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15B-025
BP-2010-0286 GIs # COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0286 Project # JS- 2010 - 000371 Est. Cost: $8900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 46609.20 Owner: SCHRADER ROBERT W & CAREN M WEINER Zoning: URA(100) / Applicant: ADAM QUENNEVILLE AT: 112 CHESTERFIELD RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON. 911512009 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 9/15/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo Department use only {�> City of Northampton Status of Permit: ;X U ing Department Curb'Cut(Driveway Permit Main Street Sewer /Septic'Availability S tm 100 Water/Well Availability '5 on , MA 01060 Two Sets of Structural Plans 46.t - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans r' Other Specify A ' �Ia4T]iON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Le es Name (Print) Current Mailing Address: Telephone Signature ++SS 2.2 Authorized Aaent: A"A1 Que nneville Roofinu & S1&E, In Name (Print) _ Old Lyman Road is� �� Current Mailing Address: South Hadle MA 0 107'5 '� 4.S 5 S Sig re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building qoo (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) r� �:(� Check Number 5 This Section For Official Use Onl Building Permit Number: IIsssued: 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 arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW Q YES Q IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q . IF YES: enter Book Page and /or Document # 8. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES a IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO s IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 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 Q NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all apalicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding [O] Other [ctl Brief Description of Proposed n cc yy���( Work: S10.1(� � J h l� C r" co r 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 I ' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 u nder the pains and penalties of perjury. Print Name o Signatur er gent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder rw , 0 7 C (�-, �, , License Number Adam auennevilie Hoofing & Siding, Inc, & - a i - 0 f ( Address SOUth Hadley, MA 01075 Expiration Date "S ig nature _ Telephone 9. Registered Home improvement Contractor: Not Applicable ❑ f ) Company Name Registration Number Adam ®uenneville Hoofing &Slang. l � ._ � � — 1 C� 46 0 Old Address 8 Expiration Date South Hadley. MA 01 075 S. - Telephone � -� SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6j) 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. CAM 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 Hill 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 QU EN N EV1 LLE www.1800newroof.net ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1. 800- NEW -ROOF 0 413- 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 Bu'ilder's Association of western Mass. CT Registration #575920 Member of the Building & Trade Association Member of the Better Business Bureau P.P.C. 38710 Proposal Submitted To: Date Phone #'s Work: ,p S&)c r l�I d� H: f 9 1 00 Cell: Street Email: H I h�.5��� �� P, City, State, Zip Code Special Requirements 0107) V4.11 -� CuS 4 e�`c" Complete Roof System � N . , We shall acquire all appropriate permits for all work (z i/ Home exterior and landscaping to be protected ® P� 9 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 & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls Install (15 lb. felt Syntheti underlayment over remaining decking area [] Install Metal drip edge at eaves and rake-4ia6/ 5 ") (hite brown/copper) Install manufacturers starter shingle on all eaves and r ke edges Install new pipe boot flashing (standard/ copper) &/� ® Install new step flashing where necessary (standard / copper) Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilatio � �{0 nails per shin le) Shingles: (6 } ShTng es 25 year � 30 year ❑ 50 year Color C P� Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years (see our warranty coverage) GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney ptions: Lea unter Flashing ❑ V1(ater Sea F] . .Rubberized Crown [I Metal Chimney Cap We Propose hereby to furnish materials and labor, complete in a'e� a ce with above specifications for the sum of: Total Sale Price $ QJ I © C - O 0 Down yment $ 2 `� 0 Upon Completion $ ACCEPTANCE OF PROPOSAL: The above prices, s cifications and onditions are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment ii wn upon signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reason- able attorney's fees incurred by Adam Que�nneville RoofinZd g, Inc. to recover any sums due under this contract. Date:�C � / Signature. �/�' � Phone # Dater ) S Estimator's Signature: 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 -� -.600 Washington Scree Boston, MA 02111 www.mass.gov/dia Workers' C'ompensatiou Insurance Affidavit: Builders/ outrac ors/ElectricianslP'lumbers Applicalaf.Znfolnma�ioxl Pl ease Punt Lczib y Nii7?le (Busincss�Organization /Individual): Address: L City /State /Zip:_ ^c , S - Phone #: Are yo am employer? Check the appropriate box Type of project (required): 1. I am a em lover with _ ] 5 4. ❑'I "am a general contracto and I ew 1 p 6. ❑ N construction em (fiill.and / orpart- tune). have bir-d the sub - n co ctors e 2. ❑ am a sole proprietor or partner- listed on the attacbed sh et. t 7• ❑Remodeling ship a-A6 have h no employees These sub- contractors ve S. [] Demolition work for snc in an ca kers' comp. ins e. g Y P aci tY wor . 9. ❑ Building [No workers' comp. insurance 5. ❑ 'We are a corporation d its required ] officers have exercised it 10.0 Electrical repairs or. additions 3. ❑ I am a homeowner doing all wotk . right of exemption per GL ]LED .❑ Plumbing repairs or additions myself [No workers'• comp. c. 1'52, §•1(4), and we h ve no 12.�of repairs insures dce required.] t employees. [No .worke 13 ❑ Othe�i • comp. insurance requir d.] 'Any applicant at cheeks box 41 must also fill out the seetiou below slowing their workers' ompenution licy information. ;Any mcownas o submit this affidavit indicating they are doin; all work and thm-birc ouui c conhactots submit a naw aff`i'davit indicating such. h. that check this boa; must anacbed an additional sheet showing the.nama trf t11e su ntractois' then workers' comp. policy ittfoanatioq. I am: an emu Ayer that is providing worke►s� cornpensadon insurance for y employ es.' Below is' the policyandjob site information. Insurance Company Name: 1 t J I UUV+,S Policy # or Self -ins. Lic. #: AW �- �� � �E��•� � E xp' lion Date` �." ;A_aoi 0 ej Job Site Address: Ci /S te7Zi C t y p . Attach a cop of the workers' compensation policy declaration Ithis- ing tb policy nnmber and expiration date). Failure to sec are coverage as required underSection 25A of MGL ad to a imposition of cn' h"nal penalties of a fine up to $1 aild/or•one -year imprisonment, as we'll as civi the f6 of a.STOP•WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised'that a copy e • ay be forwarded.to the Office of Investigations oft ie DIA for insurance coverage•verification. Z do Thereby Cettif}� under t pai>'is wtdpenalties ofperJury that the info n pr ed above is true nd a'correeL Si Qnature: Date: Phone f �,� !.�L • t Official use only. Do not write in this area, to be completed by city, o town offie L City or Town; Permit/Li ense # Issuing r utvority (circle ope): :. 1. Baard,,of Health 7..'Buil ing Departmept 3. Cityr1 owu'Cierk 4 Mectrica Inspector 5. Plu 6. Other: mbing Inspector Contact Perse.n• one #• K • 'RX Date /Time 07/09/2009 14:55 1 413 538 6010 F.UU1 Jul -09 -2009 02:38 PM Remillard Insurance 1 -413- 538 -6010 1/1 ACQRD CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MMIDDWYYY) ADAMQ -1 07/09/09 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 Phone: 413 -538 -7862 Fax:413- 538 -7179 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Aix Mutual ibeurance Company INSURER B: Travelers Ins. Co. Adam Quenneville Roofing & INSURER C: Scottsdale Ins Co. Sidingg Inc 160 Oid Lyman Road INSURER O: South Hadley MA 01075 INSURER E: COVERAGES 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 RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A= POLICY EFFECTIVE PffCffY1TPTRrff(5IT rc NSR TYPE OF INSURANCE POLICY NUMBER DATE MMfDD/YY DATE MMfDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1000000 X COMMERCIAL GENERAL LIABILITY CLS1034980 06/23/09 06/23/10 PREMISES (Es occurenca) S 50000 CLAIMS MADE X❑ OCCUR MED EXP (Any one person) S 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG S 2000000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000000 B ANY AUTO BA7450L946 /01/06 111 /01/09 (Ea accident) ALL OWNED AUTOS BODILY INJURY S IX SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY (Par accident) S NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) I GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABIUTY EACH OCCURRENCE S OCCUR CLAIMS M E AGGREGATE $ a DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATION AND X TORY LIMITS X ER _ EMPLOYERS' UABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE AWC701286101 04/29/09 04/29/10 E. L. EACH ACCIDENT $10 OFFICER/MEMBEREXCLUDED? E.L. DISEASE - EA EMPLOYEE 51000000 11 yes, describe under SPECIAL PROVISIONS below E.L. DISEASE • POLICY LIMIT 31000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 0 py CERTIFICATE HOLDER CANCELLATION ADAMQUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Adam Quennevi lle Roofing Inc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL fax #53 6 -144 8 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO Box 612 South Hadley MA 01075 REPRESENTATIVES. AUTHO;gZED REPR SENTATIVE ACORD 25 (2001108) Vr7fy © ACORD CORPORATION 1988 p� tan oar o One Ash burton Place -Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 70626 Restriction: 00 Birthdate: 812111971 Expiration: 812112011 Tr# 3712 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 Update Address and return card. Mark reason for change Address Renewal Lost Card DPS-CA1 CS SOM- 07107- PC8490 B in �Re la. ons an tan ar s Boar g � One Ashburton Place - Room 130.1., ' Boston. Massachusetts 02108 Home Improvemelit: C6ntractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2010 Trtl 264937 ADAM QUENNEVILLE ROOFING, ADAM QUENNEVILLE 160 OLD LYMAN RD SO. HADLEY, MA 01075 - Update Address and return card. Mark reason for change. Address' E Renewal Employment Lost Card DPS -CAI Co SOM -07107- PC8490 - Be 1t known that l r ADAM QUNl�EVILZE 4 160 D ROAD SO — ` ; A U 2632 . is certified by the Depae>�Cf.r�iiter?otecttoii as a registered T- % T IM 1�T�ONTZACTOR F 20. ADAM I ADAM;QUETNEVLLE ROOFING 1 Effective+ 12/01 /2008 ;at1on: i Jeffry Farrell; Jr , Cor missioncr