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15B-027 BP- 2010 -1003 GIS #: COMMONWEALTH OF MASSACHUSETTS 15B - 027 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 -1003 Project # JS- 2010- 001474 Est. Cost: $11347.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 27007.20 Owner: PARSONS EDWARD & JOANNE M Zoning: URA(100)/ Applicant: ADAM QUENNEVILLE AT. 146 CHESTERFIELD RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.5 11112010 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 Sisnature: FeeType: Date Paid: Amount: Building 5/11/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo City of Northampton r� Building Department ' 212 Main Street a ..Room 100 Northampton, MA 01060 phone 413 - 587.1240 Fax 413 - 587.1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING �r. - a - r _�'E�TI.�N' �.� i��•�t�`dY1��"�`�y,,�t� .,�:.� teed �:;�- ,�M;,:x,�, -.., .Erl �. :,�: ._ -.��. • � r • •, .;r-; .. �rr....:•I. ,,;w F 1.1 Property Address _J— I- �--• - n � ` � ����::7. P "_' .. L w}r,• 1 , -. Iry• ..Y }, , +� }� y A 15�, .. ,r � r• ,NT,. 0 }�Y:N H' l�U' � I.Z. , Q.w I A � . . 1:'r.. .. • :r.�' — e"'ry !'� ':J"' °i'.r 74 fi i"u .._Fwq _ ^,!tvry ,_ ...X , .. •r r° �'hn!•r.d �.�•'. 1ni Atz •.• 2.1 Owner of Record :. r Aj. - PA s rK OL Name (Print) Curre Ma!I!ng,Address: Teleph- `,o�ne� - S�'y— .1 Signature — 2.2 Authorized Agent: _ Name (Print) C�� Signat Telephone _ .ems �k - •; • : , , r ;C1 ' � !•�• SM � �' r . �5"•1=��t{1. ; N3 ��E��al'tl�� •A�t�a�0 : 'S� . ' � ;.'�'� ,�'ilA;h ;�'.-•m:w:: , ..:�w- ww:��. r .xmc,nc'.nsu ; w:.�x ..rr.. .. rya _ •, L; 1M . Item Estimated Cost (Dollaf's) to be ;;ia' cJzLiljee com feted by ermit a` licant 1. Building uilding Fermc�.�eer. 7 g j 1,� �7. ( 2. Electrical ( bj,. stiCrited Tvt;t'aost CensXructi.gn,,fr•'om::,r - -�'.. ':.... 3. Plumbing Building Permi 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 +3+ 4 + 5) 3 47 , Od Check „Number 00or ,S This Sect�on',For yr r tt .],a /•� • • r C�yrV 1.i'� . uY ,1,+ 1 I.. r- rrrr ,r: r.0 r" +. r ,� 1•ra, 'r .... '� rJ r �.r.: ,• �.,.. la ar'F_:.I .q :; * •. ��a. r nth r-a6; r;�:r• : y. r. - -'.!�. r: faF ..... .r, h ^,.•,,.L:. ., i ,�7� = '!IYIa:;P - q��i" 5i�r�atvre h P' ' 1 ] ,?,,,,� _ ;... ,•,Bu.ilcTing.,�oifnmiss!on!er' In p'' gcto,rvol',Bjiildi,rig', „• ' D.��e t 1 New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors O Accessory Bldg. ❑ Demolition❑ New Signs [) Decks [ ] Sid Ing [) Other [ ] Brief Description of P- roposed Work -motif_ e>c�.s'l� � 11100(►r-q 14 QX Yt Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative O Renovating unfinished basement es No Plans Attached Roll ❑ - Sheet ❑ a. Use of building : One Family. Two Family . __ Other. b. Number of rooms in each.fa.mily unit: N u:mber.of Bathrooms c. Is there a garage atta.ched� d. Proposed Square .footage of. new construction. Dimensions e. Number of stories ?. f. Method of heating? Fireplaces or Woodstdves NO M I i ber'of each g. Energy Conservation Compliance. Masch,eck : Energy Compliance, form'att ached? h. Type of construction; ." . i. Is construction- within 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 ao.the.Building and Zoning regulations ? Yes Na ;. I. Septic Tank City Sewer Private well _ City water Supply - D . `gy S p as Owner of the subject property hereby authorize QfJ �rhYIL, _ to act on my behalf, in all rihatters'relative to work authorized by this 6ui ding permit application. Signature of Owner Date 19� ' I, a fl1 L ihPi/j� �()�,1'1 _ri�� as Ow er /Authorized Agent - -- hereby declare that the statements and information on the fdregoing application are true and accurate to the best of my knowledge and belief. Signed under the pains and penalties of-perjury. Print Name Signature o wner /Agent Date ;����"",��' '. ° •4 �,• • ':off 8 1 Licensed Construction Supervisor Not Applicab e ❑ Name of License Holder : en • v� ?