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39A-054 (3) 74 LYMAN RD BP-2019-1234 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 39A.054 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category:ALTERATION BUILDING PERMIT Permit# BP-2019-1234 Project JS-2019-001992 Est Cost' 195000 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103081 Lot Size(sp.ft.Y 10802.88 Qwner: LANTZ SUSAN B TRUSTEE Zoning, URB(100)/ Applicant: JAMES FLANNERY AT: 74 LYMAN RD Applicant Address: Phone: Insurance: I LOVERELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:5/3/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE CHIMNEY(CLOSEST TO DRIVEWAY) 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*0 Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: ,OCL: Insulation: Final; o e: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvae: Date Paid: Amount: Building 5/3/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019.1234 APPLICANT/CONTACT PERSON JAMES FLANNERY ADDRESS/PHONE 1 LOVEFIELD ST EASTHAMPTON (508)294-4052 PROPERTY LOCATION 74 LYMAN RD MAP 39A PARCEL 054 001 ZONE UPB(I001/ THIS SECTION FOR OFFICIAL USE ONLY PERMIT APPLICATION CHECKLIST REQUIRED DATE ZONING FORM FILLE OUT Fee Paid uildin Permit filled o t Fee Pei TypeofCmstruction: REMOVEMMNEY(CLOSESTT WAY) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Slatement or License 103061 3 sets of Plans/Plot Plan THE FOLLOWING ACTION RAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: `Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project:— Site Plan AND/OR_Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: §_ Finding Special PermitVariance*— Received&Recorded at Registry of Deeds Proof Enclosed__ _Other Permits Required: ,Curb Cut from DPW Water Availability Sewer Availability _Septic Approval Board of Health --Wei[Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay SiZ.u�f Building Official v~4 T Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. DocuSign Envelope ID:D33AFCD7-3A E4316-BgOB-26237C432553 City of Northa ptotRECEIVOf y it mord uason .r Building Depa me cum yPermit A 212 Main S et Sewer Availebglq 1 Room 10 MAY 2 e3 liability Northampton, M 010 0 Two S to of truclurel Plane phone 413-587-1240 F 41 s t wr,iNs NORTBAMPTON.M APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 ProoeM Adtlrese: Thh4is secgnoto be completed by office 74 Lyman Rd. Map_�.Y __— Lot hsy Unit Zone Overlay District Elm at District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Susan Lantz 74 Lyman Rd., Northampton MA 01060 Name(Print) D«usyo.�e�q�:�} Current Mailing Address: lxsaw Signature Imzroecsech Telephone 413-586-3544 2.2 Authorivid Agent: James J. Flannery 1 Lovefield St., Easthampton MA 01027 Name(Print) � Current Meiling Address: 413-203-5888 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only war leted by pernutapplicant 1. Building $1,950.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Coster Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �J 5.Fire Protection 6. Total=(1 +2+3+4+5) $1 95D.DD Check Number aZ This Section For Official Use Onl Building Permit Number Dale Iswed: Signature: r5 — Sterling Commissicnerlinspeoter of Buildings Data peakperformanceroofingllc ,gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope to D33AFCD7-3A3E4316-B90B-262370432553 SECTION ii DESCRIPTIO(OF PROPOSED WORK(check 11 awfi bl ) New House ❑ Addition ❑ Replacement Windows Alleration(s) ❑ Roofing or Doo a 13 Accessory Bldg. ❑ Demolition ❑ Now Signs [O) Decks IO Siding[DI Other[[Zo Brief Description of Proposed Remove chimney (closest to driveway)past the roofline. Frame/plywood/shingle over hole. Work: Alteration of existing bedroom_Yes No Adding new bedroom_Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet s..If New house and or addition to existing housing 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 W oodstoves 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 I. 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 7a-OWNER AUTHORIZATION-TO 8E COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. Susan Lantz as Owner of the subject property hereby authorise James J. Flannery / Peak Performance Roofing, LLC to acl on my bahail,innat matters relative to work authorized by this building permit application. 4/30/2019 VSal4 Siqn.I...(O.nek Date 1. 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 Prins Name ri l 04/30/19 signorina of OwnerlA9ent Data DocuSign Envelope ID:D33AFCD7-3A3E-0 16-BgOB-26237C432553 SECTION 6-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ CS-103061 Name of Lkenae Holder: License Number James J. Flannery 09/21/2020 Address Emiation Date 1 Williams St., Holyoke MA 01040 Signature Telephone 413-203-5888 S.R btersd Noma Inmrowmant Contractor Not Applicable ❑ Compenv 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.6.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 Afidav6 Attached Yes....... d No...... ❑ DowSign Envelope ID D3WCD7-M3E4316-8901-262370432553 City of Northampton Massachusetts A c DSPAa1}BtNT OF BUILDING ZNBPSCTIONS 211 IYin lc •aunt<ipal Bantling � porNupcoa, IP 01060 la 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: 74 Lyman Rd. (Please print house number and street name) Is to be disposed of at: Valley Recycling, 234 Easthampton Rd, Northampton, NIA 01060 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 7 (Company Name and Address) ��� 04/30/19 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.massgov/din Workers' Compensation Insurance Affidavit: Bufiders/Contractors/Electricians/Plumber3 Applicant Information Please Print Legibly Name(Buainesaorga,dxaeoanadividuap: Peak Performance Roofing LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 phone #: 413-203-5888 Are u an employer?Check the appropriate bon Type of project(required): 1.Ly I am a employer with 4 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).