30A-032 (110) 320 RIVERSIDE DR BP-2020-0833
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30A-032 CITY OF NORTHAMPTON
Lot: -000 N'RSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT.
Permit# BP-2020-0833
Project# JS-2020-001438
Est.Cost: $13950.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq.ft.): Owner: BURTON SAM
Zoning: SI(108)/WP(38)/ Applicant. JAMES FLANNERY
AT: 320 RIVERSIDE DR
Applicant Address: Phone: Insurance:
1 LOVEFIELD ST (508) 294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.1/27/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST THIS CARD SO IT ISIVISIBLE 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 1/27/2020 0:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
DocuSign Envelope ID:612C3DCA-F846-42C5-9097-89DDDOC4A29E lV F
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit: -
_J! '� �ullding Department Curb Cut/Drivewa Permit
V -'212 Main Street Sewer/Septic Availability,
441 2 oom 100 Water/Well Availability
oFpT ? ?Q rth pton, MA 01060 Two Sets of Structural Plans
phone 3-5 -1240 Fax 413-587-1272 Plot/Site
Plans_
Other
ON� SpF
APPLICATION TO UCT, REPAIR, RENOVATE,
THAN A ONE TWO O DWELLINGOCCUPANCY OF,OR DEMOLISH ANY BUILDING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
Map Lot Unit
320 Riverside Drive
� � b��
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sam Burton 320 Riverside Drive, Florence MA 01062
Name(Print) DocuSigned by: Current Mailing Address:
S
413-695-6597
SM �jltJ�'bin.
Signature mn Telephone
2.2 Authorized Aaent:
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 b permit applicant
1. BuildingE $13 950.00 (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) $13,950.00 Check Number
This Section For Official Use Only
Building Permit Number Date
3 Issued
Sign ure:
Buildi g Commissionerlinspect%ols Date
DocuSign Envelope ID:612C3DCA-F846-42C5-9097-89DDDOC4A29E
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing 0 Change of Use❑ Other ❑
Brief Description Strip and re-shingle.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
❑ A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational F-1
2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify.
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1
St
2nd
2nd
3rd
3`d __....._m,_..... µ.... ....... .. ... ...... _... ..�.........
4m
4th :
...
Total Area( )sf Total Proposed New Construction (sf)
...._ _...,._.
Total Height(ft)
_..._ .. . ............,,,,,.,..,.._. ,,..,,.,....._._n,., ,...._.
Total Height ft
7.Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system[]
DocuSign Envelope ID:612C3DCA-F846-4205-9097-89DDDOC4A29E
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I Sam Burton 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: 11/142019
Signature of Owner AaM GSL Date
59D3332E978043F...
I 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
2!4�J I t \.511 C�
Signature of Owner/Agent V Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
James J. Flannery CS-103061
Name of License Holder
License Number
Holvoke. MA 01040 09/21/2020
Address Expiration Date
413-203-5888
Signature Telephone
SECTION 13-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:612C3DCA-F846-42C5-9097-89DDDOC4A29E
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work: 320 Riverside Dr.
The debris will be transported by: Aaron's Roll-Off Service, 1 Loomis Way, Easthampton
The debris will be received by:
Building permit number:
James J. Flannery, Peak Performance Roofing, LLC
Name of Permit Applicant
Date Signature of Permit Applicant
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
1 LOVEFIELD ST. Expiration: 111/03//03/2021
EASTHAMPTON,MA 01027
Update Address and Return Card.
SCA 1 O 20M4)W17
Office of Consumer Affairs 8 Business Regulatlon
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Bli91stnatioJf EtO rstlon Office of Consumer Affairs and Business Regulation
183698 11/03/2021 1000 Washington Strad -Suite 710
PEAK PERFORMANCE POMNG,LLC. Boston,MA 02118
JAMES FLANNERY J
1 LOVEFIELD ST. �Grw•�'6 iCG�k
EASTHAMPTON,MA 01027 Undersecretary NJ valid withoutgnature
Commonwealth 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(981 cubic meters)of enclosed
space.
CS-103061 Expires_09/21/2020
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 01040
Failure to possess a current edition of the Massadwsetts
l('/'Ie" State Building Code is cause for revocation of this ficense.
Commissioner For information about this license
Call(617)727-5200 or visit www.mass.gov/dpi
I , i
Worker's Compensation and Employer's Liability Polk v
Berkshire Hathaway AmAUARD Insurance Company'A Stode Co.
Y Policy Number R2WCO21353
43835
GUARDCompanles RaInsurance Nar No.of [21873]
Polley Infornatlon Pape(AR)
[1]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER 8 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. (LLT~)
[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
S. Employer's Liability Insurance- Part TWvo 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 indudes 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 Pians. All required information is subject to verification and change by
audit. (Continued on another page)
Total IEstinmftd Policy Premium 31,202
Total Surciviw9en/Assesamentu $1,181.00
Total Estimated Coat $32.383.00
LITRE >a Page- 1 - Inforn:ation Page
MGA :RZWCD21353
WC OOOOOlA
DON :0W01=19
MANOM
IfphNhg Ofnoe:P.O.Sox A-M,16 S.River Street,Wilks-Sere,PA 18703-0020 0 www4puar11.00nt
The.Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
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/zip: Easthampton. MA 01027 _ Phone it: 413-203-5888
Are you an employer?Check the appropriate box: Type of project(required):
1.LZ l 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
8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp.insurance.t g
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.&fRoof 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
Insurance Company Name:
Policy
Guard
Policy#or Self-ins.Lic.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address: ��V 1 \; r l CA O 1 City/State/Zip: I�rQ nC Q n p 0 3,
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 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 ofciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
iocuSign Envelope ID:612C3DCA-F846-42C5-909/-aauuuuL.qr+ztv=
Q P'n7gLCContract
Peak Performa ce oo Date co�tra�t#
PKIld St
P E R F O R CE Lovefie
Easthampton, MA 01027 1 vv2019 1075
COMM
MA CSf# 18i3698
:iii61 413-203-5888 peakperformanceroofingllc&I1!1 l.com www.peakperfomianceroofinglic.comMA HI
Job Location
BIII To
f320
m Burton Sam Burton
Riverside Dr. 320 Riverside Dr.
orence,MA 01062 Florence, MA o 1062
3-695-6597 413-695-6597
sam spake@yahoo.com sam_spake@yahoo.com
Total
Description 13,950.00
1. Remove the existing roofing shingles
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 in valleys/around pipes
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-roofmg/products/landmark/
Color Choice:Birchwood
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 areas,or on areas of potential roofing debris.
Contractor will obtain building permit. Installations are weather permitting;long stretches of inclement
weather will cause delay.
Total: Landmark shingles=$13,950
Expected installation: Spring 2020. An initial deposit of$1000 with contract will secure priority scheduling
and lock in price protection. The balance of the deposit($5975) is due prior to start of work. The balance
shall be due upon completion. Accounts outstanding over 10 days past final invoice date subejct to 2%
finance charge,compounded monthly.
Customer Signature: Dmusbnea by: Date: Total:
Contractor Signa e: 11/14/2019
S� �, L_$13,950-00