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16A-020 (10) 399 FAIRWAY VLG BP-2017-1058 /GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-020 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1058 Project rt JS-2017-001814 Est.Cost: $270450.00 Fee: $1897.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group ADAM QUENNEVILLE 070626 Lot Size(sn. ft.): Owner: FAIRWAY VILLAGE CONDOMINIUM TRUST Zoning: URA(102)/WP(171/WSP(I5)/ Applicant: ADAM QUENNEVILLE AT: 309 FAIRWAY VLG Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON: TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOFS - UNITS 201-215, UNITS 401-420, UNITS 501-511, UNITS 601-608, 701-708 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: Cas: 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 $1897.00 212 Main Street. Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Filen BP-2017-1058 APPLICANT/CONTACT PERSON ADAM QUENNEVILL..E ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY (413)536-5955 Q PROPERTY LOCATION 309 FAIRWAY VLG MAP 16A PARCEL,020 000 ZONE URA(102)/WP(17)/WSP(15)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM AILED OUT ///��� Fee Paid Building Permit Filled out ) -) Fee Paid TypeofConstruction: STRIP&, SHINGLE ROOFS-UNITS201-215,UNITS 401-420, UNITS 501-511, UNITS 601-608,701-708 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070626 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project:_ Site Plan AND/OR_ Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Size Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Olio 'clay � Sign: o'�' .ing Official Date 3-4 -,i7 Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission, Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A, Contact Office of Planning& Development for more information, Versionl.7 Commercial Building Permit May 15,2000 fr • y�pp Department use only I j a711t 2 f L'_.. City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit �- ----- 212 Main Street Sewer/Septic Availability _..._.____.. _-........ Room 100 Water/We2Avail�bility Northampton, MA 01060 Two Sets of smldtural Pana phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION 1.1 Property Address: This section to be completed by office 504 Fairway Village Road 2 Buildings Veils 201-215 Map Lot Unit Leeds, MA 01053 2 Braidings Units 401-420 4 Buildings Units S01-511 Zone Overlay District 3 Buildings Units 601-608 2 Buildings Unita 701-708 Elm SI.District CB!Nernst SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Fairway Village Condominium Trust 504 Fairway Village Road Leeds, MA 01053 Name(Pont) Curren Mailing Address: 413-650-6018 Signature See Contract _-, Telephone j 2 Authorized Anent: Adam Quennevige.Roofing&Siding Inc.. 160 Old Lyman Rd South Hadley MA 01075 Name IPnnt) Current Mailing Address: 413-536-5955 Signature r% / — Telephone SECTION 3-EST]MATED CONSTRUCTION COSTS Item Estimated Cost jDollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee $ 27045000 2. Electrical ib)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) $ 270450.00 Check Number / err Ala b / , J This Section For Official Use On Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 504 Fairway Village Road Leeds, MA 01053 The debris will be transported by: USA Recycling The debris will be received by: USA Recycling Building permit number: Name of Permit Applicant Adam Quenneville Roofing 8 Siding Inc. 3).343� 1Z Date Signature of Permit Applicant ages sar vans ity.,saw low vomits 16301dt n nMad.Salts Hadley•MA 01075 We WHIMS 1900.NEW.ROOF • 413.5965955 Fully Insured Ela :bfral146410102elatt WebsIte;wwwistioweireotsit Rectory Trained MA Combucdon Supervlmn He 1010625 MA Registration 0120962 Factory Certified Installerg N.,eewIts lin mats AazdWelmmtka CTR91Hntbn 1675920 Manbwd ea aware TrwleAsecdation PAL Yna Proposal submlQed To: Date:OlM20i7 Phone ars: C:413410043018 Fairway Village Caidonkdun Trust Ht Wt Street Email: 504 Rahwaywage Rd pal®hpr1923110.co11 O .Sate,by Cody. Special Requirement: Leeds,MA 01063 BUWagn pWgpcAr alar- 201-204 510-51t 214-216 0014302 CUM OTHER 401-404 605605 KSr:li] RECOVER AEWBUrrERS 419420 606406 layers: IQ3 4 Plywood lnduded No 901-502 701-703• ❑ Tear off SLATt gESHAKES pb60 oto 6560p3�-.�9 704-708Fatlaw eSCIA amv Pan Le SIEWZMWEEMEESDatagat Becht E,Mlramkm BT Inc Boedlloadom dared 1012215 W We shall acquire appropriateperodtsthy a0 work BS Wage Addendum land 3 Mich ere also Included In the tit Home exterior and landscaping to be protected Contract U' Strip existing roofing to nisdgdeckMgwHh fug inspection 9ONOT DO: iY A6 ptojem waste shall be removed bydurnpster jdwopstar/o mnoocta use a* ❑ Deteriorated existing decking will be replaced at 33.77 per sq.It after full Inspection ONWmerlMdob:_ 2' install lee&Water Balder at all saws 3940,va9oys.SROmays,pgooandsky6ghO .9g la 0 water If Install OEM felt underlayment overremaining decking area Sti Install Metal dip edge atems and rakesen ')(white/ ow bolts on blue building) • Insall manufacturer's starter shingle on all eaves and rake edges O' Insall new pipe boot Reining/vent earmarks 3/ instal d vets -^'TME Cobra raged/4'Bagged/Rog .. Mingles:(standard 6 nags per shingle) p 25 year p 30Year O 52Year Coin: Pewter GM GOF Ridge cap shingles Barkemod an 401404 only sVarranryDptians. ❑ We guarantee our workmanship for)O Nil years(see ow warranty coverage page) ❑ GAF System Plus Warranty 2' GAF Golden Pledge Warranty AQRF Recommendations: O Lead Counter Fk O Water Seal&Tuckpolnt Q Rubberized Crown O Metal Chimney Cap ®ale Wwow most b sired) pMason wad((w.waermirtbapMAl ❑ Heated panel or/system 0 insulation ❑Ventilation 0 Opted out of AMS recommendations Qatamf& : wa pip lwwrn mot emwak.araeM-mnMbb batman=wnaaw.miMuaaab th. n h Tow OW:(9270460.00) Aep 'tNIaaPWWWt itsabwpta,a p.mbbMano Wrreacww• Bow%Payment:t3 27040.00) nWaobrtw:awM Mawszepba.Marimultiorisschroth Mwtwmadlet l BaWxSDue Upon Campletbn:($243,396.00) Paewarltwa W 2/1{dews Maks Of}Wald ,r Date: 3/1W2011 &Timm:(Print Na) Mini . Name) r adman aeav,.wd!jM'FN)Wnfee ave Ism MITI/MON HOMEOWNER&Plena war all winced baioglp in lit a grog.e ten a Maas duet*the WWI bit/of MOMS debt or dont coSig b through dada of the wood.More QYemMwle Rootlet will net be respamiblelerdebris et dust Mthe ete4Of maize nes OaeamrmbttM The Commonwealth of Massachusetts id=.:w7L=_ , Department ofIndusMalAccidents _wni 1 Congress Street,Suite 100 7 2E�11_ s Boston,MA 021144017 p� www.massgovldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name iausiaess/Organ[rationindividual): Adam Quennevile Roofing&Siding Inc. Address: 160 Old Lyman Rd. City/State/Zip: South Hadley, MA 01075 phone#: 413.536.5955 Are yob an employer?Check the appropriate box: Type of project(required): 1lag I am a employer with 15 .amployees(full anti/orpnretimeh" 7. 0 New construction 201 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.(No workers'comp.insurance required.] 3.©Iamahomeowner doing all work myself.[No workers'comp.insurance requred.]* 9. Demolition 4.01 am a homeowner and will be hiring10 Building addition s workers' compensationmconduct onmy property, Iwili ensuretbatall contractors either have workers' insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 5CI I am a general contractor and I have bird the sub.contmeton listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance.[ 6.0 we an a corporation and its officers have exercised their right of exemption per MGL c. 14.0Otber 152,§I(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box in 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 such. :Contractors that check this box must attached an additional sheet showing the name of the subaonoactors and state whether or not those entities have er@loyees. tribe subrontracton have employees,they must provide their workout'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: AIM Mutual Insurance Policy#or Self-ins.Lic.#: }AWC4007012861-2016A Expiration Date: 4/29/2017 lob Site Address: 50-1ra raw Villa P ri. City/State/Zip: ,Q.Q OO D cy\ Q 1 O 3 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c, 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I da hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sim t : is itate: 3 an i j Phone#: 413.536.5955 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 Inspector b.Other Contact Person: Phone#: p SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS 070626 8/21/2017 Adam Quennevile _ License Number Expiration Date Name of CSL Holder 160 Old Lyman Rd. List CSL Type(sec below) U No.and Shenk TYPe Descriptitm SOUK Hedley,MA 01075 U Unrestricted(Buildings up to 35,000 cu.tt) CiTyflowState,ZIP _ R Restricted Ida Family Dwelling M Masonry RC Roofing Col .- —..... _..... WS Window and Siding SF Solid Fuel Burning Appliances 413-536-5955 production.agrs@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor MC) Adam Quenneville Roofing 120982 3125/18 HIC Company Name or HiC Registrant Nerve IEC Registration Number Expiation Dale IS0 Old Lyman Rd. producion.agr ©gmail.com No.and Street Email address South Hadley,MA 01075 413-536-5955 City/Town,State,ZIP Tel !hone _ SEC LION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.1 25q6)) 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 IX No Q SECTION 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Adam Quenneville Roofing&Siding Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. see contract _ A 4o Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'ORAUTHORIZED AGENT DECLARAION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate the best of my knowledge and understanding. f /1ryp nitiw SPA'/OP kL{ 3 i�-0 t 17 nvtAumv'a or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the home Improvement Contractor(IHC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the IRC Program can be found at www.mass.aov/oca Information on the Construction Supervisor License can be found at www masa von/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.R) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Type of heating system Number of decks/porches _ Type of cooling system Enclosed Opal 3. "Total Project Square Footage"may be substituted for"Total Project Cost" DATE A ORE) CERTIFICATE OF LIABILITY INSURANCE 6ra9rIWao s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 polley(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the Win and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not center rights to the certificate holder In lieu of such endorsement(s). PRODUCER ECT Melinda Kee*kale Ocala a Meta in Insurance Agency E (413)534-7355 FAX sae U31538-93e6 1767 Northampton Street nomma.nOLarakula@gaeemolain.corn P 0 Box 1128 INsURF�R aj AFFORDING COVERAGE NATEF Holyoke NA 01091-1128 INSURER A Nautilus Ina Company,,,,, INSURER IN�UPERB AEM Mutual Ins Co ....— Adam QuenneVilla Roofing a Siding Inc INSMRERC: ..... 160 Old Lyman Road monk .1 INSURER E ..... _ South Badley NA 01075 INBURERF: COVERAGES CERTIFICATE NUMBER:CL1662903220 REVISIONNUMBER: THIS IS TO CERTIFY THAT TGE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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.HMG'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IR TYPE OF INSURANCE INAII WY/1POI ICY HUMMER I TR 6P PO EXP MAMA X COMMERCIAL GENERAL LlA8LfY EACH OCCURRENCE 1.000,000 A CWMS'MADE X OCCUR REMED 100.01]0 te68S343 6/23/201 6/33/2017 MED EXP Yea'-") 15,000 PERSONAL ADV INJURY 1.000,000 GENT AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 2,000.000 R POKYIPS LOC PRODUCTS.COMPOPAGG 2,000,000 OTHER: Employee Bonen 1,000.000 AUTOMOBILE LAIUUyY CLCONNEOSNOLE OAT me dewy) ANY AUTO BODILY INJURY(Per person) ALL OVINE() SCHEDULED BODILY INJURY(Per maiden AUTOS AUTOS NOTTOHIREO AUTOS AUTOS O PP1�E .'—. - UMednw,e)Donna a MC MMBREllA UA5 'OCCUR EACHOCCURRENCE $ 1,000 000 c x EXCESS LAS R CUIMSMADE AGGREGATE GED X RETEMIQN$ }0.000 M1030622 5/13/2016 8/13/3017 Y WORKERS COMPENSATION R PER RE I I ELN AND EMPLOYERS'LIABILITY Y/N AANNTYTORI EEPJEXECVTIVE `y N/A I[ EACH ACCIDENT 5 3.0 0 000 EXCLLIDED?D ;ma meton/1RMii d11C40010L2661-3016h 4/29/3016 4/39/2017 E.L.DISEASE-EA EMPLOYE $ 1,000 000 H yes dein under DESCRIPTION Of OPERATIONS below E.L.DISEASE-POUOY LIMIT 6 1,000,000 onceeno a OF mammon ti M&TIONSt VEW048 IACORD 101,Additional Wmwae SCFWUF my be crumbed If more span IS rquNMl Certificate holders are additonal insured on the above captioned OL policy) subject to policy forms, conditions, and exclusions. Adam Quenneville, as an officer, is excluded from the workers Comp policy. CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE*WYE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AIITNORQED REPRESENTATIVE �j/J// �.� J J,( p M Karakula/MINDY /2f"�' e f/ ' ->Lc._.._ 01988-2014ACORD CORPORATION. All rights reserved. AGGRO 2S(2014(01) The AGGRO name and logo are registered marks of ACORD INSOts melon MassacRuserts uepartment or ruouc Safety Irli Board of Building Regulations and Standards License: CS-070626 Construction Supervisor ADAM AQUENNEVILLE'µ. a 160 OLDLYMAN2U SOUTH HAC LEYMl e 8 t . Vl - Expiration: (� � /�f"/'/y�}/t�YyCoommiisssiion�e�r�/y�(/. ^f/Mt/21/20017 ,{�,[�/`(/, V `/ '/€ 1, 07/224917-2dale(ri 0/ �f f % t er/ s Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 120982 - Type: DBA _ Expiration: 3125/2018 TM 419291 ADAM QUENNEVILLE ROOFING - _1 LT ADAM QUENNEVILLE 160 OLD LYMAN RD SO. HADLEY, MA 01075 — Update Address and return card.Mark reason for change. scx1 0 200.4-05/ii - ❑ Address ❑ Renewal ❑ Employment ❑ Lost Card i. ., STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION f: n Be it known that t% ADAM QUENNEVILLE 4. 160 OLD LYMAN ROAD SOUTH HADIFY, MA 01075-2632e 'j I is certified by the Department of Consumer Protection as a registered ' p V HOME :IMPROVEMENT CONTRACTOR Registration # HIC.0575920 hoc ADAM QUENNEV11 r E ROOFING fp, ri� i Effective: 12/01/2016 ti Expiration: 11/30/2017 '� " alit:— Athaj 3 , adA,l{vaaw . Comm, ,o "� j