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24A-199 (6) DocuSign Envelope to:435979EE-2582-4638-8OB8-BBCC63EFOA7F Department use only City of Northampton; /I Status of Permit: Building Department urb Cut/Driveway Permit t^ 212 Main Street '�q9 s r/Septic Availability !•' Room 106 I.? "'e��+Mell Availability Northampton, Nta'1� , T�"Sets of,Structural Plans phone 413-587-1240 Fax 9 127p P t/Site Flans � �� theriecify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RE R DE LISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map 0 Lot Unit 36 Murphy Terrace Zone Overlay District Elm St.District CB District ---7SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Michael Byrne 36 Murphy Terrace,Northampton MA 01060 0 Name(Print) Current Mailing Address: DocuSigned 6y: Telephone 781-325-5260 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 $9,300.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6) 3. Plumbing Building Permit Fee 4�d 4. Mechanical(HVAC) 5.Fire Protection 6. Total =0 +2+3+4+5) $9 300.00 Check Number This Section For Official Use Only 4? /l�� Date Building Permit Numb Issued. Signature: Building Commissioner/inspector of Buildings Date peakperformanceroofingllc na gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) i DocuSign Envelope ID:435979EE-2582-4638-80B8-BBCC63EFOA7F SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1Addition ❑ Replacement Windows Alterations) F-1Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[0) Brief Description of Proposed Strip&re-shingle asphalt roof. (Excludes detached garage.) 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 1, Michael Byrne as Owner of the subject property James J. Flannery/ Peak Performance Roofing, LLC hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Do usignedby: 3/24/2020 Signature of Owner Date James J. Flannery as Owner/Authorized I, 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 -3 12-0 Signature of Owner/Agent Date DocuSign Envelope ID:435979EE-2582-4638-8OB8-BBCC63EFOA7F SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ CS-103061 Name of License Holder: - ---- License Number James J. Flannery 09/21/2020 _._._ Expiration Date Address I U, lUILmS * Holyoke MA 01040 Signature � Telephone L)j 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...... ❑ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinessiOrganizationnndividual): Peak Performance Roofing, LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888 Are y u an employer?Check the appropriate box: Type of project(required): 1. Are a employer with 4 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 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 'many capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.VRoof 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. xContractors 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: 36 M U h ok( J tr ra( .Q` City/State/Zip: l r mI0� N i)JA 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 above is true and correct Si ature: / 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 k 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#: DocuSign Envelope ID:435979EE-2582-4638-8OB8-BBCC63EFOA7F Peak Performance Roofing LLC I Lovefield St. PE:FOER4C K Easthampton,MA 01027 P E R E 413-203-5888 1,11 WC2 � peakperformanceroofingllc@gmail.com MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10060 Michael Byrne DATE 03/23/2020 36 Murphy Terrace. Northampton,MA 01060 781-325-5260 michael.byrne28@gmail.co m DESCRIPTION AMOUNT *Excludes detached garage.* 9,300.00 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 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) http://www.certainteed.con/residential-roofing/products/landmark/ Color Choice: Best match to garage(TBD) 7. Install ridge vent on peak 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. Contractor will obtain building permit. Installations are weather permitting. Please use caution during the process: do not walk/drive under active work, or on areas of potential roofing debris. PRECAUTIONS DURING COVID-19 OUTBREAK: Please refrain from direct interactions with the crew. Your project manager will be available by cell during the installation process. DocuSign Envelope ID:435979EE-2582-4638-8OB8-BBCC63EFOA7F DESCRIPTION AMOUNT Total: Landmark shingles=$9,300 A deposit of$4650 is due at contract signing. The balance shall be due upon completion. Accounts outstanding over 10 days past final;invoice date subject to 2%finance charge, compounded monthly. TOTAL $91,300.00 Accepted By °ocuSign*d by: Accepted Date 3/24/2020 554EME27FEB4CA... t,i&Ad f�V1A.t, DocuSign Envelope ID:435979EE-2582-4638-80BS-BBCC63EFOA7F City of Northampton F Massachusetts DEPARTMENT OF BUILDING INSPECTIONS S t. 212 Main Street •Municipal Building Jy Northampton, MA 01060 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: 36 Murphy Terrace (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 wner 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.