38D-034 (5) 23 HARLOW AVE BP-2019-1084
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 3813-034 CITY OF NORTHAMPTON
Lot:- 01 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category. ROOF BUILDING PERMIT
Permit# BP-2019-1084
Project# JS-2019-001767
Est.Cost$11250.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group JAMES FLANNERY 103061
Lot Size(sg ft.): 4486.68 Owner: GUPTA SAN11V&KATHLEEN M WELLSPRING
zoning:URBLIOoy ADDlicanh JAMES FLANNERY
AT: 23 HARLOW AVE
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:4/2/2019 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/Cbimney:
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:
FeeTyne: Date Paid: Amount:
Building 4/2/2019 0:00:00 $40.00
212 Main StreeL Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck--Building Commissioner
Departmealt use ony.
City of Northampton Status of Permit:
r ' '^ Building Department Curb CuVDdvswsy:Permit
212 Main Street Seaver/Septic AvOebAhy
Room 100 Water/Wall Availability
-
Northampton, MA 01060 Two Sets of Structural Plena
' phone 413-587-1240 Fax 413-587-1272 PtoMSitu Plana
other Specify
APPLICATION TO CONSTRUCT ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION UEZIVED I IJP IR'I0 7
1.1 Prooenv Address: APR 1 201
This secdon to be completed by office
23 Harlow Ave. 9 M. _ '>90 Lot 03Y unit
DEPT OP BUILDING INSPEC$aNy Overlay District
NOUHAMPTON.MA01060
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Kathleen Wellspring k 5AN�) V Gup}a 23 Harlow Ave., Northampton MA 01060
Name(Print) Current Mailing Address:
sa i �y � Telephone 413-210-9052
Signabire
2.2 Authorized Agent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Poop Current Meiling Address:
413-203-5888
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed b permitapplicant
1. Building 11,250.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee ,,TT
4. Mechanical(HVAC) L i O W
5. Fire Protection
6. Total=(1 +2+3+4+5) 11 250.00 1 Check Number
This Section For Official Use Only
Building Permit Number: Dale
Issued:
Signature: "1-2."Xt 9
Building Commissionedinspector of Buildings Date
peakperformanceroofingllc ®gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5.DESCRIPTION OF PROPOSED WORK Icheck all applicablet
New House ❑ Atltlition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors El
Accessory Bldg. ❑ OemolKion ❑ New Signs [0) Decks Siding[01 Other[L71
Brief Description of Proposed Strip & shingle roof
Work:
Alteration of wasting bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
as.If New house and or addition to existing houslingi 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?
I. Method of heating? Fireplaces or Woodstoves Number of each_
g. Energy Conservation Compliance. Messcheck 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
I. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. Kathleen Wellspring & SANSIV (;uP+a as Owner of the subject
property
hereby authorise James J. Flannery/ Peak Performance Roofing, LLC
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
i James J. Flannery ,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. Flannery
Print Name
03/25/19
Signature of OwnenAgent Date
SECTION 6-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: CS-103061
License Number
James J. Flannery 09/21/2020
Address Expiration Date
1 Williams St., Holyoke MA 01040
Signature Telephone
413-203-5888
9. Replatararl Nome Imerovemant Contractor. Not 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 with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ld No...... ❑
City of Northampton
"e
Massachusetts 4
l c
ra'PABTNBNT OF BUILDING INSPICTIONS
012 Win tnamt •Municipal Building
Borthwpton, xr. 01060 a
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:
23 Harlow 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)
03/25/19
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
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Basinees/organixatian/Indiciduab: 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):
1.91 am a employer with 4 4. ❑ I am a general contractor and I 6 ❑New contraction
employees(full and/or pan-time).- have hired the sub-contractors
2.El am a sole proprietor or partner. listed on the attached sheet. 7. [D Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' q ❑ 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.&fRoof repairs
insurance required.] t c. 152,$1(4).and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
'.Any applicant that checks hie-1 must eels,fill.,it the scaion Fein shnwing chair worken'tem,m.um he,intiamenam.
I Humenamo elm submit his a05dnrn indicating the,are doing all wink and then hire outside emaracmrs must submit a new amdatit indicating such.
-Comeatun that cheek this has must mtad¢d an additional shat show lees the nanm of the sub-conuaaturs and state whether cr nut those amities have
employees. Ifthesub-cmancnm have employeesthey must pmvsle their woekeY com,policy number.
