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30B-028 (5) 269 RIVERSIDE DR BP-2022-0034 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-028 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-2022-0034 Project# JS-2022-000058 Est. Cost: $2200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAMES FLANNERY 103061 Lot Size(sq. ft.): 43995.60 Owner: THOMSON JULIE Zoning: URB(100)/ Applicant: JAMES FLANNERY AT: 269 RIVERSIDE DR Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508) 294-4052 WC EASTHAM PTO N MA01027 ISSUED ON:7/12/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF ON PORCH ONLY 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. (Pi Certificate of Occupancysignatu I y , � • s4 - I FeeType: Date Paid: Amount: Building 7/12/20210:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner DocuSign Envelope ID:6A5B6B7A-767F 43C7-B3C6 A98A205B571A //: The Commonwealth of Massachusett do oFs 9 PO?1 *R J� Board of Building Regulations and Standar 9Ty�i4o W ` Massachusetts State Building Code,780 CMR �11'pT Nc/,vs, US TY M Building Permit Application To Construct,Repair,Renovate Or Demolis 074414..sed r 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: X n-y>" 3 Date Applied: Building Official(Print Name) Signature D to _ SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Nu s 269 Riverside Dr. 30B-028-0 1 I.la Is this an accepted street?yes no Map Number P el umber 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Julie Thomson Northampton, MA 01060 Name(Print) City,State,ZIP 269 Riverside Dr. 786-269-5486 julie.r.thomson(agmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building 11 Owner-Occupied ❑ Repairs(s) d Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other el Specify: Roofing]. Brief Description of Proposed Work2: strip and replace rolled roofing on front porch roof only • SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 2,200.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ � Suppression) Total All Pees'$ Check No3q1 VCheck Amount Cash Amount: 6.Total Project Cost: $ 2,200.00 Cl Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:6A5B6B7A-767F-43C7-B3C6-A98A205B571A SECTION S: CONSTRUCTION SERVICES • 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2022 James J. Flannery License Number Expiration Date Name of CSL Holder ' l�t S 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 SF Solid Fuel Burning Appliances peakperformanceroofinglic@gmail.com I Insulation Telephone Email address D Demolition 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. peakperformanceroofingllc@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 0 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. 1-DocuSigned by: 7/2/2021 Julie Thomson Print Owner's Name(BIEg.eig, 4 ) 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 �, • //47,02/ Print Owner's or Authorized Agent's N. (E1e 3i onic Sign e) 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.£ov/oca 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:6A5B6B7A-767F-43C7-B3C6-A98A205B571A City of Northampton .:tt 4, Massachusetts /,�w,r � i, v. °� DEPARTMENT OF BUILDING INSPECTIONS y s ' Fg ay,± ( 212 Main Street • Municipal Building vd, �,b it r, Northampton, MA 01060 gloi""�y%j1'�O ten. 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 J. Flannery Signature of Applicant: Date: (0 'Z 1 1 ne uummunweuun of lvlusa•ucnuseus• 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 Are an employer? Check the appropriate box: Type of project(required): 1.L II am a employer with 4 4. 0 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. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 12.121Roof 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.#: R2WC202869 Expiration Date: 4/27/2022 Job Site Address: o�6 I /ei v"—(2-rveLeII VI- City/State/Zip: )1J f a.f )042U C1l�Yv� 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 abo e i/21921 rue and correct. Signature: JP- Date: 6 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#: Worker's Compensation and Employer's Liability Policy Berkshire H ath awa AmGUARD Insurance Company-A Stock Co. y Policy Number R2WC202869 - 41 GUARD Insurance Renewal of R2WC130849 IA Companies NCCI No. [2i873] Policy Information Page(AR) [1]Named Insured and Mailing Address Agency PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC. 1 Lovetleld St 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, 2021 to April 27, 2022, 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 $500,000 Bodily Injury by Disease-each employee $500,000 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 s audit. (Continued on another page) 0 I I. i V C 7 Total Estimated Policy Premium $ 27,082 Total Surcharges/Assessments $ $926.00 Total Estimated Cost $ $28,008.00 INTERNAL USE )0( Page- 1- Information Page MGA :R2WC202869 WC 000001A Date :03/23/2021 MANOTE Issuing Office:P.O.Box AH,39 Public Square,Wilkes-Barre,PA 18703-0020•www.guard.com 7 ® DATE(MM/DD/YYYY) A��o CERTIFICATE OF LIABILITY INSURANCE 04/29/2021 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 have ADDITIONAL INSURED provisions or 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,CISR Webber&Grinnell PHONE (413)586-0111 FAX No): (413)586-6481 (A/C,No,Ext): 8 North King Street E-MAIL s: aedgett@webberandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Admiral Ins Co/BRECK INSURED INSURER B: Citation 40274 Peak Performance Roofing,LLC INSURER C: WCAR-Berkshire Hathaway GUARD Attn:James Flannery INSURER D: 1 Lovefield Street INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 04/22 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. R ADDL SUER POLICY EFF POLICY EXP INS TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAG`E'1 O RENTED 300,000 . CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A CA00003521801 07/07/2020 07/07/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 XIPOLICY❑jECT n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefit $ 2,000,000 AUTOMOBILE LIABILITY (Ea GGMBBINN )SIN©LE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED BCDR47 06/27/2021 06/27/2021 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB 1_, OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH_ AND EMPLOYERS'LIABILITY Y/N 500'000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Eil NIA R2WC202869 04/27/2021 04/27/2022 E.L.EACH ACCIDENT $ (Mandatory In NH) EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ WC:James Flannery is excluded DESCRIPTION OF OPERATIONS/LOCATIONS/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 Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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. • Re 183698 1 LOVEFIELD ST. Expxpiration:ration: 11/03/2021 EASTHAMPTON,MA 01027 Update Address and Return Card. CA 0 20M-05/17 .7ge 6 INi//rhypeO�,�! Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TRIPE:LLC before the expiration date. If found return to: Recjistratl.Rp Fxpi atiort Office of Consumer Affairs and Business Regulation 1838 11/03/2021 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY 1 LOVEFIELD ST. adfss " EASTHAMPTON,MA 01027 Undersecretary No valid without gnature Commonwealth of Massachusetts ,Division of Professional Licensure Construction Supervisor • • 1/4 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:09/21/20' .� JAMES J FLANNERY 1 WIWAMS ST HOLYOKE MA 01040 ;u ,4 • 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(517)727-3200 or visit www.mass.gov/dpl fe-e.ritak0 d .a yeaul- 3i►(( no rink e a.R_cl • pow? 5 taf_e____ r DocuSign Envelope ID:6A5B6B7A-767F-43C7-B3C6-A98A205B571A Peak Performance Roofing LLC 1 Lovefield St. PE K Easthampton, MA 01027 P E R F O R C E 413-203-5888 peakperformanceroofingllc@gmail.com ROOFING MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10394 Julie Thomson DATE 06/28/2021 269 Riverside Dr., Northampton, MA 01060 786-269-5486 julie.r.thomson@gmail.com 01) DESCRIPTIONS -This contract is for the front porch roof only 1. Remove the existing roof materials 2. Install CertainTeed Flintlastic SA rolled roofing(or equal) https://www.certainteed.com/commercial- roofing/products/flintlastic-sa-cap/ Total=$1,300.00 1. Remove the gutter and replace the existing wood fascia board with primed pine. 2. Apply one coat of exterior white paint. 3. Re-install the gutter. Total=$900.00 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 the attic. Please use caution during the process; do not walk/drive under active work or on areas of potential roofing debris. Contractor will obtain a building permit if necessary. Installations are weather permitting. Long periods of inclement weather will cause scheduling delays. Total=$2,200.00 A deposit of one third, $730 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 monthly. TOTAL $2,200.00 DocuSigned by: 7�2�2�21. Accepted ByCAvv____. Accepted Date 5C0B9111 D8C1 477...