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23A-017 I:A uate /Iline u7 /us /LulU 1L: .E 1 413 538 6010 P.001 May- 03.2010 02:22 PM. Remillard Insurance 1.413•538.6010 1/1 ACCRA CERTI$ ICATE OF LIABILIT INSURANCE O JD 2DM DATE 05 Ma3 0 r PRODUCER i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ! ONLnAND 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 BYITHE POLICIES BELOW. South Hadley VA 01075 Phone : 413- 539 -7862 Fax :' 413- 538 -7179 INSURERS AFFORDING COVERAGE _ NAIC # INSURED • INSURER�A•, Air Fermi] inearrnce CaoP$nY ._ INSURER!;: Travelers Ins . Co . • — Adam Quenneville Roofing & INSURER ;c: 8 00ttsdala Ins Co. sdin InTTC��DDaa Sou Lyman MA 01 INSURER D: 075 INSURER E: COVERAGES- I THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OR ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i iNSK UJU L POLICY NUMBER DATE E FFE C TIV ATE (MM1D LIMITS CE S 1000000 LTR I TYPE OP INSURANCE _ GENERAL LIABILITY EACHO CCUIiREN Uw 1U Rt4L a• C X COMMERCIALGENERALUABILWY CPS1034980 06/23/09 06/23/10 pREMISES (Ea ccr•Ircerxe' 5100000 CLAIMS MADE I "] OCUR MED EXP. )Any oae person) S 5000 PERSONAL & ADV INJURY S 10 0 0000 I 1 OFNERALAGGREGA.TE a 2000000 GEN'L AGGREGATE LIMIT APPLIES FiER: ( PRODUCTS •COMPIO!PAGO 5 2000000 7 POLICY ^ 1 2•61 7- 1 LOC I AUTOMOBILE LIASIUTY COMBINED SINGLE LIMIT 91000000 g ANY AUTO SA74501,946 11/01/09 11 /01 /10 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ _, (Per person) X SCHEDULED AUTOS -' — X HIREDAUTOS • BODILY INJURY ' 5 (Per accdent.) X NON•OWNEOAUTOS _. PROPERTY DAMAGE S (Per accident) ' AUTO ONLY • EAACCIDENT S GARAGE UA ;IUTY H ANY OTHER THAN — ACC $ . AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S 7 OCCUR n CLAIMS MADE AGGREGATE $ 4 DEDUCTIBLE •; RETENTION B X IT {{ ORY41� 8 'C [ C� �:! WORKERS COMPENSATION AND A EMPLOYERS LIABILITY AWC701286101 04/29/10 04/29/11 - E.L.EACH s 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE LUDED E.L. D;SEASE w EA EMPLOYE s 1000000 OFFICER/MEMBER EXCLUDED? It yes, describe under I E.L. DISEASE • POLICY LIMIT 91000000 SPECIAL PROVISIONS below OTHER ' r DESCRIPTION Or OPERATIONS I LOCATIONS r 'MNICLas r EXCLUSIONS ADDEO BY ENDORS SPECIAL PROVISIONS CERTIFICATE HOLDER I CANCELLATION , AD Quz SHOULDIANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION Adam QUenneViIle Roofing DATE 7H, REDF, THE ISSUING INSURER WILL ENDEAVOR TD MAIL 30 CLOGS WRITTEN' Brian NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL fax #53 6 -144 8 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR PO $OX 612 REPRESENTATIVES. South Hadley MA 01075 -- O ED REPRESENTATIVE • 0 ACORO CORPORATION 1988 ACORD 26 (2001/06) . . ; ,.., "„ , ea. . „ AN =# /` lns al'].. tan. ar i s • : , oar. o • ui • ing egu o One Ashburton Place - Room 1301 -�- Boston, Massachusetts 02108 • wf, Construction Supervisor Lic License rict on: C081205:111971 706 , , .. Resti Birthdate: Expiration; 8(21(2011 Tr# 3 AQA A; .• 60 OLD LYMAN RD _ _ $, 'HADL:EY, MA 0107 Update Address and return card. Mark reason for nge Address Renewal [] Lost cha Card t...../Ae -621 0 .., • ,r te , -= 1 t L 1 ! _ r � _ Office of Consumer Affairs and usiness Regulation �1= 1-0 Park Plaza -Suite 5170 .