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29-400 (4) 76 SANDY HILL RD BP-2020-1027 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-400 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-2020-1027 Project# JS-2020-001733 Est.Cost: $4300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq.ft.): 11761.20 Owner: SHIELDS-TABAKA TJ Zoning: Applicant. JAMES FLANNERY AT: 76 SANDY HILL RD Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:3/16/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ROOF SHINGLES OVER EXISTING 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 Dwartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON t1PON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/16/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:26CAAF90-C2D1-498E-9B7E-734277939181 _ Department use only -- City of Northartipton - Status of Permit: Building Department—� "� Curb-qut/DrivewayPermit �. A 212 Main Street SewerrSeptic Availability Room 100 i MAR 3 2 haterNVell�vailability Northampton, MA 01060 Two Sots of Otructural Plans phone 413-587-1240 Fax 413-587-4.2-72` �r���ire r , �g Plans NORTH,%,,Ar'T(`N,P.^ Otft*9peCify T�70T OF 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 q 0V Unit 76 Sandy Hill Rd. Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: T3 shields-Tabaka 4 Mountain Laurel Path Florence Ma 01062 Name(Print) DocuSigned by: Current Mailing Address: it LIS—t4bab, Telephone 413-875-5773 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 com leted b ermit a licant 1. Building $4,300.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) �(J 5. Fire Protection 6. Total = 0 + 2 +3+4 + 5) $4,300.00 Check Number This Section For Official Use Only — - �(� Building Permit Number: Z-7 DateIssued: Signature: Building Commissioner/Inspector of Buildings Date peakperformanceroofingllc Ca) gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:26CAAF90-C2D1-498F-9B7E-734277939187 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Toofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [pj Other IQ Brief Description of Proposed Install architectural asphalt roof shingles (over existing single layer of 3-tab shingles) Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. 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 T7 Shields-Tabaka 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. Do Signed by: 3/13/2020 Signature of Owner JVTi Date James J. Flannery 1, , 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 a _ 3i3u Signature of Owner/Agent Date Docubign Envelope ID:26CAAF90-C2D1-498F-9B7E-734277939187 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 (7 ! 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,§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....... IDS No...... ❑ DocuSign Envelope ID:26CAAF90-C2D1-498F-9B7E-734277939187 City of Northampton SSS r SSC •�"' Massachusetts d c DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street *Municipal Building yJti CDS 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: 76 Sandy Hill Rd. (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) 3 13 24_ 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 .. www.mass.gov/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 #: 413-203-5888 AYl u an employer?Check the appropriate box: Type of project(required): 1. 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 F1 New construction 2.❑ 1 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. msurance.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.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. tContractors 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. IBerkshire Hathaway Guard Insurance Company Name: Policy#or Self-ins. Lic.#: R2WCO21353 Expiration Date: 4/27/2020 � j,�,� kk Job Site Address: a-� �� ' '`I' City/State/Zip: 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 bove 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 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#: Berkshire Way Am�AUARD Insuranca Company-A Neoac Co. Polity Nwnber R2WCO21353 GUARDInsurance Renewal of R2WC943835 Companies NGCi No. [21873] Policy Information Page(All) [1]Nmmed Insured and Nalling Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY,INC. LDVEFIBD 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. (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 f B. Employer's Liability Insurance- Part Twro 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: 1 Bodily Injury by Accident-each accident $100,000 Bodily Injury by Disease-each employee $100,000 f Bodily Injury by Disease-policy limit $500,000 I C. Refer to Residual Market Limited Other States Insurance Endorsement-WC200306B w 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) TOW Mmaead Policy Premium $ 31,202 Total / $1,181.00 TOW btlmaI Coat Drr9WM.USE XX Page-1- InfOnnatimt Page MGA :R2w0021353 WC 000001A Dift :0~/81/2019 MANOTE INUMS oaks:P.O.III=A-K 16 S.River 9ble,MIIN004 V%PA 1x703.0020 0 W WW4&Wrd con 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 L OVEFIELD ST. F-tion: 11/03/2021 EASTHAMPTON,MA 01027 Update Address and Return Card. SCA 1 O 20M-W17 .�/� �ivnviirnnwv/1rf r��/o.�sirSiiu// office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the explration date. K found return to: H!lalsbudon Eoratittn Office of Consumer Affairs and Business Regulation 183608 11/03/2021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY J 1 LOVERELD ST. w•R'6 "W' EASTHAMPTON,MA 01027 Undersecretary No valid Without gnature Comrnonweatth of Massachusetts 19 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 •0110120 JAMES J FLANNERY - 1 WILUAMS ST HOLYOKE MA 01080 a _ / Failure to possess a current edition of the Massachusetts l/'/'�'"' State Building Code is cause for revocation of this license. Commissioner For information about this license Call(617)727-3200 or visit www.mass.gov/dpi DocuSign Envelope ID:26CAAF90-C2D1-498E-9B7E-734277939187 Peak Performance Rooft LLC 1 Lovefield St. Easthampton, MA 01027 PE K 413-203-5888 P EFF O R CSE peakperformanceroofmgllc@gmail.com • • MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10054 Loom Properties LLC DATE 03/12/2020 4 Mountain Laurel Path Florence, MA 01062 413-875-5773 tj@loompropertiesllc.com JOB LOCATION 76 Sandy Hill Rd., Florence DESCRIPTION AMOUNT Property owner will be responsible for supplying all of the material (shingles, starter, drip 4,300.00 edge, cap.)We will be adding an additional layer of shingles. Contract is based on 17 square. 1. Install new aluminum drip edge on all eaves and rake edges 2. Install architectural shingles over existing 3-tab shingles 3. Install ridge vent on peak of roof 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 reasonable caution during the process; do not walk/drive under active work, or on areas of potential debris. Contractor will obtain building permit. Installations are weather permitting. Total: $4,300.00 A deposit of$2150.00 is due at contract signing. The balance shall be due upon completion. Accounts outstanding over 30 days past final invoice date subject to 2% finance charge, compounded monthly. TOTAL $49300.00 Accepted By u& by: Accepted Date 3/13/2020 EiSUJS-T�66 9356659E5453_.