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17C-055 (8) BP-2022-0430 168 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-055-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0430 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: PEAK PERFORMANCE ROOFING Est. Cost: LLC CS-103061 Const.Class: Exp. Date:09/21/2022 Use Group: Owner: GILLETTE DANA L& CAMILLE M GAGLIARDI Lot Size (sq.ft.) Zoning: URA Applicant: PEAK PERFORMANCE ROOFING LLC Applicant Address Phone: Insurance: 1 LOVEFIELD ST 413-203-5888 R2WC202869 EASTHAMPTON, MA 01027 ISSUED ON:04/26/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RESHINGLE SECTIONS OF 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ' � . (� �. . i, . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:54199DDD-F5AA-4B55-82EC-347BA7F5F7D8 i APR 2 2 2022 x ) The Commonwealth of MassachusettsFOR Board of Building Regulations and Standa}rcuiirnnic iNSPEeTicNMUNICIPALITY Massachusetts State Building Code,780 CMR•k>m n,,-N PIA m oqo USE Building Permit Application To Construct,Repair.Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number. �fl ?' -e4 Date A lied: J�Cvlh� ' 2OSS t- —'I 27 2O2 L Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 168 Chestnut St. Florence 17C-055-001 I.1 a Is this an accepted street?yes no Map Number Parcel Number 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 0 Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system 0 SECTION 2: PROPERTY OWNERSIfLP' 2.1 Owner'of Record: Dana Gillette Florence MA 01062 Name(Print) City,State,ZIP 168 Chestnut St. 413-563-9978 dana.gillette@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building le Owner-Occupied ❑ Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ISpecify: Roofing. Brief Description of Proposed Work2: Strip and replace sections of asphalt roof SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only I.Building S 5,400 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost''(Item 6)x multiplier x 3.Plumbing 2. Other Fees: S 4.Mechanical (1-IVAC) S List: 5.Mechanical (Fire $ Suppression) Total All Fees:S it� Check No.4 Check Amount: �� Cash Amount: 6.Total Project Cost: S 5,400.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:54199DDD-FSAA-4855-82EC-347BA7F5F7DB SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103061 09/21/2022 James J. Flannery License Number xpiratioon Date Name of CSL Holder List CSL Type(see below) U No.and Street Type Description Holyoke MA 01040 .J Unrestricted(Buildings up to 35,000 ca.ft.) ' Restricted i&2 Family Dwelling City/Town,State,ZIP • M Masonry RC Roofing Covering WS Window and Siding 413 203 5888 I SF Solid Fuel Burning Appliances peakperformanceroofingllc@gmail.con' Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 183698 11/03/2023 Peak Performance Roofing LLC WC Registration Number Expiration Date FIIC Company Name or HIC Registrant Name 1 Lovefield St. peakperformanceroofingllc@gmaiLcom No.and Street Email address Easthampton, MA 01027 413-203-5888 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. Siened 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 all matters relative to work authorized by this building permit application. DocuSigned by: 4/13/2022 Dana Gillette n, Print Owner's Name(E.ectryz 4334Kci) Date SECTION 7b: OWNER'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 4// /2 Z' 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 vr.vw.mass.<tov/'oca Information on the Construction Supervisor License can be found at www,mass.nov/dos 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" The Commonwealth of Massachusetts ,_ Department of Industrial Accidents �, , .�:t Office of Investigations 600 Washington Street -zap= ' Boston,MA 02111 K www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (13usinessiOrganizationiindividual): 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. "WP I am a employer with 4 4. n I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors b. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees These sub-contractors have 8. n Demolition workingfor me in anycapacity. employees and have workers' t 9. ❑ Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.n Electrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their 11.1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.V�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. }Homeowners who submit this affidavit indicating they arc 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.Lie.#: R2WC202869 Expiration Date: 4/27/2022 Job Site Address:/ 22 Cy ✓""l "I CityiStatelZip' r Ot ao 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$1500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. (.7q/*/ Signature_ Date: Phone #: 413-203-5888 ri41"itt 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 It: DocuSign Envelope ID:54199DDD-F5AA-4B55-82EC-347BA7F5F7DB City of Northampton �yy7-r-4''' SAS . ••. sir, c- A Massachusetts �4? ,.. .� „,Vct DEPARTMENT OF BUILDING INSPECTIONS } � 212 Main Street •• Municipal Building yvb �D Northampton, MA 01060 441, \'‘' ' 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 413-587-4279 The debris will be transported by: Name of Hauler: Aaron's Roll-Off Service 413-529-1100 V(/3/2Z-- James J. Flannery `C /�3/v Signature of Applicant: Date: DATE(MMIDD/YYYY) ACORL® CERTIFICATE OF LIABILITY INSURANCE 05/12/2021 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 NAME: Webber&Grinnell PHONo,Extt (413)586-0111 (AA/c,No): (413)586-6481 8 North King Street E-MAIL aedgettc@webberandgrinnell.corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Admiral Ins Co/BRECK INSURED Plymouth Rock Assurance INSURER B: 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 06/2022 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 LTR TYPE OF INSURANCE INSO SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSD WVD, (MMIDD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE T $ 1.000,000 CLAIMS-MADEX OCCUR PREMISESO(EaENTED occurrrence) $ 300'000 MED EXP(Any one person) $ 5,000 A CA00003521803 07/07/2021 07/07/2022 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER Employee Benefit $ 2,000,000 AUTOMOBILE LIABILITY ,SOM BINE&SIN®kE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ g OWNED X SCHEDULED PRC00001007091 06/27/2021 06/27/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED N/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /"4 AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH PEATUTE ER AND EMPLOYERS'LIABILITY Y I N C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A R2WC202869 04/27/2021 04/27/2022 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE D 0—JP ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD mn72•CR/!eoe€z 1 P 4.& e Jr1e/4- 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: 11/03/2023 EASTHAMPTON, MA 01027 Update Address and Return Card. SCA t 0 20M 051177 / °Me a of ons'umer Affairs& usiness 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 11/03/2023 1000 Washington Street -Suite 710 PEAK PERFORMANCE ROOFING,LLC. Boston,MA 02118 JAMES FLANNERY I J 1 LOVEFIELD ST. / .:��f' • EASTHAMPTON,MA 01027 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor Unrestricted-Buildings of any use group which contain •.onstrsczion Sum-. less than 35,000 cubic feet(991 cubic meters)of enclosed space. CS-103061 Expires: 09/21i1 , JAMES J FLANNERY 1 WILLIAMS ST HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts Commissioner ���✓ State Budding Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl • 'R LAtQ.W a 8 a c V9 OY\<lac • w\AA Ca rc)S • • DocuSign Envelope ID:54199DDD-F5AA-4B55-82EC-347BA7F5F7DB Peak Perfinmsmce 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# 10643 Dana Gillette DATE 04/12/2022 168 Chestnut St. Florence,MA 01062 dana.gillette@gmail.com 413-563-9978 DESCRIPTION -This contract is for certain sections only. See attached diagram. 1. Remove the existing roofing shingles 2. Inspect the sheathing for any rot or deterioration.Any new plywood necessary will be$100 per sheet installed.Any new roofing boards will be $6 per foot installed. (Wood prices subject to change based on market fluctuations) NOTE: We will not be able to confirm the exact amount needed until we begin installation,but based on the damage noted,a minimum of 4-5 sheets will be required. 3. Install six feet of ice and water shield on eaves,three feet in any valleys,and three feet around all penetrations 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: Burnt Sienna 7. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) https://www.certainteed.com/residential-roofing/products/certainteed-ridge-vent-12-filtered/ 8.Complete all necessary flashings including new LIFETIME pipe boots and base flashing around chimney Includes CertainTeed Lifetime Limited Warranty (Transferable) with 10 year SureStart period. https://www.certainteed.com/resources/Asphalt_Warranty_CTR3782_1912_E.pdf 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 reasonable caution during the installation process: do not walk or drive under active work,or on areas DocuSign Envelope ID:541990DD-F5AA-4B55-82EC-347BA7F5F7DB DESCRIPTION of potential roofing debris. Peak Performance Roofing will obtain the building permit. Installations are weather permitting; inclement weather will cause scheduling delays. Total: Landmark shingles=$5,400 A one-third deposit of$1,800 will secure contract,permitting,material order,and priority scheduling. The balance shall be due upon completion,within 10 days of invoice. Accounts outstanding over 30 days subject to 2% finance charge monthly. Warranty confirmation shall be provided upon final payment. Installation and manufacturer warranties are not in effect until Paid In Full. TOTAL $5,400.00 '—°ocu8i°"gd by: Accepted By Accepted Date 4/13/2022 Oar&.a. 6itit f h. 7D76915A9082467... DocuSign Envelope ID: 54199DDD-F5AA-4B55-82EC-347BA7F5F7DB 145 - - C}2 80 21 21 275 21 r (99 519 i 370 518 1g ry�DS 19 � � - - - -