pro.Ide their workers compadiq number.
I am an employer that is proriding vorke"'colopensarion insurance for my employees Below is the policy and job site
information.
Insurance Company Fame: Berkshire Hathaway Guard
Policy#or Self-ins. Licp#: R2W,,/C943835 Expiration Date: 4/27/2019
lob Sitc Address: o �^x'P S �V'� —C'ity/StateiZip: Neo(A 4:2T4� In'
0/LY00
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 in the imposition of criminal penalties of a
fine up to S1.500.00 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
Instigations of the DIP.for insurance coverage verification.
I do hereby certify under the pains and penalties of perjupvhat the information provided aboveis rue and correct.
Signature: Date: 311 /
Phone# 413-203-5888
Official use only. Do not write in this area,to be completed by city or town c iciaL
City or To": Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
Worker's Compensation and Employer's Liability Policy
11187
Berkshire Hathaway AmG°ARD Insurance Company - A Stock Co.
Y Policy Number R2WC943835
Insurance G U A R DCompanies Renew NCCI No.l of [21873]
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
EASTHAMPrON,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 - Infomia0on Page
MGA :R2WC943835 WC 000001A
Date : 04/04/2018
MANOTE
Issuing Office: P.O.Bot A-N, 16 S. River street,Wilkes-Barre,PA 18703-0020 s www.guard.corrr
Vren�noreuletzi a��) ac/u�veta
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachuseris' 02108
Home Improvement Contractor Registration
Typo' LLC
PEM(PERFORMANCE ROOFING,LLC. RngisOs6m: 189698
1 LOVEFELD ST. - - 11I09/ZO7g
EASTFIMAPTON,MA 01027
OPaah Admeesand Realm Gra.
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alaaeofE MPROVENE rCOUr• CTORlan
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TYPE:LLC 0elere Ne ngfYeLlon deh. Nbmtlrsaanto:
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PENIN PERFORMANCE ROOFING,LLC. 110610MAIA palls
JAMES FLANNERY r�Q .--
I LOVERELD ST.
E STHAMPTON.MA 01027 llndaeecredry willixa sIgtlBlaro
Gmmnnvpaaa of Massacnuesgs
DMenn of Proh,,Wml Lieewue
Bona of Building Rag daSnns and Standards
Omaoktad-BUBdings of any ase g—P WWI%coram
CS-103061 Ewrw:Ogr2112020 ksstsas 00,000 aubie last(991 Cuhic ntateas)of enclosed
spw.
JAMES J FLANNERY e
1 Wl11AMS ST
NOLYOIIE MA 0100
Commissioner CL / , Fagmal0 pawns a euwm sdMm afgte MasasdaMdb
Efine outing Gds is amen for raaaeagut 611111511 a 4e.
Fu inlmrnalian asma this Bauw
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DocuSign Envelope ID:477344FA-AD3A-0A55-88CB-7D5AD9EOBBA6
K Peak Performance Roofing LLC
P E
Contract
P E R F O R C E I Lovefieta St Dale Contras#
Easthampton, MA 01027 3/15/2019 793
MA CSL#103061 q13-203-5888
MA 141C# 183698 peakperformanecroofingllc®Bmeil.com www.peakpedormanecroofivgllc.cgm
Bill To Job Location
John Pattnosh John Patmosh
78 Forbes Ave. 78 Forbes Ave.
Northampton, MA 01060 Northampton, MA 01060
617-529-3518 617-529-3518
pattnosh@gmail.com patmosh@gmail.com
Description Total
I.Remove the existing roof shingles 10,950.00
2.Inspect plywood sheathing or boards
3. Replace up to 64 square feet of CDX plywood if necessary at no cost.Any additional plywood wilt be$60 per sheet
installed over roofboards. Ifthere is existing plywood that needs replacement,$75 per sheet applies
4. Install six feet of ice and water shield at eaves and three feet in all valleys, around pipes and chimney
5.Cover remaining roofwith Certainteed"Roof Runner" synthetic underlayment
6. Install new 8"aluminum drip edge on all eaves and rake edges
7.Install architectural shingles by Cerminteed(Landmark PRO 40yr)
https://www,ceminteed.corrVresidential-roofing/products/lmdmark-pro/
Color Choice:
8. Install new Certainteed ridge vent on peak ofroof
9.Complete all necessary flashings including new 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. Installations are weather permitting.
House,Landmark PRO shingles=S 10,150
Garage,Landmark PRO shingles=S800
Total cost=$10,950
A deposit of$5075 is due at contract signing. The balance shall be due upon completion. Accounts past due 14+days
subject to 2%finance charge monthly.
*We are not responsible for dinxi.bris that may fall into attic.Please check for debris after dumpoer is removed.'
Total:
Contractor Signaunc: Customer Signatare: Data
oo<"sa".a a: 3/18/2019
fj7T` $10,950.00
czar s a