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32A-119 110- 112 MARKET ST BP-2019-0080 GIs N: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 119 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv,ROOF BUILDING PERMIT Permit k BP-2019-0080 Project JS-2019-000122 Est.Cost: $7800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group ADAM QUENNEVILLE 070626 Lot Size(sp.ft.): 3920.40 Owner. VALLEY BUILDING COMPANY INC Zonina:URC(1001/ Applicant: ADAM QUENNEVILLE AT. 110 - 112 MARKET ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.7/23/2018 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 F 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 Sienature: FeeType: Date Paid: Amount: Building 7/23/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Conunissioner � i i I i l I City of Northampton 1 - Building Department ISI x 212 Main Street �� s a- Room 100 Northampton, phone 413-567-1240 ax APPLICATION TO CONSTRUCT,ALTE I,REJAII616NMTAWDEOLIS A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION DEPT OF Bun.DING lnlsaecTlosr , _ /� 1.1 Property Atltlress'. action to be compo ed by office Map _ Lot 16" Unit 110-112 Market St Northampton, MA 01060 Zone Overlay District Elm St District CB Dlslricl SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDRGENT 2.1 Owner of Record: Valley Building Company PO Box 246 Hadley, MA 01035 Name(Pnnp 1...,-., y, CuoeM Mailing Address: 413-539-1787 t>L— C cn t t L Telephone Signature 2.2 Authorized Agent: dam ©wx�Y ev I le 1100r1� l Name(Pont) Curtent Mailing Atltlress'. (O"1 5 Signature Teleplgne SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7,800.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee jl 4. Mechanical(HVAC) 5. Fire Protection 6, Total=(1 +2+3+4+5) 7,800.00 Check Number Y This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissionefllnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to Fe filled in by Building Ihpurtmem , Lot Size Frontage Setbacks Front Side L: R:',. L:'. R. Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved urkin 4o Puking Spaces Fill: �owme&l_ounon A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES Q IF YES, date issued:'. IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book '. Page, and/or Document#i B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 t acre? YES O NO O IF YES,then a Northampton Ste"Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Allerallon]s) ❑ Roofing 0 Or Doors Accessory Bldg. ❑ Demolition ❑ Now Signs [M] Decks [O Siding lOj Other[0] Brief Description of Proposed kcmovc ex,v,ng mo[mmenal andranrall sew avpnaR cninglesysfem. Work: Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea' If Now house and or addhton to ezisdria housing.corrin the followlna: a. Use of building. One Famili Two Family Other b. Number of rooms in each family unit'. Number of Bathrooms c. Is there a garage adached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of healing? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attacheV h. Type of construction 1. Is construction within 100 It of wetlands? Yes No. Is construction within 100 yr floodplain_Yes No I. 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 APPLIES FOR BUILDING PERMIT I, Q- Q� as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building pe itapplication. SLL (cv)t ( -IIIkPp Signature of Owner Date I. "Ph QUJrrtUas 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 penury. Adam Qua r rreil l I Le Print Name -I I 18 IIS Signature of OwnerlAgenl Date SECTION S-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor: Not Applicable ❑ Name of Licanse Holder Adam Quenneville License Number 160 Old Lyman Rd. South Hadley, MA 01075 CA 070626 Address n Expiration Date Yf^� 8/21/2019 Signature Telephone 413-536-5955 9.Rimilletimild Mom Im " ` Not Applicable ❑ n1111.A ry 4'1 ��0 IZMEl v./4 ¢ Sldthcl UV_ Company Name Registration Number 1l00 h\A \ � P � 1U10- S 191093 Address ` c Expiration Date Telephone "1k3 .� -SV Tl9 r 3/22/2020 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§251 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...... ❑ City of Northampton 4 .�..^.r....rr0 Massachusetts c ,r DETUM MENT OF BUILDING INSPECTIONS 212 Mein Btreet a tl nicipal B—lain, /C Northampton, [ 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owneroccupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Nate:Lfthe homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: ®oi, VVA 1 Est Cost: -1 s��w. Addressof Work: "O-'� _ C�fILo4 St Mork 040-\mnyq { 00 or) Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): _Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND TINDER M.C.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PACE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: `1 Ili I Id LAal I I/ amga 1.( L 1°1109-3 Date Contractor Name H IC Registration No. OR: Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts �f R DEPAN22ffiNT OF BUILDING INSPECTIONS 212 Main Street *Municipal Building J� gCt Northampton, Mw 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c40, 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. The debris from construction work being performed at: iiO- iia M YX-eA- �. (Please print house number and street name) Is to be disposed of at: usp�- V�aw 'V IS Mu(tzn e-1 EnFu)d CT (Please print na a and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: U� H�IuIIYW IS I�u1l2n Q In�t�lr� Cr (CoJm// ny Na a and Address) y Signature of Permit Applicant or Owner Date If, for any reason,the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. QUENNEVILLE www.1800newroot.net ROOFING W SIDING � WINDOWS We Ara Ucensed 18o Old Lyman Roes•South Heday,MA 01075 Fully Insured 1.800.NEW ROOF a 413.5363955 Ental;Mee1s00rwwm0l.nN WePab:www.teawwwwol.m Factory Trailed NAconmrrtlbr,txeaveore tl0 N7oeN leu MFatwaen#120aes Fadory Cw#RW Installers awwwaea arnw awara,rawa„aw.awa.. OT Roghftn#575920 NwP,a T.aJprM6TM M1wxYalp PAC .10 Prkpoeel 8ubmlawl To: Date Phom,V. C: VAN % 1 r H: 9-17 7W. 6IM1 Em W: (/O —l1 k ?ft-kr,T 37Ytc7* 5y.Esta,2PCode SPWW Repukems %: t14r IPA ❑Recover r8 SMp O Layer Complete Roof System &We shat acquhe all appropriate permits for all work rffi Homs exterior and landscaping to be prolec ed M,SMP exyllng ran**lo exWOOKMV and dbpme of. Oo not Do. C.Deteriorated existing dw*AV will be replaced at$3.47 par sg.R after hA Inspection. Ck Install lex&Water Barrier at all eaves,valleys,chimneys,pipes and skylights IQ Inlet edc)uderRYmem over rermwmg dockhig area AM install KUW chip edge at eavm err rakes(B'I5')(whirs/brown/copper) PQ Imteli merWacturerb starer shlroa on all amuse and rake edges E Insist new pipe boot flashing(Ma dad/capper)/vents 'E9.Insist Snow Country or Cobra rolled vent rdge ventams s W 11 I,etue n argfirl"miloson TORCH AWARD Shing! ^ (6 nails per shingle) F Shingles ❑ 25 year ❑ 30 year 2JW year Color Ridge cep shingles Warranty Options: PWe guarantee as workmanship for 10 full years(see our warranty coverage) ❑ GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: p)- -Lead Cwnter Rachkg ❑W&W S"It Tuo"Int ❑ RubbWU9d Croom ❑ Metol Chh"Cy�gp 1Wa00a.IrawwerMmdAwwY -wept#.w ww,err we xw.p.dawbn Wft.M.TaWOw(37, Ws ) ACCArarrCE Or PMPmaL: no saw Fk,wwousm M ml®aa M pawl PaPrrx(S ) eehNrNrr W M hmw aewpad.Yes M)IIIIIOII N do air w"MANE Pw.NAa®brlAae.na Mrlwlrl,rM�MMaM y-�rn00 Qw 0000 GamGl+Om(ai.J--=-1 DAW Derv: 7 Eearelom M"Nara) (Sign Nems P-retie sa Mmlad br asy(eo)dm hon moo dw ATTEOM HOMEOWNERS:Para sow wl prwul tiMonekwbteaaftasasaarsbpeerredeetera poular IY otrkdNr9 dwda Ordret Mrlrhrp N though areww w Ola ween.Adw Duov"go 110011,12 wR mol be reepmatlble b debMw row h dm WJC xebratfa arae#. r ACOBd CERTIFICATE OF LIABILITY INSURANCE SA ('M MyYy,T 0812812010 THIS CERTIFICATE M 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 Me cari W holder M an ADDITIONAL INSURED,Me po"lef)must lova ADDITIONAL INSURED provtsions or be endorsed. It SUBROGATION IS WAIVED,subject M the burls and condition of Me paltry,certsin policies may require an endmsemam. A ftatsment on this cariMcats does not colder rights W has cerdfl holder M lieu M such endoreamgngf). Peo DUCE^ xaxE: Mehoo.Kmakula Goss&McLain hourence AgelmyWIOLE H13)530.7355 N As (413)538-8288 1787 NONlamplon Street RpORE66: mkarekola®g0MmCain corn PO BOX 1128 IN811RMISAFPORDINDCOYFRAGE NAIL/ Holyoke MA 01041-1128 x/SBnEfl A: Nautilus InBaRMe Company W911RED WBURERe- Naudm Insuranm Comprey Atlam O.Y.Alle Ro IIq&Sklm,1. INSURERG: ALM.MUNeI Ina Co. 150 OM Lyman Road INSURERS The Bon i Eachari e,Inc. NWREs E' SOMM1 Hetlley MA 01075 INBVRER F: COVERAGES CE"FIWLTENUMBER: CLI85IN974 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE POLICY PERIOD INDICATED. NOTyMTHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANYCONTRACT OR OTHER DOCUMENT HATH RESPECTTO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SUCH POLICIES.LIMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIP Tn EOPINFUR NCE pIX1CV NUMBER NMN MM UNITS X1 ME..L...LUABUT .14OCCURRENCE E 1,OOD.000 cumBMADE ®CCcufl vREMIBEs f 100,000 MD.EXP(Arl f ISo,DC A NN952216 CS23CHO18 MEMOIR OIR PEMNALa AOVIWUeY E 1008000 GENLAGGREWTE UMITAYPUES PER'. GENERALAGGREGATE E 2000,000 PMILv D sn LW PF0xXrCi8-CCMPNPACG f 2,000,000 OTHER: Emp"Benefts E 1,000,000 AUTOMOBIIE WBIUry DOWN�E081NGLE NMIT f ANY AUT achou AlUs"Ors'..m) f .ED SCHEDULED BJgLYIWURYIPersomnn f AUTOS ONLY AUTOS AVT�ONLY AUTSONED PRCPERryIIIDAIMGE f Underinsured motchout IN f UMBRFIIA UAB oocue ESONOLCURREHCE f 3,000,000 B IDCESSUAB Cl-N.DE AN030022 OW13/2017 08/13,2018 AGGREGATE f 3,000000 OED RETEMION E 10.000 f WORNERS CONFENSATION X STAOTM AMD EMPLO UABLITY YIN NTE ER ANY"OFFEOPPARTNEREI(ECUTVE EL FACHACCIDEW f 1000000 C CFHCRRMEMMER EICLDDED2 ❑Y Xla AWC4007012881-2018 Od1282018 OM2B12119 massery In E L.DISEASE.EAEMPIAYEE E 1.000,0130 SESCRIRIIXIOFIOPERATION.EMar EL.DEEASE PODCYLIMIT E 1,000000 Surety Bond-HSS ARIIafe Bond Amount 20000 0 3384840 O4119CM310 041192019 ESCmFrIpI OF Or£MTKKIS/LOCaINXSI VFHICL6IPCORO101,AYdtluul llnneN EMwluMmeY aHMMMIeJMmontpaw NreMII,M1 Ce tricale holders are addltonal insured on the al m e up0oned GL polity;subject N policy forms,oordidons,and exdubuns.Adam Ouennevi le,as an oficer is Mooed form the V.blkers Comp pdk.Y. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE]POLICIES BE CANCELLED BEFORE THE EXPIATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Atlem Ouennaville Form,&Si 1%d,,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORREDREPEMENUT��rNIF 0 18 8 8 3018 ACORD CORPORATION. All rights reaervetl. ACORD 2S)2016103) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 0211 4-2 01 7 www.mass.gov/dia t\'orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AOTIIORITY. ApplicandInfornattim Please Print Le¢'bly Name(Businessh0rganizatio0ndlvidoa1):Adam Quenneville Roofing&Siding Inc. Address: 160 Old Lyman Rd City/State/Zip:South Hadley, MA 01075 Phone #:413-536-5955 Am you.n employee Check the appropriate box: Type of project(required): I.O l am a employenvim 15 employees(full anchor part-time) 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. E]Remodeling any capacity.[No workers comp.insurance required) 3❑l am abomeowner doin nwork myself Nowmkerscom . surom d 9. Demolition gr yu L pin ereymre ]' 4.❑1 am a homeowner and will IN,hiring cmorwars to conduct all work on my pm,rp,. I will 10 Building addition ensure that all contractors either have worlem'compensation insurance or em sole I1.❑Electrical repairs or additions proprietors with no employees. p,❑Plumbing repairs or additions 5.❑1 am a general gmpareg or and I have hired the mbcontrocmrs listed on the roughed sheet 13.®Roof repairs These subwntmemrs have employees and have workers'comp_ormarneet 6 We area corporation and its officers have exercised their right or exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.IN.walkers'comp.insurance acquired I 'Any applicant that checks box#I most also fill out the section below showing their workers compensation policy information. s Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors shot check this box must attached an additional shed showing the name ofthe sub-watiscmrs and state whether or not hose entities have employees. If the subcontractors have employees they must provide their wakens'comp_polity number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Policy#or Self-ins.Lie.#:AWC4000/7012861-2018_ Expiration Date:�4//29�/2019 Job Site Address: �(C)' IlliIv eLrV—Q_A- t City/State/Zip: mPis- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ()ICCOC Failure to secure coverage as required under MGL 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 N forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains nit penalties of perjury that the information provided Pbav Vrue and correct. S' t Date' , I(F �f 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 6.Other Contact Person: Phone#: Commonwealth of Massa,husens ®1 Divlsmn of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-070626 Expires:01112112019 ADAM A OUENNEYILLE 160 OLD LYMAN ROAD SOUTH HADLEY MMA 01675 S 4-1 Commissioner L/^" Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement:Contractor Registration Type: Corporation ADAM OUENNEVILLE ROOFING AND SIDING,INC. Registration: 181003 03/22/2020 160 OLD LYMAN RD. Explra0on: $O.HADLEY,MA 01075 Update Address and Return Card. Sf0 O N1d0S1] STATE OF CONNECTICUT 4 DEPARTMENT OF CONSUMER PROTECTION 1 Be it known that I ADAM QUENNEVILLE 160 OLD LYMAN ROAD e SOUTH HADLEY, MA 01075-2632 ' e is certified by the Department of Consumer Protection as a registered HOME IMPROVEMENT CONTRACTOR Registration # HIC.0575920 ADAM QUENNEVILLE ROOFING Effective: 12/01/2017 Expiration: 11/30/2018 M4hdk 5exutl,Commbduner � I