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36-008 (5) 40 FOREST GLEN DR BP-2019-1351 GIs#: COMMONWEALTH OF MASSACHUSETTS MamBlock: 36-008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: ROOF BUILDING PERMIT Permit BP-2019-1351 Proieot# JS-2019-002177 Est.Cost: 511600.00 Fee: 540.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot SiuAw. it): 15333.12 Owner: AMSTUTZ ANNIRA Zorn : Applicant: JAMES FLANNERY AT. 40 FOREST GLEN DR Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508)294-4052 WC EASTHAMPTONMA01027 ISSUED ON:5/28/2079 0:00:00 TO PERFORM THE FOLLOWING WORkSTRIP & 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: 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: FeeTyue: Date Paid: Amount: Building 5/28/2019 0:00:00 540.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner DowSlgn Envelope ID:5E76702B-4Effi4lE5-87CF-208A3E89B1FC PZ F— Department use only City of Northampton Status of Permit: Q" Building Department Curb CuaDdwway Permit 212 Main Street Sewer/Septic AwgeblBly 1 Room 100 Water/WellAvailability Northampton, MA 01060 Two Sete of Structural Plane _ phone 413-587-1240 Fax 413-587-1272 plws le PlanQs Other specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE jOR TWO FAMILY DWELLING SECTION 7 -SITE INFORMATION ✓ �/ -/ 1.1 Pmollov Address: �hiThiss section to be comP7fi ce 40 Forest Glen Drive Map' Lot � Unit zone Overlay DNblct Ehn at Dlatrict CS District_ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Annika Amstutz 40 Forest Glen Drive, Florence MA 01062 Name(Print) Asa _ Current Mailing Address: UtAA6 W1 Telephone 413-281.4828 © Signature 2.2 Authorized Anent: James J. Flannery 1 Lovefield St., Easthampton MA 01027 Name(Print) / Current Melling Atltl y-+.•.,.f 413-203-58888 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Eslimated Cost(Dollars)to be Oficial Use Only completed by rmit applicant 1. Building $11,600.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost or Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) $11,600.00 Check Number This Section For Official Use Only Building Permit Number:g 4Z Date Issuetl: G pp signature: 5-ZO-Zo)9 Budding Commenuaved1mipeclw of Buildings Date peakperformanceroofingllc a gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:SE767028-4E6641E5-87CF-206A E89B1 FC SECTION 5 DESCRIPTION OF PROPOSED WORK(check II applicable) New House ❑ Addition ❑ Replacement Windows Alleration)s) Roofing Or Doom ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [OI Deeks [q Siding[❑) Other[E:3 Brief Description of Proposed Strip& re-shingle roof. 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 Now house and or addition to attfs ria housinD comolf"that followlnM a. Use of building:One Fanl 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 now 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 100 ft.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes No j. Depth of basement or cellar floor bolow finished grade k. Will building conform to the Building and Zoning regulations? Yes No. L Septic Tank City Sewer Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Annika Amstutz as Owner of the subject property hereby authorize James J. Flannery / Peak Performance Roofing, LLC to act on my banal(in all matters relative to work authorized by this building permit appliwton. 000.aanw w. 5/22/2019 SignatureIN Owmw Dale 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 !� Q 2 ' I Signatum of OwrorlAgant Date DocuSign Envelope ID:5E76702B-4E6641 E5-87CF-206A3E89e1 FC SECTION e-CONSTRUCTION SERVICES 8.1 Licensed Censtmoion Supervisor: Not Applicable ❑ Name of License Hower: CS-103061 License Number James J. Flannery 09/21/2020 Address EVbon Dale 1 Williams St., Holyoke MA 01040 Signature Telephone 413-203-5888 9 Repiatered Nara WMEM aRgi t C rltMCtOP Not Applicable ❑ Company Name Registratlon 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 Affidavil Attached Yes....... d No...... ❑ Docu Sign ebpe ID:5E787026-4[ 1E5­87CF-206A"fE89131 FC City of Northampton Massachusetts jrO f a . i DSPANTlA'NT OF BVILDZNG ZNSPBCPZONS � 212 win Stmt •Municipal Buil,U� �^ �� Northugrton, M>1 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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 m a properly licensed solid waste disposal facility, as defined by MGL c 111. S 150A. The debris from construction work being performed at: 40 Forest Glen Drive (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) r�, f/z-z/jp 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. 77/te.CommonweakhofMassachusefts Department of Industrial Accidents Office of Invesidgadans 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: BuBders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgsnendion4ndivuhral): Peak Performance Roofing, LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888 Are an employer?Check the appropriate box: Type of project(required): 1.pf I am a employer with 4 4. ❑ I am a general contmctor 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 subcontractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' n aP ty 9. ❑ Building addition req workers' comp.insurance comate ,a corporal required.) 