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32A-014 (4) 17 WALNUT ST BP-2019-1493 GIs#, COMMONWEALTH OF MASSACHUSETTS Map:Block:32A-014 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Siding BUILDING PERMIT Permit# BP-2019-1493 Proiect# JS-2019-002417 Est.Cost:$20670.00 Fee:S60.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(so.fl.): 6229.08 Owner: RAINBOW PROPERTIES LLC Zoning:URCn00y Applicant: ADAM QUENNEVILLE AT: 17 WALNUT ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:&27/20190:00:00 TO PERFORM THE FOLLOWING WORE NEW SIDING 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: Q11- 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 Occuoancv Signature: FeeTvyc: Date Paid: Amount: Building 6/2720190:00:00 $60.00 212 Main Street, Phone(413)587-1240,Faz:(413)587-1272 Louis Hasbrouck—Building Commissioner S�D�rI/C- r..� L Department use only Vi10 mpton Status of Permit De rtment Curb CWDriveway Permit 212 Sin treat Sewer/Septic Availability UN 2 6 P019 R om 00 Water/Well Availabil y Northa tan MA 01060 Two Sets of Structural Plans o°P 240 Fax 413-587-1272 Site Plans ^rin 4+pp EONS 10', NS 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 3d A Lot '01 /fUnit 17 Walnut St Northampton, MA 01060 zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Rainbow Properties 17 Walnut St Northampton,MA 01060 Name(Print) Current Mining Address: 413-885-9038 11Z— ll nIX71 f-It' Telephone Signature 2.2 Authorized Anent: Atkam 2 fYd lurvinn QJ. Su-1,�11f1I YYIA _ Name(Print /1 Current Melling l a: 0"" 4\- - Sol SS Signature I Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building 20,670.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from S 3. Plumbing Building Fell Fee #60 p/ /l 4. Mechanical(HVAC) 60 5. Fire Protection S. Total=(1 +2+3+4+5) 20,670.00 1 Check Number This Section For Official Use Only Building Permit m4pr: Date Signature: Issued: Z/vBuilding Commissioner/Inspector of Buildings pare production @ 1800newroof.net EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Seiztlon 4. ZONING Alt Information Must Be Completed.Permit Can be Denied We To Incomplete Information Existing Proposed Required by Zoning This column io be filled in by Building Departmcnl Lot Sim �-Frontage Setbacks Front �� r Side L:= R:= LF_., Rs Rear 0 Building Height O O Bldg.Square Footage Open Space Footage -� O /e O O O Ilat area minus bldg a paved toroidal N of Parking Spaces Fill: - - - odui A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued:`f IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page _ __ and/or Documeni B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW Q 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 Issti d: - - C. Do any signs exist an 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 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows TAlteratloni ❑ Roofing ❑ Or Doors I-] Accessory Bldg. ❑ Demolition ❑ New Signs 101 Decks [O Siding[GI] Other[ Brief Despription of Proposed wprk o e nx 51,ryrt a J rnnti .Q D artcL lY)ynll t%t.-) vtn..l �I`5 Alteration of eaishng bedroom_Yes%No Adding new bedroom Yes x No 0 Attached Narrative Renovating unfinished basement _Yes a No Plans Attached Rall -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 c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodall Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance forth attached? In. Type of construction I. Is construction within 100 ft.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. l 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, 80.1 Y bCV3 Pre p Q K[O-6 as Owner of the subject property Adam Quenneville Roofing&Siding Inc hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. S.2¢_ IMIYAfl- (i �l9 Signature of omier,f� Date I, 1 l VI A).Y1 rw-u I I�. ,as Owner/Authorized Agent hereby dedare that the statements and information on Me foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Ad ivYl @IA AY9 Ili I IP_ Prim Name lnl3'{ II9 Signature of CliviterlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Namepf License Holder: Adam Quenneville License Number 160 Old Lyman Rd South Hadley, MA 01075 CS 070626 Address ^ Expiration Date 8/2112019 Signature Telephone 413-536-5955 B.R"Istered Notes Im r m Not Applicable O "W, nj t 1 l ul I tI (Q oah ii .. IA1vt I,YLP_� Company Name Registration Number Ilan 0'J II f&-6 vi �rl . ,Souf h l �sdLc u YY114 a47S' 1s1os3 Address /I Eviration Data IVA�/ Te ephpna ( ll�c 5 �1 3/22/2020 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.D.L d.152.1 28C(8)) 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....... 0 No...... O City of Northampton — n yf Massachusetts f fSPARTMr'NT Or 3111WINa za"Scrioas ' 212 Min atroot • Mnniaipal BuilGinq N..thauptan, Bt. 01060 6 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, innovation, repair, modernization, conversion, improvement, removal,demolition, or construction of an addition to any pm-exisfing 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. Note.ljthe homeowner has contracted with a corporation or LLC,that entity mast be registered Type of Work: SlrA% V1Est.Cost: ��1n7000 Address of Work: 1-1 Wof yxuA 4r Noo-"aniptIn MA OIOLOD Date of Permit Application: tDId7(Vol, 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 UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: IP layll9 AAam tO 1Lin"A-)i llv 191093 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts c c DEPARTMENT OF BOILDING INSPECTIONS 7 F 212 Mein Street •Municipal Building •C Northampton, ! 01060 0 Debris 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. The debris from construction work being performed at: 1 -7 0 )nInut .5F (Please print house number and street name) Is to be disposed of at: ()514 I6LJ-tt(ja P"-L'ycatn5 I-K�- AAuItBn (Zit LCq-kelit CT Oln03a (Please print name and location of facility) Or will be disposed of in a clumpster onsite rented or leased from: u� f4al,cl l v1� + QeC xId l yt k y1c— is MLAtun fid. Enhird r -T aoos;� (Company Name and Address) , ("I"jIS 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. '.•} Yr� OUiNN[VRLE!PAMAW >ta.`3a' �l-lnwevr VISAS ms< ova e— 160 Old Lyman Read•South Radley•MA 01075 We are Licensed 1.900MIEW.1i • 415.536.5955 Fully Insured Email mica Iflocrewcolne WebS.te:wwrvanawwmf.Mt Factory Trained Mil rnnsleetbn 5u,wwsms in.1070636 W112098 Factory Certified Installers errX noes wlMs"cum.a weurn aua' R Repioratmu 157597. yas. n nns Ywss.'aaearvurm eI le)lo Pru osal Submitted To: Date:41302019 Phone Ift C. Rainbow Properties N w street Emtll: 17 Walnut St CitµState,lop C ke'. Northampton, MA 01080 Proposal to fum ilh sred MUg the follawks, 1)Acquire all building permits 2)Remove old aluminum siding and Inm 3)Replace any rotted wall sheathing at$4.00 per sq.ft 4)Install insulation board to manufacturer speciflcaeons 5)Wrap all windows,fascia and rakes with white alimunum coil 5)Install all vinyl siding oomponents to make the vinyl siding system,including vinyl soffits 8)Clean up and remove all debris *Additional options not included in pnce -Install new gutters and downspouts$1,975 -Install new 18 pairs of shutters$1,450 -Ship off wood dapboards to Original sheathing$1,920 Atk us about a//ordodr honk pnprrcmel AMNnON MMEOWNERS:Please cover all persmal bekargings In the allk,garage or storage nen dire to the sensibility of roofrrg debris m dust coming In through cracks of the wood.pease remove any haven ornaments or yard furnmi e.Adam Ouennevllle Rodin,will not oe resPonsibe for debris or dust in the*"IC or storage areas. cvdOmer reach'. M, lmal Due:(518.750.001 "T AcamAxaarilarosu:tlw.lwn lrim.rPwaimiww ammndldom ova Down Payment:IS 6.250001 rausseeland—lan6rmpn.rauwawassa mea.maas meZ Lounm Doe upon CmnPkhon:IS 12.500.00) rarrrwm w1i r 7/a ewe ra.pe9,N 6alrrsa era Open mmlRmbn. Date: (r 17 5 sgmture/�?�— Date:4KICI&01) EAinel(Print Name)Adam OuennmiM IS an Name, rdmowear®a+MsMfaAaarahwnavwwu. ` AU& CERTIFICATE OF LIABILITY INSURANCE s/24/2019 THIS CERTIFICATE IS ISSUED"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 INSURERISI,AUTMORIIED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:If dre uNficab holder is en ADDITIONAL INSURED,the policy(i e)must he andoreed. U SUBROGATION IS WAIVED,subject to Bre bans end wntl lou M tM ando,cerendtrollciae may require en eldoreement A ebbmaM on Nh udlfkab tloea not wMer Hghb to 1M cedMub holder in lou of such eMoreemsMls). Nast: SacN Prm Martin 1 Clayton Insuranca Aqenry, Inc. PMON! N131536-0801 ru Ind, - 1669 NorWs,pton BtrYt .spcmps,iclaytw.eY P. O. Sox 999 1sa.FaaSI AROIbIMJ COVERAGE Mo. Holyoke NA 01041-0989 W RA;Mautilu9 Ineuracoa Cowany '"reRG RIMMaRa:OrNn Mountain Insurance C Ades, Q..ill. Reefing E Siding Irnf. sMUMRO:AIM Mutual Loa. Coaparry 160 Old Lyaan Road aaewAp: sasRYe: South Hadlay IDL 03075 WWIG16: COVERAGES CERTIFICATE NUMBER:2019 N 9TLR REVISION NUMBER: THIS ISTO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOME INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTPATHSTANDINGANY REQUIREMENT TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN.THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECTTOALLME TERMS, EXCLUSIONSANDCONDITNONSOFSUCHPOLICIES LMITSSHOWN MAYHNVE BEEN REDUCEDBYPNDCVJMSsee, ADDL . TrPEa W1MAMCF YWOY MIIBER r9F 1. WW xCOMYERCIALOGERULAaGrY EACH acnnlElllf s 11000.000 A CIAIMSNPnE aCCCW MOUSES da 100.000 X If x3000130 6/23/3019 6/]3/30]0 ME,EW Ike me 11 f 5.000 IEn50I aAw IMUfY f 1,000.oco GEML.W]REGXTEUYRARLEe ATA' GE3E JaOGREf n s 2.000.000 PoIN:YO ❑UX PROOXTS.()CWPF AGG 6 2.000.000 G' S AurOM0aI1l LlAelnY 'N " L ° f 1,000,000 B A"yAM BoULY IN ury'Fe Iwnnl S 'LLAI.QS 0 X AD1D$ 0 % y 100f0aG 6/23/3019 6/33/3030 eoDLY M (PacNno f X NUEDADiOa A NONGYfEo MgpIrvOXMXGE $ AU103eaeaen f % DNeIV11AIMB OCCTIR EACH OCCAIRRENCE S 31000,000 A IXCGt11Va CIRMS E AGGREGATE f 5,000,000 DED RETENTION 6 M06T66 6/13/3019 6@1/2020 S sec Osa antes lXIX AT IINDBROIIIIS'WiPY ANytPCPME1Q29AR11Eq£XgVINE YIN n106001012.61 6/]9/]036 6/29/3030 EL FAOI.ACdOEM f 11000,000 L, CfEILEWLEY09i E%LWDFD) MIA IYyyNMNIMI3n N0 EL D3FASE.EAEY0.0VEE S 1.000,000 EESCg10Rl�C£GEMTq OMv` EI tlSF/SE.P7LICY LIMn S 1.000.000 pGO�Ip0Fo96NTg1611p1�61g10/vBR9D NCMOf01.a.MISM RrNe Ww.�YNMYeA�YEeNgeoeneYM) Mariners' CYpYeation bacafite will b paid to MuYachae.tta 6uployws only. Pursuant to Lndorsesant MC 20 03 06 e, na authori.atien is qa. to Pay olaiY for barwfits to exployees in stets. othat than Massachusetts if Trus insured hirss, o[ has hired those employees outside of Massachusetts. able certificate of iruurance eho.. the policy in force on the date that Mae oa[tificat. x (.1...ssued ( l..e the expiration date on the above policy pEewdle. the issue data of this certificate ofain....). The statue of this coverage can be Ynitored daily by eacassinq the Proof of Cov.raga - C." Verifinatiw Search tool at 3nw.Yea.gov/1Md/Yrkera-eosPYsatlWime.[igationsl. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR PERMITS ONLY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELNEREO IN ACCORDANCE WITH THE PWSCY PROVISIONS. u31110RgG IOfIQ801N1I0E ichael Regan/ENT me[r✓ p l ,,, ©1988-2014 ACORD CORPORATION. All rlghb reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSO251muon The Commonwealth ofMassachusetls Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 n'ww.mass.gov/dia V11.1ters'Compensation Insurance Affidavit:BuUders/ContractorsMectricians/Plumbers. TO BE FILED WITH THE PERMMING AUTHORITY. Aoolicaot Information Please Print Legibly Name(Bmtaea9Orgaardshowletdividua0: Adam Quenneville Roofing & Siding Inc _ Address: 160 Old Lyman Rd City/State/Zip: South Hadley, MA 01075 Phone#: 413-536-5955 Avert an mployer!Check rbeappmpriate boa: Type of project(required): I.M(l ma mpbYm with-15—coaloyees(fuumml/m pniunc).• 7. E]New canstmction 2.❑Imaahk pmpriucrm pmmvshiPatd true na cvgbycn wwkuq formcia 8. ❑Remodeling M isometry.[No mankmW emnp.tmmanee remained.] 3.❑Imehmaewtndoittp all xak myulf lNa wohers'comp.inwntme reyuima.J' 9. El Demolition 4.❑Inn.hmrcawnm and will be hour,mnsremanm rand.,ell work.my Po sous. I will 10❑Building addition am lMrall mnaacmneither have worker'mmpemarion imumrce or arc sale 11.❑Electrical repairs or additions P10p"0t011 W1a'"O C1"PIOyCC1' 12.❑Plumbing repairs or additions 5. Ima,ercnl ehnmemraMihave hkW rhe sub-covmetors tiatedan Ne titin)ieacet 13.❑Roof rs These subromrdar have empkyeesa,d havewotkvx'mmp.ituvercet r@C�' fi.Qw<emaroryomdoomd rts onmen lave acrviadrisrirri,bs ofucmpiw pn MGL c. 14.©Other ',Idlvlc 753,pI(e),and we have romployees.INo workers'mmp.insutumemquird.] ��T • erarmaenthat checks box al mart dmfille,rhes r,dam, a blow oolong theiramkersie moructerspolicy imfnt a nMn. e Hmm .who mbmiuhisernernais indicniathey arc thins,all moment,anttima hheounidecnmkxtonnd matemitanew not don indimtlnh sock. tC°naea. )setelmekthuclbe.mananirpleanndheymalsheetidewN,theomsm ofd.auh-connacronand nate whmM or not thou entities have mnPloYees. Iftm mbconkactors M1ave nnpl°Ytts,Nry mmr Provide @ci, xmkers'mmp.polity number. I exam,an employer that isprovining workers'cnmpensadon(murancefor my employees. Belowisthepulicyandjobsia, information. Insurance Company Name: AIM Mutual ' AWC40070128612019A 4/29/2020 Policy Won Self-ihs.Lic.k: Expiration Date. lob Site Address: /-? 14)/ nt-rl- 9 City/St,terziP: N1,0V f ,6LaVW lti 4 aObD , Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,d25A is a criminal violation punishable by a fine up to 51,500.00 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 do hereby certify under the sins mrd prrmlties of perjury that the infornmtion provided abov fs nue and,*,,e,4 s t Dale ��9 Phone W: 413-536-5955 Official use only. Do not write In this area to be completed by city or town oJTciat City or Town: Permit/License W Issuing Authority(circle one): 1.Board ofHeahh 2.Building Department 3.CRyrfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone W: Commonweafth of Massachusetts Division of professional Lkensure Board of Budding Regulations and Standards Con strection supervisor CS-070626 Expires:08/2112019 ADAM CRUEN SOUTH HADLEY MA 0111 100 0LD LVMAtI ROAD.. SOUTH HAOLEY/M�A`0e�/076 Commissioner C14 r%/L� C�4/J2177,0?,/.11P.lLll.1G O�///(7p�jr1Q.(/lCI�P-�f1 Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: corpore6on ADAM QUENNEVILLE ROOFING AND SIDING,INC. Registration: 191093 160 OLD LYMAN RD. Expiration: 03/M020 - SO.HADLEY,MA 01075 Update Address and Return Card. "I I <% zm.+asn STATE OF CONNECTICUT i DEPARTMENT OF CONSUMER PROTECTION Be it known that ADAM QUENNEVILLE 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075-2632 has satisfied the qualifirstions required by law and is hereby registered as a �I - HOME IMPROVEMENT CONTRACTOR I Registration # HIC.0575920 ADAM QUENNEVILLE ROOFING Effective: 12/01/2018 Expiration: 11/30/2019 ,] i i