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12C-078 56 CAROLYN ST BP-2011-0160 GIs #: COMMONWEALTH OF MASSACHUSETTS Man:B ock: 12C 078 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate BUILDING PERMIT Permit # BP- 2011 -0160 Project # JS- 2011- 000266 Est. Cost: $3276.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 12109.68 Owner: GOULET KERRY R & CYNTHIA L Zoning: URA(100) //RI/WSP Applicant: ADAM QUENNEVILLE AT. 56 CAROLYN ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON :812412010 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: FeeType: Date Paid: Amount: Building 8/24/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner r Department use only City of Northampton Status of Permit: i Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Nort mpton, MA 01060 Two Sets of Structural Plans ��� pf�orie'41 - 87 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify ., A kICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SE'CTtON 1 -SITE INFORMATION 1.1 Property Address This section to be completed by office J G �GCo Map Lot Unit T , M A Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 21 Owner of Record .1 c - 1�e`C�l 6-oj �c+ Jc CaCo1NrN 5 TjoftAee,AA OtC)6 r � Name (Pri Current Mailing Address: M 13 - SYI - S tf9 -1 Telephone Signature 2.2 Authorized A ent: ^� 1 I GD � J A �_LAIM x IN . S cpu a%.Y(04 1 _%e AA Q to) S_ Name (Print) Current Mailing Addres� 413- 536 - 5 s Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building 3 Wo D o (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) 3 r a G . v0 Check Number This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 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 p arking) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW • YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , 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 ? YES O 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 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 DK Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [0] Other [EI] Brief Description of Pr,Qposed Work: S r' cyk W t6"GC VC'0 � - 1 n!� ' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. If New house and or addition to existina housing. complete the followina: 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, K� cc.� G ou I -%- as Owner of the subject property 3 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. �- Iq - to Signature of Owner Date I, Qv" R & S& t , 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. Ado 0uc, (xncu f ':- Print Name -Iq -tU Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder: f 1s cw.� 10 6 a G License Number I GD DC� Lvl t MIk atv25 g -?A-1 1 Address J Expiration Date 4t, - 573G'Sg5's Signature � Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Ad= Queuue b RAM & Siding, loc. ta© a S z Company Name 169 Old j PH ReW Registration Number Sedh Address tn�r HO Expiration Date Telephone 4(3- - S9SS 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....... ■ No...... ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature /A:ATD,A , �mAAA X7 *�d yam` Q U E N N EV I L L. E www.1800newroof.net ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1. 800 - NEW -ROOF • 413- 536 -5955 Fully Insured Email: info@ 1800newroof.net Factory Trained MA Construction Supervisors Lic. #070626 MA Registration #120982 Factory Certified Installers Member of the Home Builder's Association of Western Mass. CT Registration #575920 Member of the Building & Trade Association Member of the Better Business Bureau P.P.C. 38710 Prop sal Submi ed To: Date Phone #'s WorkTYA a J V H: J_j c c Cell: Street Email: �� I , (4m�_ City, to e, Zip Code Special Requirements Q) Complete Roof System 9 We shall acquire all appropriate permits for all work IN Home exterior and landscaping to be protected P Entire existing roofing materials to be removed to existing decking Deteriorated existing decking will be replaced at $3.47 per sq.ft. Install Ice ater Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls Install 5 lb. fe /Synthetic) underlayment over remaining decking area Install Metal drip edge at eaves and rakes (8" /a (2y brown / copper) Install manufacturers starter shin le on all eaves and rake edges Install new pipe boot flashin stan a / copper) A Install new step flashing where necessary ( a ar / copper) Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: // AA (6 nails per shingle) L�7"Z Shingles ❑ 25 year N 30 year ❑ 50 year Color I&Apk 44jocy A f C Ridge cap shingles Warranty Options: W-We guarantee our workmanship for 10 full years (see our warranty coverage) ❑ GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty VJ Chimney Options: ❑ Lead Counter Flashing ❑ Water Se & Tuckpoint ❑ Rubberized own ❑ Metal Chimney Cap We Propose hereby to furnish materials and labo - complete in accordance with above s cifications for the sum of: Total Sale Price $ z ' �� --- Down yment $ l.�" Upo Completion $ � 2 ACCEPTANCE OF PROPOSAL: The above prices, s ifications and conditions ar tisfactory and are hereby accepted. You are authorized to do work as specified. Payment w down upon , and balance due upon completion. Unpaid balances shall accrue with interest a 18% per annum. Purc aser ill pay for all costs, expenses and reason- able attorney's fees incurred by Ad�Que evi lle Roof' g and Siding, Inc. to recover any sums due under this contract. (I I G 2 Date: n J Signature: Phone # Date: 9-13.` Estimator's Sign ure: 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 and Sidings will not be responsible for debris or dust in the attic or storage areas. 1/09 The Commonwealth ofMassachuseas - Dgwonent ojrindm&W Acci 0j)Tce oflnvesd9adons 600 Washington Street Boston, MA 02111 www massgoY1din Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Left Name ( Business /organiatio ntindividtw): a 1.1 w 0$.L/1A Y° V t i 10i f�@ b'�` � _ IQ i i r� �1 ✓I C Address: IL n 1 a4man CA, <J City /State/Zip: ') I 1 nme #: [ Are you an employer? Check the approprhtr box. Type of project (required): L;K I am a employer with _ J S 4• ❑ I am a general contractor and I ( part-time).* have hired the sub - contractors 6. Q New construction employees full and/or 2. ❑ 1 an a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub - contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' con i ce.t 9. Q Building addition [No workers' comp. Insurance P• regWmd•] 5.0 We are a corporation and its 10.Q Electrical repairs or additions 3. officers have exercised their I am a homeowner doing all work � l 1.Q Plumbing repairs or additions myselg [No h gip. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no 12 KRoof repairs employees. [No workers' 13.E Ether comp. insurance required.] • �►nY +�PPh sr dud dwc1m box t:l mast also fill cot the section blow showing their woekers' w on policy ioformnion. t Hameoaers who winnit this affidavit indicuting they ace doing ag wank mdd mbim outside eaottactom mop subanhamFw affdavit indwoungaudL = Con 2 -cftma that *beck thix boos mast attxdwd an s&Vdwd sbwt dx wing dwnnimofdw nodmm who@= a nor d owen fi t i gs h m amptoyaes. If the sob- coubaaass have employeM they mm provide their wuskers' comp• policy number. I ant an etryployer && 1S pnovJiititg workers' contpttrsadfvn l mMsce for my employe= Below is die policy end Jbb site Wormasm Insurance Company Name: Policy # or Self -ins. Lic. #: ��., ry Q (�� (o I C Expiration Date: q �� G l Job Site Address: S`G C a colu n s+ City /State/Zip: l /or^cnce. , /-1 H 01 06 a Attach a SPY of the workers' eompeesadata polky deellmdoe pale (AowMg the poney number and expiradoe tifek Failure to sectae coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penal ies of a fine up to $1, 500.00 anul/or one-year imprisoucne K as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do 6errby c"fy ws&w the Ins efir0ftefts oj`perj try that Me bronxaetow pror&W above Is true and comet Signature: 6 -11-10 Phone FOthe only. Do trot wtdte In dru area, to be cont�plded by city or town t�'tcta[ Town: Permit/Lieense # hority (circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumi>i -g Inspector rson: Phone #• oar o u1 mg egul ioA� ta�ars One Ashburton Place - Roo'm 1301 ti Boston, Massachusetts 02108 Construction-$upervisor License License CS: 70626 Restriction: 00 Birthdate: 8/21 • Tr# 3712 Expiration: 8121/2011 ADAM A QUENNEVILLE 16p.OLD LYMAi4 RD - -- S" HAMEY, MA 01075 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Mass�usetts 02116 Home Improvement f t' -actor Registration Registration: 120982 Type: DBA Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFING^__, ADAM QUENNEVILLE ^E�� 160 OLD LYMAN RD SO. HADLEY, MA 01075 • , `~ Update Address and return card. Mark reason for change. " -- Address Renewal Employment Lost Card DPS -CA1 fi 50M- 04/04- G101216 { STATE OF ' CONNECTICUT + .DEPARTMENT OF CONSUMER PROTECTION Be it known that ADAM QUENNEVI i 160 OLD ROAD SOUTH ,1Q75 -2632 j i is certified by the DeparnrC3�rtectio�n as a registered �. HOME IMPR NTRACTOR I Y S '. � � � � � ✓� , 1. � 1 Reg i ADAM QUENNEVILLE ROOFING ' i I ( Effective: 12 /01/2009 f ' Expiration: 11 /30/2010 f Jerry .Farr e% Jr., Commissioner i I ACORD CERTIFICATE OF LIABILITY IN OP ID DM DATE(MMIDO/YYYY) ADAM -1 06/24/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 I Phone: 413-538-7862 Fax : 413 - 538 -7179 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: AIM Mutual Insurance Cmnpamj INSURER B: Travelers Ins, Co. Adam Quenneville Roofin & Sidin Inc & Guttershutger INSURER C: First Speciality Ins Co gg 160 Oid Lyman Road INSURER 0: South Hadley MA 01075 Hanover Insurance Company 22292 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUNMENT, 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INbK LTR r SR TYPE OF INSURANCE POLICY NUMBER DATE MMIODm DATE (MMIDO/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 C X COMMERCIAL GENERAL LIABILITY) TBI 06/23/10 06/23/11 ' PREMISES S 1 00000 CLAIMS MADE 7X i MED EXP (Any one person) $5()00 I r PERSONAL&ADVINJURY � $ 1000000 GENER AGGREGATE $ 2000000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $ 2000000 POLICY 7 JECOT. n LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT S1000000 $ ANY AUTO BA7450L946 11/01/09 11/01/10 j (Ea accident) ALL OWNED AUTOS BODILY INJURY S �J SCHEDULED AUTOS (Per person) }{ HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS I (Per accident) $ PROPERTY DAMAGE I (Per accident) I $ GARAGE LIABILITY I AUTO ONLY • E A ACCIDE $ ANY AUTO I ' i OTHER THAN EA ACC $ AUTO ONLY: AGG i S EXCESSIUMSRELLA LIABILITY EACH OCCURRENCE S .1 OCCUR 1 CLAIMS MADE I AGGREGATE 5 5 DEOUCTI BLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS ER A , EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE AWC701286101 04/29/10 04/29/11 I E.L. EACH ACCIDENT 31000000 OFFICERWEMBEREXCLUDED7 E - EA EMPLOYE $ lOOOOOO yes, describe under S PECIAL PROVISIONS below I I E.L. DISEASE - POLICY LIMIT : $ 10 0 0 0 0 0 S OTHER D Equipment Floater iIRN7140610 02/01/10 02/01/11 Rental _ Equipment $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SERVMAG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORZED REPRESENTATIVE ACORD 25 (2001108) ©ACORD CORPORATION 1988