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35-238 (3) 5 BAYBERRY LN BP-2020-0056 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-238 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0056 Proiect# JS-2020-000112 Est.Cost: $25078.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: i Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sg.1): 30056.40 Owner: MCOUAY DAVID D&SUSAN A Zoning: Applicant: ADAM QUENNEVILLE AT: 5 BAYBERRY LN Applicant Address: Phone: Inscurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:7/18/2019 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# 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: Feer e: Date Paid: Amount: Building 7/18/ 019 0:00:00 $40.00 12 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner oe�-� �- Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 A ailability Northampton, MA 0106 C' pm s of SructUral Plans phone 413-587-1240 Fa 413-�J �--C� e Plans cify APPLICATION TO CONSTRUCT,ALTER, RE AIR, f ENgojEAOA LIS A O E OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION n,N�t��`��cp�1O 1.1 Property AddressNoRjH his section to be completed by office � 1 Map Lot / Unit 5 Bayberry Ln Florence, MA 01062 Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Susan McQuay 5 Bayberry Ln Florence, MA 01062 Name(Print) Current Mailing Address: 413-586-2528 l �t1�1—1z,C - Telephone Signature 2.2 Authorized Aqent: m (AA L n c Name(Print) Current Mailing Address: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building 25,078.00 (a) Building Permit Fee 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) 25.078.00 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date production @ 1800newroof.net 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 be filled in by Building Department Lot Size Frontage Setbacks Front .� Side L= R:= L:= R:= Rear ..........._....I .••.-- t Building Height U Bldg. Square Footage �.� 010 Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 NO e IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property? YES © NO Q 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 © 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 Alteration(s) ❑ Roofing ❑✓ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0) Other[0) Brief Description of Proposed Remove existing roof material and install new asphalt shingle system. Work: v Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housina, 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 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Jl�t s(X in ! ! I C �(��U 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. �- Contra ct -1 k'5`1-1 Signature of Owner Date I, (J�t4,l IlQ1/�6CJrn►� `�17C , TAC - as Owner/Authorized Ag nt hereby declare that the statements and inform n on the foregloilng application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. @rx aUi IG rint ame ^ �V I Signature of wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville License Number 160 Old Lyman Rd South Hadley, MA 01075 CS 070626 Address Expiration Date 8/21/2019 Signa r Telephone 413-536-5955 9.Reoistered Home Improvement Contractor: Not Applicable ❑ o O d Company Name j Registration Number KJ SOU.4, 6 191093 AddresJ�— Expiration Date Telephone y��' 531 -1�I. 3/22/2020 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))_71 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 S ' c � Y" �• Massachusetts ��� �• � a t' 1 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 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 owner-occupied 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:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: oc�l Est. Cost: L;2 5,0-7 pp,ad Address of Work: f J Am4 Lh , Ror n 016(0 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 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: --1�(1�-\Ick Ac6m tlanaulL_ 9 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 wi •,� DEPARTMENT OF BUILDING INSPECTIONS e j 212 Main Street •Municipal Building Northampton, MA 01060 rs •,• ��o 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: 562W/X M4 -1k)- (Please print use num er and street name) Is to be disposed of at: u 1ing (Please print natne and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: uf:6 176,dom /T Mown l Ic C7- D(o() (Company NaMA and Address) 4, -1 1 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. QY�NNSV�LLi C�%%E✓'�V VISA DtSCQVeR wen»rr.rc.. srn.euct wn�twws AWARD aoio wlrvrvea 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully 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 Builder's Assoc.of Western Mass. CT Registration#575920 Member of the Building&Trade Association PRC 38710 Proposal Submitted To: Date: Phone#'s: C: Susan McQuay 7/1/19 H: 413-586-2528 W: Street: 5 Bayberry Ln Email: labman99@comcast.net City,State,Zip Code: Special Requirements: Repair 2 Window Screens Flo-renrp_ MA 01062 2 Velux Venting Skylights $2360 PROPOSAL FOR: No Interior work done by AQRS HOUS GABA OTHER Repair and replace Soffit & Fascia 50 Linear Feet $2000 IP RECOVER on Far left side of house and bac Layers: 1 (D 3 4 Plywood Included: !�e or No corner Tear off SLATE or SHAKES 10 Pieces Install two 4x4 bathroom vent COMPLETE ROOF PROTECTION SYSTEM: y We shall acquire appropriate permits for all work )C Home exterior and landscaping to be protected Strip existing roofing to existing decking with full inspection DO NOT DO: Y All project waste shall be removed by dumpster(dumpster for contractor use only) �( Install Ice&Water Barrier at all eaves 3' valleys,chimneys,pipes and skylights �( Install(151b.felt/ nth-e- nderlayment over remaining decking area x Install Metal drip edge at eaves and rakeso/5")(white ro Install manufacturer's starter shingle on all eaves and rake edges }( Install new pipe boot flashing/vent accessories )C Install ridge vent< now Countr Cobra rolled/4'Baffled/Roll Shingles:(standard 6 nails per shingle) Barkwood GAF Timberline HD Shingles Color: GAF Ridge cap shingles Warranty Options: We guarantee our workmanship for_ full years GAF System Plus Warranty X GAF Golden Pledge Warranty Chimney Options: 1 K Lead Counter Flashing E] Water Seal&Tuckpoint O Rubberized Crown O Cricket O Mason needed(customer provided) Additional material and labor charges may apply. Y Deteriorated existing decking will be replaced at$3.77 per sq.ft.and dimensional lumber at$7.00 per linear ft., after full inspection. Customer Initials:-�5&Yh_ We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($2 5,0 7 8 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 8378 ) Pd Ck# satisfactory and are hereby accepted.You are authorized to do work as specified. I 2nd Payment at Start Job:($ 8350 ) 167 Payment will be 1/3 down at signing,1/3 at start of job,and balance due Balance Due Upon Completion:($ 8350 ) upon completion. Date: 7/l/19 Signature: Af Date: 7/1/19 Estimator:(Print Name) Joe Snopek (Sign Name) 413-221-4329 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 will not be responsible for debris or dust in the attic or storage areas. Customer Initiols:s� I ACC"llla�Ra CERTIFICATE OF LIABILITY INSURANCE DATE 6/24/2019' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER UUN IAG I Sarah Premo NAME: Martin J Clayton Insurance Agency, Inc. n/C NN Ext): (413)536-0804 AX No: t4131 534-7e74 1649 Northampton Street E-MAIL spremo@mjclayton.com ADDRESS: P. O. BOX 989 INSURER(S)AFFORDING COVERAGE NAIC N Holyoke MA 01041-0989 INSURERA:Nautilus Insurance Company INSURED INSURER B:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc. INSURERC:AIM Mutual Insurance Company 160 Old Lyman Road INSURER D: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:2019 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM/DDYIVYYY MM/DI CY EXP RDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FX OCCUR DAMA 100,000 PREMISES Ea occurrence)$ X Y NN1000129 6/23/2019 6/23/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIESPER. GENERAL AGGREGATE $ 2,000,000 POLICY F JFEC RO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident _ ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS Ix AUTOS X Y 20030065 6/23/2019 6/23/2020 BODILY INJURY(Per acadent) 8 NON-OWNED PROPERTY DAMAGE XHIREDAUTOS AUTOS Per accident $ $ X UMBRELLA LIAOOCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000 HDED RETENTION$ AN069764 6/23/2019 6/23/2020 $ WORKERS COMPENSATIONx P R OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE ANC4007012861 4/29/2019 4/29/2020 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑N/A C (Mandatory In NH) E1 DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance) . The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR PERMITS ONLY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .�y7 Michael Regan/FMT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) r r The Commonwealth of Massachusetts Department of Industrial Accidents > 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Adam Quenneville Roofing & Siding Inc Address: 160 Old Lyman Rd City/State/Zip: South Hadley, MA 01075 Phone#: 413-536-5955 Are you an employer?Check the appropriate box: Type of project(required): 1.Ndl am a employer with___1_5 employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working forme in 8. n Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition In 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.1-11 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or arc sole I LE)Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.a I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance) 6.0 We are a corporation and its officers have exercised their right of exemption per MCL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy 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 AWC40070128612019A 4/29/2020 Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 5 8owbcryuCity/State/Zip: P7 (ore ri U , ff)R 01 OLOD Attach a copy of the workers'c pensatio policy declaration page(showing the policy number and expiration date). 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 be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' s and penalties of perjury that the information provided above i true and correct Signature: Date: 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 Massachusetts ® Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-070626 Expires: 08/21/2019 ADAM A QUENNEVILLE ' 160 OLD LYMAN ROAD '''` SOUTH HADLEY MA 01076 .'. Commissioner � 1- C� Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation ADAM QUENNEVILLE ROOFING AND SIDING•::INC" Registration: 191093 160 OLD LYMAN RD. �i+ :-_ - .4:,'_ Expiration: 03/22/2020 SO.HADLEY,MA 01075 ° SCA 115 20M•0S 7 Update Address and Return Card. 1 b A� STATE OF CONNECTICUT .+ DEPARTMENT OF CONSUMER PROTECTION Be it known that j ADAM QUENNEVILLE y, 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075-2632 a � ji tia has satisfied the qualifications required by late and is hereby registered as a s HOME IMPROVEMENT CONTRACTOR !� r 1 Registration # HIC.0575920 ADAM QUENNEVILLE ROOFING j Effective: 12/01/2018 Expiration: 11/30/2019 Michelle Sepgull,Commissioner