24A-244 18 PILGRIM DR BP-2020-0562
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-244 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-2020-0562
Proiect# JS-2020-000970
Est.Cost: $12375.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor., License:
Use Group: JAMES FLANNERY 103061
Lot Size(sg.ft.): 7840.80 Owner: KOTZ DAVID M& KAREN A PFEIFER
Zoning: URA(100)/ Applicant. JAMES FLANNERY
AT. 18 PILGRIM DR
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMAO 1027 ISSUED ON:11/4/2019 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:
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 Occupant signature:
FeeTyae: Date Paid: Amount:
Building 11/4/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
—b--� 410�
DocuSign Envelope ID: BBB6D51 E-87CE-4A38-A4B8-BF5E6CEB81 BE ---�—
Department use only
-"' City of Northa�mpt Statu of Pe it:
.� Building Depame 3 rb t" eway Permit
'A 212 Main St et i� �C� Sewer/ eptic vailability
E Room 100 '( r II A ilability
Northampton,.MA 10 F`�p�ptolG tt ,Set uctural Plans
phone 413-587-1240 Fax 13769 02 ^ TOS t ot/Site Plans
- t Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed b office
18 Pilgrim Drive Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
David Kotz & Karen Pfiefer 18 Pilgrim Drive, Northampton MA 01060
Name(Print) DocuSigned by: Current Mailing Address: 413-584-2547
� � _ Telephone
Signature
2.2 Authorized Agent:
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 $12,375.00 (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) $12,375.00 1 Check Number y
This Section For Official Use Only
Building Permit Number: Date-- Issued.
Signature:
U 0 U
Building Commissioner/Inspector of Buildings Date
peakperformanceroofingllc CCD gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
3
DocuSign Envelope ID:BBB6D51 E-87CE-4A38-A4B8-BF5E6CEB81 BE
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ([] Siding[O] Other[p]
Brief Description of Proposed Strip and replace shingles
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
David KotZ
%li% I• __ _, 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 permit application.
DocuSigned by:
10/29/2019
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
DocuSign Envelope ID:BBB6D51E-87CE-4A38-A4B8-BF5E6CEB81BE
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
AddressHolyoke, MA 01040 Expiration Date
1 �i 11 1 C3�'('( � C��-�'
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 11/03/2021
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,g 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...... ❑
DocuSign Envelope ID: BBB6D51 E-87CE-4A38-A4B8-BF5E6CEB81 BE
City of Northampton
s J s�
Massachusetts
c
'A m S
DEPARTMENT OF BUILDING INSPECTIONS S
212 Main Street •Municipal Building `gyp CD
Northampton, MA 01060 fsMyt ��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:
18 Pilgrim 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)
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
IF www.mass.lgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizationAndividual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Gip: Easthampton, MA 01027 Phone It: 413-203-5888
Are an employer? Check the appropriate box: Type of project(required):
1. am a employer with 4 4. ❑ 1 am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. F1 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 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp. insurance.
t ❑
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 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. Lie.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address:
1 \Y 1 l C�Y 1 �� City/State/Zip: K � p ZU
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 penaQles of perjury that the information provided above is true and correct.
Signature: ! Date: ()
Phone#: 413-203-5888
Official use only. Do not write in this area, to be completed by city or town of iciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. Cityll'own Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:_ Phone#:
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement 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 9 O 20M-M17
Office of Consumer Affairs 8 Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Register Expiration Office of Consumer Affairs and Business Regulation
183668 11/03/2021 1000 Washington Street -Suite 710
PEAK PERFORMANCE ROOFING,LLC, Boston,MA 02118
r
JAMES FLANNERY
1 LOVEFIELD ST. aGGs+�
EASTHAMPTON,MA 01027 Undersecretary No valid without gnatUre
® Comfnonwealth of Massachusetts
Division of Professional Licensure Construction Supervisor
Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of enclosed
space.
CS-103061 Expires: 09121 12020
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 01010
S Failure to possess a current edition of the Massachusetts
l(' J' State Building Code is cause for revocation of this license.
Commissioner For Information about this license
Call(617)727-3200 or visit www.nuss.gov/dpi
Worker's Compensation and Emplover's Liability Policy
Berkshire Hathawa AmGUARD Insurance Company-A Stock Co.
Y Policy Number R2WCO21353
UARD Insurance Renewal of R2WC943835
GCompanles NCCI No. [21873]
k,
Policy Infbrmatlon Page(AR)
[1]Named Insured end Melling Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
A LOVEFtELO STREET 8 NORTH KING STREET
EASTHAMFrON,MA 01027 Northampton, MA 01060
Agency Code: MAMAINIS
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 fl
CC_ Refer to Residual Market Limited Other States Insurance Endorsement-WC100306B �
D. This policy includes these endorsements and schedules:
See Extension of Information Page-Schedule of Forms Ji,
[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 Estlmaftd Policy Premium $ 31,202
Total Surcharges/Assessments $1,181.00
Total Estimated Cost S $32.383.00
AlnMM USE XX Page- 1 - Inforrnation Page
MGA :RZWCD21353
Oahe :04/01/2019 WC OOOOOlA
MAN=
Inulno Office: P.O.Box A-N,16 S.River Street,MIIRaa-dRrre,PA 18703-0020 0 www.guamndAwn
DocuSign Envelope ID: BBB6D51E-87CE-4A38-A4B8-BF5E6CEB81BE
p �JIS
Peak Performance Roofing LLCContract
PERFO R 1 Lovefield St Date Contract#
Easthampton, MA 01027 10/24/2019 1W
MA CSL#103061 1 413-203-5888 peakperformanceroofmgllc@gmail.com www.peakperforTnanceToofinglic.com
MA HIC# 183698
T
Bill To Job Location
Karen Pfeifer&David Kotz Karen Pfeifer&David Kotz
18 Pilgrim Dr. 18 Pilgrim Dr.
Northampton MA 01060 Northampton, MA 01060
413-584-2547 413-584-2547
dmkotz@comcast.net, kpfeifer@smith.edu dmkotz@comcast.net, kpfeifer@smith.edu
Description Total
1. Remove the existing roofing shingles 12.125.00
2.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
3. Install six feet of ice and water shield on eaves and three feet around pipes/chimneys
4.Cover remaining roof with synthetic underlayment
5.Install new 8"aluminum drip edge on all eaves and rake edges
6.Install architectural shingles by Certainteed
(Landmark 30yr)http://www.certainteed.com/residential-roofing/productsAandmark/
Color Choice:
7. Install ridge vent on peaks of roof
8.Complete all necessary flashings including new pipe boots
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 under active work or on areas of potential roofing debris.Contractor will obtain building
permit if necessary. Installations are weather permitting.
Total:Landmark shingles=$12,375
A deposit of$6187.50 is due prior to the beginning of the job.The balance shall be due upon completion.
Accounts outstanding over 10 days past final invoice date subject to 2%finance charge,compounded
monthly.
Contractor Signature: Customer Signature: oocus gnea by: I>atc: Total:
10/29/2019
� � '� ,12,375.00