$Q a ,.,. License Numb r Address Expiration Dat �f l3 - Sib- 595 Si Telephone Me lfe`le p�mo", ©v rrtnent�'t'� tC► Not Applicab e ❑ Company Name 4 rt Registration Number Address Expiration Date Telephone f �3 _•S3b "S q5_5 , ' s A Workers Compensation Insurance affidavit, must be completed and submitted with this application. Failu e to provide this affidavit will. result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes......... No...... ❑. The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of o e (1) or :two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, RL2yi ed that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definitiori-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 pers who constructs'mor.e than one home in a two-year eriod shall not be considered a homeowner. Such "homeoNvnee' shall submit to the Building Official, on a form acecptable to the Building Official that he/she shall be responsible for all such work performed .under the buildinE permit. As acting Construction S.utiervisor 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 (Lia ility of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you m be liable for person(s) you hire to perfonn,work for you under this permit.. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Bu Iding Code, City of .:;' Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Law notated. Homeowner Signature '2' U F: M N ENF 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 4575920 ember of the Building & Trade Association Member of the Better Business Bureau P.P.C. 38710 o>s )� r5 0 _n , 5 - itted To Date Phone #'s p� Work: J tai - 511 -10 H: �3���y Yl Cell: Street Email: l q � C-A 1 7 HIV / G r re_at ✓n h 700 Cow easy, h� City, St at Zip Code Special Requirements��/f� �y Complete Roof System We shall acquire all appropriate permits for all work Home exterior and landscaping to be protected 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 4EP underlayment over remaining decking area Install Metal drip edge at eaves and rakes 5") white brown / copper) Install manufacturers starter shingle on all eaves and rake edges [ Install new pipe boot flashinggtand copper) Install new step flashing where necessary EtaEdD copper) Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles nails per shingle) da , C �� ' `/ Shingles ❑ 25 year A30 year ❑ 50 year Color 0,W - r l h L 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 Options: Lead Counter Flashing Water Seal & uckpoint I j Rubberize Crown Xf Metal Chimney Cap We Propose hereby to furnish materials and ab6i} om a hr _Ye with above specifications for the sum of: Total Sale Price $ / o yment $ �� 4 pon Completion $ 76 ACCEPTANCE OF PROPOSAL: The above prices, ecificat o s an c3ndition are satisfactory and are hereby accepted. You are authorized to do work as specified. Paymen ill be 1/3 down u igning, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per an aser(s) will pay for all costs, expenses and reason- able attorney's fees incurred by Adam Quenneville o Siding, Inc. to recover any sums due under this contract. 5- #-16P 15P� YI V Date: Signature: Phone # y0 Date: 0 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 The Cf)mXC onweakh. of Massachusetts Department of ln&m "al Accidents lee of InveftWoms 600 Washington Street .i on, *_MA 02111 www.mass govfdia oekerg' - insurance AffidrauiL- BuildersJCo ntractarg/Electricians/Plambers Applicant Inform Pleas Print Legibly Name (Business /Ga`ga taoW Q �naeuf ) t it. Address: oa-1 CityrfState Z,P. /l 10 Phone . t113, 5 Are you an employer? Check the appropriate box: Type of project (required): 1. 1 am ac employer with � _ 4. - Q 1 am a general ca tractor and" 1 6. Q New construction employees (full andlor part- time).* have Fred the sub - contractors 2.. Q l am a sale proprietor or partner- listed oil the attached sheet. t Reraso�k ng sl ip and have no employees These sub-contractors have 8. F Demolition working for me in any capacity. workers' comp. insurance. 9. Q Bng addition [No workers' comp. insurance 5• Q We -are a corporation and its required.] officers have exercised their 10.