31B-015 (3) 105 PROSPECT ST BP-2019-1194
GIs 4: COMMONWEALTH OF MASSACHUSETTS
NMI p:Blxk:s 1B•015 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permiv Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit BP-2019-1194
Proiect# JS-2019-001936
Est.Cost: 54700.00
Fe $40.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 193061
Lot Siyg(w.ft.): 7100.26 Owner: HENLE JAMES&PORTIA C
Zoning:URC(100)/ Applicant. JAMES FLANNERY
AT: 105 PROSPECT ST
ApplicantAddress: Phone: Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON:4/24/2019 0:00.00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF - REAR OF BUILDING -
ON LOW SLOPE PORTION, INSTALL STANDING SEAM METAL
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: FiveFire beoeetment Fireplace/Chimney:
Rough: QI L 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:
FeeTvim Date Paid: Amount:
Building 4/24(20190:00:00 540.00
212 Main Street, Phone(413)587.1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
DocuSign Envelope ID:20019222-gBD54D1A-A337474846050981 cro~
— G Department use Doty
City of North mpt _. `-' JbID
t:
Building Dep rtme t wway Permit
212 Main S eet APR 2 4 ?0 Awwabaltyits
Room 1 D wirebill
Northampton, M 01 60 of bucturel Plains
Ns Inls
phone 413-587-1240 F 41aoH, nA
Other Speafy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION bP-l q-,(6 2l
7.1 Property Address: This
section to be com/pby office
(leted
Map 3{Q/ Lot Unit
105 Prospect St.
Zane Owday District
Elm SL District CS bill
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
James Henle 105 Prospect St., Northampton MA 01060
Name(Print) a salla M. Cument Mailing Address.
.o. hay Telephone 413-586-4588
® Signature
2.2 Authorized Anent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(PHM) / Current Mailing Address:
9-+.•_.)r 413-203-5888
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building $4,700.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fes
4. Mechanical(HVAC)
5.Fire Protection
6. Told=(it2- 3+4-5) $4,700.00 Check Number
This Section For Official Use Only
Building Permit Num r: Date
Issued: /J /l
Signature: _/-Z+w I )p
Building Commissioner/Inspector of Buildings Data
peakperformanceroofingllc (, gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
DocuSign Envelope to 20019222-OBD54Dl A-A33?1?4946050961
SECTION 5 DESCRIPTION OF PROPOSED WORK 1 heck all apalicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [C3[ Decks [p Siding[OI Other[OI
Brief Description of Proposed Rear of building: strip & re-shingle. On low slope portion, install standing seam metal.
Work:
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
ea.N Now house and or addition to existing housing complete the foliowina
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number or Bathrooms
c Is mere 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
1. Is construction within 10011.of wellands? 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. 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
James Henle ,as Owner or the subject
property
hereby authorizeJames J. Flannery / Peak Performance Roofing, LLC
to act on my behalf. all matters relative to work authorized by this building permit application.
m
4/22/2019
Sgnalured r Date
James J. Flannery as OwnanAuthoraed
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 /
yw) 04/22/19
Signature of Dwni lAg.nt Det.
DocuSign Envelope ID:20C19222-9BD54D1 A-A337474846050981
SECTION e-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervise r: Not Applicable ❑
CS-103061
Name of License Holder:
License Number
James J. Flannery 09/21/2020
Address Expimtion Date
1 Williams St., Holyoke MA 01040
Bgnelure Telephone
413-20
413-203-5888
g Registered Helm Imnramem rd Contractor. Not Applicable ❑
Company Name Registration Number
Peak Performance Roofing, LLC 183698
Address Expiration Date
1 Lovefeld St., Easthampton MA 01027 Telephone 413-203-5888 11/03/2019
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit vnll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... d No...... ❑
DocuSign Envelope ID:20619222-9B)6 oIA-A337474846050981
City of Northampton
f Massachusetts +rO4c
6 . i
' 1 N AA044'NT OF NOILOINN IN"SCSIONS 2
212 Min 6tonaipal Building. NostAhae wp[en, MelA 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:
105 Prospect St.
(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)
r41-4 1— 04/22/19
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
Officeof Investigadogis
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/Organvatiodlndividual): 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):
L pd I am a employer with 4 4. ❑ I am a general contractor and I
employees(full and/or part-time)." have hired the subcontractors 6. ❑ 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 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers'comp.insurance cemp.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 l l.❑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
cemp.insurance required.]
'My applicant that checks box#1 horst also 611 out the sc tian bclow showing thchworkers'comtwnaeGnn policy information.
t Honaownas who submit this affidavit indicating they are doing all work and than hire outside contra tors most submit a new andivit indicating such
tCmtlactsaa dw check this boa must attached an ad ucisal sheet showing the none of the subcontractors and state whether a not those cones have
wWloyees. If the subwntractas have employees,they must provide their workers'comp.policy number.
I am m employer Aha is providing workers'rompensadon insurance for my mnployeee Below is thepobiry and job she
inriBerkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins. Lic.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address: 105- Pro.r�i.Q S-E cityisnd,/zip: Nor'>Lhamlei�N M0 01 0
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 Ake pains a�n,.d p,, ¢ een�a-t of�pe jury that the information pro vided above iiss/true and correct
(
Signature, � "h r t ill Date '//;G-I/K
Phone#: 413-203-5888
OBkfi l we 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
ka
rkshire Hathaway Am6UARD Insurance Company- AStuck Co.
Y Policy Number R2WCO21353
UARDInsurance Renewal of R2WC943835
Companies NCCI No. [21873]
Policy Information Page (AR)
[I]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER a GRINNELL INSURANCE AGENCY, INC.
1 LOVEHELD 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, 2019 to April 27, 2020, 12:01 AM, standard time at the Insured's mailing address.
[3] Coverage
A Workers'Compensation Insurance - Part One of this pocky 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 Endorsement-WC200306B
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 $ 31,202
Total Surcharges/Assessirlerls $ $1,181.00
Total Estimated Cwt $32.383.00
Im ML ME xK page- 1 - - Informa0on Page
MGA :R2WCO21353 WC 000001A
Date :04/01/2019
MANUrE
Issuing Office!P.O.Box A-N, 16 S.River Street,Wilkes-Barre,PA 18703-0020 •www.guard.cere
C%16
Office of Consumer Attain;and Business Regulation
One Ashburton Place-Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Typs LLC
PEAK PERFORMANCE ROOFING,LLC. RegisuiWw: 183080
1 LOVEFEID ST. - E)pRrlan: 11JUNW19
EASTHAMPfON,MA 01027
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D.Sign Envebpe ID:2W19222-WD"D1A-A337474818050881
K Peak Performance Roofing LLC
PE Contract
P E R F O R C E 1 Lovefield St Date Contract#
Easthampton, MA 01027 4/22/2019 827
MA CSI.#103061 413-203-5888 peakperfommnccmofmgllc@gmail.com www.peakperformencemofinellc.mm
MA NIC# 183698
Bill To Job Location
Jim Henle Jim Henle
105 Prospect St. 105 Prospect St.
Northampton, MA 01060 Northampton,MA 01060
jhenle@smith.edu jhenle@smith.edu
413-586-4588 413-586-4588
Description Total
1.Remove existing shingles on the rear of the building,and ridge caps 4,700.00
2.Install 3'of CertainTeed Wimerguard ice&water shield at shingleAow slope transition. Cover remaining surface with
synthetic underlayment.
3.Install CertainTeed landmark Pro shingles and caps to color match the front roof.
httpsJ/www.ccnainteed.com/residential-mfinglpmductsAmdmark-pm/
Low Slope Porton:
4.Remove the metal from the perimeter of the roof
5.Install Englert 24 gauge standing seam metal roof system.Panels will be 16"wide with 1.5"mechanical lock seams:
https://www.angler inc.mn 1-%C2%BD-mcchmically-seamed-metal-roof-system-al3oo.hanl
Property will be protected at all times to prevent any damage to the home or plantings.All debris will be removed from
the premises.Contractor will obtain building permit. Installations are weather permitting.
Total Cost=$4700
A deposit of$2350 is due at contract signing. The balance shall be due upon completion. Accounts outstanding past 10
days post completion subject m 2%finance charge monthly.
*We are ma responsible for dirt/debris that may fall into attic.Please check for debris after dumpsrer is removed.-
4/22/2019 Total'
Copnt�ra.,ct�or$ignalure: Customer Signature: ooe.agwM Dare:
J l—o D.'. S4r700.00