� Boston, Massa �usetts 02116 Home Improvement,;. oriffsctor Registration ---- Reg istration: 120982 T ype: DBA "'"'""" ' i w Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFIN -_ .., . `� ADAM QUENNEVILLE _'� d - 160 OLD LYMAN RD== SO. HADLEY, MA 01075 .~ ' <, 4 ,," Update Address return card. M reason for 'k s ', Address Renewa l [� .Employ ment Lost Ca change. rd DPS -CA1 Ci 50M- 04/04- G101216 �, _ 1 . :, • , r 3 L } : :s. y � • i! ' F - • :l - _ 'ii � "i •1 1 I _ y y " i At .: + ' : :. II. '.'4 1 . r,f { . ,I , Y•. � :d. . ' j ,1 'O 4 I °ti I _ " .. F ' •rs• . _J { /:::::.:3 '•4 1' � 1 � 'e I J. .' Yr i 1 . `r'u'• ' l { 5 f � / - v EL ,., 1 :' : . 4 �. • 'i;:. 1 5 5" . . r. .W ; l .Y V. - ._.G. 4 •• •.YV in t •. ' 1 - ( r `1 V i . '. +v • I : 'i� 7.1 I rr . � J . 1 h. ' ^i ,t L uV ; � r. :E i t� • r,! eta "ta'•. 5p n l� �l a .#, x :, . -J' y . 1 , :, .4• .L ' J rat : # •�} , a . ' a i +: �''« y ") s 1i 0 Ir M1s v' 1 yi J•t w • i ' f . , C• i 1: i '+ %il 1� h IJ1� • J :.t - 5 �} 'J' i ' f� E , M1- r f • t Yr . J.. �l f'''!.;:'''''.:;:::' f ' l 'Y � r•. �' i r {I :r ' l� 1' _ ;,g • fir lM ' t - r r -. 1:•,• r i' �: 4 V J�' w ' . :f 1 , � •: 'I'. ' 4 ; T • FI' • hV ' x'61" !:I.!v- :,.•.: • _ ' I ` .., .n. N N r . __�. The thoutdomealth af Mastic/In . '" — _ Department of Industr Accidents it ■ =flit= .fief 4 o �.,, ,: .� 600 Washington ,street . a.ue. �► .^yam 711�J�1 , 11..1".7.7. B n, P'2 1 www. mass govIdia Workers' Insurance Afflidayit Bull i 1tra &tars /Eiectri:cians /plumbers. Applicant Information Please Print . Name (BusinessiOrga death vnidue�i,): /wr , atinn tie Qc t _ Address: /6C DOS lInan Roct.0 . City /StatelZip: 0107',S Phoiie : d-/ 13 S66.S gY3Y Are a ou an employer? Check the appropriate box: Type of project (required): y - �P P 1.. anu as employer with v . = Q' I air a. general er contractor andl - " '� i 1 '' 6. 0 New cuesemartnon • employees (full and/or part- time).* have hired the stub- contractors 1 2 Q I am a sole proprietor or partner- listed on tilt attached sheet. t 7. 0 Remodeling 1 ship and have no employees • Esc sub -on ass tae a. Q Demolition working for me in any capacity. work' comp. ranee. 9. Q Building ; . rli€►nt ■ [No workers' comp. insurance 5. Q Wc.are a corporation and its ! reaired_j officers love exercised their 10, ❑Electrical repairs or addition ' 3, Q 1 am a homeowner doing all work . eight ofexe tion per MGL 11. Plumbing repairs or additio myself. [No workers' comp. c. 152, §1(4), and we have ho 12 R reps . ins/lance t employees.. [No workers' • 13;Q Other comop, in uaranee�retluired j . _... ._- *Any applicant that checks box #1 must also fill out the section below showing their Workers' coMpeieaatiosk policy you. t Homeowners who submit this affidavit iridicating,they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. FCCatrmetoaes that check ibis box mug attached Silk additional Rheet showing the name of the sub - contractors and their workers' comp. policy information. lain an. employer that is prai g wor.kere compense €ns at� for et keyeex: & Saar epolicy ens j L site FnfOYY17.aztf)I't. A Insurance Compa ny� blame: ) Au4 _.-.. Policy # or Self -ins. Lie. #: A ( 4 ) C - 70 1'aR - ( ! 0! Expiration Date: H' " aci - _) [ 1 Job Site Address: I ® Rif e`► Slut+ Cit * /Statc/Zip: C'fa 6)66;1- i . 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. $1, 5fi0 :al1andlor. one-year imprisonment, as.well.as.a l penaties in.theibrm.a$f :STOP VC/OM:ORDER and_aLfilu`. 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 investigations of the DIA rot Lesurava aurczusg wr .Z.ti . I do hereby certi; jy under the pains and penalties of perjury that the information provided above its true and correct Signature: Drat : 'S 110 Phone #: L i 13 53 (IL S 95 q a Official use 01114 Do not write in this area, to dieted by e or town official ; C ity ur ng own: Fern it /License # f ru A itho ' i y (circle ono: 1 . Board of Health 2. Building Department 3.. City/Town Clerk 4. Electrical Inspector :h Plumbing baspedrar 1 6.' Other Mee — D Mader 111C.d DIK•VER QUEN IV EVI LILE www.1 800newroof.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 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 G Proposal Submitted To: �'j S+, Date Phone #'s Work: Lt.( 3 5 "fi 8 �' /-/ < cc )4:: 37 ?13)i H: L '('/ 6. >r1 4 Cell:L 0.3 ix�3e Street Eptai: 1, i Wit- c urn �,e,. il - a L vr�.) City, State, Zip Code Special Requirements (' 1 l /, c ` I t s }2. . C, ,„nA n,, S L, S; D t cc • t c c 2 l� l�l S 1 � �' " i ' J I t Lcvc QZaeeff'1 -to `5 t I*mot_ act- Complete Roof System N® 1y © We shall acquire all appropriate permits for all work a Home exterior and landscaping to be protected 'f 11 Entire existing roofing materials to be removed to existing decking ( g ® Deteriorated existing decking will be replaced at $3.47 per sq.ft. [ - 2 2 Install Ice a ter Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls L , © Install lb. fe / Synthetic) underlayment over remaining decking area ® Install Metal drip edge at eaves and rakes (8 "�15�' ( kite brown / copper) ■, .., r O Install manufacturers starter shingle on all eaves and rake edges ( t.u` r , ` ® Install new pipe boot flashing / copper) f \\ ® Install new step flashing where necessary tanda / copper) �, Or `') `\ cri Install Hand nailed rigid baffled continuous ridge vent J,. 1 'A ,, C ?. - ❑ Install proper soffit ventilation \ Shingles: ,� (6 nails per shingle) c Pr 4-" Shingles ❑ 25 year .,' 30 year ❑ 50 year Color GARCcOtA t <' Ridge cap shingles Warranty Options: 14 We guarantee our workmanship for 10 full years (see our warra y overage) ❑ GAF ELK System Plus warranty '>' ❑ GAF ELK Golden Pledge warranty g .- 3- l0 Chimney Options: (A X3 8 t 0 N Lead Counter Flashing ❑ Water Seal ;, ❑ Rubberized Crow El Metal Chimney Cap We Propose hereby to furnish materials and labor - co plete in accordance with above sp-o fications for the sum of: �j CG '''Ca-CL 6°' _ Total Sale Price $ /C�' ` Down Pa t $ .�ft�� U • Complet $ _ �x ACCEPTANCE OF PROPOSAL: The above prices, sped ations and conditions satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will b= 1/3 daw I ning, and balance due upon completion. Un aid balancesshall p accrue with i - Brest at 18% per nnum will pay for all. costs, expenses and reason - able attorney's fees incurredf by ' .m Que neville ofing g d `Siding Inc, to recov any rims due under this contract. Date: '- I Signature: ' Phone # 4' ( - �0 & -) / T ' .�� �`rC ny + Sk1, fe tl .I, w ,, :' ,` `,. � : .,' t - . ,, r q 1 '' g f' 2 Pi d to . i += h r `t'Apt t � Date � ��° � ESfImalOrS��lgnature �.L° t , t � * �+� q �� � r � ,. , ,art , ' M : �` r 9 f 7r�� , i .+ ¢' t 1 ' i '' Ot t �." s,40P: I �"4 u 1 n �,. 4 '1 � � �',�ts� � .,� a� 1 � � � r � alj �� 1 w''?t '�"1 �r t �` a a r ' S � e - r � , a d .'g r'l � A N, O O � P ase co� ' �rsona `b Yoe y � qq��,, �' � rea L ,1 . IAA c oming.; t r >i6° -6 -J* Jftc �� ` 1.1.t -, t,f OO In p. i' R ibl o . eb is' dust l •" d � Xo� 1 a ' , r � M Y`- �, y 'r C O i( �' N t a o, "" �d t ,,, I '�;�'�`4 :., ,. ,,„ ,:,} 4 " ' ', i +, �1 , �s .+�i�'?° ^,!i , ..a,,�'"4 C*" t ;, I t, C t l� b� 'r n f�� C "`, h dre R ";r �` H • • ..w::,"nt'-r...:tr ^ cir*,s"' j`- `- ... ; : R J� w:�� S q °:n1!L' 8.1 Licensed Construction r Supervisor: /l (( Not Applicab e ❑ • Name of License Holder : J Q./Y1 LYU�/)�f� /6..70(0 ref 1 ` License Number ) D Did ( mcn leg Sol44tacik I 01021 Address Expiration Date Signature IG� Telephone to:. ;tis :6. :"" ., o.;�y =m efi Go ra . W � � .� , . r " Not Applicab e ❑ Company Name Registration Number /6o Old hn<p aci- 5 A-41 l.IucJ , 1q vg7s /as 11,, Address Expiration Date Telephone 0 • ;WAWA - .�•• -� ar.. , .i.. m. .rS�•i5i;:•. 'YI': t_' Y..JU;:: i. n ": 1:'4dy ". [.': ^:rte lhl :M:'I:v:.. :,, ��i.' :�:�- ..:'!1 .1 r r'�'k F 4 T.s�`',k�;.J• ' .' :. - .�, ., Idlli � ��1 .'i � �'�Sdi•+;✓� � � 'r' �' I!ia+ . � � •,. , i , � �' 4 : - q t ' `f F A la L,Itc ' 51= I; o © '� � $ '� 'pIOJ t, „ / » :rID. J vrttM ( : I ;,. 1 .. , t G ' z. :� l �� �� .iwa.v.l., �.Affi vtf xy ee: # V' fwY: _uA1y 9'(Fi(T57'I . y .,.. M � � .��...� ..,,�.;� '!�4�E ,�.k'�'.�•. ,.I: I .. ': I. . - _•.l Workers Compensation Insurance affidavit must be completed and submitted with this application. Failu'e to provide this affidavit will result in the denial of the issuance of the building permit. _ Signed Affidavit Attached Yes No 0. • ice 1 jn_ ) Btu V•t`ilf ifxs �E 0 StRA 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, proviced 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 Bu (ding Code, City of, Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws An notated. Homeowner Signature • • - dT •s"wy��a r . r r i '} r� p �lw i a h,,� f 'p�:� • .a. J; ° YE le' ",1 ' Li.4 ;,c.g i :41 n �C e 0; ; i a iePi � N J d � 5' � L '4 � ri _'' �1'� i n � - +,, `L�:y J3w ..., G, . - .. �, ,a, � �.y't,YFL ?'..-71--.._ s:E' . _ iH +�S- mrr.-i'%. 3Lw�5.:n r - r7:,1 1 .. ''. P '..vvt ...' 1u . iA4 ' 9 &: : , . e.._ ' z, :-..Y _. New House ❑ Addition 0 Replacement Windows Alteration(s) 0 Roofing /-` , Or Doors 0 , Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: Rea .' 3_. ilk. 0' 4 , N 0f rp j • Alteration of existing bedroom Yes : No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement "es No Plans Attached Roll 0 - Sheet 0 • ;65:11; :=r :., - 6.i „ew ,�, 0 :' ;' ; ®aii r n to a istitig hor 1111 COJ1 ilifel.. ',a fo•'i?7rs1;N +er is 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. Masch,eck : 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 4 � fie gF �lf ”' t . 1 4 �. - E� 4 GCS , L�`E ' , O R 6I r 000fi, tff40,, ti .'psi`: i£;.'r:v,, iMS,.� a ';rru_'*7 S.�r.'° . '4 'Ir te.,.., ill r "m�,d�{n,"i p ia' ali` -r.�g{ k�a:�TVEI_PA:FuRjl�mtq, 1 . � 64- , as Owner of the subject property hereby authorize w it . y it - '111 h • 0 $1 . '-I i + ' )I c- to act on my behalf, in all matters relative to work authorized by this building permit ap: ication. -5 COINtAtel_C . ....51) i i) 0 ' . ' Signature of Owner Date I, 11.45_09 arnile I/6 e r1 ' °J _S, CL 1 = , as Owner /Authorized Agent hereby declare that the statements and information on the fo" regoing application are true and accurate to the best of my knowledge and belief. • Signed under the pains &UfflL)I/t2 and penalties of. perjury: J da.r _ Print N ame ) d, Signature of Owner /Agent Date . • p ''' 4'Y I� ` , ' 1ak 8 '" :'{`- Fj� Ir y - � )'7 - • City of Northampton � s ° x � �_ � ' . • Building Department 'G > Fri- • r • yY r n ` � )'.'1\ 212 Main Street � r �.xk da� � -;- i 1 J G h r • • A\ ' 1 \ \ Room 100 4 "e';t' e1 .0.1t f t " N�rtha pton, MA 01060 1 9"r � P `iV ;, ; ` ;t , - x•. ,i s s n e phone 41 - 87.1240 Fax 413 - 587 -1272 y # f` � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWo FAMILY DWELLING • • SECTIO S ,I T El tifi . • r '" 4 WfID "ere M ' r { 'h •'�Y' '+M'IW `d £ ' " "� { 14 T,ft"e ;ech tare pi "e n,115 tofhce _ 4:: 1.1 Property Address: , s� ' _ k R e �, t 1 � .- r 9 ` w r M ' V 4 1,51! " " p' 1 ,M 1 4-e. , ,t ; .Z t. - �,< A ; 'e j , ita *A xk � .. Y rZ one � ..� -. v• ta f M '- max ; , i c - Pit A l _ � �� ` r � ` L � ' • ! a , , fa t v . .. p r 0, . 4.a . ^4, "` + 1 ¥Eln - ak t.: rldt +a � ,, d L. °i . Qp��C-� DIS f;ot r i K .t.� " ' , 7r, h am ' . . ,..'r Wr 5�'; +'a'a!,, • ..,.. . TIO,M). ., P;F OR.E-11, u1fa,.O1 N' j�t a i'� Q, IZ D.`: ENT> ... r. _ : ,. t.u ?i :. ..,.''. :' �.:f- :�,��:�1_,. ,,]`�5j.r.4hi.4tla.,. ,.04�;•:,a!r._t�yH �;!!"�fi!7riia9:�,:r:. 2.1:Owner of Record: • wed ers d . .. s I1 ore iv, , ft o /off Name (Print) Current Mailing, Address: 004ra yJ3-si-- ,S 9,• .(4 Telephone Signature ' • 2.2 Authorized Agent: L 1 ! .6_11 1 ) ' / h f ■ • a 4.S11 n j Ji) OirI l ratan ■1. . _:. i A 4 _ Name (Print) . Current Mailin ddress: '.`i13 k -g9SS" - S ignatu Telephone • a 6-PAR gi "r ,1;;, S ". 1- ^"-'!' 1, +'` IFS ear N�'I!6. v : �. �lli d hi. t1 pith' '� i - ti'S:'E i t tF 3 5E55 AUED' N 7 C O. N CQ S r i,, � - • vy.; v::?' � x � , q:" � r d::.: t Mxf! �:' Y r '. ri. h1. MJN :!�sl:':! ?_ ^1,C.�P.n.Phv:: ^,.:J NAB ,,�•allrvdrn y.5n ":'_1.:::!1A � . Item Estimated Cost (Dollars) to be • : -,, 'fifrcI;&Lfl ,. :? i . ' ;r::^ F .. 5 p completed by permit applicant -, g (a) Building Perriirt Fee • 1. Building r t 2. Electrical (b) sttmated. Total' Construction;;from::(6). . • 3. Plumbing Building Permit F'e .. • 4. Mechanical (HVAC) • . I 5. Fire Protection C, • �j . Total = 1 +2 +3 +4 +5 OD '' '/!" O .., 6 ,3 s Thi .;SectiohFor.Off i:a:I; Use;.C;n'ly Bu `d in gp01. ir t'TN'ui4h' er 'Dateilssued ! �xx r ... r : J, xr a • � ' fm: ( ••.I ��I• '' �. � i� L it ,. •., ?A • .. .F I � ts ' - • r,,. . .. .', � ;Bu11�T in g �ciJrmission1Wr , /I{Iipecto'r5f0 • r n 64ke • • • a 10 PARK ' BP- 2010 -1031 GIs #: COMMONWEALTH OF MASSACHUSETTS .. f= •.X y�: 017 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1031 Project # JS- 2010- 001522 Est. Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 33497.64 Owner: FIERST FREDERICK U & EVA C Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 10 PARK ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:5/19/2010 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 5/19/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo