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31A-143 (6) BP 022-1177 34 FORBES AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-143-001 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-2022-1177 PERMISSION IS HEREBYGRANTE'I TO: Project# ROOF Contractor: License: PEAK PERFORMANCE ROOFING Est. Cost: 3900 LLC Const.Class: Exp.Date: Use Group: Owner: TIRK ERICKSON DAVID B& LUCY J Lot Size (sq.ft.) Zoning: URB Applicant: PEAK PERFORMANCE ROOFING LL Applicant Address Phone: Insurance: 1 LOVEFIELD ST 413-203-5888 R2WC342657 EASTHAMPTON, MA 01027 ISSUED ON:09/23/2022 TO PERFORM THE FOLLOWING WORK: STRIP ANE RE-SHINGLE GARAGE 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: 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ' , - 'l •` I ' I Fees Paid: $40.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:EF06452E-86A1-4612-85F8-726139131EFF37 IC?�c i The Commonwealth of Massach etts sep ,i f _' Board of Building Regulations and tan+ :. + FOR ' i Massachusetts State Building Code,78�(1' n •F �C) C>p; 1 TY Building Permit Application To Construct,Repair.Reno teal a i,+ a edtar 2011 One-or Two-Family Dwelling 'oti,,;'spFc This Section For Official Use Only a °eon S Buz • Permit Number. '6P' - 1 i 77 Date Applied: Ev,►J (;`075 /// q-21-26ZZ Building Official(Prim Name) Signature Dare SECTION 1:SITE INFORMATION 1.1 Property Address: 34 Forbes Ave, 1.2_Assessors lap&Parcel Numbers Northampton ?- 1 , 1`f 1 Ida Is this an accepted street?yes no Map Number Parcel Number I 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 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 D Zone: _ Outside Flood Zone? Municipal 0 on site disposal system 0 Check if yes0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Lucy Tirk Northampton, MA 01062 Name(Print) 34 Forbes Ave Cam,State.ZIP 828335 8401 Iucytirk@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 I Remit-5(0)SO Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units I Other )fs Specify: Rooting Brief Description of Proposed Work2• Strip & replace asphalt roof on garage only. , SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building s 3900 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical S 0 Standard City/Town Application Fee ❑Total Project Cost''(Item 6)x multiplier x 13.Plumbing r S i 2. Other Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S Total All Fees:S, Suppression) Check No.Po 6)Check Anwtmn Y Cash Amon_: 6.Total Project Cost: S 3900 0 Paid in Full 0 Outstanding Balance Due: VVI.UO19II CI IVCIVpC IV.CV VCY./LC-our I YV I L-ov/r U-/LVOUC ICI- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ; CSL-103061 09121/2022 James J. Flannery License Number Expiration Date Name of CSL Holder U List CSL Type(see below) No.a"d o Type Description Ff et oyoke, MA 01040 U Unrestricted(Buildings up to 35,000 ca.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 413-203-5888 peakperformanceroofinglIc@gmail.com SF Solid Fuel Bunting Appliances I Insulation Telephone Email address D Demolition 5.2 .Re isttejcdUome Impreo onj Contractor(HIC) 183698 11/03/2023 e orma • HIC Registration Number Expiration Date TUC�mmagy r ilIC Registrant Name 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 'E=1 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subjectherebyauthorize James J. Flannery/ Peak Performance Roofing LLC bJ property, to act on my behalf,in all matters relative to work authorized by this building permit application. Lucy Tirk 9/11/2022 Print Owner's Name(Eleectronic6Siggriature) 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 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 1 www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.govIctpi 2. When substantial work is planned,provide the information below: Total floor arca(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" uocu ign tnveiope tu:trub4)ZL-25nA1-4b1L-2f5rt-/zbtsatiltrrs/ Peak Performance Roofing LLC 1 Lovefield St. Easthampton, MA 01027 413-203-5888 P E K peakperformanceroofingllc@gmail.com P E R F O R C E ROOFING MA HIC #183698 MA CSL#103061 ADDRESS Lucy Tirk 34 Forbes Ave, Northampton 828-335-8401 lucytirk@gmail.com ESTIMATE# DATE 10787 09/09/2022 JOB LOCATION 34 Forbes Ave, Northampton