[] Electrical repairs or addition 3. Q 1 am a homeowwr doing all wort right of exemption per MGL 1 F. Q Plumbing repairs, or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12 Roof repairs instuwxe- require&j t employees.. [No workers' 13:Q• Oilier comp. in=ance required - *Any applicant that checks box # I must also fill out the section below showing their workers' compensation polio informauca. t Homcvwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t ontaactars thal check Ws box must atuaelied' an additional sheet showing tho name of the sub - contractors and their warkers' comp. policy information. I am an. employer that is pr.oviOng wortieW conrensatim inswvncefor my empkye4m Adow. & the paw andfiRb side infarrxzation. linsurarnce Company Marne. A ] € so tar % Policy # or Self-ins. Lic. #:� W 7o I •a b'' � ( 0 I Expiration Date: Job S ite Address: �7 L � -• Cj �,� Cityistatemp: Lids� 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; Head to the imposition of criminal penalties of a - fine up. to $1,500:0.0 andfor ow -year ilnnprisOnmeht, as- W611 as civil pengWes in - orm.6fa *STOP WORK :l}RDEP, arnd.a_fin 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 hivestigat ons of ft DiA for mswanw uov=gp vein &-ation - I do hereby certify under Me pains andpenalties of perjure that the information provided above is Crue and carrea Sim atnure'. /` 5� Phone #: LY 45 s3 (.9- 595 I Qf icid rase only. Do not a in this area, to he co aced by chy o town o, �ucial 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 Phone #t ..� .d.•athe.r I RX Date /Time - 05/03/2010 12:28 1 413 538 6010 P,001 May -03 -2010 02:22 PM Remillard Insurance 1- 413 - 538 -6010 1/1 cqm CERTIFICATE OF LIABILITY INSURANCE OP W DM DATE(MM /DD/YYYY) -1 05/03/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MA ER 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 BYITHE POLICIES BELOW. South Hadley MA 01075 Phone: 413 -538 -7862 Fax:913 -538 -7179 INSURERS AFFORDING COVERAGE NAIL INSURED INSURER A; ASM MILUSl Inenranw Camixany ding INSURER 8: Travelers Ins. Co. $ A g d am ggg _° uenn ®villa Roofing & INSURER C: Scottsdale Ins Co. 1fi0ld L n Road South Hadley MA 01075 INSURER D: 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 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. LTR NSRE TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY ) F'8 A L TE y (MMIDD1YYI LIMITS GENERAL LIABILITY EACH OCCU ENCE S1000000 C X COMMERCIAL GENERAL LIABILITY CPS1034980 06/23/09 06/23/10 PREMISES occurw= 8100000 CLAIMS MADE D OCCUR MED EXP (An one Person) 55000 PERSONAL&ADVINJURY S1000000 GENERAL AGGREGATE s2000000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG 82000000 JE POLICY PRO CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 ANYAUTO BA745OL946 11/01/09 11/01/10 (Essoddent) $ l000000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON•OWNEDAUTOS (Per accident) 5 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S ANY AUTO OTHERTHAN. EEAACC S AUTO ONLY.* AGO S EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION 8 S WORKERS COMPENSATION AND X T Y LIMIT X 1 ER JA EMPLOYERS' LIABILITY AWC701286101 04/29/10 04/29/11 E.L. EACH ACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? E.L. DISEASE o EA EMPLOYEE $1000000 If yea, describe under SPECIAL PROVISIONS below E, L. DISEASE • P OLIC Y LIMIT I 8 1000000 OTHER DESCRIPTION OF OPERATIONS r LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ADAMQU, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Adam Quennevil 1 e Roofing DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Brian NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT', BUT FAILURE TO DO SO SHALL fax#53 6 -144 8 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO sox 612 South Hadley MA 01075 REPRESENTATIVES. AUTHO ED REPRESENTATIVE a ACORD 25 (2001108) © ACORD CORPORATION 1988 J. 4' 4 ' •* i •, l L u� ulg egul pans a� an ' �'E S w n As url dace -= a6m,130 Boston, Massachusetts 02108 Cons ttuctionf� e sor License License CS: 70626 ti Restricon: 00 i TrAt 37112 I�I ,NEV1� LE E ; 1t � '• w , '•4 ''1 1 I 1 .. f�"�ce.of C_ onsumer Affairs and Business Regulation 4 10 Park Plaza - Suite 5170 ,.: Boston, Massa usetts 02116 + d . ro em erit f et.or Registration f �'. ReQistrafion: 12090 r Type: d8A c : i Expiration. 312.512OI T!# 293069 I . - AD� M QU�N�� hLLE �OQFIN " .— — r �ADAW. UENNEVILLE. T64 O : LYM4N RD A'�'�Q7 .S 'r.,,:• fi ..+a•4• t �-t+. 4 -�' 'mo.'s` -'`• -:- -s `�, __ -, .. -., -_ _.... _... ... ._.. _ 0 �:: =, 1 Jl i k � , T:/� �• �L'YR 1 Jli"1. O OF - �:r0l�t7;�7�FR �cCT IO$� - 3 Be it liiown that ' 1G0 OLD h 0 t a1L° +L ?r1 ce�tion s a reg�ste�ee� _ L t HOME' IMPR�;,� I�NTRACTOR OFING