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31A-263 (6)
BP-2022-0666 71 DRYADS GREEN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-263-00I 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-2022-0666 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: PEAK PERFORMANCE ROOFING Est.Cost: 3200 LLC CS-103061 Const.Class: Exp.Date:09/21/2022 Use Group: Owner: V TURNER KHAHTEE Lot Size (sq.ft.) Zoning: EU/URC Applicant: PEAK PERFORMANCE ROOFING LLC Applicant Address Phone: Insurance: 1 LOVEFIELD ST 413-203-5888 R2WC202869 EASTHAMPTON, MA 01027 ISSUED ON:06/07/2022 TO PERFORM THE FOLLOWING WORK: ROOFING REPAIRS 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: n f• X11 • Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:049EB5FB-BE08-489D-BOCD-3DE74DC613F0 RECEl ?c e'''' E,,, wealth of Massachusetts / JUN _ l2O22B , CBnilding Regulations and Standards FOR tvaiCIP ssachusetts State Building Code,780 CMR NiU EMI TY /. "r3THAMbaig . Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 70N.Mq�ro60 NS One-or Two-Fancily Dwelling This Section For Official Use Only Buil ' Permit Number: ( O a• ....- Cie (� Date Applied: kEt.)43 I 53 62-7.ZQZZ Building Official(Prim Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 63 Dryads Green 31 A-263-001 l 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards I Rear Yard Required Provided Required Provided I Required t Provided 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Cl Private Cl Zone Outside Flood Zone? Municipal O On site disposal systcin ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Khahtee Turner c/o Jenni Gunnell Northampton MA 01060 Name(Prim) City,State,ZIP 63 Dryads Green (347) 756-1926 jennigunnell8@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 I Existing Building I Owner-Occupied 0 Repairs(s) I Alteration(s) 0 Addition ❑ Demolition ❑ I Accessory Bldg.0 Number of Units Other WSpeciff. Roofing. Brief Description of Proposed Work`: Apply Gaco rog coating. Install copper ridge cap. Install small gutter. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building S 3,200.00 1. Building Permit Fee:$ Indicate bow fee is determined: 2.Electrical S O Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x muhiplier x 3. Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) i S ' List: 5.Mechanical (Fire S Suppression) Total All Pe s: S oft a Check No. Check Amount: 1 V Cash Amount: 1 6.Total Project Cost: b 3,200.00 0 Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:049EB5FB-BE08-489D-BOCD-3DE74DC613F0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) • CS-103061 09/21/2022 James J. Flannery License Number F.xpirarion Date Name of CSL Ilolder List CSL Type(see below) U No.and Street Type Description Holyoke, �1 0 U Unrestricted(Buildings up to 35,000 ea. ft.) Restricted I&2 Family Dwelling M ason City/Town,State,ZIP R Masonry RC Roofing Covering WS Window and Siding 413-203-5888 SF Solid Fuel Burning Appliances peakperformanceroofingllc@gmaitco I Insulation Tel •hone Email address D Demolition 5.2 Registered Home Improvement Contractor(FIIC) 183698 11/03/2023 Peak Performance Roofing LLC HIC Company Name or H1C Registrant Name kI1C Registration Numhcr Expiration Date 1 Lovefield St. peakperformanceroofingllc@gmail.com 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. Signed Affidavit Attached? Yes No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUTLDD'G PERMIT I,as Owner ofthe subject property,hereby authorize James J. Flannery/Peak Performance Roofing LW to act on my behalf in all matters relative to work authorized by this building permit application. t—DocuSlanedby: 5/6/2022 Khahtee Turner do Jenni Gunnell jutytl r'rldl/tLt1�1, Print Owner's Name(Electronic Signatures eoFtacauasa4zc.. 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 one 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: I. 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 Rome Improvement Contractor(FIIC)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.eov/oca Information on the Construction Supervisor License can be found at ww v.mass.eov/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 hearing 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 Office of Investigations 600 Washington Street :; Boston,MA 02111 ` www.mass.gav/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 ypu an employer? Check the appropriate box: Type of project(required): 1.iNfI am a employer with_ 4 4. ❑ I am a general contractor and I b. Ej 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. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance. t required.] 5. [] We are a corporation and its 10.[]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.] 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 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.Lic.#: R2WC202869 ,._ Expiration Date: Job Site Address: 10'7 1I\(C(d 7 g� City/State./Zip; 6 facC 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. Signature: � Date: Phone 1t: 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DocuSign Envelope ID:049EB5FB-BE08-489D-BOCD-3DE74DC613F0 City of Northampton a Massachusetts 1 �¢` . M DEPARTMENT OF BUILDING INSPECTIONS t��yQ 212 Main Street •• Municipal Building �sc. Northampton, MA 01060 'tyft l'',°' 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 James J. Flannery C Signature of Applicant: Date: 7i 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 I O 20M-05/1�177 Offke of consumer rrss& ustneess Regulations HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration EXpirliti.013 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 cet. 1 LOVEFIELD ST. EASTHAMPTON,MA 01027 Undersecreta Not valid without signature ry V Commonwealth of Massachusetts Division of Professional Licensure Construction Supervisor Board of Building Regulations and Standards Unrestricted-Buildings of any use group which contain :onstri,:Gtion Supervisor , less than 35,000 cubic feet(991 cubic meters)of enclosed space. CS-103061 1 pires:09/21q , JAMESJFLANNERY 1 WILLIAMS ST HOLYOKE MA 01040 Failure to possess a current edition of the Massachusetts CommissionerCL State Building Code is cause for revocation of this license. For information about this license Call(517)727-3200 or visit www.mass.gov/dpl .o.Acc— $ c C A-1Vl1 001( (ICE LjakA Ca \rc) 5 DATE(MWDDNYYY) 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 PA/C. E o.Ext). (413)586-0111 FAX No): (413)586-6481 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC S Northampton MA 01060 INSURER A: Admiral Ins Co/BRECK INSURED INSURER B: Plymouth Rock Assurance 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 ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED 1.000,000 CLAIMS-MADE /� OCCUR PREMISES(Ea occurrence) $ ��'�� MED EXP(Any one person) $ 5,000 A CA00003521803 07/07/2021 07/07/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000000 JECaT LOC PRODUCTS-COMP/OPAGG $ 2'�0'000 X POLICY OTHER Employee Benefit $ 2,000,000 AUTOMOBILE LIABILITY G6MBINED-3INOLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED PRC00001007091 06/27/2021 06/27/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED %/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE �. N/A R2WC202869 04/27/2022 04/27/2023 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 I 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:O49EB5FB-BE08-4890-BOCD-3DE74DC613F0 Peak Performance Roofing LLC 1 Lovefield St. P Easthampton,MA 01027 413-203-5888 PERFOR CE peakperformanceroofingllc@gmail.com ROOFING MA HIC#183698 MA CSL#103061 Contract ADDRESS CONTRACT# 10665 Khahtee Turner c/o Jenni DATE 05/06/2022 Gunnell 63 Dryads Green Northampton,MA 01060 (347) 756-1926 jennigunne118@gmail.com DESCRIPTION ROOF COATING: 1. Power wash roof surface at rear of building. 2.Apply GacoRoof coating according to manufacturer's specifications. https://gaco.comlwp-content/uploads/2016/02/GacoRoof brochure-WEB.pdf GacoRoof comes with a 50 year warranty and 10 year labor warranty.If any leaks occur during the 10 year period commencing on the date of final payment,we will investigate and make any repairs that are caused due to faulty application by the contractor. COPPER RIDGE CAP: 1. Install Copper Ridge Cap on the Dormer of slate roof. SMALL GUTTER: 1.Remove the existing gutter. 2. Fabricate and install 6" gutter and downspout. 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 of potential roofing debris.Peak Performance Roofing will obtain the building permit.Installations are weather permitting; inclement weather will cause scheduling delays. DocuSign Envelope ID:049EBSFB-BE08-4890-BOCD-3DE740C613F0 DESCRIPTION COST SUMMARY: Roof Coating=$1,900 Copper Ridge Cap=$700 Gutter=$600 TOTAL= $3,200.00 A one-third deposit of$1,000 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. TOTAL $3 ,00 Accepted By DOeY""N01�` Accepted Date 5/6/2022 EDF18C42433442C_..