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25-006 (6) BP-2022-0183 144 RIVERBANK RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25-006-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0183 PERMISSION IS HEREBY GRANTED TO: Project# CHIMNEY REPAIR Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 2499 SIDING 070626 Const.Class: Exp.Date:08/21/2023 Use Group: Owner: WHITLEY NANCY B Lot Size (sq.ft.) Zoning: SC Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 1600LD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:03/01/2022 TO PERFORM THE FOLLOWING WORK: CHIMNEY REPAIR 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:. Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney,: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: (RI i Q Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only ,- N we.„.„, City of Northampton C Status of Permit: `'r ° Building Department .;°/ Curb Cut/Driveway Permit s� f,. 212 Main Street FeeSewer/Septic Availability It , ,� : Room 100/ (---)� Water/Well Availability r Northampton, MA 0�;©60 �Q', Two Sets of Structural Plans " - phone 413-587-1240 Fax 41 ' -1272 ` Plot/Site Plans � Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: 7 This section to be completed by office 144 Riverbank Rd Northampton Ma 01060 Map �%� Lot 6 t1.J2 Unit Zone Overlay District Elm St. District CB District I SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Nancy Whitley 144 Riverbank Rd Northampton Ma 01060 Name(Print) Current Mailing Address: 413-530-3064 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name{ ,t{Pt)k,y G,afr;iiw, Current Mailing Address: 413-536-5955 i Atia4 Ouennevil(e /Li Signature'7/2o22 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2499 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) fi-to 5. Fire Protection 6. Total = (1 + 2+ 3 +4 +5) 2499 Check Number / ( 7(j This Section For Official Use Only Building Permit Number: %p,- -p '-/Y,3 Date- Issued: 7: Signature: 3 Z 1 - ZO Z/ Building Commissioner/Inspector of Buildings Date operations.aqrs @ gmail.com 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 Building Height Bldg. Square Footage 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 DON'T KNOW X YES IF YES, date issued � � IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW X IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW X YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained I , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YEF—I NO X IF YES, describe size, type and location: E. Will the construction activity disturb clearing, gradin excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YE jI NO 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) n Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [I—I Siding [El] Other[El] Brief Description of Proposed Chimney repair, remove existing shingles &flashing install new along with ice barrier&lead counter flashing Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -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 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 Nanvy Whitley I, , as Owner of the subject property Adam Quenneville hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. see contract 02/17/22 Signature of Owner Date Adam Quenneville , as 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 perjury. Adam Quenneville Print Name I 02/17/2022 Signature of 0 ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quennville CS-070626 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2023 Address Expiration Date 413 536 5955 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable D Adam Quenneville Roofing& Siding Inc 191093 Company Name Registration Number 160 Old Lyman Rd South Hadley Ma 01075 3/22/2022 Address Expiration Date Telephone413-536-5955 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(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 X No ❑ City of Northampton �S-r.�sr�r� / � ` Massachusetts - , ��, DEPARTMENT OF BUILDING INSPECTIONS - + - 212 Main Street •Municipal Building /° Northampton, MA 01060 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: 144 Riverbank Rd Northampton Ma 01060 (Please print house number and street name) Is to be disposed of at: Adam Quenneville Roofing &Siding 160 Old Lyman RD South Hadley Ma (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Adam Quenneville Roofing& Siding 160 Old Lyman Rd South Hadley Ma (Company Name and Address) Verified by pdffiller /dan7 Quennede 102/17/2022 ')-V/ 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. 2/17/22, 1211 PM Whitley_Chimney Package-1 6451 0754651 8.jpg(3024x4032) I 6 t' _ r .t7 / rim immommomimm,-- r•Q N^\i * xc/J OUIENNEVILLE UAwnuo K,wsc vrR I` POOFING 3 t O I tt x 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:InfoC41800newr ovf.nnt Weiasite.www.1800newroof.net Factory Trained MA Construction Supervisors Lic.4070626 MA Registration 4120982 Factory Certified Installers Member of the Home nn er's Assoc.ut Western Mess. CT Registration OS75920 Member of the Building&trede Assam hoe F,PC3871t1 Proposal Submitted To: Date: Phone 9's: C Nancy Whitley 2/12/22 C. 413-530-3064 H: W: Street: Email• '�_ 144 Riverbank Rd nbwhitley@gmail.com City,State,Zip Code: Northampton, MA 01060 Proposal to furnish and install the following: we will pull all appropriate permits for work. we will remove and dispose of all shingles and flashing around chimney. we will install ice barrier around chimneys. we will install new step flashing around chimneys. we will install new shingles around chimney. we will install lead counterflashing around chimney. shingles will be Pewter Gray install cricket yes/no minor tuckpoint and waterseal 4111 no $5.19 all deteriorated or rotted wood will be replaced at'6 ,/sq ft Ask us about affordable bank financing! ATTENTION HOMEOWNERS:Please cover ail personal belongings in the attic,garage or storage,areas due to the possibility of roofing debris or dust coming in through cracks of the wood.Please remove any lawn ornaments or yard furniture.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: We propose hereby to furnish materials and labor—complete In accordance mth above specdiations for the sum of Total Due:($ 2499 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 800 ) satisfactory and are hereby accepted.You are authorized to do work as specified. Balance Due Upon Completion:($ 1699 ) Payment will be 1/3 down at signing,and balanca on completion. Date: 2/12/22 Signature: �� � Date: 2/12/22 Joe Snopek Estimator:(Print Name) (Sign Name) Estimates ore honored for sixty(60)days from above dote. 1/1 https://ww2.marketsharpm.comNF_Attach/850/74198/Whitley_Chimney Package-1645107546518.jpg w A�CI CERTIFICATE OF LIABILITY INSURANCE DATE T (MMIDo)21Y) 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 are ADDITIONAL INSURED,the poticy(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 N1i`4' Sarah Promo Clayton Insurance Agency, Inc. IAH1c.�c � (423)536-0804 IA,�Nol. (4141144-Ta74 1649 Northampton Street E.raAIL apremoialaytoninsurance.net AOnHESET P. O. Box 989 INSURER(SI AFFORDING COVERAGE NAIC w Holyoke MA 01041-0989 INsuRERA;Nautilus Insurance Company INSURED INSURER e:Arbella Insurance Co, Adam Quenraville Rooting & Siding Inc. INSURERc;AIM Mutual Insurance Company 160 Old Lyman Road INSURER D: South Hadley, MA 01075 INSURER E. INSURER F COVERAGES CERTIFICATE NUMBER:2021 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT rHE 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 NE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IMRRI ADZE WSW— - POLICY EFF POLICY EAR LTR TYPE OF INSURANCE O. KNO. POLICY NUMBER ,IMMIDOIvvvvl (wintry UMITS X COMMERCIAL GENERAL UABMUTY 1,000,000 EACH OCCURRENCE S r 7ht4'4 I $ 100,000 A ....W P9EM)31:5(E CLAIMS-MADE X OCCUR J -� NH]2933:A O 6/23/20ZL 6/23/2022 N¢ EX^(Any one pm m) S 5,000 PERSONAL A.AOV INJURY 5 1,000,000 GENLAGOREOATEUMItAPPUESPER. GENERAL AGGREGATE 3 2,000,000 I POLICY I I PRa ''') 4ECT LOC PRODUCTS-COMP//OP AGO S 2,000,000 f(Yrt.ER $ AUTomosiLE UABIUTY L`CMSi NE0 S]kCi1.E LIMIT 3 1,000,000 IEn 4LtePsr1) _ _ 13 ANY AUTO BODILY INJURY;Per PereonI 3 ALL 04114E0 X SCHEDULED 102010T09S G/23/2021 6/21/2022 BODILY INJURY(Per Cadent) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS ...la 'fgAtli „ _ UNIN&UNDCRM9 MOTORISTS S 100,000/300,000 X UMBRELLA LIA9 OCCUR EACH OCCURRENCE 3 fW 5,000,000 A EXCESS LIA9 CLAIMS-MADE AGGREGATE S 5,000.000 r- DED R.qTNT1ON S AN1242102 S/23/2021 6/23/2022 S WORKERS COMPENSATION PER Oht- AND EMPLOYERS'LIABILITY X SI'AtI rE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT 3 1,000,000 OFFICERIMEMEER EXCLUDED, r yl N/A C (Mandatory in NH) AttC4007012861 4/29/2021 4/29/2022 E.L DISEASE.EA EMPLOYEE S 1,000,000 It yen,datcnba under DESCRIPTION OF OPERATIONS no-ow E.L.DISEASE-POUCY LIMIT _$ 1,000,000 _ _ I DESCRIPTION OF OPERATIONS,LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may he sitanhsd it mon*Nicole rsgahed) S3'or Informational Purposes Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Adam Quenneville Roofing 6 Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 160 Old Lyman Rd ACCORDANCE WITH THE POLICY PROVISIONS. South Hadley, MA. 01075 AUIHOHIZEO REPRESENTATIVE l Michael Regan;il4T //moat.,-r Q 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) CX. The(ommonweattn of 1uassacnuseus r , 1,��� Department of Industrial Accidents 10 =, Office of Investigations =Til4 600 Washington Street �„i Boston,MA 02111 t.*:,i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� (1 Please Print Legibly Name(Business/Organization/Individual): A Clem awry t tit- e_ri t'i StcIl►1 (l 1 02.. � � Address: 01 L. vv a,.� L City/State/Zip: 50 i 1\1c .4lc,4 Alto 0l015— Phone #: II 13 —53C 59 55 _ Are you an employer?Check the appropriate box: Type of project(required): 1..K I am a employer with 15 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ lam a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p h 9. ❑ Building addition [No workers' comp.insurance comp.insurance.t required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.‹Roof repairs insurance required.]t c. (52,§1(4),and we have no employees. [No workers' 13.El comp. insurance required.] "Any applicant that checks box NI must also till 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. t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ l Insurance Company Name: �'M V 1 Veil1 /'5 U tc nC C., Policy#or Self-ins.Lic. #: AWC Lio010 I an i Expiration Date: j/ I1 a Job Site Address: 144 Riverbank rd CityJ5tateizip:North/ampton Ma 01060 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 et'tlfpudlQ the pains and p allies of perjury that the information provided above is true and correct. Hdae Quenne nle Signature: 02,.1_,2022 DAte: 02/17/2022 Phone#: 11 1 3 - 5 3L - 59 9 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 I Division of Professional Licensure Board of Building Regulations and Standards Consttr,eithk Apervisor CS-0�AM A QUEPINE"V ¢ :� . Tres:08/21/2023 ,z ;' 160 OLD LYMAN RD"t ' ' SOUTH HADLEY MA ? k ti if.o 1 tE `� k Commissioner r ea ct , L'f'lhrci ack, 1 eYr(' l? I?I,/0I?ffver///fI C�,; iii.jell,/i vr Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING,INC. Expiration: 03/22/2022 160 OLD LYMAN RD. SO.HADLEY,MA 01075 Update Address end Return Card. SCA 1 = 1OM O !t7 rkly "`A. *`' r''%y`Y" 14,'''sq;, 4�,'{ „ ..4i40 . 1,4 �` I 4 " ''''' r' !��z pup p ii� i��,,, �Lt�'#t,a sj�+'.._ *7'�„ 4 �, ,,�,e�h zt}�.`',� �4 `�, te��y �.'� .�fit': �,p��f' �F �. I it � ,. �,�� �,ai� t5r<' !i�e f STATE 'LC'' "1'411 '� '14' � � g4 '1,t; I ° ':**j y} '`t�rl ''I.. : r ^�.(-l��'^ ��1 1�#.''; OF CO,'V)<IEC`FIC"UT + DEPARTMENT OF CONSUMER PROTECTION j Be it known that at ADAMQUENNEVILLE u f l 1 fir; 160 OLD LYMAN ROAD ` '''. ' SOUTH HADLEY) MA 01.075-2632(" has satisfied the qualifications required by law and is hereby registered as a HOME IMPROVEMENT CONTRACTOR `* 'f Registration # HIC.0575920 f< v' I, pk;,, � ADAM QUFNNEVII,I,E ROOFING 1!' Effective: 12/01/2021 ° � .: 1:..;:.•.::‘ lifil •A''147 I# '','.:::; d . Expiration: 03/31/2023 , Michelle Seagull,Commissioner r,. f.{. le .zet_ 1i 1, �r,... L 2 .} � �. g . ;,.i " 7 . %�>- kf' �}^ '2'rEA S, Y --,,A :'N. ° r'" " ,1,',, fi Y ' 4 t p. i-Weh} 4 ' t .0 .r1 J i s�.+y r, k ..*, Sr—.l =re i*rn.,