• have hired the sub-contractors 2.❑ I in 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 camp.insurance.t required.] 5. E3We are a corporation and its ME] Electrical repairs or additions 3.❑ 1 in a homeowner doing all work officers have exercised thew 1 L❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.yRoof repairs jnsumnaee required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant at checks box#1 noun also fill our the section below showing their workers'compwastiou policy infatuation. t Hooeow air who submit this affidavit indicating they are doing all work and than hire outaide contactors most submit a new affidavit indicating such. teonweton that check this box moat attached an additional ahcet showing the name of the nob-contve[ors and state whedo r acme three coutes lave employees. If the subconnactma have amployeea,they coat provide Lair wohkm'comp.policy number. I am an employer that is providing workers'compewadon insurance far my employees Below is the poBcy and job site InsuranceC Berkshire Hathaway Guard Insurance Company Name: Policy#or Self-ins..LLic.#: R2WCO21353 Expiration Date: 4/27/2020 Job site Address: TN L U/nal City/State/Zip: r—er�Yod Attach a copy of the workeA'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 terrify ander the pains and pe of pnnerjury that the information provided w ' true and carred Signature' 30 Phone#: 413-203-5888 OJfWal we only. Do not write in this area,to be completed by city or town ojffeial City or Town: Permit/l.icense# Inning Authority(circle one): 1.Board of Health 2.Building Department 3.City/1'own Clerk 4.Electrical inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Worker's Compensation and Emolover's Liability Policy Berkshire Hathaway Ain°°ARD Insurance Company-AStock Co. Q Y Policy Number R2WCO21353 43835 GUARD Companies Renewal No.[21873] Policy Information Page (AR) [1]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC. 1 LOVEFIE D 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 Fmm 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 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 $300,000 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 anomer page) Total Estimated Policy Premium j 31,202 Total Surcharges/Assessments $ $1,181.00 Total Estimated Cost $32,383.00 INTERNAL USE xK Page- 1 - - Information Page MGA :VWM21353 WC 000001A Date :01/01/]019 MANOTE Issuing Office: P.O.Box A-H, 16 S.River Street Wilkes-aorto,PA 18703-0020 0 www.guard.com v�e �oanmo�ursea�i o�C%vGu�Qac�u�e%la Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home ImprrnremeMContractor Registration Type: LLC PEAK PERFORMANCE ROOFING.LLC. 187SBS 1 LOVEFELD ST. - 11ATN2019 EASTHAMPrON,MA 01027 Opdeb Aedtse EW INIUM CRC. OA 14OPEE Ag,aTEM MAAMIE a d1RYer•Rea�AniNA NENTCONTRACTOR ROSIssRAvdNfor YAdlvllaNlus adY TYPE.LLC OW"0I the emYetlon Leta S d s nwmm: S 183M 11MA i 9 OIBad dffS-SNr SI70 rrp ByYNp Repee6a 169008 11pS2019 10 PMt Plm-$lab 5170 PEAK PERFORMANCE ROORNG,LLC. BsbAy MA 0211S JAMES FIANNERY SCG -- 1 LOVERELO ST. � EASTHAMPTON.MA 01027 Underse"S" W&valw wfttwl IIgn@Wro C...Weeeh of Msaachum"SIt .. ONisbn d PfD%SSioMI Licensure ARMS of Buddbe Repaaaoos and St AM& candructlan SaPSrMsr URewids•Suedhpe af wry use Woup which ev"I A CS-107081 FJtpiree:OW2112020 NSS1Wn 70.000 euelefeat leM euek ff*Wzlof-d—d W¢e- JMES J FLANIERY s 100111ANS ST HOLYOIQ MA 51000 Commissioner C4 At, FIRM IS PoaSS S eRfRNemon onhe MsrdmMb StrOe WW g Caleb Onus Or 19WCA110n Of INS Baine. Rw hdarmMlaa.hull 00 Smug Cae(sin 77.1500 a vbk w 1SOW4WWCW DocaSign E lope ID:1333AFC073ME4316690-262370432553 K Peak Performance Roofing LLC P E Contract P E R F O K (� E 1 Lovefield St Data cont am# Easthampton, MA 01027 14/30/2019 926 MA CSLB 103061 413-203-5888 peekpcoiumarxe odmgllc@mnail.wm www.peakperformancemmfmgllc.com MA IIIC# 183698 Bill To Job Location Susan Lantz Susan Lantz 74 Lyman Rd. 74 Lyman Rd. Northampton, MA 01060 Northampton, MA 01060 413-586-3544 413-586-3544 susanlmtzl@gmail.com susanimtzl@gmail.com Description Total 1.Remove the existing roofchimmy(closest to driveway)past roofline 1,950.00 2.Install new framing to support plywood 3.Install new 1/2 inch CDX plywood 4.Install architectural shingles by Certainteed(Landmark 30yr)and blend into existing shingles hap//www.certainteed.com/residential-roofing/products/landmark/ Color Choice:Best match Remove all debris from premises,and throughout thejob,continue cleanup and kap the premises undamaged. Contractor will obtain building permit. Installations are weather permitting. Total cost:$1,950 A deposit of$975 is due prior to the beginning of thcjob. The balance shall be due upon completion. Accounts outstanding over 10 days post complction subject to 20/a finance charge monthly. Contractor Sigoalme: Custwner Sigrimure: °o� Wn°0y' Date: 4/30/2019 Total: vviL-q� Casae" Ih st,vso.00 M]lE16PC8m4.A)