42-145 (3) 923 WESTHAMPTON RD BP-2020-1080
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV-.Block:42- 145 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-2020-1080
Proiect# JS-2020-001825
Est.Cost: $11950.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sa.ft.): 34368.84 Owner: SOSSA TIMOTHY
Zoning. Applicant: JAMES FLANNERY
AT. 923 WESTHAMPTON RD
Applicant Address: Phone: Insrn rrrrcc�:
I LOVEFIELD ST (508) 294-4052
EASTHAMPTONMA01027 ISSUED ON.412212020 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 Occupancy signature:
FeeType: Date Paid: Amount:
Building 4/22/2020 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
`' f �-
DocuSign Envelope ID:45736093-F39D4CBA-837D-52946992CDD6
Department use only
—"' City of Northampton Status of Permit:
Building Department A9 Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability __
Room 100 ��, �Q�� Watst/Wcll Availability
7 Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-127 PloUSite Plans
Other Specify
i
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: j�� Lot_This section to be/coGm�pleted by office �
Map
923 Westhampton Rd Florence f _ ` i � unit _
Zone Overlay District
trim at.Uistda CD Distract ___-- I
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Timothy Sossa 923 Westhampton Rd, Florence MA 01062
Name(Print) Docs 9ned by: Current Mailing Address:
— 914-774-6331
0lA4 14 bSSrt. 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 $11,950.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Cnnstruction from!6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= 0 +2+3+4 +5) $1 1,950.00 Check Number
This Section For Official Use Only
Building Per Num er: (d W Date �l
Issued:
Signature: FW
Building Commissioner/Inspector of Buildings Date
peakperformanceroofingllc n gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
DocuSign Envelope ID:4573B093-F39D-4CBA-837D-5294B992CDDB
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks {Q Siding [0] Other[O]
Brief Description of Proposed Strip & re-shingle asphalt roof
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 iamily 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
l Timothy Sossa 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.
DocuSigned by:
4/16/2020
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 �_411----3
;� I//1�hei'Z'0
Signature of Owner/Agent Date
DocuSign Envelope ID:45738093-F39D-4CBA-837D-5294B992CDDB
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
Acdress St j Holyoke, MA 01040 Expiratior Date
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,§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:4573B093-F39D-4CBA-837D-5294B992CDDB
City of Northampton
`5 f`
S C
Massachusetts
c
A WK
4 DEPARTMENT OF BUILDING INSPECTIONS x'
212 Main Street •Municipal Building
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:
923 Westhampton Rd, Florence
(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 vdiii 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.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leizibly
Name (Business/Organization/Individual): Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888
Areypu an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4 4. ❑ 1 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 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. Building addition
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.gRoof 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 situ
information.
Berkshire Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.Lic.#: R2WCO21353 Expiration Date: 4/27/2020
Job Site Address: ra3 1V,0sAQYY!p16A /C-Fi� City/State/Zip: tr`6V,'Wa Mq 610&2
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 ofperjury 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 official.
Cite 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#:
DocuSign Envelope ID:4573B093-F39D-4CBA-837D-5294B992CDDB
Peak Performance Roofing LLC
1 Lovefield St. PE K
Easthampton,MA 01027
413-203-5888 611 —ow-0 R F O R CE
peakperformanceroofingllc@gmail.com
MA HIC#183698 MA CSL#103061
Contract
ADDRESS CONTRACT# 10073
Timothy Sossa DATE 04/15/2020
923 Westhampton Rd.
Florence, MA 01062
sossatimothy@gmail.com
914-774-6331
DESCRIPTION AMOUNT'
1. Remove the existing roofing shingles 11,950.00
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 in valleys/around pipes and
chimney
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.com/residential-roofing/products/landmark/
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. Installations are
weather permitting. Long periods of inclement weather will cause, scheduling delays.
Total: Landmark shingles=$11,950
A deposit of$5,975 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.
TOTAL $M950.00
Accepted By °°`uSignedby: Accepted Date 4/16/2020
E-150EFCEBC1745496
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T..,; -�±. iR`a,.,'i.; ,� ; _ .�. '��M� A jas•�;.d,f� -'I.' �-`��'t I}r
d1
Worker's Compensation and Employer's Liability Policy
Berkshire Hathaway Am6UARD Insurance Company-A stock co.
Y Policy Number R2WCO21353
GUARDInsurance Renewal of R2WC943835
Companies NaCl No. [21873]
B ]
Polky Infornfflm Page(AR)
[1]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER 8 GRINNELL INSURANCE AGENCY, INC.
LOVEFIEID STREET 8 NORTH KING STREET
EAS7MAMPTON,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
B. Employer's Uability 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-1Wo 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 Umited Other Stages Insurance Endorsement-WC200306B
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 Esdnmftd Policy Premium $ 31,202
Total Surcharges/ $1,181.00
Total Estimated Goat 00
iNLEBNAL USE I0C Page-1 - Inftww hon Poge
HGA :R2wCO21353
Dabs :04/01M19
WC OOOOOlA
MANarE
ISM**01111M: P.O.sox A-fl,16 S.rover Wilboo-sore,PA 18703-0820• w4uwd com
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 1 O tom-ordW
Office of Cormumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Rilgisbytion EWrdion Office of Consumer Affairs and Business Regulation
183668 11/03/2021 1000 Washington Street -Suite 710
PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118
JAMES FLANNERY I
1 LOVEFIELD ST. w rY L ,"-A'
EASTHAMPTON,MA 01027 Undersecretary No valid withoutgnaiture
c
t
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 36,000 cubic feet(881 cubic meters)of enclosed
space.
CS-103061 EXpirgw=21=20
JAMES J FLANNERY
1 WILLIAMS ST
HOLYOKE MA 01010
Falure to possess a current edition of the Massachusetts
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