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
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PEAK PERFORMANCE ROORNG,LLC. BsbAy MA 0211S
JAMES FIANNERY SCG --
1 LOVERELO ST. �
EASTHAMPTON.MA 01027 Underse"S" W&valw wfttwl IIgn@Wro
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100111ANS ST
HOLYOIQ MA 51000
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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
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