I am an employer that is providing workers'compensation insurance far my employees. Below is the polity•and job site
information.
Insurance Company Name: Berkshire Hathaway Guard
Policy#or Self-ins.Lia#: R2WC943835 _ Expiration Date. 4/2//7/2019
Job Site Address: .�3 Ilardot.0 t)ra-- City/State/7.iP N6�1-flarrrO�ri ��
a/o60
Attach a copy of the worker'compensation policy declaration page(showing the policy number and aspiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties uta
fine up to 51.500.00 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penatlliiiees�of pedugvharthe information provided above is nue and correct.
Signarurc- Date;. .. 3�L9�f
Phone# 413-203-5888
OJrcial use only. Do not write in this area,to be completed by city or town official
Cite 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 Lability Policy
Berkshire Hathaway AmGUARD Insurance Company -A Stock Co.
Y Policy Number R2WC943835
GUARDInsurance al of R2WC811187
Companies Rem" NCCI No. [218 3]
Policy Information Page(AR)
[1)Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIEO3 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 Surchargea/Assessments $ 606.00
Total Estimated Cost 14 256.00
iNTERNAL USE xx Page- 1 - - Information Page
MGA : UWC94305 WC 000001A
D&e :04/04/2018
MANOTE
Imuing Office: P.O.Box A-H, 16 S.River Street,Wllkm-Barre,PA 18703-0020 a www.guard.corn
v�e �n�nwozu�ecc� a�C�QaacleuaeC�
Office of Consumer Affairs and Business Regulation
One Ashburton Place-Suite 1301
Boston, Massachusetts 02106
Home Improvement Contractor Registration
TYPE LLC
PEAK PERFORMANCE ROOFMIO,LLC. 189033
1 LOVEF ELD ST. B0111fal: 11103=19
EASTHAMPTON,MA 01027
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HOLYOKE MA MCN .
Commissioner C114 AL, Fdkn to Pis a euroat am-atom MrsadnMMM
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For bdanndion about this Oases
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PE K Peak Performance Roofing LLC
Contract
PERFO R C E I LOvefield St
Data �°^" #
Easthampton, MA 01027 3252019 796
MA CSU
103061 413-203-5988 akperfenn ncemefin 11 l.com www.
MA MC# 183698 a 9 �9mai prakperfimrmceroofingllc.mm
Bill To Job Location
Kate Wellspring L S&Ot'lY Kate Wellspring
23 Harlow Ave. 23 Harlow Ave.
Northampton,MA 01060 Northampton,MA 01060
413-210-9052 413-210-9052
k.wellspring@gmail.com k.wellspring@gmail.twm
Description Total
1.Remove the existing mof material 11,250.00
2.Inspect plywood sheathing or boards
3. Replace up to 64 square feet of CDX plywood if necessary at no cost.Any additional plywood will be S60 per sheet
installed over roof boards.If there is existing plywood that needs replacement,$75 per sheet applies
4.Install sic feet of ice and water shield at eaves and three fat in all valleys,amund pipes and chimneys
5.Cover remaining roof with Cerminteed"Roof Runner"synthetic underlayment
6.Install new 8"aluminum drip edge on all eaves end rake edges —&. V)
7.Install architectural shingles by Certainteed(Landmark PRO 40yr)
httpss'www.certamteed.cam/residential-roofingtpmducWlmdma&-pm/
Color Choice:Max Definition Granite Gray
S.Install new 1/2 inch polyisocylumm a insulation on flat roof using approved screws and plates
9.Install new.060 EPDM rubber on flat roof _
10.Complete all necessary flashings including new pipe boots and new base flashing around chimney
Remove all debris from premises,and throughout thejob,continue cleanup and keep the premises undamaged.
Contractor will obtain building permit Installations areweather permitting.
Total cost:
Landmark PRO shingles-411,250
A deposit of$5625 is due at contract signing. The balance shall be due upon completion. Accounts past due 14+days
subject to 20/*finance charge monthly.
*We sre not responsible for dirt/debris that may fall into attic.Please check for debris after dumpsler is removed• Total-
Contractor Si Customer Signature: Dale:'
( - 6�� Mwf 2 B, W t-I $11,250.00