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31B-030 (3) 43 SUMMER ST BP-2020-0768 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B-030 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0768 Project# JS-2020-001323 Est.Cost: $3350.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq.ft.): 14287.68 Owner: CAINE THOMAS P Zoning: URC(100)/ Applicant. JAMES FLANNERY AT. 43 SUMMER ST Applicant Address: Phone: Insurance: I LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:12/30/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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: FeeType: Date Paid: Amount: Building 12/30/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:033BEB71-3323-45A7-A853-17DF01 F2DBET--- f-1�- Department use only ` City of Northa�nptoin Status of Pe'mit: Building Depa ment QG� ? 7 ?(C.urb 0ut/Drieway Permit AA 212 Main St et Sewer' eptiAvailability 4 Room 10d ik ailability Northampton, Ml 01 s P T of r..un nTO trl R`v e'ts of Structural Plans soy,. , , phone 413-587-1240 Fa 413-587LR J: Ptot/5ite Plans 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 by office Map /� Lot d � Unit 43 Summer St. Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Thomas Caine 43 Summer St., Northampton MA 01060 Name(Print) DOCUSignedby: Current Mailing Address: 413-586-1993 �l(NM(AS�lt11tiL 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 $3,350.00 (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) $3,350.00 Check Number 2 This Section For Official Use Only �P_ Building Permit Number: -7(p� Date � Issued: Signature: 1 Building Commissioner/Inspector of Buildings Date peakperformanceroofingllc na gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:033BEB71-332345A7-A853-17DF01F2DBE7 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 [tom] Decks [Q Siding[O] Other[O] Brief Description of Proposed Install EPDM roofing on garage over existing. 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. Dim to s' 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. -t. 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 Thomas Caine 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: 12/24/2019 Signature of Owner Date 1 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 ``^' 76 Signature of Owner/Agent Date DocuSign Envelope ID:033BEB71-3323-45A7-A853-17DF01F2DBE7 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 Holyoke, MA 01040 Signature f Telephone �rl¢,� 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,§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....... L/ No...... ❑ DocuSign Envelope ID:033BEB71-3323-45A7-A853-17DF01F2DBE7 City of Northampton •"' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 sNy1 �� 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: 43 Summer 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) / Z ? L� 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 IF 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Peak Performance Roofing, LLC Address: 1 Lovefield St. city/state/Lip; Easthampton, MA 01027 phone #: 413-203-5888 Are u an employer? Check the appropriate bog. 1. I am a employer with 4 4. L] I am a general contractor and I Type of project(required): 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. T ❑ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.[:11 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.(TRoof repairs insurance required.] t c. 152, §1(4),and we have no 13.[1 Other employees. [No workers' 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. lContractors 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.Lic.#: R2WCO21353 Expiration Date: 4/27/2020 Job Site Address: Y5l V � City/State/Zip: br�GtQn�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 and penal es of perjury that the information provided above isa and correct Signature: Date: 1L1 2719 �0 Phone#: 413-203-5888 Official use only. Do not write in this area, to be completed by city or town ofciaL City or Town: Permit/License# LCssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .Other ontact Person: Phone#• Worker's Comoensation and Emnlaver's LiabNifty Policy (Berkshire Hathawa AmGD Insurance Company-A Stock Co. y UA1tPolicy Number R2WCO21353 GUARDInsurance Renewal of R2M/Cl143835 Companies NCCI Na [218773] Policy Information Page(AR) [1]Nanmd Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER 8:GRINNELL INSURANCE AGENCY, INC. 1 LOVEFIEW STREET 8 NORTH ICING STREET EASTHAMPTON,MA 01027 Northampton,MA 01060 Agency Code: MAMAINI5 Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC) F' f' a [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. WorkeW Compensation Insurance - Part One of this policy applies to the Workers'Compensation Law of the following states: Massachusetts B. Employer's Llabllity 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-WC2003065 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 Esdmabd Polity Premium $ 31,202 Tool Surchargai/Assessments $ $1,181.00 Total Estlawled Cost $3LS83.00 011ERNAL USE XX Page- 1 - Intbnn mm Page MGA :RZWVCO21353 Date :04/01/2019 WC OOOOOlA MANOTE Inuhm 011los: P.O.Boor A-M,16 S.Rhrer Street,W 1111m -eine,PA 18703-0020 0 www.gwrdA wn 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: 1 83698 1 LOVEFIELD ST. 111/03J/03/ '2021 EASTHAMPTON,MA 01027 Update Address and Return Card. SCA I 0 20M-W17 .T/M SielriiiiNv►iivn�//f��lin•,iJir�e.,3�1/,� Office of Consumer Affairs&Buslness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the esplration date. K found return to: HBgiftrotiaa Location Office of Consumer Affairs and Business Regulation lea" 11/03/2021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Ignature undersecretary No valid without Commonwealth of Massachusetts . Division of Professional LleenSure Construction Supervisor Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(881 cubic meters)of enclosed space- CS-103061 ftpiroLr 0012112020 JAMES J FL ANNERY 1 wLL IAMS ST HOLYOKE MA 01010 Failure to possess a current edition of the Massachusetts (' L_ State Building Code is cause for revocation of this license. Commissioner v"` For information about Ods license Call(617)727-3200 or visit www.mass.gov/dpl DocuSign Envelope ID:033BEB71-3323-45A7-A853-17DF01F2DBE7 Peak Performance Roofing LLC 1 Lovefield St. E Easthampton,MA 01027 PERF O R C 413-203-5888 peakperformanceroofmgUc@gmail.com Contract ADDRESS CONTRACT# 823 Caine Mitter c/o Stella Statham DATE 12/23/2019 43 Summer St.,2nd Floor ssthathain@cainemitter.com S(212)-686-8820,0(413)586- 1993 JOB LOCATION 43 Summer St.,Northampton DESCRIPTION AMOUNT Garage Roof: 3,350.00 1.Mechanically fasten 1/2"high-density polyisocyanurate insulation over the existing roof with approved screws and plates. 2.Install Genflex mechanically fastened EDPM roof system: http://genflex.com/wp-content/uploads/2014/11/CB02_GenFlex-EPDM- Brochure_1014_web.pdf 3.Fabricate and install aluminum drip edge. Property will be protected at all times to prevent any damage to the home or plantings.We are not responsible for dirt/debris that may fall into attic.All exterior debris will be removed from the premises.Contractor will obtain building permit.Installations are weather permitting. $3350 A deposit of$1675 is due at contract signing. The balance shall be due upon completion. TOTAL $39350.00 Accepted By Accepted Date Dow3lpned by: CVA Mas ��- 12/24/2019 --YC�ttrfl-*- ignature oz czzoosesaae_. Date