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38B-101 (5) 46 MUNROE ST BP-2021-1155 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B- 101 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1155 Project# JS-2021-001938 Est.Cost: $1200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq.ft.): Owner: TOWNSEND JOHN Zoning: URB(100)/ Applicant: JAMES FLANNERY AT: 46 MUNROE ST Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAMPTONMA01027 ISSUED ON:4/13/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE FRONT CHIMNEY 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. i � 3-1 " Certificate of OccupancySignatur. g . ' ' l FeeType: Date Paid: Amount: Building 4/13/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:3384B8E2-99C4-4835-ADC2-EEE92FB4AD33 RECE: 1 _The Commonwealth of Massachus[---APR Board of Building Regulations find S �ndards 202� FOR qy Massachusetts State Building Cbde,18 _. f MUNICIPALITY ,vo , iLnrn,,r—"' J ; USE Building Permit Application To Construct,Repair,Rend T'° 'Dmtgio v Revised Mar 2011 One-or Two-Family Dwelling �''--=°_ This Section For Official Use Only Building ermit Number: [Q'" 'J-" f 1 9, Date Applied: /1-)3-2o2 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numb 46 Munroe St 38B-101-001 1.1 a Is this an accepted street?yes no Map Number Parcel r 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal Cl On site disposal system ❑ _ Check if yes❑ SECTION 2: PROPERTY OA/NERSIJIP' 2.1 Owner'of Record: John Townsend Northampton, MA 01060 Name(Print) City,State.ZIP 46 Munroe St 413-575-0295 john.d.townsend@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building I Owner-Occupied 0 Repairs(s) d Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ilSpecify: Roofing. Brief Description of Proposed Work2: Remove front chimney to just below roofline. &roof over. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1,200.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (BVAC) $ List: 5.Mechanical (Fire $ /` Suppression) Total All Fees:$ Check No. '" Check Amount: 1 Cash Amount: 6.Total Project Cost: $ 1,200.00 Cl Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:3384B8E2-99C4-4835-ADC2-EEE92FB4AD33 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2022 James J. Flannery License Number Expiration Date Name of CSL Holder List CSL Type(see below) U No.and Street Type Description Holyoke, MA 01040 U Unrestricted(Buildings up to 35,000 Cu.ft.) y R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 413-203-5888 peakperformanceroofingllc@gmail.com SF Solid Fuel Burning Appliances Insulation Telephone Email address D DemoIition 5.2 Registered Home Improvement Contractor(HIC) 183698 11/03/2021 Peak Performance Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1 Lovefield St. peakperformanceroofinglIc@gmail.com No.and Street Easthampton, MA 01027 413-203-5888 Email address City/Town,State,ZIP Telephone SECTION 6: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 ! No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize James J. Flannery/Peak Performance Roofing LLC to act on my behalf,in ail matters relative to work authorized by this building permit application. DocuSigned by: John Townsend ����� 4/8/2021 Print Owner's Name(Electronic Signature) 463890558DE1445.. Date SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. James J. Flannery Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.£ovioca Information on the Construction Supervisor License can be found at www.mass.gov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DocuSign Envelope ID:3384B8E2-99C4-4835-ADC2-EEE92FB4AD33 City of Northampton T �M ) Massachusetts A.. `c. * `t„ �I� °� i' "jy DEPARTMENT OF BUILDING INSPECTIONS y. A' ,' . F & 212 Main Street • Municipal Building 0S. OD Northampton, MA 01060 �.1' 11 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: Valley Recycling, 234 Easthampton Rd., Northampton MA 01060 The debris will be transported by: Name of Hauler: Aaron's Roll-Off Service James Signature of Applicant: J. Flannery Date: The Commonwealth of Massachusetts a Department of Industrial Accidents a „ , Office of Investigations .. N Lafayette City Center t jr 2 Avenue de Lafayette, Boston,MA 02111-1750 —.� '�' 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 Are y u an employer? Check the appropriate box: Type of project(required): 1.Are am a employer with 4 4. ❑ I am a general contractor and I 6. 0 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. 0 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 10.0 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 site information. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lic. #: R2WC130849 Expiration Date:4/27/2021 Job Site Address: We l ,`V/11 St City/State/Zip: / 1" '° in A 0/O 7O 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 Hams and penalties of perjury that the information provided ab ye i true and correct. Signature: re.'"-LI Sit Date: y 7 2-62/ 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(check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone #: A / Worker's Compensation and Employer's Liability Policy !Berkshire HathawayAmGUARD Insurance Company - A Stock Co. ♦ ( Policy Number R2WC130849 4" Insurance Renewal of R2WCO21353 lA GUARD Companies 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: 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 • www.guard.com ®ACGRL) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ` 7/10/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Adina Edgett NAME: g Webber & Grinnell NE PHO (413)586-0111 FAX (413)586-6481 IAIC.No.Ext1: (A/C,No): 8 North King Street ADDRIess: aedgett@webberandgrinnell.com INSURER(S) AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Admiral Ins Co/BRECK INSURED INSURER B:Plymouth Rock Assurance Peak Performance Roofing, LLC INsuRERc:WCAR- Berkshire Hathaway GUARD Attn: James Flannery INSURER D: 1 Lovefield Street INSURERE: Easthampton MA 01027 INSURERF: COVERAGES CERTIFICATE NUMBER:Exp 04/21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD, POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE A CLAIMS-MADE X OCCUR PREMISES�a o currrrence) $ 300,000 CA00003521802 7/7/2020 7/7/2021 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefit Coverage Form $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED pRC00001007091 6/27/2020 6/27/2021 BODILY INJURY(Per accident) $ _ AUTOS AUTOS X HIRED AUTOS X NNONOSWNED PROPERTY DAMAGE $ Per accident) - Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE R2WC130849 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? y N/A C (Mandatory In NH) James Flannery is excluded 4/27/2020 4/27/2021 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,DESCRIPTION from WC coverage describe under DESCRIPTION OF OPERATIONS below e. E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /J • Q� W Grinnell, CPCU, CIC hlit-•� 1( --�i' I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 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. SCA 1 0 20M-05/17 ty Office of Consumer Affairs&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 No valid without gnature u ` , 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: 09/21/2 JAMES J FLANNERY 1 WILUAMS ST w l; HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts r,� State Building Code is cause for revocation of this license. Commissioner v For information about this license Call(617)727-3200 or visit www.mass.gov/dpl DocuSign Envelope ID.3384B8E2-99C4-4835-ADC2-EEE92FB4AD33 Peak Performance Roofing LLC 1 Lovefield St. P E K Easthampton, MA 01027 413-203-5888 P E R F O R CE peakperformanceroofingllc@gmail.com ROOFING MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10303 John Townsend DATE 04/08/2021 46 Munroe St. Northampton, MA 413-575-0295 ©©),, �� john.d.townsend@gmail.co DESCRIPTION This contract is for the chimney located on the front of the house: 1. Remove the existing chimney just past the roofline 2. Bricks will be thrown into non functioning chimney for disposal 3. Cover hole with plywood and feather in new architectural shingles Remove all debris from premises, and throughout the job, continue cleanup and keep the premises undamaged. Please use reasonable caution during the process; do not walk/drive under active work or on areas of potential roofing debris. Peak Performance Roofing will obtain the building permit if necessary. Installations are weather permitting; long periods of inclement weather will cause scheduling delays. Total: $1,200.00 The balance shall be due Upon Completion. Accounts outstanding past 30 days subject to 2%finance charge, compounded monthly. TOTAL $1,200.00 Accepted By LSI # gned Accepted Date 4/8/2021 46389O558DE1445_.