Loading...
13-016 •(1�•000� u�;u� rII f�Cllll I IUI U llwul DATE( MMIDONMI FII A! QRD f6—ERT1F1GIATE OF L1A 1L1TY INSURUANCE R o4/a�/u8 PRODUCER—r -� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Aainill>ard 1Z1ZUXana® Agcy, 7[s1C 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 NAIL# INSURED INSURERA: Asa matoal xnnur—a,C-0a" INSURER B: ST 1-3. /Treaelots Snaursnae Adam QuerMOV-11113 R00fing & wsURERC: Scottsdale.Ins Co. Siding Inc P 0 BOX 612 INSURER D: South Hadley MA 01075 INSURER E: COVERAGES . THE POLICIES OF INWRAR LISTED BEI OtlY,HAUF BEEN)SSUED.�CI THE INSURE :'NAMED ABOVE kOR T)1E POLICY`PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR GONDR70N OF ANY 6bi4 r 6ron oi-Hex eor-um WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I33UF-D OR MAV PERTAIN,THE INSURANCE AFFORDED 8Y THE.POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY-HAVE 135EN-REDUCED BY-PAID CLAIMS. - ^-- T�Y NUMBER - DATE MMIDD DATE MM1DD LIMITS LTIK NSR TYPE OF INSURANCE. _ GENERAL LIABILITY " - EACH-OCCURRENCE $ 1000000 C X COMMERCIAL GENERAL LIABILITY CLS13841.98 06/23107 -'06(23/08 PREMisn(Ea mm,enee) $50000 CLAIMS MADE rx�OCCUR MED EKP(Anyone person) $5000 PERSONAL A ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GWL AGGREGATE LIMIT APPLIES PER ! PRODUCTS-COMP/CPAGG S2000000 POLICY JECT 7 LOC `-•.-..- _. .., AUTOMOBILE LIABILITY .COMBINED SINGLE LIMIT $1000000 B ANY AUTO BA745OL94607 11/0.1107 11/01/08 COMBINED ALL OWNED AUTOS - BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS ` BODILY MIJURY X NONAWNED AUTOS I (Per accident $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY' AUTO ONLY�EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY, AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE - AGGREGATE S DEDUCTIBLE S RE FWTX3N S _ S WORKERS COMPENSATION AND TORY LIMITS X ER A EMPLOYERS'LIABIUIY jik/01286101200 04/29/07 04/29/08 E.LEAGHACCIDENT $1000000 ANY PROPRIETOR/PARTNERIEtECUTIVE OFFICER/MEMBEREXCLUDED7 AWC701286101200 04/29/08- 04129/09 E.L 131SEASE-EA EMPLOYEE $1000000 N Vyaes,describe Under 5PECIALPROVISIONSbelow EILDISEASE-POLICY LIMIT $1000000 OTHER OESCRiPT(06(OF OPERATIONS/LOCATIONS I VEHICIAS/EXCLUSIONS ADDED.BY E IDORSEMENTI SPECIAL.PROYISIONS .. CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF T141;ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OAT.THEREOFy THE ISSUING INSURER%-LL W-OEAVca TO Marl S.O OAVS WpIrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL JMPOSE NO 013UGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES ° AUTHORIZED REP TIVE. st:ep ef s ACORD 25(2001108) `"r"�RD CORPORATION 9988 .r 9. foaffo ru ffQ egul ions an ta�ars One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Constructioni�$upervisor License License CS: 70626 Restriction: 00 Birthdate: 8/21/1971 Expiration: 8121/2009 Tr# 3712 ADAM A QUENNEVILLE 160 OLD LYMAN RD —_- S HADLEY, MA 01075 - Update Address and return card.Ma reason for change Address. Renewal Lost Card 5-CA1 0,5OM-07/07-PC8490 Boar o' Building eg;ulat ons an tandar s One Ashburton Place - Room 1301 Boston. Massa.,chusetts 02108 Home Improvement;Q6atractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2010 rr# 264937 ADAM QUENNEVILLE Rob FiNGr.:: ADAM QUENNEVILLE 160 OLD LYMAN RD - SO. HADLEY, MA 01075 Update Address and return card.Marl{reason for change. Address Renewal Employment E] Lost Card i-CA1 Co 50M-07/07-PC8490 .,..,mr.a.e...•,�,.o.�r p...�.�r..,�.�..�.rm..r.:..�.�..,.-•...a.,..,;.,-.�.�.1..�.�.:.,m.s.�...a.�._5:�:,....e - •tif. r+a+ ' cr1"Y�. .c:.i�r .{' ••,";L''r, `. •�"i tfh',,,.+.A.,....4;•.,f •b.. ...rrN•."r .,td;:' .:.i. r.;''l:..r - vr'7n:x°y. .r. r r..-.,;�,.,S.r. ,M•r.' ,s1,S1..S:" - .:S !if:'_. .p' '� i; rd' u:3 .'n•r+ ��: ;,: ►...k:i�i. -{.i.HF'�..,,:•s.. n�a:r'a �1r..i}rt•�Ir..,i;;+..,r. .}a,., .;a..,,. ,%r.=; - rr t.ir= C .tit;,d`:.' .'C✓,.r r� {•4.t. 1'• :alr t.. _ tom•{ - `-5 f: - f,. t- :�{ •vim" 11( yr}:':t '�4. !• •� IL r•ri /., r,r f' T '`N f r'� Ott S .[� [y„' 1 .1 7J 4r :.i, •w. Y.T� t "Q” „.r,L.v.. _ j f:. T -y - i,m 8 - Y - T rs• 2, tt S� •i. r �O :i ' ra r.•r,• �, •s .•IN L =.;r.i JC. - d' .a:. r. _ N 1, '+J ,1 >f �. J.. a' [ •i i �A. - - rr'•` 1(' P' t�!n '••5 't' '-i'+-`r'•Tom:.. r-µ y, r _ Vii: R�A �ll'}'•� �J b F •'i^ '4h'.r•'^ f .� I, [t•'. }r'''.} ��9,••'ter.::..-'`. W. :y. t.-1•' 99 t a _ yr, i• - L.'. i' r.•` l' fr r•tir, �- tF�. k._.' -rtJ'•'. .I, Ji!r •4 - '.r.: �• k Yx:, J Mob N r J r --1 d' h r•, 'r y�, VN - 1 e 1'. ••J 2"l �r. 1Ycc `Y�. L� - �l 4i u A� r''d 'f r a4'' 1'•. T :•V r - I:. , lb :0 - Q. Z. Y y .x. w.yt •i 1 1 Sr. .I. r r r Department of Industrial Accidents Office of Investigations ,l ;1 600 Washington Street Boston, MA 02111 " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t Please Print LeZibly Name(Business/Organization/Individual): Address: I(vo W Lwiyr_xc� RCIA �T Ciry/State/Zip: 3 A O Ms Phone#. L I B 53L S 9S Y Are Vol]an employer?Check the appropriate box: Type of project(required): 1. I aim a employer with J 5 4. ❑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. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5_ ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12, of repairs insurance required.]t employees. [No workers' ]3.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information-Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. f .{ Insurance;Company Name: Policy#or Self-ins.Lic.#: W 0 I o 0.co? Expiration Date:_ Job Site Address: ©l1 �� P7 City/State/Zip: Alo/"�t/ ✓�/&y 014 COO �7 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Certify under$te pains andpenalties of perjury that the information provided above is true and correct: Suture: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town of j4ciaC 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 Inspector 6.Other Contact Person: Phone#: r s , DA a Premium:Choice• 11114 ING & SIDTGvI NC160 Old Lyman Road, South ley, MIA 01075 We Are Licensed 1-800-NEW-ROOF • 413.536.5955 Insured Email:info @1800newroof.net '' Website:WWW.1800newroof.net Factory Trained MA Construction Supervisors Lic.#070626 MA Registration#120982 Factory Certified,Installers Member of the Home Builders 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 -'H; Street Mail To: City, State,Zip Code Special Requirements �I�J'L¢t*t� -Pro osal t � I p furnish and install the following ❑ Re-,Roof Tear-Off ❑r utter �1 4�1--��4 Complete Roof Preparation ❑-Home exterior to be protected by tarps and plywood j�Shrubs, landscaping,trees to be protected Entire existing roofing material to be removed to existing decking, including flashing,etc. Site to be cleaned everyday with roll;magnet debris removed at project completion C Deteriorated existing decking replaced at$2.50 per sq.ft, jC3.GC, i<r t r:r 5>!Y 2 F © U�V,gel Brown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only �❑/ New flashing will be installed where necessary(see Special Requirements) ❑ Install new pipe boot flashing �! We shall acquire all appropriate permits etc. for all roofing work Complete'Roofing System ELK Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ELK Leak Barrier,installed in all valleys, around penetrations,and chimneys to protect critical areas 15 pd. reinforced underlayment installed over entire decking Shingles: j2 ELK Prestiquee Series J7(30 year El 50 year Colo Nailable ridge vent willl be`installed ELK ridge cap shingles Warranty Options: /C) AJ We guarantee our workmanship for 5 full ye�Lrs�m 6 K J ❑ ELM-6-�ti f,--,Ha--Govemge-L*ted-- lagaoty-tea ❑ El f(15 earldrnbreffa overaggltm! pg We Propos ereby to furnish materials and labo complet2 In do ro1,3�.h above spe ifications for the sum of: 2 ,- Total, ale Price$ y `' Down ayment$ f� U on ompletion$ - - ) ACCEPTANCE OF PROPOSAL:The above is i Z pr es, ecif catio an:ftgl con tt ons re otisfacio,and are,hereby accepted. You are authorized to,do as.specified.Paymen ill be 1/3 don uponaignin -and balanae,due'upoq comp{etion. Unpaid balances shall accrue`with interest at 18%per a m. Purhasers)will 'for,all'costs,expenses and reason- able attorney's fees incurred by Adam Quennev{lle Roofing an {d �nc,to recover any sums due under this contract. Date: "/ Signature: !r7-" Phone# Date: '7 Estimator's Signature: Estimates are honored for sixty(60)days from above date 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 Quennevil{e Roofing and Sidings will not be responsible for debris or dust in the attic or storage areas: ':iR5ti �,�.d F1.r34 f?0 S 1RNL � 105! S RV®rM111141,19M 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : :70 6,z A6MQw11nevft Roofing&Siding, License Number ISO Old Lyman Road V— l( __ 0 Address ftd!OY, Expiration Date s 34� Signature Telephone MR Not Applicable C3 Company Name Registration Number Abm Quepneville Roofing&Siding, Inc. 160 OW Lyman Road Address_ _ South Hadley, MA.01075 /5 Expiration Date Telephone J 36; �_�_ Q f.. p©.�_. � a:A" Q N1 cL 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...... ❑. 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. CNM 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 S.unervisor 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 M. fi day MEN cw rll. —11 ETON, 131 ..dR- New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ) Other[ ] Brief Description of Proposed Work: .S+f;-(e Alteration of existing bedroom Yes No Adding new bedroom Yes - No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll❑•Sheet 0 6 of a tRe MO xstI M° TTm . MIb<w,rn> 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 constructionwithin.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 , 1_ Septic Tank City Sewer Private well _ City water Supply 001E .-._ n.{r.r..•G :YTV. .. 1. .... r.F.l. r{._ .R�:�r!•!9RI'r..• ..v._F. Ta—_!^v'•.WTI'd�r9r+R_ 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. Signature of Owner Date MM i I, A ekl /1 r-, V We— /�c 0)`� t-1 .1 as Owner/Authorized Agent hereby declare that the statements and information on the foregoing applica.An are true and accurate, to the best of my knowledge and belief. Signed un i er the pains and penalties of.perjury. 01a t)may?J1 if V / Print Nam Signature of Owner/Agent Date City of Northampton__ Budlg le- art�rnr�t ,Room 100 No r- h m ptpioG PA A40 100 y phone 4138 ,1240 Fax 413-587r-1272 , _, APPLICATION TO CONSrRt,l ,-ALTER, REPAIR,"RLN TE OR DEMOLISH A 0N�,QR,7O 1=AMILYI DWELLING r C_ S,ECTiaN l -slr�,,rl�FO�nn�,�rl'�N� . t 5 ;�,��� �;� ,�rs4` ect�"�"`�c b�;. 4ornp•F'ete`�d�b officeW�' "�f � yi. 1.1 Property Address: 2 . . �,E m�SY Distr ct�� �.�",��� ���� _.,.'��a�,� ,CB.�gys rfcf ��•,���`'"?°�-� ' I 1 Ldt 7Pr,�.>f4ad +yi 6 ,, � ! �t,5 �, �i ,• _._ -- ._.. .,.. _ .., SEOTION:2 P{F�,OP,ER��Y4r`Ok111;1E'F���kt�P'�/r�UT�IQ.�IZ�,D A(,',EN'3' , 2.1 Owner of Record: Name(Print) Curr nt •Iing,Addre : Telephone Signature _ 2.2 Authorized Agent: r Aar Qve-nir, v� `l � 'oo ' 01J L y � Name(Print) Current Mailing Address: Signature Telephone _ S1=C710N 3 EE �T)IVIATaED CONSI R �� iCTSr� Item Estimated Cost (Dollars) to be Offrcial Us"e only , ,u completed by ermit applicant rr :� 1. Building (a) Building Perm[t .ee pF, } 2. Ele-;rical (b) ':stima.ted. Total'Cost:of Censtrucfion,;fro:m;.:;5 ., 3. Plumbing " Building Permit`Fe'e 4. Mechanical (HVAC) 5. Fire Protection 6. Total = G + 2 + 3 +4 + 5) I.Qh eck,.Number _:This:Section'For Officua :Use;Onay. . . Budding Perrnft;Numbder Dateilssued:.� ., i n. I. p-- Buildin „g,, �iimiss�oner[lnspector,of,Bu�ldmgs; Date: . roo moe-- kl KONG S1 BP-2009-0129 . GIS#: COMMONWEALTH OF MASSACHUSETTS �k t�3 - °t 6 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-2009-0129 Project# JS-2008-001326 Est.Cost: $8624.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Adam Quenneville Lot Size(sq. ft): 101059.20 Owner: PATEL VINU V&SUSHILA V zoning SR A licant: Adam Quenneville C�UV (vvt4z�t kl AT. Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955-0 SOUTH HADLEYMA01075 ISSUED ON: TO PERFORM THE FOLLOWING WORK.-STRIPE AND RE-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 8/5/2008 0:00:00 $25.0012927 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo