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22D-054 « = D = im I V/SA ^ ?Card — c , OIIGOVER :I /I QU EN N EFI LLE www,1800newroof.net ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1.800- NEW -ROOF • 413. 536 -5955 Fully Insured Email: info@1800newroof.net Factory Trained MA Construction Supervisors Lic. #070626 MA Registration #120982 Factory Certified Installers Member at the Home Builder's Association of Western Mass. CT Registration #575920 Member of the Budding & Trade Association Member 01 the Better Business Bureau P.P.G. 38710 Proposal Submitted To Date_3--24,- .2G/J Phone #'s Work: H: ? '2 9 /5 Cell: .SAC - 243 3 7 Stree Email: 1 t — i City, State, Zip Code Special Requirements Complete Roof System 1X shall acquire all appropriate permits for all work Home exterior and landscaping to be protected Entire existing roofing materials to be removed to existing decking Deteriorated existing decking will be replaced at $3.47 per sq.ft. Install Ice & Water Barrier at all eaves. valleys, chimneys, pipes, skylights and sidewalls Install (15 Ib. felt / Synthetic nderlayment over remaining decking area ►! Install Metal drip edge at eaves and rakes (8" / 5 ") (white / brown / copper) Install manufacturers starter shingle on all eaves and rake edges install new pipe boot flashing (standard _/ copper) [ Install new step flashing where necessary (standard / copper) X Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) rat }` .Z4 A Shingles E] 25 year .k year ❑ 50 year Color 't ) H&4 C2"y j___ __ __ Ridge cap shingles Warranty Options: ;We guarantee our workmanship for 10 full years (see our warranty coverage) 'GAF ELK System Plus warranty GAF ELK Golden Pledge warranty Chimney Options: p< Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Sale Price $ 157 S s 2.<T ` sa ] _ Down Payment $ f DC?_ Upon Completion $ /4 � '- � - ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion. Unpaid balances shall accrue with in erest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reason- able attorney's fees incurred by Ada Quennevil ofing and Siding, Inc. to recover any sums due under this contract. x` - - ice 2:).----- r _ Date;. - . - 140/1__ Signature: x ,31,4„/ Phone # Date:3 -2 (0%2011 Estimator's Signature - 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. ,m„ ' ' ' ' ' ' , 1 I l f , . 00 PM R€ i I I dr d I n urdnco 1 4I_ 3 -')J8 bl) U) , ----- DArE199 YY) ACZO CERTIFICATE OF LIABILITY INSURANCE OP ID LL 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA' ION 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 :ertiticate holder in lieu of such endorsement(s). I PROOUCER NAME: _ Remillard Insurance Agcy, Inc PHONE ': — _____ (N R - =MAI o , No): 9'm L 79 T Street , ADDRESS Lyman atze - PRODUCER `- -- - South Hadley MA 01075 CUSTOMER ID #. ADAMQ 1 F_ o';c 413 538 7 862 Fax 413- 538 -7179 INSURER (S) AFFORDING COVERAGE NAICO INSCRc'C 1 INSURER A: First Speciality Ins _Corp — ' Adao, Quenuevilie Roofing &, I __ SU _ - ---- - - ers Company C -- -- -_.. Roofing Inc & GutterShu INSURERO Axrt Mutual innuzance g INS G T ra v e l ers Ins. Co . � din Inc. & Adam uennevillo 1 Of Western MA yy —. -_ _—___ -. -- - -__ 16C Old Lyman Road INSURER D: Hanover Insurance Company 1 22 292 South. Hadley MA 01075 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I C EF F` - D tAT THE CLICIES OF INSURANCE LISTED BELOL' 11A DEEN ISSUED TO Tlir. INSURED NAMED ABOVE FOR THE POLICY PERIOD -„ N'�, JJITHSTAND +C ANY REQUIREMENT TERM OR CONDIDON Jr ANY CL NIRAO I OR OTHER HER DOCUMENT WTIi RESPECT TO WI-11CH THIS j R'I°IC4TE A BE 158003 OR MAY PERTAIN THE INSURANCE AFFCROE3 BY THE POLICIES DESCRIBED HEREIN IS SUBJEC TO ALL THE TERMS, _ ■slo^„E Am; .0031E 10N5 or SUCH POLICIES LIMITS SHOWN MAY HAVE 0E50 REDUCED BY PAID CLAIMS. __ _. .. -I -- -__._ - - --.- _. - -- -- - _ _.._ .__ ._. D._._ MDDIYYYY)L LIME ' -- -- _.__ WVDI . - -_- (M11MfDDIYYYY) IMI ,- — -- .-. -- --. -. ---- i j 1Y00 FL OP'NSJLANCE NSR FOLIC. NUMBER LTCY F POLICYEXP ' GENERAL ABI ,""Y 1 ! EACH OCCURRENCE ' $ 1.000003 ' :' UAMAGL- U RENItu _ T-__ -_- 1 Y .,,:IMIn0 crNLAA I_1AS 3Y IRG98441 10 5/ 23/10 + 1 PREMISES (Eaoccurrencoi I $ 100000 AM0 MADI X I O crUR MEDEXP (Any ono person) $ 2500 I PERSONAL 8 ADV INJURY 1 $ 1000000 - I i (GENERAL AGGREGATE Is 2000000 N! AGGREGATFL;MI FFLESPER ' PRODUCTS - COMPIOPAGG ) S 20 0 ^ FOL:C JE LDC 1' -- - --- 1 AUTOMOBILE LIABILITY T T ICOMEINEDSWGI_ELimn- 1 „' ;NSA;rc BA7450L946 U1!1D 11/0 ,' BODILY' INJURY (Per per5on) $ I . CA'NEO ALfiOS t - -._. .... BODILY INJURY (Per 3c Ien, 9 .50. _E ,U -OS PROPERTY DAMAGE -- - -- .... - -- -- - X HIRED Au 111 (For accicnr2! I b I X 00) •. I NED AU i'')S 1 a - 1 OCCUR j EACH OCCURRENCE 1 UMBRELLA LtA6 I � EXCESS LIAB CLAIMS MADF i 1 ' ' .' AGGREGATE � wi.TIBLL RE,SNTION 3 _ S ._- YIN T— -- - 00 E PrLOYER AWC701286101 1 04/29/10 04/29,/11 S unstur `E)CE�J Y • � I X TORY�LIM O S 3 I AND EMPLOYERS' L I__ -{ - ...__. , 1 E L EACH ACCIDENT 1$ 100000 IA ran c ry n NF) .— L L_ DISEASE- EA EMPLOYE: $ 1000000 k OPERATIONS qu ipment Floater v IHN71 _0610 _ 102/01/10 E DISEASE PDU YuMIT c 10000 00 a 10 j ll 1 02/01/11 Rental ; ■ Equipment $100,000 OESCR FT:ON OF OPERATIONS I LOCATIONS, VEHICLES (Attach AC088109, 1ddltlonal Remarks Schedule, If more space i requ rod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ADAMQUE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ad,m n,,,,,l will hoofing & Siding -- - - AUTHORIZED REPRESENTATIVE 160 Old Lyman Rd, South Hadley MA 01075 // /� C ,r��� ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 20 (2009;09) The ACORD name and logo are registered marks of ACORD e= --N. I 4.4 P .4 ' f • o leu oin eguldris aria tans aro s One Ashburton Place - Room 1301 \f Boston. Massachusetts 02108 COD.Struction Supervisor License license CS 70626 . , Restriction; 00 Birthdate: 8/2111971 T rg. 3712 Expiration: 3/21/20 AQAM A QUENNEV1LLE — _ . — 160 OLD LYMAN RD -- — — — - ----- S 'HADLEY, MA 01075 • . _ ' - ,- _.--:-. - 7 lie - 6 2- olen/marteveda a 'Business t!tia/JOaclui-Jead Office of Consumer Affairs and Regulation 10 Park Plaza - Suite 5170 Boston, Massasetts 02116 Home Improvement '..cgpi4ctor Registration Registration. 120982 Type. DBA (_7(df Expo 3125/2012 Tr# 29306 9 ADAM QUENNEVILLE ROOFING ti.. _.. .' --- --; —........ .c - ADAM QUENNEVILLE - -T•i•---.-= • • 160 OLD LYMAN RD \ -----,LL,7 0 ma , ,,4,/ SO. HADLEY, MA 01075 ' ----- /.:// / Update Address and return card. Mark reason for change. Address 7 Renewal 7 Employment — Lost Card 1,P;., ,a C., SOM-C 5 I STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ........ ;; Be it known that ADAM QUENNEVILLE ), i e4 , I .' 160 OLD *,, ,t,:.,,. 4 ,, -,,A41 , , : s . 3 . - . th 75-2632 SOUTII,e14. : ,,), I i ' :.::.... . ,‘; '' '..,'.; /,' li' •-: . i ..-. is certifled by the Dep ';,-",', • ., ' '-' .. - ,_ *r.4 rtit t ' o ,:l ;;;tection as a registered , ,:. 0 i HOME IMPROL ,,,; %i P'ONTRACT OR " '".:.i..“ ,,,,. , -- • * ' 0 ..,. :T.: ; , ,,t... • ADAM QUENNEVILLE ROOFING Effective: 12/01/2009 . i Expiration: 11/30/2010 .' ---1 ) ---4..... . 1 ' The Commonwealth of Massach usetts Department IittlandrialAccidents k x,,...._ ' ,10 Office of Investigations 680 Washington seat � = Boston, MA O2111 st p www.mem.gov/tha Workers' Compensation Insurance Affidavit: Buildera/Contractors/E bers Apnlicant laf©nnation Please Print i,e ibty 1 __. AP \ Name ( ): m 6, AA I ' A t ' a • s s- " - s SIC, Address:_l 1o1) ()t A L e. City/State/L. + rLi a i f1 Phone #: I - • _ --• Are yew an employer? Check the appropriate boa: TYPe of project (required): 1. I am a employer with 1 �a` 4. [] 1 man a gene c ontract o r and t 6. 0 New construction employees (hill and/or part-time).* hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the ached shut 7. ❑ Remodeling stop and have no employees s� have & ❑ Damoli6ot working forme m any may. em = [No workers' have wtxk' ets 9. ❑ Building addition rkers comp. insurance req ed.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions uir 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plluabng repairs or additions myself. .writers' right of exemption per MGL t 2. Roof insurance required] t c. 152, §1(4), and we have no '�' employees. [No workers' 13.0 Other ____ 1 comp. insurance required.] *Any applicant Ant cboeb boat #I mast also fill out the section below rbowimg their voodoos' compassed= policy information i Homooaaeas who a t h m i t this affidovit =boating * cy ate doing as wort aid hew him atafsida =tract= mast mhmits maw *Wait in diestionsacb. Cosa nt atesdos check this boat mut ataaduda, additional that Mowing de tonne of l aaobeostraaloas atatlate whether :root dose entities him employes. 1f the wbcoatiataom inn employees, hey mast pswida their wodaara' asap. policy number. / an as a pioyer Mel Is providing wtorkets' compemetion kunracee far ay employees. Below 1s the ............. paw sod job she Insurance Company Name: MIA IA 14 u` -u n . )tr-, U t'Y,111 t / P o l i c y # or S e l f - i n s . Lie. #: (} Lt) C 7 O x,49, i0 1 C ( Eamon Date: / oZ 9 ` ( lob Site Address., C f /O (A#t' /f a/ — / C/0 lest - - A City/State/4p: /OA 0/ 6 Attach a copy of the workers' cosapem adisa peaky declare** page (mewing the policy atnaber sad esp4radaa data). Failure to seam coverage as required render Section 25A of MGL c. 152 can lead to the hnpasition of criminal penalties in the form of a STOP WORK ORDER m fine up to S1, 500.00 and/or one-year imprisonment, as well as civil and of a ad 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 Iffvestigations of the DIA for insurance coverage verification. f do hereby cm t under the andpemdttes ofperfary that the brfi nntttllorr povtited � b true and Signatw : Date: g /— /l bone #: l i l 3 - ,5.3 (n - S9 SS Ofidel use only. Do not write in this area, to be completed by city or town offidel city or Town: PeraaiUi # bwiu6 Authority (circle one): 1. Board of Ifeadth 2. Baikfing Department 3. City/Town) Clerk 4. Electrical Inspector 5. Pl uwbatg Inspector ' 6. Other Contact Person: Phone a: 0 r�. t, t`r� r' ,t►w. "4' p SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ / Name of License Holder : . , ' • 70 r2 I; I '1 11 11 i i .1 License Number 160 Old Lyman Road Addres South may, MA 01075 Expiration Date yi 3-5310- Sign re Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quenneville Roofing & Siding, Inc, Re /a0 9 803 Company Name Registration Number 160 Old Lyman Road _ a 5_ Address South Hadley, MA 01075 Expirati . late Telephoney /37.53 595 SECTION 10- 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 ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner occupied DwellinEs 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 building 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 Uri floolutt, SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [J Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] Other [0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. 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 APPUES FOR BUILDING PERMIT I, MArg(rfT ) / /t°� , as Owner of the subject property .J Q Siding, authorize Adam Qo Roofs; & g, Int. to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Adam Quenelle Roofing & Siding, Inc, , 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. A /kM //'€' Print Nam Signs Owner /Agent 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 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW la 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 e. 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, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. :' 4 z1 . 4 i .. \V Department use only j► ity of Northampton Status of Permit: 1 g' ��� uilding Department Curb Cut/Driveway Permit ■ _ 12 Main Street Sewer /SepticAvailabiiity , Room 100 Water/Well Availability \ '`�' Northampton, MA 01060 Two Sets of Structural Plans 'e\ • '" •. ph e 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 5 �d Tehd.c. Rd' Map Lot Unit ren et, /I1 /i 0 /06a Zone Overlay District !! ' Elm St. District CB District _ ....._ SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT ` 2.1 Owner of Record: /� mztrgttre frIt2J 1°ry r` Idefgy A / /L ,S I hrfhPr /'c /- /1 /'ea - Name rint) Current Mailing Address: y /3- ssa - 9'4s6 , Telephone Signature 2.2 Authorized Agent: Adam Quenneville Roofing & Siding, Inc. 160 Old Lyman Read Name Pri Hadley, MA Current Mailing Address: South HA 01V 075 Signa South DWG lf4 J Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building >'/T .cga (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) / S-ka Check Number 7 7O _ This Section For Official Use Only Date Permit Number: Issued: su Building Issued: Signature: Building Commissioner /Inspector of Buildings Date 5 FLORENCE RD BP- 2011 -0793 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22D - 054 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 -0793 Project # JS- 2011 - 001307 Est. Cost: $15582.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 11630.52 Owner: ALLEN BETSY P & MARGARET FLAHERTY Zoning: URA(100) / /WP/WSP Applicant: ADAM QUENNEVILLE AT: 5 FLORENCE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/5/2011 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 4/5/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner