17C-153 (9) 92 HIGH ST BP-2021-0022
GIS#. COMMONWEALTH OF MASSACHUSETTS
MV.-Block: 17C- 153 CITY OF NORTHAMPTON
Lot:'-00 I PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-0022
Proiect# JS-2021-000028
Est.Cost: $10800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot Size(sq. ft.): 16335.00 Owner. MARY C DONOVAN
Zoning: URB(100)/ Applicant: JAMES FLANNERY
AT. 92 HIGH ST
Applicant Address: Phone: Insurance:
1 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 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 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:D73B654C-5F62-4B34-BC14-775879187220
(� Department use only
- --� City of Northarrq n �1> Status of Permit:
Building Depart <G& Curb gbUDriveway Permit
212 Main Stre n�T Q, Se v r/Septic Availability
n
�~ Room 100 � A�0 'A, ter/Well Availability
Northampton, MA 01060 'qo AlpCr, wo Sgfs of Structural Plans
phone 413-587-1240 Fax 413-587-127 '�h°oh PIoUSte Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
92 High St. Map l � � unit
Lot � � �
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mary Donovan 92 High St., Florence MA 01062 _
Name(Print) OocuSigned by: Current Mailing Address.
jjjF8Agg�F44!- Telephone 413-559-7750
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 $10,800.00 (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) $10,800.00 Check Number
This Section For Official Use Only
Date
Building Permit Number: ^oeli 1 Issued: _
Signature:
Building Commissionerrinspector of Buildings Date
peakperformanceroofingllc Ca) gmail.com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
DocuSign Envelope ID:D73BB54C-5F62-4834-BC14-7758791B7220
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
__J
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 17-1
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [ice Siding [01 Other[O1
Brief Description of Proposed Strip&re-shingle asphalt roof(excluding slate sections and newly shingled sections)
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 i Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Mary Donovan 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.
Docu Signed by:
7/2/2020
Signature of OwnerDate
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
Signature of Owner/Agent Date
DocuSign Envelope ID:D73BB54C-5F62-4B34-BC1 4-7758791 B7220
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
Address Expiration Date
L�_, 'I ��S St 1 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:D73BB54C-5F62-4634-BC14-7758791B7220
City of Northampton
Massachusetts
° G
.3 DEPARTMENT OF BUILDING INSPECTIONS v D
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:
92 High St., 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)
/? / L' L i
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.
SIIN 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 Le0bly
Name (Business/Organization/Individual): 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. F-1 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. 1VRoof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13T] Other
comp. insurance required.]
*Any applicant that checks box 41 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 Hathaway Guard
Insurance Company Name:
Policy#or Self-ins.gLic.#: R2WC 130849 Expiration Date: 4/27/2021
Job Site Address: / / City/State/Zip: k U r f `7l� /711P
Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration dal (D
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.
Signature:
Date: Z
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
v/Berkshire HathawayAmGUARD Insurance Company - A Stock Co.
♦ Policy Number R2WC130849
Insurance Renewal of R2WCO21353
4eX GUARDCompanies NCCI No. [21873)
Policy Information Page (AR)
[1]Named Insured 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: MAMAINI5
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 • www.guard.com
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
Registration: 183698
PEAK PERFORMANCE ROOFING,LLC. Expiration: 11/03/2021
1 LOVEFIELD ST.
EASTHAMPTON, MA 01027
Update Address and Return Card.
SGA 1 O 20.Lt-05117
Office of Consumer Affairs b Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If 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 r NOi�valid without 'gnature
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.: 0912l/2020
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 C4 For information about this license
Call(617)727-3200 or visit www.mass.gov/dpi
r
DocuSign Envelope ID:D73BB54C-5F62-4834-BC14-7758791B7220
Peak Performance Roofing LLC
1 Lovefield St. PE JiE
Easthampton,MA 01027413-203-5888 PERFOR
peakperformanceroofingllc@gmail.comLem
MA HIC#183698 MA CSL#103061
Contract
ADDRESS CONTRACT# 10135
Mary Donovan DATE 07/01/2020
92 High Street
Florence,MA 01062 Poll mdonovan6@yahoo.com
413-559-7750
DESCRIPTION AMOUNT
-This contract excludes the slate roof/two newer sections of shingles.- 10,800.00
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)
http://www.certainteed.com/residential-roofing/products/landmark/
Color Choice: GRANITE GRAY
7. Install ridge vent on peaks of roof
8. Complete all necessary flashings including new pipe boots
9. Install EPDM roofing on low slope section on front of the house
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= $10,800
An initial deposit of$500 will secure contract/building permit/priority scheduling for Summer
2020. A deposit of$4,900 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 $10,800.00
Accepted Byl,1,cusignedby: � � Accepted Date 7/2/2020
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