ACTIVITY DESCRIPTION OTY RATE AMOUNT Asphalt This contract is for the GARAGE ONLY. 1 3,900.00 3,900.00 Residential 1. Remove the existing roofing shingles 2. Inspect the sheathing for any rot or deterioration.Any new plywood necessary will be$80 per sheet installed.Any new roofing boards will be$6 per foot installed. (Wood prices subject to change based on market fluctuations) 3.Cover entire surface of roof with synthetic underlayment 4. Install new 8"aluminum drip edge on all eaves and rake edges 5. Install architectural shingles by CertainTeed: LANDMARK: MOIRE BLACK http://www.certainteed.com/residential-roofing/products/landmark/ 6. Install Shingle Vent II ridge vent on peaks of roof(where applicable) httpsi/www.certainteed.com/residential-roofing/products/certainteed-ridge-vent- 12-filtered/ 7. Complete all necessary flashings. 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. Installations are weather permitting;inclement weather will cause scheduling delays. uocubign tnveiope iu:truti4bZt-tsbAi-4b1z-obt-13-1zbtsatsit1-1-3i ACTIVITY DESCRIPTION OTY RATE AMOUNT Peak Performance Roofing will obtain the building permit. Warranty confirmation shall be provided upon final payment. Installation and manufacturer warranties are not in effect until Paid In Full. Includes CertainTeed Lifetime Limited Warranty(Transferable)with 10 year SureStart period. https://www.certainteed.com/resources/Asphalt_Warranty_CTR3782_1912_E.pdf Total:$3900 A one-third deposit of$1300 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 $3,900 00 c--DocuSigned by: 9/11/2022 Accepted By -F3BAAED2F9F14FA Accepted Date tfi" dt The City of iithampton - ;. z= Building Department �,, 212 Main Street ��, Northampton, Massachusetts 01060 Phone(413) 58%-1240 Fax (413) 537-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, 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, s150A. \L The debris will be disposed of in: Pc L(fJn ?-„,_\i ,A , ,...sD ., Location of Facility G_b ► b • 'b. , o , ., ' • 113 The debris will be transported by: Name of Hauler ApA(b t 5 D -I 7 I ou\i pc-vs DR.\\ - t-J Signature of Applicant: Date: 9, I rj 2 b Z a- The Commonwealth of Massachusetts _ Department of Industrial Accidents -. ----,a.t. Office of Investigations 4 s t 600 Washington Street a = _ Boston,MA (12111 =-;4 -, - v.mass_govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name(BusinesaJOrganirationtindi4iduaij_ Peak Performance Roofing. LLC Address: 1 Lovefield St. City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888 i Are g u an employer?Cheek the appropriate bit: 4I am a enerai contractor and I , Type of project(rewired): .t'►�[1 am a employer with g I 6. 0 Nee,construction 's employees(full and/or part-time).* have hint the sub-contractors 1 ` 2_❑ I atn a sole proprietor or partner- listed on the attarhed sheet. I 7. LI Remodeling . ship and have no employees These sub-contractors have j B. f I Demoliti n_ working for me in any capacity_ employees and have workers' i • iNo workers'comp.insurance co ist4ttr'atice' ( 9_ 0 Building addition wed.) 5.❑ Wt:arc a corporation and its I 10.0 Electrical repairs ur additions _..0 I am a homeowner doing all work officers have exercised their 1 11.0 Plumbing repai s or additions myself.[No workers'co right of exemption per MGL yi cc. 152,§1 t`tjl,and we have no 1 t 2 Rcilf repairs ' insurance required.]_ employees.. No workers' i 13.0 Other — . r i comp_insurance required 1 J Any applicant that thteks box#1 must also fin out the section below stho'ine their workers'compensation policy information- 1 Homeowners who submit this affidavit indicating they are doing nit crock and then heir:outside contractors must submit a new aWdinii%t • cling such, 'Contractors that cheek this box mist attached an additional sheet showing the name of the sub-e_nntmciors aced state whether tic not tht :L. itics have employers. If th,:sub-conuactoas have employees.they must pro>:idc their workers'comp.policy number. I am as employer that is providing workers'compeasatwn insararlce for my employees. Below it the policy . job site information_ y Berkshire Hathaway Guard Insurance ct ,an Name: .. ...... .,. _..,.._._. R2WC2.028 9 Policyfl or Self-ins.Lit.#. � 6 Expiration Date; �-,. . 1 �� o a Sib Site Address: 3 Li l o r�7P_5pc.ic City/Statc!Zip:_ oY ' • ,A I 010 e )- Attach a copy of the workers'compensation policy declaration page(showing the policy number and e.,, ation date). Failure to secure coverage as required udder Section 25A of NIGL e. 152 can lead to the imposition of criminal i pretties Of a fine up to S1500.t)O and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK 0` 'ER and a fine of up to 525090 a day against the violator. Be advised that a copy of this statement may be forwarded to the 0; ice of Investigations of the DIA for insurance coverage verification. I do hereby cerllfy under the pains and penalties of perjury that the information provided above is true and . # a sett, :�.__._�_��� �._. _ . . _r� , • �_ . �an : � I S a 2.2- _ _.___,__ lit_ a�3- cry- t1 4' f ' _ —+ 1) ©f icial use only- Do not write in this area,to be completed by city or town official. ' i ¢i . City or Tossii Permit/License4 } Issuing Authority(circle one): II I.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical inspector 5.Plumbing,inspector ill6.Other Contact Person: Phone%tr. . ,.... it �i z /7/ e/-" ./ • // 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 fa 20M-00t17 A. YP/1////r/1//'r//���/'/, ORice 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 Expiraatti 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 1 LOVEFtELd ST. �d ( tf • J JJ EASTHAMPTON,MA 01027 UndersecretaryNot valid without signature Commonwealth of Massachusetts Division of Professional Licensure Construction SuperVisof unrestricteBoard of Building Regulations and Standards -Buildings Of ang►use grv4p which certain less than 33,000 cubic teat(991 ttib1 ers)of enclosed ., , 0 sue. C S-1 03061 Expires:09/211b'* 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 Commissioner license. For information about this license g R Call(617)727-3200 or visit www.mass_gov/dpl lzosti„ojza cit,ka.lwJAA c• ,rci ) ACORE CERTIFICATE OF LIABILITY INSURANCE DATE It't!DD/1'YYY' .121/zo22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS I 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 iNAMECONTACr Adina Edgett, CISR Webber & Grinnell PHONE (413)586-0111 FAX No: (413I5e6-6421. 8 North Ring Street ADESS: aedgett0webberandgrinnell.com INSURER(5)AFFORDING COVERAGE ' NAIC it Northampton to 01060 INSURER A:Crum & Forster Specialty/BRECE INSURED INSURERB:Plymouth Rock Assurance 14737 Peak Performance Roofing, LLC wsuRERc:NCAR- Berkshire Hathaway GUARD Attn: James Flannery INSURER D: !�_•_,-�,___..-__ __. 1 Lovefield Street INSURER E: Easthampton NA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 06/23 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 THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THEIti!=ms . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L I I TYPE OF INSURANCE ADOL VIVO POLICY NUMBER MIWOO YYYY) (4srooryYYY) LAMS I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,080,000 A !CLAIMS-MADE I Z PR Ett05MIS OCCUR PR TO RENTED 100,000 TO (Ea Oeclmrence) s G10089451 7/7/2022 7/7/2023 MED EXP(Any One person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENT.AGGREGATE LIMIT APPLES PER: GENERAL s 2,000,000 x POUCY JECT LOC PRODUCTS-COMPIOPAGG s 2,000,000 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE NOWT S 1,000,000 (Ea accedern) ANY AUTO BODILY INJURY(Per person) S B AUTOS OWNED x SCHEDULED PCC00001007091 6/27/2022 6/27/2023 BODILY INJURY(Per model) S x HIRED AUTOS x ANOt YYfNED (Per STY DAMAGE s �^ Marts.. Oaerneris 5 5,000 (UMBRELLA!JAB OCCUR EACH OCCURRENCE S � i EXCESS LIAR CLAWS-MADE AGGREGATE S 'DED RETENTION S S WORKERS COMPENSATION - x PER ATUTE I ER AND EMPLOYERS'NUBILITY ZANY PROPRIETOR/PAHTNERIEXECUTIVE Y/N EL EACH ACCIDENT S 500,000 L.- IOFFICER.MEMBER EXCLUDED? I = I N/A (yldMgy In IOU) I211C342657 4/27/2022 4/27/2023 EL DISEASE-EAEMPLOYEE S 500,000 `r yes.Oescnbe under DESCRIPTION OF OPERATIONS below Sanas Flannery is eseLIM IT EL DISEASE-POLICY S 500,000 I 1 1 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Remarks Schedule,may be anaclad B owe weenie ea4.Imt I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE I W Grinnell, CPCU, CIC 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025: o;:a: