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35-147 1 .1 , . • i . I • , ' I # 1 4_ 4 Oar. o Ul sing ' ---------- '' ' ' * ' i . Ii ° . e gu 1 lons ail' tali. ar 1 s • One Ashburton Place - Room 1301 . . — Boston, Massachusetts 02108 ConstructioniSupervisor License • .. - ,• .. _ License CS: 70626 . . , • . ..".. ,, • ..: ..... .. .. Restriction: 00 . Birthdate: 812111 . . . ... ..... .,. .., . ... Tr# 37 2 Expiration: 8/21/2011 . .. , . . _ ..._ i'. '' '':'" A'OP,kM..'• ',10uENN • .•:,........ ::.... • ...•.. — : .. , .'.10 '1(:)„D, 'LYMAt,\E RD ' 1. ' '.. .-... . ...: ,.• - ... .....' . ;'' ' :§' 1 I Q 15' ., p p 4 ' '4 °I i .M. m - l ilt t A 7-- 1 al i Office of Consumer Affairs and usiness Regulation - . 4 ... ------4 11,_------ ------------ ' • , , , • 10 Park Plaza - Suite 5170 — ' Boston , Massausetts 02116 • -',. • •. 1 , Home Improvement,(4 ntractor Registration --.,-...----s---:---------..,.-...-----.::..-_---7.---.-y..2-A Registration: 120982 . 11.7....."4:=1 ____, , ,, Type: DBA ir,• -_--:_17:,— ', Expiration: 3/25/2012 Tr# 2930.9 • , ADAM QUENNEVILLE ROOFINQ-/ ,1, - .:',,,.81.:_---, , , - 7 , , , \' ADAM QUENNEVILLE a --„::::...9 ‘,_-_-.-:, 1,, • 1.60 OLD LYMAN RD \,-,;.. \ S 0 HAOLEY, MA 01075 ,.... . , ...7 „f,, - - - -- - , v. -.. _ - - -- - - .- -- - --- - , 1,- - -.------ - v - -...Y. , --- 17- '- -. ;Iry-' s2 • 17 4 - *-; . . -4. "41,..4':-.1,:‘, 1 ';:fai'i . ,;fr.tif;t:t1',.. ,-;0:Iiiik... ,,fiV, , e . -,,,:s.- V - t -,..:-.-- - ff y gf.....:.:-.. \vik-ix-:.... \ t''',16.;-;;x-.1,..q",,prA;w47,..:%.`v„..§ ,g:-.:,,.,.. ,0"::,.:Vi,,, , Arp.,g,p: . ';;zi,::;,'':;;;; (", .:-.1:-.1:-`1%.ilie::'5,7W;iPli i i ' ‘-'-',.";x111,;:-. ,-9:...-:-',-,101:-. Aiq i'''' - ' : ' , Y 1:. ;si'"P"Mrp f :4,e''''I' s :''''''!'lxk''''W": 4 ■'''''/i.e:'''', , '''-:''''''' '' : ''''';'Ill,C'''r i '",'''' , 4)...,,. '' ''' '',;;IIAL'''' ,' 4011... '''„,,-'::1?-li'- " .-- ''-,.,.....,,: ' ', ' ,,,ipt, Pr_ ,-..._- ,.)ii --,61,06''' --141-44'---:=110P-------"---"'---- ' --•' - - - ---- ------------- 1'1'7 ,_.,, _:: --t,::: ,—..,4- , - , --- , -4.--- -----"----------------' -- A T - .b V'''tabl'iTN*Orti + CONNECTICUT DEPARTMENT OF CONSUMER PROTE I N I ,' Be it known that v ir - 17 , ADAM QUENNEV1.1.4i.x. •-..V.,: '',, : , , ' ,, ' ' 160 OLD LYMAN ROAD SOUTI-1,14ADL ,:E ;Itk Q1075-2632 ._.,..., „...-... ,:lf ( ii?' '' ‘ ' \ \ , , ;',.', , ,,,K • (wir- . . '\y ' .,....-;-** 4 ,,,,,,,, is certified by the IDe Par f0- 8 - eizi:Aiirar Vftection as a registered imPRO , ONTRACTOR , •,,-e..04.:; HOME I ,VE , :- ME-NX — '''''''-'''..:-:4' 7' :lid -- ^. -- ,- "':'''' . , k,., .,..- - '-- R ......,.. r'' ".. ' , , • ' ', -,,,,...„.„.. „.., 1 7 A u4,t2 Tj NTNT 1,T1 LLE ROOFING \ 44 ''' ' ' ' gfccove:12/01/2009,„ [...' ,,:, ; , ' r ‘,.....„, . , , f-,........4% $1.,1r,ti 11/30/2010 . , Terry Farrell, Jr., Commissioner • ........ , . . . OP ID LL DATE (MMIDD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE ADAMQ-1 C1 /29/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A M,ITTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAI E 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 Phone:413- 538 -7862 Fax:413- 538 -7179 INSURERS AFFORDING COVERAGE NI\IC# INSURED INSURER A: AIM Mutual Insurance Company/ -- • INSURER B: Travelers Ins . Co, Adam Quenneville Roofing & — Siding Inc INSURER C: Scottsdale Ins Co 160 Old Lyman Road INSURER D: South Hadley MA 01075 — — - ._..... - — INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHISTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS R DD r - -- - - -' -- POLICY EFFECTIVE POLICY EXPIRATION LTR �NSRI TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MM /DD/YY) LIMITS — GENERAL LIABILITY EACH OCCURRENCE $ 10 ) 0 0 0 0 - ITAMAGE I (4 HtN 1 EU .. - -.. .--- '-- -'---.._.- C X COMMERCIAL GENERAL LIABILITY CPS1034980 06/23/09 06/23/10 PREMISES (Ea occurence) $ 10 )000 - -, CLAIMS MADE C1 OCCUR MED EXP (Aky one person) $ 50 ) O _ -- _ PERSONAL 8 ADV INJURY $ 10 ) 0 0 0 0 GENERAL AGGREGATE $ 20J0000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG $ 2000000 POLICY PRO- JECT LOC - - -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 10 0 0 0 0 0 $ ANY AUTO BA7450L946 11/01/09 11/01/10 (Eaaccidenl) - —_ _ - ALL OWNED AUTOS _ BODILY INJURY X SCHEDULED AUTOS (Per person) ! X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident $ - ---_ -- - - -_ — __ PROPERTY DAMAGE $ (Per accident GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO EA ACC $ • AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ L_.J $ OCCUR CLAIMS MADE AGGREGATE — — — - -- DEDUCTIBLE $ RETENTION $ • -- $ - - - -- -- - --- WC STAU- WORKERS COMPENSATION AND X TORY LIMT X O S ER EMPLOYERS' LIABILITY A AWC701286101 04/29/09 04/29/10 E.L. EACH ACCIDENT $ 1007000 ANY PROPRIETOR /PARTNER /EXECUTIVE - - -- — -- — OFFICER /MEMBER EXCLUDED'? E.L. DISEASE - EA EMPLOYEE $ 100D 000 If yes, describe under SPECIAL. PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1003000 OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS • • • • • CERTIFICATE HOLDER CANCELLATION SAMPLED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P-lB EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SAMPLE ONLY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND! UPON THE INSURER, ITS A.3ENTS OR REPRESENTATIVES. AUTHOFj�ZEDNTATIVE_ • ACORD 25 (2001 /08) C/ © ACORD CORPORATION 1988 The Commonwealth of Massachusetts *��� Department of Industrial Accidents it - #t '' , AIM ti - Ofce of Investigations =iii.--= 600 Washington Street .u. w r . Boston, MA 02111 www.mass.gov/dia - Workers ' - Compensation Insurance Affidavit: Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): Ai . 0e,ut ((e (A. Address: /60 C(c - man Roceel L City/State/Zip: S 14 T)1 ()WS Phone #: l-/ j 3 S S q(.K.Y Are you an employer? Check the appropriate box: Type of project (required): 1. YI am a employer with L5 4. 0 I am a general contractor and I 6. ❑ 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. t 7 . 0 Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10. Electrical repairs or ad litions 3.0 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or ad iitions myself. [No workers' comp. c. 152, § 1(4), and we have no 1 Roof repairs insurance required.] t employees. [No workers' 13: Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating su. h. 1 Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy informatic n. I am an employer that is providing workers' compensation insurance for my employees. Below, is the policy and job ! ite information. (� ) Insurance Company Name: A l ti J VtS O tag 42 Policy # or Self -ins. Lic. #: A CO — 70) ' (l G I _ Expiration Date: 4 ' aq ' .-1 ( V Job Site Address: 7 (c/ R f Rao City /State /Zip: F!orfAxcc. /IA t (0 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 penaltie; of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 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: (-- Cr — < D Phone #: 1 113 53k 5 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspecto 6. Other Contact Person: Phone #: ■ VISA Maste II DISCOVER CC U E N N E V I L L E 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 @l800newroof.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 Phone #'s Work: L uc :Ile I /1e ,fr/ co r �ora , H: �l 3 1 21 G.� Cell: Street , .) Email: City, State, Zip Code d I� Special Requirements (t o'reh / c ) . 0 IO(o moll ad , u,/ ..Zce Ltx4, oaf A 7 4,, (5 _sew 5oo "rd1) Co7lete Roof System -- W hall acquire all appropriate permits for all work R e G /�y 0d A.1 ,s me exterior and landscaping to be protected cb .� o w�r.Lc t `50 a s4J' Entire existing roofing materials to be removed to existing decking 4 0x8 -- ED 'eriorated existing decking will be replaced at $3.47 per sq.ft. In II Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls Install (15 lb. fe� nderlayment over remaining decking area Ins Metal drip edge at eaves and rakes 5 ") white brown / copper) In II manufacturers starter shingle on all eaves and rake edges II new pipe boot flashin (standard copper) In new step flashing where necessa, stand d copper) In copper) Install Hand nailed rigid baffled continuous ridge vent 9 9 ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) f p e4 l Shingles ❑ 25 year 30 year ❑ 50 year Color S "l° wood 64 crt 1 z- Ridge cap shingles Warr • Options: „4; - guarantee our workmanship for 10 full years (see our warranty coverage) 'FW GAF ELK System Plus warranty ,-� ❑ GAF ELK Golden Pledge warranty / t ,- , 3 �1 g Chimney Options: ( K � I r (�, � ❑ Lead Counter Flashing ❑ Water Seal:, Tiickpoint ❑ Rubberized C own Metal Chimney Cap c4 -� We Propose hereby to furnish materials and labor - complete in accordtancd w it tr above cations for the sum of: $ � Total Sale Price $ 78i Down Paym- 't $ 3000 pon Completion $ yS /0 ACCEPTANCE OF PROPOSAL: The above prices, specific. ions and condijio s are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 113 clown -upon signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reason- able attorney's fees incurred by Adam Quenneville Roofing and Siding, Inc. to recover any sums due under this contract. Date: _ / signature:yM / ��� < " � �6� ' - Phone # Date: I/.D / C Estimator's Signature: , — o< u ,v 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. 1109 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 03 06 D( Adam Quareleville Rooting & Suing, lnc. License Number v 1Ro Old Lyman Road 2-al- 11 Address �/ South Hadley MA 01075 Expiration Date Signat Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Adam Qul,;,avilie Hooting & Sitl!IIIW, )tll. Registration Number 160 Old Lyman Road 3 - Address S iutli Hadley, MA 01075 Expiration Date Telephone S3(4 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 O 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 building permit. As ac€ing' Coristruction . 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing v Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [0] Other [., Brief Description of Proposed Work: 5' (- a n e.Ot)c Alteration of existing bedroom_ Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 I c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? i 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 f SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. I Signature of Owner Date I, _ /O f 3LCrAcJLU( ^ 0S ,L, , as Owner uth l mrized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best o and belief. Signed under the pains and penalties of perjury. Print Name �� Signature of Owner /Agent Date k i i uuig rroposea xcequtrea Dy [,omng 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 _ I Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces g Fill: Svolume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO U DONT KNOW 0 YES O W YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO C) DONT KNOW Q YES C) W YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO C) IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 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 C) NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Drivevoay Permit 212 Main Street Sewer /Septic Availability =ti j z-u'u 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 Map Lot Unit --) y( �a{l � OQk Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: /-ienrtk 8 can Qou 7 4 ` I Raix1 � I F Ingo. cP 11 A of Ol•d Name (Print) U Current Mailing Add s: Telephone Signature 2.2 Authorized Agent: Name (Print) 160 Old Lyman Road Current Mailing Address: South +Hadlay. MA 010Th 3CRS155 Sin a Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 76/0 • (a) Building Permit Fee v 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) 76/0 pp Check Number /7� ( � 3 J This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 1 BP- 2010 -0899 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: BUILDING PERMIT Permit # BP- 2010 -0899 Project # JS- 2010 - 001330 Est. Cost: $7810.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 23609.52 Owner: SCARBOROUGH HENRY F & LUCILLE Zoning: SR(100) //WSP II Applicant: ADAM QUENNEVILLE AT: 746 RYAN RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/13/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P & 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 4/13/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo p