36-295 (5) 57 SOVEREIGN WAY BP-2020-0416•
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-295 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-2020-0416
Project# JS-2020-000703
Est. Cost: $19600.00
Fee: $40.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): 59459.40 Owner: GEORGE RICHARD N JR&
zoninc: Applicant: JAMES FLANNERY
AT. 57 SOVEREIGN WAY
Applicant Address: Phone: Insurance:
I LOVEFIELD•ST (508) 294-4052 WC
EASTHAMPTON MA01 027 ISSUED ON:10/1/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & 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:
Footmgs:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:.
Gas: Fire Department Fireplace/Chimney:
_
Rough: OSI: 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 10/1/2019 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-i 272
Louis Hasbrouck—Building Commissioner
�o-O F
Lz:Utz
Department use onty
" City of N ha pton �� fetus f Permit
Building epa rn uiii t/Driveway Permit i�
212 M in S eet r 2019 ewe Septic Availability,.. i
Ro ml ,0 ate tWell Ava►lab►�ity
r Northarnp on, filfA. Two; ets ofStrutural Plans
;
. - phone 413-587-1 ° 6 '' cr►oro Plotl ite Pians
....__,. A ioso
rSpecify
APPLICATION TO CONSTRUCT,ALTER,REPAIR;RENOVATE O DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION f'" �V !/&
1.1 Property Address: Th s section to be completed by office
n Way. Map �ot, a"/� Unit
57 Soverei
9
Zone Overlay District.
Elm St.DistrictCB District ,
SECTION 2,-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Richard George 57 Sovereign Way, Florence, 01062
Name'Print) Current Mailing Address:
i
6�81,.- _. Q &I '' Telephone 413-586-1953
ature•'.�'�"s�.`f'
2.2 Authorized Aqent:
James J. Flannery 1 Lovefield St., Easthampton MA 01027
Name(Print) Current Mailing Address:
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 $19,600.00 (a)Building Permit Fe
2. Electrical (b)Estimated Total Cost of
Construction,from 6
3. Plumbing Building Permit Fee f f
4. Mechanical(HVAC)
(�
5.fire Protection
6. Total=0 +2+3+4+5) $19,600.00 Check Number , Lao b
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature;
WWIIV0
•
Building Commissioner/Inspector of Buildings + Date
peakperformanceroofingllc gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
d ,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
oe
New House ❑ Addition ❑ Replacement Windows Alterations)' ❑ Roofing Ef
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[a
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 J
64,"-ft,Near"hduse bad or add tiorn`to existing hausing, 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
I Richard George ' ,as Owner of the subject
property
James J. Flannery/ Peak Performance Roofing, LLC
hereby authorize
` tomy
behalf,in all tters relative to work authorized by this build' per it application. {
2c. Z� l I
6'"'
,Aia(u a ofiN�7re r Date
James J. Flannery ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true ad accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
James J. Flannery
Print Name I
19
rill
Signature of OwnerlAgent Date {
i
SECTION 8-CONSTRUCTIONSERVICES
8.1 Licensed Construction Supervisor: i of Applicable ❑
Name of License Holder: CS-103061
License Number
James J. Flannery 09/21/2020
Address Holyoke, MA 01040 Expiration Date
1 \��\ams St.
Signature Telephone
413-203-5888
i
9.-Recister®d-Norm6 enprovement'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
l
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
i
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....... LlOf No...... ❑
B
City of Northampton
Massachusetts ,�o?�' ►= �'<<�
�.:
�•� DEPARTMENT OF BUILDING INSPECTIONS y z
212 Main Street •Municipal Building
Northampton, MA 02060
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:
57 Sovereign Way.
(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
Ofce'of Investigations
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib�l y
Name(Business/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 phone#: 413-20315888
Are,ypu an employer?Check the appropriate box: Type of project(required):
1.0/I 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. 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
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers'comp.insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.E] 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#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 thepolicy and job site
information.
Berkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.Lic.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address: ,-1 SCN City/State/Zip: ��bT �C)Qa Met
Attach a copy of the workers'compensation policy decla ation 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 hof 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 above is true and correct.
Signature: OL Date: I
Phone M 413-203-5888
Official use only. Do not write in this area,to be completed by city or town official
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#:
MEAdm 's Sm NOW and Emokaffles LSa Ift PdkPdkw
Berkshire Hathaway AMCIUM D Inouremn Company-A Stock Co.
Policy Number R2WCO21353
GUARDCompanles N�No. [2C9 8731
PWkay Dd1on=&m rag®JAR)
[1]Neined Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER.&GRINNELL INSURANCE AGENCY,INC.
3 LOVEFIaD STREET 8 NORTH iQNG STREET
EAST1 NVFON,NA 01027 Northampton,MA 01060
Ageniy Code: MAMAIN1S
Federal Employer's ID 00-1191951 Insured Is Limited Liability Co.(LLC)
I
[2] Po11ci Period
From April 27, 2019 to April 27,2020, 12:01 AM,standard time at the IrI sured's mailing address.
I
[3] Coverage
A. 1Norkers'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 Endorsem -WC200306B
D. This policy includes these endorsements and schedules: 7
See'Eutension of Information Page-Schedule of Forms I
[4] Premium
The Premium Basis and,therefore,the premium will be determined by our Manual of Rules,
Cia sillcations,Rates,and Rating Plans. All required jnfbffnWon is subjid to verification and change by
audit. (Continued on another page)
Talal Esdn W"Policy Pranrlurn 21,202
Total Surdrergw/As merrfo * $1,181L.00
Total Esdmabed Gast AO
rnrwws� u roc Page-1- Inbrmatien Paye
MGN :RZWCD21353 WC 000001A
Date :04/01M19
MAN=
Issuing 011lee:P.O.Mx A-%16 S.River Street,Wilkes411arre,PA 18703-0020•Www.guard atm
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvemett:Contractor Registration
- Type: LLC
PEAK PERFORMANCE ROOFING,LLC. Registration: 183698
1 LOVEFIELD ST. Expiration: 11/03/2021
EASTHAMPTON,MA 01027
Update Address and Return Card.
SCA 1 O 2CM4)W17
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:
RWIshyHp Expiration Office of Consumer Affairs and Busl'ess Regulation
183898 ' . 11/63/2021 1000 Washington Street -Suite 710
PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118
JAMES FLANNERY ,
1 LOVERELD ST.' emo►'�'L %a�/fi '
EASTHAMPTON,MA 01027 Undersecretary No valid without gnature
Commonwealth of Massachusetts
Division of Professional Licensure
Construction Supervisor
Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain
a 6, Sr -•.,O 6 'I 1 fV,�, r less than 35,000 cubic feet(981 cubic meters)of enclosed
space.
CS403081 Empires.:09/2V2020
�Ai� �
JAMES J FLANNEfZY h�°a a` -
i WILUAMS ST,,
HOLYOKE MA-'01m, 9
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
CommissionerFor information about"a license
Call(617)727-3200 or visit wwwinass.gov/dpi
a