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06-034 232 HAYDENVILLE RD-Route 9 BP-2021-0023 GIS#: COMMONWEALTH OF MASSACHUSETTS MQ Block: 06-034 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-2021-0023 Project# JS-2021-000029 Est.Cost:$5800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sg.ft.): 19035.72 Owner: ANDREWS RANDY K Zoning: URA(100)/ Applicant. JAMES FLANNERY AT: 232 HAYDENVILLE RD - Route 9 Applicant Address: Phone: Insurance: I LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON.7/8/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF POST THIS CARD SO ITIS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Budding 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 Sianature: FeeType: Date Paid: Amount: Building 7/8/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:D0995C9C-018B-48EE-ABCD-12B33D02CE76 Department use only i \ City of Northamptbn \ Status of Permit: sr Building Deparvment✓l/j \ rb CuUDriveway Permit 212 Main t Se\r{er/Septic Availability Room 1 & W ter/WellAvailability Northampton, MA � r�, of Sets of Structural Plans phone 413-587-1240 Fax 413- ^ Plot/Site Plans 0),T%N Ott'r Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVAT R MOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 232 Ha Ydenville Rd. Map Lot Unit Zone Overlay District E:Irn St. CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Randy Andrews _ _ 232 Haydenville Rd., Leeds MA 01053 Name(Print) Docusr9ned by: Current Mailing Address: fawJ4 Ayuktws Telephone 413-519-1853 Signature -F41D9cA337462498_. 2.2 Authorized Agent: James J. Flannery 1 Lovefield St., Easthampton MA 01027 Name(Print) w lf� 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 $5,800.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. MechanicalHVAC t ) 5. Fire Protection 6. Total=0 +2+ 3+4 + 5) $5,800.00 Check Number QQ This Section For Official Use Only Date Building Permit Number:J�' c� ' Issued: Signature: Building Commissionerflnspector of Buildings Date pea kperformanceroofiIng llc (a) gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) DocuSign Envelope ID:D0995C9C-018B-48EE-ABCD-12B33D02CE76 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition [� Replacement Windows Alteration(s) 7Roofing EV Or Doors F-1 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] 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 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 I, Randy Andrews as Owner of the subject property hereby authorize James J. Flannery / Peak Performance Roofing, LLC to act on my behalf,in all ?Dr,,%sr@JpJ4e to work authorized by this building permit application. 7/2/2020 � II�YT.IA/S Signature of Owner F4D9cA 37462498.. 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 Signature of Owner/Agent Date DocuSign Envelope ID:D0995C9C-018B-48EE-ABCD-12B33D02CE76 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 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....... L/ No...... ❑ DocuSign Envelope ID:D0995C9C-018B-48EE-ABCD-12B33D02CE76 City of Northampton .._ .T� Massachusetts R� DEPARTMENT OF BUILDING INSPECTIONS Z 212 Main Street •Municipal Building Northampton, MA 01060 TSHjy ��' 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: 232 Haydenville Rd., Leeds (Please print 1house 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 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 kiz VW;.- 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/Organizationgndividual): Peak Performance Roofing, LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-203-5888 Are you an employer?Check the appropriate box: Type of project(required): 1.LI 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.$ required.] 5. ❑ We are a corporation and its 10.El 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. l/ Roof 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. BerkShlre Hathaway Guard Insurance Company Name: Policy#or Self-ins. Lic.#: R2WC130849 Expiration Date: 4/f27/2021 Job Site Address: 14,a l.j/l Ql�V/11,1�. C� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy .umber 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 bov is true and correct Si nature: Date: 5 2 � 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#: A Worker's Compensation and Employer's Liability Policy �!�Berkshire Hathaway AmGUARD Insurance Company - A Stock Co. y Policy Number R2WC130849 ..,'A'-, BerkshireGUARDCompanies Insurance Renewal of R2WCO21353 �'A NCCI No. [21873] Policy Information Page (AR) [1]Named Insu d and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER & GRINNELL INSURANCE AGENCY, INC. 1 LOVEFIELD STREET 8 NORTH KING STREET EASTHAMPTON, MA 01027 Northampton, MA 01060 Agency Code: MAMAIN15 Federal Employer's ID XX-XXX1951 Insured is Limited Liability Co. (LLC) [2] Policy Period From April 27, 2020 to April 27, 2021, 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 Liability 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-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 Estimated Policy Premium $ 25,108 Total Surcharges/Assessments $ $867.00 Total Estimated Cost $25,975.00 INTERNAL USE XX Page - 1 - Information Page MGA : R2WC130849 WC 000001A Date : 04/07/2020 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 9 www.guard.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 Expiration: 11/03/2021 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Update Address and Return Card. SCA 1 t3 20Ff-0&17 Office of Consumer Affairs h Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. It found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 183698 11/03/2021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY 1 LOVEFIELD ST. .� EASTHAMPTON,MA 01027 Undersecretary If No valid without gnature 1 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(991 cubic meters)of enclosed space. CS-103061 Expires.:0812112020 JAMES J FLANNERY 1 WILLIAMS ST HOLYOKE MA 01040 Failure 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.rnass.gov/dpl DocuSign Envelope ID:D0995C9C-018B48EE-ABCD-12B33D02CE76 Peak Performance Roofing LLC 1 Lovefield St. PE �Easthampton,MA 01027413-203-5888 PERFOR peakperformanceroofingllc@gmail.com • • MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10136 Randy Andrews DATE 07/01/2020 232 Haydenville Rd. 10 Leeds,MA 01053 O Randad27@gmail.com 413-519-1853 DESCRIPTION AMOUNT 1. Remove the existing roofing shingles 5,800.00 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 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.com/residential-roofing/products/landmark/ Color Choice: CHARCOAL BLACK 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/INTERIOR. Please use reasonable caution: do not walk/drive under active work, or on areas of potential roofing debris. Contractor will obtain building permit. Installations are weather permitting. Total: Landmark shingles=$5,800 An initial deposit of$500 will secure contract/building permit/priority scheduling for Summer 2020. A deposit of$2,400 shall be due prior to material delivery order. The balance shall be due Upon Completion. Accounts outstanding over 10 days past final invoice date subject to 2%finance charge, compounded monthly. ............................... ................. .......... .... ........ .... ... ... .. . ........ ... ... .. . .............. ....... .. TOTAL $59$00.00 Accepted By DOeU$ipnedby, Accepted Date 7/2/2020 CKa1n, b4mm F4D 3746248B...