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41-033 /\j D% JI/ A \ VISA i exad e.+ DISUVER A Z\ Q U E N N E V 1 L L E www.1800newroof.net ROOFING 'V SIDING 'V WINDOWS We Are Licensed 160 Old Lyman Road • South Hadley, MA 01075 F Insured 1.800.NEW ROOF • 413.536.5955 v Email: info@1800newroof.net Website: www.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 P.P.C. 38710 Proposal Submitted To: Date Phone #'s C: #1 t r r)/// H: (`/13) 4'r 7 W: Street Email: City, State, Zip Code Special Requirements: Le r ll//�� /[ * '1( (' __ 14 /T (/ 7 // SIG L�l�/�rf, 7',[ n� �Ea / / s / ; l / " C O/ / G L / VG � ❑ Recover Strip U Layers Complete Roof System Kam. ^. �{ S „ . 11,, 6e, 4514) We shall acquire all appropriate permits for all work Si Home exterior and landscaping to be protected ,Q • Strip existing roofing to existing decking and dispose of. Do not Do. /CFS71-c � P Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. • Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights L Install 1bib. e Synthetic) underlayment over remaining decking area St Install Metal drip edge at eaves and rakes (8" 50 (white' .row copper) Install manufacturer's starter shingle on all eaves and rake edges BBB ❑ Install new pipe boot flashing (standard /copper) / vents 1 • • Install Snow Country oed vent dt glrn gwent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) �!� 64 (` Shingles E] 25 year X 30 year ❑ 50 year Color 5'{c (i&/ Ridge cap shingles Warranty Options: We guarantee our workmanship for 14 full years (see our warranty coverage) ❑ GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: ❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ /G ya ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ SCt[1 Cos >M ) satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down at start of job, and balance due upon completion. Balance Due Upon Completion ($ / /v"..2, Date: )- ) - I Signature: 7) (f it r j c /t' Date: ,2 (/ / /4 Estimator: (Print Name) Zs: ,v." 6J e (Sign Name) Estimates are honored for sixty (60) days from above date 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 will not be responsible for debris or dust in the attic or storage areas. A ` °R° CERTIFICATE OF LIABILITY INSURANCE ii�3 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 policyties) 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 L e Methot, Ext. 102 WANE: Ynn r Foley Insurance Group Inc. 1 p( ro N „ � xt) . (413) 214 -7474 1 mt. No) (413)214 -7447 37 Elm Street ApRE lmethot @foleyinsurancegroup.com INSURER(S) AFFORDING COVERAGE NAIC # West Springfield MA 01089 -2703 INSURER A : Peerless Insurance Company 24198 INSURED INSURER B :Safe Indemni ty 33618 Adam Quenneville Roofing & Siding Inc. INSURERC: 160 Old Lyman Road INSURER D : INSURER E : Sou th Hadley MA 01075 -2632 . INSURER F: . COVERAGES CERTIFICATE NUMBER:cL1111305985 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLTSUB POUCY R POLICY EFF PO CY EXP LIMITS LTR INSR WVD POUCY NUMBER (MM/00/YYYYI (mHDoiYYYY) GENERAL. LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 DAMAGE X COMMERCIAL GENERAL UABIUTY � (E a a Eoccu rrrence) $ 100,000 A CLAIMS -MADE X I OCCUR 61,6912267 6/23/2011 6/23/2012 MED EXP (Any one person) $ 5,000 — PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 I POLICY PRO [ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED 'SCHEDULED SAF765493 11/1/2011 11/1/2012 X AUTOS ., AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS x NON -OWNED PROPERTY DAMAGE $ AUTOS (Per acc den!) _ _ PIP -Basic $ UMBRELLA UAB OCCUR EACH OCCURRENCE _ $ EXCESS UAB ~ CLAIMS -MADE AGGREGATE $ — DED 1 1 RETENTION $ $ 1 J T WORKERS COMPENSATION I TORY LIMITS 1 I AND EMPLOYERS' LIABILITY Y) N ER ANY PROPRIETOR/PARTNER/EXECUTIVE ( N / A E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? t (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, AdditIona$ Remarks Schedule, H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r. Brian Foley /LYNNE " -i— .' - �' �"..- ~.0,04. - 1 ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. AU rights reserved. INS025 n1 s ni Th. ArtnRf name anri Irwin am rs+nictnra,I markc of A OPfl The Commonwealth of lifassachztsetts Department of Industrial Accidents X33:.. Office of Investigations 6 awls:= 600 Washington Street s ; — Boston, MA. 02111 :, -a www-nutss-gov1trza Workers' Compensation Insurance Affidavit Builders! Contractors /Elect iciansiPlnmbers Applicant Information Please Print Y,egibiy Name 03 : A J6tOlt 0it AnAl ; 1te dQl t) t- S r t� � N C Address: (Li O 01J ', J do 44 4I. City /Statelfap: 5i 41 TI4 Ol(17Sphone# l "l 3 - - 511 SS Are you an employer? Check the app op tte box: Type of project (required): I. VI I am a employer with ( 4. Q I am a general cofactor and I 6. 0 New construction employees (full and/or part-time).* have hired the sub- cx»�a�xars 2. ❑ I am a sole propriclDr or partner listed on the shod 7_ ❑ Remodeling ship and have no employees _ These suit contractors have B. ❑ Demolition working for me in any capacity. employees and have workers' 9 - 0 Building addition [No wotixrs' camp- imam= Comp.. it> tecr~$ 5. ❑ War are a corpoaatiea and its 10.0 Electrical repair' ss or additions d their i h ffi ocers have exercised 3. ❑ 1 am a ho meowner doing all weak 11_Q Plumbing repairs m additions right of exraaaptrun per 2 myself [No workers' j f�� C. 152, §1(4), and we haveno 1` Roof repairs . employes.. [No worms' 13-0 Other comp- insurance nxinired.) 'Any applicant that checks box t I mast also hill oar the section below showing their wwieis' c a s ± policy is maion t Humcewacs who submit this affidavit indieaaiag they are doing all wort sad Men bite outside contraeLom must submit anew af iodicatiag such IContraetws that check this bar mast attached ea additional sheet showing the name oftba sob- eamhacta s sad state whether asset these entities have employees. If the sob contreslns have aasptoyoas, they meat provide their workers' comp. policy ma aber. I crm an employer that is providing workers' conpensartion Insurance for my employe= Below is the policy and job sfte infornratort Insurance Company Name :AIM m 1.t tU Q ( I PS�� Y A h C Policy # o r S e l f - n t s . L i c . # # _ R e u e r 7 D 1 2 i G ID t p: 1- a rj 1 a Job Sitn A: l (l(, Cc,�0 tea im p lore — �—1 v / i e Address: c t /Sininf : /14,4 £ (6 (() ,: Attach a copy of the workers' compensavtuna polity declamation page (showing the policy number and eipkaiion date).. Failure ID stoat coverage as requital nude Section 25A ofMGL e.. 152 can lead to the o f qua] pies of a fine up to $1,500.00 and/or one-year Wit, as well as civil penalties in the fistor of a. STOP WORK ORDER and a fine of up to 5250.00 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 tag; under the parties and penalties afpe jur that the information provided above is hue and correct Signature: ;0, L Danz: T 4_ ON Pitons ii: L i + 3 -,, � 6 -6ei SS p -inl use ugly Do not wits in this area, to be coroplefeei .Sy' cry or foams of¢Qu( City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 7- Building Department 3. City/Town Clerk 4. Electrical Inspector 5.. Plumbing Inspector 6. Other Contact Person_ Phone SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ /� 7O U a-' Name of License Holder : f 1��uY1 f,CQ b I � I� 1 ��C' License Number Pa° n 1d 11 r na ,?a Wr1( yit & orbs e -a (- dol 3 Aaaress Expiration Date i/z-t l `C36 — SrSs Sign j cd Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quennnville Roo ,n : & Sling, Inc, 1 ie Company Name 160 Old Lyman Road Registration Number Address South Hadley 01075 3- S o I Expiration Date Telephone tf /3 5 - S - 1.S 5 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 J s( 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, von 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [l Addition [_] Replacement Windows Alteration(s) ❑ Roofing a Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed Work: 1 c _ 4 0 c _ 4 0 i A 5 5 - 1 n � . l4 Ir 6� S /i s 6' { !� %, � e � �`d e v u rtX (Cl 2 `� Vt fr t . _ OJ Y i S No Adding ne w dro Sk4� Yes No Alteration of exi bedroom Attached Narrative Renovating unfinised 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 < ER a r / e t- `€ 1101 , as Owner of the subject pr hereby authorize Adam Quenneville Inc. Roofing & Siding, In to act on my behalf, in all matters relative to work authorized by this building permit application. c ji Sign of Owner Date I, Adam Quenneville Roofing & S1dmg, Int 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. P it-144- (i GIP Le a /i.t' Print Name Signatu r /Agent Date RECENED \ Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 't`k , e tin 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability D OF BUILDING A OCnors Northampton, MA 01060 Two Sets of Structural Plans rlo - ' 13- 587 - 1240 Fax 413 - 587 -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: (, This section to be completed by office S4 /GL vY(p / N1 � (�G[OL Map Lot Unit r i 6 (' vi e.F_ / MA A 01 U (e Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: c� r ( e v►�e ) 1 f 1(t ` j,� SfLlCi vpig fiC n F16 re ri cry Name (Print ) Current Mailing Address: Telephone q 3_ 6--E6 q S 7 Signature tt 2.2 Authorized Agent: r� 1 // tt��'',, C PO vn Qlc -0 vlP t/ i l Co t) Ol ci L� mark Icce • JD. 66- 1 Name (Print) Current Mailing Address: if(?) 536 -5155 Sign Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building # / (,4 00 (a) Building Permit Fee 2. Electrical fY (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) /04, OO Check Number 033 /(e This Section For Official Use Only Building Permit Number Date g Issued: Signature: Building Commissioner /Inspector of Buildings Date 1162 WESTHAMPTON RD BP- 2012 -0728 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 41- 033 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2012 -0728 Proiect # JS- 2012- 001269 Est. Cost: $1642.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 12588.84 Owner: KELLOGG DARLENE J Zoning: RR(100) / /WP/WSP II Applicant: ADAM QUENNEVILLE AT: 1162 WESTHAMPTON RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:2/17/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE LEFT SIDE ADDITION 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 2/17/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner