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25-068 BP-2011-0361 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit# BP- 2011 -0361 Project # JS- 2011- 000268 Est. Cost: $18285.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groun: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 13372.92 Owner: LANG JESSE L Zoning_SC(100)/ Applicant: ADAM QUENNEVILLE AT. 67 RIVERBANK RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON :1012012010 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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: 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/20/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sever /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be completed by office (7 K vub 0'nt4� Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record SeSSe .any 67 W % a r\ k /9d, N oc jiw.�r}on� aa oio b o Name (Print) Current Mailing Address: 413 5 'Scs' - 9y 17 Telephone Signature 2.2 Authorized Agent: Aac,w, OvcnntV ►11(, 1W Gt�Lymo� (�� Sou�1,N�.tey� Name (Print) Current Mailing Add ss: 41 3 - sic -s4 S Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (Y (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3+4+5) Check Number This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved p arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO ® DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained © , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, xcavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [lam] Other [C]] Brief Description of Proposed Work: 4 6 1i:. Ar`a pluwooZ —h pvkon PkwSk-A% Alteration of existing bedroom Yes x No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Y' No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: _ Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, :JG SS a L& as Owner of the subject property hereby authoriz �� ��� to act on my behalf, in all matters relative to work authorized by this building permit application. iU -IS -(J Signature of Owner Date I. my= InG , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. AdC.*. Print Name lU -lS -)o Signat foreu Winer /Agent Date 1�� 1.� � �i�R'Nif ��ia SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applica Name of License Holder : MW Q= R & swi& loc. 1 7 0 � DXo 160OW Lyon RoW License Number -2� -1< Address � Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ fr aw& RWM & W i lea , l ao950 Company Name 160 OW Lynn Rood — Registration Number 3 -;)Ls— (2 Address y , Expiration Date Telephone 41 3-53( , - SASS SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(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...... ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, You may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 'low ( jpotloq J onom Ile 7f: fqM 7 �j , Jul' VISA �a wm_w_ Z QUENNEVIL �� ROOFING & SIDING, IN E - www.1800newroof.net 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1. 800 - NEW -ROOF a 413 - 536 -5955 Fully Insured Email: info@ 1800newroof.net Factory Trained MA Construction Supervisors Lic. #070626 MA Registration #120982 Factory Certified Installers Member of the Home Builder s Association of Western Mass. CT Registration #575920 Member of the Building & Trade Association Member of the Better Business Bureau P.P.C. 38710 Proposal Submitted To: Date Oti2- 10i Phone #'s Work: H: 413 5 it 7 C ell: — Street Email r Clty, State, Zip Code i Special Reee uirements Complete Roof System We shall acquire all appropriate permits for all work Home exterior and landscaping to be protected L J $] Entire existing roofing materials to be removed to existing decking N Deteriorated existing decking will be replaced at y3._17 per sq.ft. X1 Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls [� Install (15 lb. feltSyDheic under layment over remainm Lng area Install Metal drip edge at eaves and rake (8' / 5 ") (whi /brown copper) ® Install manufacturers starter shingle on all eaves and rake edges ® Install new pipe boot flashin (stand 9 copper Install new step flashing where necessar (standa) / copper) Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) Shingles ❑ 25 year 30 year ❑ 50 year Color Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years (see our warranty coverage) Qg GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney Options: Lead Counter Flashing ❑ Water Seal & uckp"Rubberized ❑ Metal Chimney Cap We Propose hereby to furnish materials and labor - omplete in accordance with above specific tions for the sum of: - 2 C > � J� Total Sale Price $ `�? -____ Down ay (n``t��$C < — Upon C pletion $ r J 1 ACCEPTANCE OF PROPOSAL: The above prices, sp2clficattons and conditions are sat' actory and are hereby accepted. You are authorized to do work as specified. Pay_ t will be 1/3 down upon signin d balance due upon completion. Unpaid balances shall accrue with interest at 18% p annum. Purchaser(s ay for all costs, expenses and reason- able attorney's fees incurred by Adam Quenneville Roo i iding, to recover any sums due under this contract. Date: _G_ 1. 1 7. _ll' _ -- Signature ,�x 1 Phone # - - -�. 1 Date jl _`t " t Estimator's ature: _ ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage areas due to the possibility of roofing debris or dust coming in through cracks of the wood. Adam Quenneville Roofing and Sidings will not be responsible for debris or dust in the attic or storage areas. IAN The COMNwxweakh of Mamachusels Deparla� of'�irr�A Office 00"esggadons 6W W'osJftbrg W S~ WW9 Bostotr, MA 02111 xavrv. gorr/&a Workers' Compeaastion be"Muce Afdavit: Bea Mers/CoaU 'mctricians/Plembers AMWIR Please Print Logm Name (BWnass/organi Jlndividuai): - �1� Y � 1 ed ba \�1 a " �� ntt�L ✓ C A ddress: 1� 0 nl A L n CA, CW/S ) t 7 Ptoue #: jf --- Are ym = empoyer? Ctmck tic appropri to bW- I'M of Project (ro4dbvm: 1.0 I mn a employer with I_!E3,____ 4- ❑ 1 am a general contractor and employees (fun and/or part-time).* have hired the suboouttadors 6. ❑ New cotnwtion 2. ❑ 1 am a sole proprietor or partner- listed on the cued sheet 7- ❑ Remodeling ship and have no employees Thm sulb- � have & ❑ Demout m working for we in any deify. employees and have workers' 9. ❑ B��B �� [No workers' comp. ix comp. .t 10. Electrical a or additions 5. 0 We are a corpomtim and its ❑ � 3. ❑ required.] a homeowner doing an work officers have exaased their l l.❑ Phnnbiog repairs or additions myWV Rio workms' Comp right of wwraptim per MOL 12. Rooftepairs u�nanoe re4Wre&] t c. 152, §1(4), and we have no 13.E Odor e�yeeL [No worimW comp. insumme .] •Aar rpplieoaot to doff bou ft mmt alto m oat Wo mWoe below abowia6 f> Ck wodWe ooraram doa rover information. t ttomeorrrerawho sabeaifiia at�daritmdradrigflralr aaa doioaat wedcaod.�.bieaarraide motoason moetadoritanew at�g aoch.. seaarr.aoraflae d�airboo� addilirarl rbaetatiowi�fieaaraeoPUrcaobaeoaaaaors aoaaeacalteliera- aoct�e are earloyaea. if t>tear>toodradoa i.wa eaiployee� tiny � praviae ffiar wodoms' �- t+� aosiKr. I iurr sae aaloleya ttrrrt la p ' coraperes�larr b mace. jor erg' eanpd�ee�. Below it W policy aafjsb sfe Lvbnnmgba I Company Name: U�gat Xrr u O2 yjC e... Policy # or serf -ins. lac. #: ja WC_ r101gq to j C31 Expiration Dole: 61 1 job site Address: G 7 R V e k R a.- /Vnc k ko,%, koy% tA City/: V ► U v Attack a cW of tke wartrees' po ft fke6rathm Pop (fit &e policy a* ulh P =A esphutise dafte Faihrre to secure covaW as regabW under Sec ti�tm 25A of MOL a 152 can lead to the Mposition of ai.W peaelties of a fine up to S1, 500.00 and/or one -year kPUOMM*, as WeR as cxvn penaMes in the form of a SMP WORK OR )Etc and a fine of up to $250.00 a dsy 4ptinst the vbla/or. Be advised that a oogy of this Mmeat may be forwarded to the Office of Imestiptiom of the MA for insluaaee coverage verification. S D Ile fraa6y rrndar lfit ardpuaal� ofperiirry tfret t>Cit b� P� is brk awdcoerax i u - ls' - lo Phone OJ W use only. Do net W*e In AW mem, to be conrpkAW by d& or Mm qPWd City or Town: # b is6 AardwW (tuck one): 1. Board of ff 111 2. Big meat 3. City/rown Cleric 4. Electrical inspector S. Phumbing inspector 6.Otker Contact Person: Pkone #: ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DM DATE (MMrpory' `n ADAM -1 06/24/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 I Phone: 413-538-7862 Fax : 413 -538 -7179 INSURERS AFFORDING COVERAGE i NAIC # INSURED INSURER A: AIM Mutual Ineu=nce company INSURER B: Travelers Ins. Co. Adam Quenneville Roofin & INSURER C: First S ecialit Ins Co Sidingg Inyycmm& Guttershutger rp Sou th i Hadley n MA 01075 ;INSURER D: Hanover Insur Comp are 22292 i INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. EFFECTIVE LTR IJSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDONY DATE (MMID LIMITS ! GENERALLWSILM I EACH OCCURRENCE $ 10 00000 C X COMMERCIAL GENERAL LIABILITY TBI 06/23/10 06/23/11 I PREMISES Eaocaxence $ 100000 CLAIMS MADE OCCUR MED EXP (Any. person) $5000 I PERSONAL A ADV INJURY f$ 1000000 ' I i GENERAL AGGREGATE s2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO j 8 2 00 0 0 0 POLICY JECT � LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 51000000 B _ ANY AUTO BA7450L946 11101109 11/01/10 (Feacdidem) ALL OWNED AUTOS BODILY INJURY I X . SCHEDULED AUTOS (Per person) I S X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per aceldenh $ ( PROPERTY DAMAGE I ! (Per accident) i $ I GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ ANY AUTO ! OTHER EA ACC S I AUTO ONLY. AGO S EXCESSNMBRELLA LIABILITY EACH OCC URRENCE 5 L OCCUR CLAIMS MADE I ! AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY A ' AwC701286101 04/29/10 04/29/11 I E.L EACH accro ENT $ 1000000 ANY PROPRIETORRARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED7 I E.L. DISEASE - EA EMPLOYE $1000000 If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE - POLICY LIMIT : S 100 0 000 OTHER D Equipment Floater IHN7140610 02/01/10 02/01/11 Rental i Equipment $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SERVMAG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AU�OREPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 J la/oAs= �ar s oar o u ing egu One Ashburton Place - Room 1301 Boston,. Massachusetts 02108 Construction 'Supervisor License 70626 . • .. .License CS: . . Restriction: 00 Birthdate: 8/21/1971 Tr# 3712 Explrati on: 6/21/2011 A[)AIVb'A, QUENNEVIL• LE 1!.60 OLD 'LYMAI i RD - -- .S MA 01075. ` 91?e -P�� Office of Consumer Affairs and f siness Regulation 10 Park Plaza - Suite 5170 Boston, Massa usetts 02116 Home Improvement � ctor Registration Reqistration: 120982 Type: DBA " r Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFIN M ADAM QUENNEVILLE �� r 160 OLD LYMAN RD SO. HADLEY, MA 01075 Update Address and return card. Mark reason for change. �r 5,4 E] Address 7 Renewal 0 Employment Lost Card DPS -CA1 t5 SOM-04/04- G101216 STATE OF 'CON.NECTICUT +DEPARTMENT OF CONS TM R pR4T CTION 4 Be it known that A►M QUENNEVILI; 160 01M. ROAD _.. 75 -2b32 • li � � ��� l is certified, by the Dep _ ri r3 tection as a registered HOME O . IMPR NTRACTQR Regis X20 r" �`R�rvsr ADAM . •UENNEVILLE ROOFING Effective: 12 /01/2009 I Explratlon: 1,1/30/2010 Jerry Farrell;: Jr., Coma ssignet