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35-266 (12) BP-2024-0774 21 WEST PARSONS LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 35-266-001 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-2024-0774 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 20999 SIDING 070626 Const.Class: Exp.Date: 08/21/2025 Use Group: Owner: TRUSTEE MANGIONE LORRAINE Lot Size (sq.ft.) Zoning: WSP Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 06/14/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: • THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 172. Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildine Commissioner !<(\ The Commonwealth of Massac• setts <c•/ FOR gI Board of Building Regulations • Sta :ards JG� Massachusetts State Building Co , •:!,r MR J ICIPALITY # . E Building Permit Application To Construct,Repair, ;• •r DemkApli a v vised ;ar 2011 One-or Two-FamilyDwelling6q ��o, �i„ .yQ This Section For Official Use Only �4f 4tis R Buildin Permit Nu ber;,6/1"'t y- J Date Applied: afro,I''• "Et/40 n ///>Z (, IL1zOzq Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 21 West Parsons Ln Florence Ma 01062 1.1a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Ownert of Record: _Jim&Lorraine Schumacher _Florence Ma 01062 Name(rnnt) City,State,ZIP 21 West Parsons Ln 413-210-3322 drschu@comcast.net No.and street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Se Owner-Occupied 0 Repairs(s) I Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units I Other IX Specify:_ _ Brief Description of Proposed Work: New roof,remove and replace existing roofing,install new synthetic underlayment,drip edge,ridge vent,pipe boot flashing and ice and water barrier SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 20,999.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ O Standard City/Town Application Fee O Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fep1 2 Check No. I heck Amount: * Cash Amount: 6.Total Project Cost: $ 20,999.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-070626 8/21/25 Adam Quenneville License Number Expiration Date Name of CSL Holder 160 Old Lyman Rd • List CSL Type(see below) U No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) South Hadley Ma 01075 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-536-5955 kaylec.agrs@gmail.cont I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 191093 3/22/26 Adam Quenneville Roofing&Siding Inc MC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 160 Old Lyman Rd kaylee.agrs@gmail.com No.and Street Email address South Hadley Ma 01075 413-536-5955 City/Town,State,ZIP Telephone SECTION 6: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 No . ❑ SECTION 7a: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 to act on my behalf,in all matters relative to work authorized by this building permit application. See contract 06/12/2024 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION 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 to the best of my knowledge and understanding. Adam Quenneville 06/12/2024 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (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 Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 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: 21 West Parsons Ln Florence Ma The debris will be transported by: Adam Ouenneville Roofing 8 Siding The debris will be received by: Adam Ouennev`Ile Rooting&Siding®160 Old Lyman Rd South Hadley Building permit number: Name of Permit Applicant Adam Ouenneville Adore Quef neVlle oei�time!. • 06/12/2024 Date Signature of Permit Applicant L D v k pt�ENNEVgLLE ,. © At AC VISAC _ O tc-Y" —All boil 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:into@l800newroof.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 P.P.0 38710 Proposal Submitted To: Date: Phone#'s: c: 413-210-3322 Jim Schumacher 6/7/24 H: 413-584-4727 W: Street: Email: drschu@comcast.net 21 West Parsons Ln City,State,Zip Code: Special Requirements: Florence, MA 01062 PROPOSAL FOR: HOUSE GARAGE OTHER STRIP RECOVER Layers: 1 Z 3 4 Plywood Included: Yes or No Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: X We shall acquire appropriate permits for all work X Home exterior and landscaping to be protected X Strip existing roofing to existing decking with full inspection DO NOT DO: Shsrj nr Stinrnnm X All project waste shall be removed by dumpster(dumpster for contractor use only) X Install Ice&Water Barrier at all eaves 3'/6',valleys,chimneys,pipes and skylights X Install(151b.felt/Synthetic)underlayment over remaining decking area X Install Metal drip edge at eaves and rakes(8"/5")(white/brown) X Install manufacturer's starter shingle on all eaves and rake edges X Install new pipe boot flashing/vent accessories X Install ridge vent-Snow Country/Cobra rolled/4'Baffled/Roll Shingles:(standard 6 nails per shingle) GAF Shingles Color: Barkwood Seal a Ridge Ridge cap shingles Warranty Options: X We guarantee our workmanship for 10 full years GAF System Plus Warranty GAF Golden Pledge Warranty Chimney Options: Lead Counter Flashing El- Water Seal&Tuckpoint 0 Rubberized Crown Li Cricket 1 Mason needed(customer provided) Additional material and labor charges may apply. X Deteriorated existing decking will be replaced at ss5.19 r sq.ft.and dimensional lumber at srs per linear ft., after full inspection. Customer lnitlalsl1."- t We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 20999 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($6,300 ) satisfactory and are hereby accepted.You are authorized to do work as specified. Balance Due Upon Completion:($ 14,699 ) Payment will be 1/3 down at start of job,and balance due upon completion. Date: 6/7/24 Signature: 3 1„,t,� Date: 6/7/24 Estimator:(Print Name)Weston Melees (Sign Name) 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 Quepnevi'le Roofing will not be responsible for debris or dust in the attic or storage areas. Customer initials:) The Commonwealth of Massachusetts Department of Industrial Accidents =,yam Office of Investigations 600 Washington Street ==�= Boston,bfA 02111 •wr www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� � (1 +Please Printnt Legibly Name(Business/Organization/Individual): Ac.Ie r1 @vens )k ak- (CS1Ut tn1 )i� (ft r y ii(- Address: L0 O\ L vrve„, L Q City/State/Zip: 500h is Ac.6 (11,a OS- Phone#: 13 —53(.`5955_ Are you an employer?Check the appropriate box: Type of project(required): 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P 9. ❑ Building addition [No workers' comp.insurance comp.insurance.. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 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. 152,§1(4),and we have no 13.0 Other employees.[No workers' — comp.insurance required.] `Any applicant that checks box k 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AA u t vel`k I1S ll Ic nLc. Policy l or Self-ins.Lic.#: WC 90610 1 aTL I Expiration Date: 04/29/2025 I Job Site Address: 21 West Parsons Ln City/State/Zip: Florence Ma 01062 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 S 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 S250.00 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. t do hereby certifviunderithe pains and nenalties ofveriu— - rtion provided above is true and correct ma WW1. Ada,N/Cluenne✓r'tle 0: '°Wryer 06/12/2024 Signature: _ Date: q Phone#: 1 ` 5 3L — 5 i 5 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitfLicense# 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 It: l Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Constoitt rt4Aloyvisor CS-070626 w: * O}l�fres:08/21/2025 ADAM A QUt^Is4N 4 160 OLD LYMAN . 4 SOUTH HADI:FY y i J 1 ��b Commissioner _I e,�,LL., THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ' 4 : ...3 i 0..-e ,.... --, �,. 'r. ..:............! W' rs --- 14' , u= Type: Corporation i' .Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDINI 1 1C.M i« -.: . : Expiration: 03/22/2026 160 OLD LYMAN RD. . -..... . i SO.HADLEY, MA 01075 �`'+ " •'" u ! j * --—� + 1 ♦ « rw.r t�.i < , r` J.ec j4 f"'.. Update Address and Return Card. A •,r, :r 5 . t ?is y l- ,.'- , .. ,1- ,Z ;'} iii,:'� § -'' STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION i, Be it known that I k_:•V =: •�7� ADAM QUENNEVILLE �,�. _ . ' 160 OLD LYMAN ROAD • ' , _ SOUTH HADLEY, MA 01075-2632 M• 4h f <, i i iErt kt's has satisfied the qualifications required by la\v and is hereby registered as a • , HOME IMPROVEMENT CONTRACTOR .y iv:r i 1 *, " ADAMVI QUENNEVILLE ROOFING t':_ • c. Registration #: HIC.0575920 G' ' Effective: 04/01/2024 • -Xi"- V.,./1..-• I ;- :��`: 1 Expiration: 03/31/2025 - }` Hrvan'1'.(:Rfterclli,Commissioner missioner Rr , — '% ,.'. lt.f5 t# .lire > S :: t` S{l� fi t�-� t- i filr �' `4h,"> f tlt fF1, . ',9 li,i AC� DATE(MM/DD(YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/1/2024 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 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 CONTACT Lauren Eckhardt NAME: Clayton Insurance Agency, Inc. tac No.Extl: (413)536 0804 j'A No): (413)534-7e74 1649 Northampton Street ADDRIess: leckhardt@claytoninsurance.net P. O. Box 989 INSURER(S) AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURER A:NaUtilUs Insurance Company INSURED INSURER B:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc. INsuRERc:Gray Surplus Lines Insurance Company 15889 160 Old Lyman Road INSURERD:AIM Mutual Insurance Company South Hadley, MA 01075 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:2023 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 CONDI i ION 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DOIYYYY) (MM!DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE A CLAIMS-MADE X OCCUR PREMISESO(EaENTE occurrence) $ 100,000 X BI & PD DED $2,500 BN965983 6/23/2023 6/23/2024 MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jE? LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 20047429 6/23/2023 6/23/2024 BODILY INJURY(Per acadenl) $ AUTOS AUTOS �— NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) UNINS/UNDERINS MOTORISTS $ 100,000/300,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ GSL101401 6/23/2023 6/23/2024 $ WORKERS COMPENSATION X PER ERH- AND EMPLOYERS'UABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A D (Mandatory In NH) AwC4007012861 4/29/2024 4/29/2025 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attachod If more space is required) For Informational Purposes Only. 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 Adam Quenneville Roofing Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 160 Old Lyman Rd ACCORDANCE WITH THE POLICY PROVISIONS. South Hadley, MA 01075 AUTHORIZED REPRESENTATIVE i Michael Regan/FMT r72-W -� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 i2014Ct,