17C-096 (11) 140 CHESTNUT ST BP-2020-0102
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-096 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-2020-0102
Proiect# JS,-2020-000175
Est.Cost: $6200.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sg. ft.): 31842.36 Owner: ROLL JESSICA&MCNAMARA AMANDA
Zoning: URA(100)/URB(o)/ Applicant. JAMES FLANNERY
AT. 140 CHESTNUT ST
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.7/25/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ON DETACHED
GARAGE AND OUTBUILDING
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:
FeeTyne: Date 11'aid: Amount:
Building 7/25/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
V _. Department use only
_- City of Northamploii� tatus f Permit:
tl �
Building Department urb ut/DrivewayPermit _
212 Main Stt`eetJUL 2 J 2019 ewer Septic Availability
Room 100 ater ell Availability
Northampton, F wo is of Structural Plans
phone 413-587-12 0 Fax 173r+� T ` ` Polo o Iot/S to Plans
Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR/TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ����" /v47-
1.1 Property Address:
This section to be completed by office 140 Chestnut St. Map C- Lot D ql.{�/n
Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Jessica Roll 140 Chestnut St., Florence MA 01062
Name(Print Current Mailing Address:
1��t
Signature Telephone 413-345-0688
'
2.2 Authorized Agent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Print) Current Mailing Address:
�N 413-203-5888
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $6,200.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 +2 +3+4+ 5) $6,200.00 Check Number
This Section For Official Use Only
Building Permit Number: DateIssued:
Signature: 715 Z5 -Z61/
Building Commissioner/Inspector of Buildings Date
pea kperformanceroofingllc CCD gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing
Or Doors F-1Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[:] Siding[0] Other[O]
Brief Description of Proposed Strip & re-shingle detached garage and outbuilding.
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.-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?
f. Method of heating? Fireplaces or Woodstoves 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
j. 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 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Jessica ROTI as Owner of the subject
property
hereby authorize James J. Flannery / Peak Performance Roofing, LLC
to act on m behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
James J. Flannery
1, , 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
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 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.Registered Home Improvement 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....... 9/ No...... ❑
City of Northampton
Massachusetts
' ! G
c
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street *Municipal Building
Northampton, MA 01060 fsrjy \1J
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:
140 Chestnut 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)
� �_ I z' 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
p� 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name(Business/Organization/Individual): 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):
Va
1. m aemployer with 4 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]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 g. ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y p tY• 9. E] Building addition
[No workers'comp. insurance comp. insurance.#
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.gRoof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Berkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.Lic.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address: Ho C6_L1 u�—5V City/State/Zip:TJJaen ce_;M A 6 1O6 a
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 the pains andpenalties ofperjury that the information provided above is true and correct.
Signature: J u / Date: 1 1 3 D I l q
Phone#:
413-203-5888
Official use only. Do not write in this area, to be completed by ei{y or town of ficial.
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#:
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: LLC
PEAK PERFORMANCE ROOFING,LLC. Registration. 183698
1 LOVEFIELD ST. Boration. 11/03/2019
EASTHAMPTON,MA 01027
xn I 20:,4-o5m
Update Address and Return Card.
iAp*PAwAvj7a.j4-a1d ty,
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:LLC before the expiration date. If found return to:
R20s ition EWrutlon Office of Consumer Affairs and Business Regulation
163888 11/03/2019 10 Park plaza-Suite 5170
PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02116
JAMES FLANNERY
1 LOVEFIELD ST.
EASTHAMPTON,MA 01027 Undersecretary PWM&valid Without signature
® Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
Unrestricted-Buildings of any use group which contain
CS-103061 Expires: 49/2112020 loss than 36,000 cubic feet(991 cubic meters)of enclosed
space.
JAMES J FLANNERy / •
1 WILUAMS ST
WXYOKE MA 01040
Commissioner CL
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Call(617)727-3200 or visit www-msss.gov/dpl
A Worker's Compensation and Employer's Liability Policy
vAmGUARD Insurance Company - A Stock Co.
�v 'Berkshire Hathaway Policy Number R2WCO21353
Insurance Renewal of R2WC943835
G U A R D
Companies NCCI No. [21873]
Policy Information Page (AR)
[1]Named Insured and Mailing Address _ Agency
PEAK PERFORMANCE ROOFING LLC WEBBER &GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIELD STREET 8 NORTH KING STREET
EASTHAMPTON, MA 01027 Northampton, MA 01060
Agency Code: MAMAINI5
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 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 Endorsement-WC200306B
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4] Premium
a The Premium Basis and, therefore, the premium will be determined b our Manual of Rules
a P Y ,
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 $ $1,181.00
Total Estimated Cost $32,383.00
INTERNAL USE XX Page - 1 - Information Page
MGA R2WCO21353 WC 000001A
Date 04/01/2019
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street, Wilkes-Barre, PA 18703-0020 • www.guard.com
PE K Peak Performance Roofing LLC
Contract
P E R F O R CE 1 Lovefield St Date Contract#
Easthampton, MA 01027 7/15/2019 939
MA CS"103061 1 413-203-5888 peakperformanceroofingllc@gmail.com www.peakperformanceroofingllc.com
MA HIC# 183698
Bill To Job Location
Jessica Roll Jessica Roll&Amanda t tUhpww ek_,
140 Chestnut St. 140 Chestnut St.
Florence,MA 01062 Florence, MA 01062
j413-345-0688,a413-230-9751 j413-345-0688, a413-230-9751
jessica.t.roll@gmail.com jessica.t.roll@gmail.com
Description Total
-This contract is for the detached garage and structure in backyard- 6,200.00
Remove the existing roofing shingles
12.Inspect the plywood for any rot or deterioration. We will provide up to 64 square feet of plywood at no
cost.Any additional plywood will be$75 per sheet installed
Cov r entire roof with Certainteed "Roof Runner" synthetic underlayment
4.Install new 8" aluminum drip edge on all eaves and rake edges
.Install architectural shingles by Certainteed(Landmark 30yr)
http://www.certainteed.com/residential-roofing/products/landmark/
Color Choice N—W TI;TW OOP
Complete all necessary flashings
Remove all debris from premises,and throughout the job,continue cleanup and keep the premises
undamaged. We are not responsible for debris that may fall into attic.Please use caution during the process
and after dumpster is removed: do not walk/drive on areas of potential roofing debris. Contractor will obtain
building permit. Installations are weather permitting.
Total:Landmark shingles=$6,200
A deposit of$3100 is due at contract signing. The balance shall be due upon completion. Accounts are
considered past due 10 days after invoice date and subject to 2%finance charge,compounded monthly.
Contractor Signature: stomer Signature: Date: Total:
l _z/Z?-1l7 $6,200.00