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 comp.insurance required.] 'Any applicant that cheeks box dl rawat also fill out the section below slowing their workers'eompemetion policy information. t Homeowners who submit thin affidavit indicating they are doing all work and than hire notion connectors must submit a new affidavit indicating such. iCovtmcmne that check this box moat attached an additional sheet showing the name ofthesuba tnstors and nate whether in not[how entities have employees. If do subconbactnrs have ernployees,they vont provide their worsens'comp,policy number. I am a t employer that is providing workers'conrpensadon hnomance for my employees. Beim is the policy andjob site informa&m insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins.Lie.#: yR2WCO21353 Expiration Date:/ 4/27/2020 Job Site Address: �0 fri"S4 614_1,1 ARl V* City/Stete/Zip: --wLP lw# 6166,.'4, Attach a copy of the workers'compensadon 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 ono-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 the pains(annd p_enns pof /elrjury Mm the information provided w true and correct Signal=, 7r %f ACL Date: Phone#: 413-203-5888 Offw1 /we only. Do not write in this area,to be completed by city or town of]9eclaL City or Town: PernaWLiceme# Inning Authority(circle one): 1.Board of Health L Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Penson:_ Phone#: 1''',w.t� Worker's Compensation and Employer's Liability Policy BerRJll]� F18th0We AmGUARDInsuranceCompany-A Stock Co. Y Policy Number R2WCO21353 G w �D Insurance Renewal of R2WC943835 JC /�+� Companies NCCI No. [21873] Policy Information Page (AR) [3]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER a GRINNELL INSURANCE AGENCY, INC. IAVEFIELD 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 Apra 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 S. 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-WC2003060 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/Assessments ; $1,18L00 Total Estimated Cost 383.00 11frINV L IISE l0( page- 1- Information Page MCA :VWM21353 WC 000001A Date :04/01/2019 MANOTE Issuing omni:P.O.Box A-N, 16 S.River Street,Wilkes-Barre,PA 19703-0020 v v .9uard.com cglg Office of Consumer Affairs and Business RegukWon One Ashburton Place-Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration 7ypw LLC PEAK PERFORMANCE ROOFING.LLC. RagWaficorI: 1R38g8 1 LOVVEFEELD ST. - E1Iir55m: 11N51201g EASTHAMPTON,MA 01027 L"ft Ad* Mand Return Cad. su1 O LM6lM1 Diol..ata,Marwoe.•mvw aaatlesuhsan HMEMPAOY EWr CONTRACTOR RedNaanwlldrwhgadulWgiy fi�lghwldmw1]516tl1m Offl=cf uaMANmvzwWm bNM RowdaMn 1MM5 111mme lOPuh PIsM-Sulwal70 PERK PERFORaNJ=ROOFING LLC, Ream,MA 0215 JAMESRANNERY 1 LOVEFASTHA PT ST. FISTHAMPTON.MA 01027 DlldeaeeBMly h*Valid MIIOIOYr StgM1Mf0 �. ConMmvpahh of MawchuMRs .. 01110100 at ProNsabMI Llc,M Board of RuMng ReglAMima and Standard, ]s^s•, .-,, Som¢,, y.: . ConbuCI&M SuprAwr Iim,Ukd -MWdhps dl any use WOuPMRe500aain CS-103061 ESPirea:OW212020 Nsslhm MLMcubIC leaiMl cable nwwA OlenTbMd >qwN JAMES JFLA/RAM1r e 1 WILLIAMS ST xoLroltE MA x5 CO56mmissimw CL AL, Fagm to 1pMan a cwFeM edlim Ol01e 5W50dwsab Sbda&mWM Code is eaRM Mr raeacaMm of 0115 lkr - Fs IFOWU aM11 Wed this-- Can tgg)7Zr-3M is-- Ca5t5917Zr-3M ar aaiv ,,mma40adpi DocuSign Envelope ID:5E767028-4E66A1E5-87CF-206A3E89B1FC Contract KPeak Performance Roofing LLC P E R F O R C E 1 Lovefield St Date Contrac# PEAL Easthatnpton, MA 01027 stzo/zoi9 886 MA CS" 10306918 -2035888 ,mail it com MAHICM 183643poarfomanecmofin IIe' www. ak rf nnanccroofin.11o.com Pe' a 6 Bill To Job Location Aml Amstutz Annika Amstutz 40 Forest Glen Dr. 40 Forest Glen Dr. Florence,MA 01062 Florence, MA 01062 413-281-4828 413-281-4828 annikasarah@gmail.com, annikasamh@gmail.com Description Total 1. Remove the existing roof shingles 11,600,00 2. Inspect plywood sheathing 3. Replace up to 64 square feet of CDX plywood if necessary at no cost. Any additional plywood will be$75 per sheet installed 4. Install six feet of ice and water shield at eaves and three feet in all valleys,around pipes and chimneys 5. Cover remaining roof with Certainteed "Roof Runner" synthetic underlayment 6. Install new 8" aluminum drip edge on all eaves and rake edges 7. Install architectural shingles by Certainteed (Landmark PRO 40yr) https://www.certainteed.cont/residential-roofing/products/landmark-pro/ Color Choice: 8. Install new Certainteed ridge vent on peaks of roof 9.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. We are not responsible for any debris that may fall into attic. Please use caution after dumpster is removed;do not walk/drive over areas of potential roofing debris. Contractor will obtain building permit. Installations are weather permitting. Total:Landmark PRO shingles=$11,600 A deposit of$5800 is due at contract signing. The balance shall be due upon completion. Accounts past due over 10 days post-completion subject to 2% finance charge monthly. Contractor Signature. Customer Signature: oovsiva.e nr_ Date. 5/22/2019 Total: �`^'7�t Cl1LUIrA' Qxss♦>,f� $11,600.00 Dora nueara