25A-156 (2) 27 WOODBINE AVE BP-2020-0196
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block:25A- 156 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2020-0196
Proiect# JS-2020-000333
Est.Cost: $4600.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sg.ft.): 7884.36 Owner. TOULSON AMY
Zoning: URB(100)/ Applicant. JAMES FLANNERY
AT. 27 WOODBINE AVE
Applicant Address: Phone: Insurance:
I LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.8/15/2019 0:00.00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE ROOF ONLY
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:
FeeType: Date Paid: Amount:
Building 8/15/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
r
Department use only
City of Northa pton t tu"f Permit:
Building Depa en CurbuUDrNveway Permit
w 212 Main Str et AUG 1 5 2 mower Septi Availability
p Room 10 Wate ell vailability
Northampton, M 01 is of Structural Plans
P nF sun r)w IrJSP CTJQNS
phone 413-587-1240 Fa -443= '19 '201N.1 A 6?ICkt to PI ns
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6 P' '�'U —/ 0,
1.1 Property Address:
This section to be completed by office
27 Woodbine Ave. Map Lot / __unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Amy Toulson 27 Woodbine Ave, Northampton MA 01060
Name(Print) Current Mailing Address:
(0 Signature _ Telephone 413-566-3498
2.2 Authorized Agent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Print) t Current Mailing Address:
Y 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 $4 600.00 (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 = 0 +2 +3+4+ 5) $4,600.00 Check Number (S
This Section For Official Use Only
Building Permit Numb r: DateIssued:
Signature: 21/)1)
Building Commissioner/Inspector of Buildings Date
peakperformanceroofingllc all 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 (]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding [O] Other[0]
Brief Description of Proposed Strip & reshingle A R146 -'ti _ ----
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. 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
Amy Toulson as Owner of the subject
property
hereby authorize James J. Flannery / Peak Performance Roofing, LLC
to act on my behalf, in all matters relative to work authorized by this building per it application.
Signature of Owner Date
James J. Flannery
I� , 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
Signature Telephone
"L'71 413-203-5888
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 413-203-5888 11/03/2019
__Telephone
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....... I!/ No...... ❑
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building yJA Cs�
Northampton, MA 01060 r►�nQ�J
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:
27 Woodbine Ave.
(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)
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
I 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/Organization/Individuai): 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):
Vy
1. am a employer 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. ❑ Building addition
[No workers' comp. insurance comp. insurance.#
required.] 5. ❑ We are a corporation and its 10.0 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.]
*Any applicant that checks box#I 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.
Insurance Company Name_Berkshire Hathaway Guard
Policy#or Self-ins.Licc.#:/lR,2WCO21353 Expiration Date: '41/-27/2020
Job Site Address: T W �l�-Q '� City/State/Zip:NOrH4p )6N �lt�
0/bb0
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 and penalties of perjury that the information provided ov is true and correct.
Si afore: Date: � 13
Phone#: 413-203-5888
Oficial use only. Do not write in this area,to be completed by city or town ofciaL
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#:
A Worker's Compensation and Employer's Liability Policy
A�r AmGUARD Insurance Company - A Stock Co.
,� 'Berkshire Hathaway Policy Number R2WCO21353
Insurance Renewal of R2WC943835
�':►: G U A R DCompanies NCCI No. [21873]
Policy Information Page (AR)
%[1]Named Insured and Mailing Address �m m ^W Wu Agency
PEAK PERFORMANCE ROOFING LLC WEBBER &GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIELD STREET 8 NORTH KING STREET
EASTHAMPTON, MA 01027 Northampton, MA 01060
i Agency Code: MAMAINI5
i
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
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 $ $1,181.00
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-N, 16 S. River Street, Wilkes-Barre, PA 18703-0020 • www.guard.com
P37/W'
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts' 02106
Home ImprovenmW Contractor Registration
Type: LLC
PEAK PERFORMANCE ROOFING,LLC. Reostration: 183998
1 LOVEFIEL.D ST. Eq ation: 11/03/2019
EASTHAIMPTON,MA 01027
SCA I p 2aM-0em Llpdats Ad"n and Rslum Cad.
/lauais�ws.�/.-
0"Im of Conwear Afldrs i Blwhw Rewdedon
HOME RIPROVEMENT CONTRACTOR Registration valid for Individual u"only
TYPE:LLC before the VI Un date. If found return to:
11 011106 of Co n a W Affairs and Business Regulation
/03)2019 10 Park Rare-Suite 5170
PEAK PERFORhUNCE ROOFING,L.L.C. Boston,MA 02116
JAMES FLANNERY
1 LOVEFIELD ST. —
EASTHAMPTON,MA 01027 tlnderseCn3fery Na)d wNhOU' s)9fletttre
® Conmonwedth of Massachusetts
Division of Professional Licensure
Board of Building R6gulations and Standards
Co11s&uction BUPWVNW
CS-103061 tkresblcted-Buildings of any use group which contain
Eapires:49/2112020 -pas than 36,000 cubic fest(991 cubic maters)of enclosed
Mime
JAMES J FLANNERy
1 WLul1MS ST
HOLY01M MA 010M
Commissioner l/"_'" A
Failure to possass a current ed i lon of the Mnssachusetls
Stabs&Elam Coda is eauae for ravocaum of this Denim
For inform Sion about thislice-
cam(airy)727-32110 or visit www.rnss.9ovMpl
PEPeak1� Performance Roofing LLC Contract
P E R F O R C E I Lovefield St Date Contract#
• Easthampton, MA 01027 7i24i2019 953
MA CSU 103061
MA HIC# 183698 413-203-s888 peakperformanceroofmgllc@gmail.wm www.peakperformanceroofinglic.com
Bill To Job Location
Amy Toulson Amy Toulson
27 Woodbine Ave. 27 Woodbine Ave.
Northampton, MA 01060 Northampton,MA 01060
413-566-3498 413-566-3498
atoulson@gmail.com atoulson@gmail.com
Description Total
-This contract is for the detached garage- 4,600.00
1.Remove the existing roof shingles
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.Cover entire roof with Certainteed "Roof Runner" synthetic underlayment
5. Install new 8" aluminum drip edge on all eaves and rake edges
6. Install architectural shingles by Certainteed(Landmark PRO 40yr)
https://www.certainteed.com/residential-roofing/productsAandmark-pro/
Color Choice: /VLK I9
7.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;
do not walk/drive over areas of potential roofing debris.Contractor will obtain building permit. Installations
are weather permitting.
Total:Landmark PRO shingles=$4,600
A deposit of$2300 is due at contract signing. The balance shall be due upon competion. Accounts
outstanding over 10 days past final invoice date are considered past due and subject to 2%finance charge
monthly.
Contractor Signa a Customer Signature: te:, 4
Total:
I� $4,600.00