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38B-222 =# =1� oar • o • ui • ing ' egul ions anl tan. ar • s t O ne Ashburton Place - Room 1301 • Boston, Massachusetts 02108 . Construction' Supervisor License • ' • •'. • •• License CS: 70626 . • • Restriction: 00 . • : : :• • .: . :' .:.. Birthdate: 8/21/1 :: .... : . T 3712 Expiration: 8/21/2011 ADAM `A `QUENNEVILLE :.:. . :: 1;60 OLD ' LYMAN RD • • • .•S MA 01075 E7 e -� ZW. i Office of Consumer Affairs and usiness Regulation � —` 10 Park Plaza - Suite 5170 _� • Boston, Massa9lusetts 02116 Home Improvement Kotractor Registration :: q� Registration: 120982 n } ' w' 1 ' w Type: DBA .,� 5.-- -�`*'" i (-�i, ^ Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFING - 1 i ?w , .- w ADAM QUENNEVILLE t \. - + 1 160 OLD LYMAN RD \ -\ ' 1 ; `' ` � 1` SO. HADLEY, MA 01075 . �- ; - "� , t om � , � , 1/ .1 7 � S ' ,\ r A li' V� ,� ; ti n4 rt/ � ,. .,,wit , � •t. . { '•S 'd .A • t . r. . rv- . o ff'. J', 1 7 . •1 .l s, s J•,• ,I , j .; ur• ..1 . 1�" %f Y /,, 1j�t�l I �Fl (� � . ; � \:. + F II F t \ J ( \ f F � ,.� I i 1 1 \ , ... 1 t I F { � � F R -. + ... ^ l r` l F ... 7 t F . ,� J fF., jR f h ',. (� J `C r � J ^ ^� l /� SA �,'� *LiP t s u STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ; Be it known that ADAM QUENNEVILLE 160 OLD LYMAN ROAD .: SOUTH ADLEY, MA 01075 -2632 Avi rya b. : - ^ , r4 is certified by the Depart x ent o C 7 isomer P:',4 ection as a registered - 1 HOME IMPROVEMENT CONTRACTOR '�' V s I f R e s�t�a,�. � �Y�5�Z0 , . .. -. TnAl. r R - ' = - (A" ADAM QUENNEVILLE ROOFING r Effective: 12 /01/2009 if Ni I Ex iration 'gilt p 11 30 2010 Jerr .. ' y Farrell, Jr., Commissioner yam .,ten • • DATE (MM /DD/YYYY) ACORD OP ID LL CERTIFICATE OF LIABILITY INSURANCE ADAMQ-1 01,29,10 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. Phone:413 -538 -7862 Fax:413- 538 -7179 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: AIM Mutual Insurance Company INSURER B: Travelers Ins . Co. Adam Quenneville Roofing & Siding Inc INSURER C: Scottsdale Iris Co' 160 Old Lyman Road INSURER D: 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 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 RAID CLAIMS. INSRADD'Lr_. _..-__ —_- - ..- __._---- --- __._.- .— ..— _ --_ -- .- .-- -_.-__ - -- -- - -- -.. _. —. F''OLfCY POL(CY EXRIRATiSN - °--- LTR I NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/W) DATE (MM /DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DATJAGE Td RENTT:D X COMMERCIAL GENERAL LIABILITY CPS1034980 06/23/09 06/23/10 PREMISES (Ea occurence) $ 100000 1 CLAIMS MADE [ X !OCCUR MED EXP (Any one person) $ 5000 PERSONAL 8 ADV INJURY $ 10000 00 GENERAL AGGREGATE $ 2000000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG $ 2000000 - _ __... PRO ------ �_.._..-- ---- ---- ---- - - -___ POLICY f JECT - L. _ - - 1 L.00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B ANY AUTO BA7450L946 11/01/09 11 /01 /10 (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) . $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO • EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR [ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ • $ WC STATU- 0 I FF WORKERS COMPENSATION AND X TORY LIMITS LXl ER _ EMPLOYERS' LIABILITY - - -- A AWC701286101 04/29/09 04/29/10 F.L. EACH ACCIDENT $ 1000000 ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 10 0 0 0 0 0 If yes, describe under - — — — _ SPECIAL. PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 100 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION SAMPLED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SAMPLE ONLY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND' UPON THE INSURER, ITS AGENTS OR • REPRESENTATIVES. AUTHOFjJZ.EDNTATIVE_ (141-4' ACORD 25 (2001/08) © ACORD CORPORATION 1988 y_ _ = _ 7 . 31W Z - Office of Jnvesngu«uIi "1 600 Washington Stree f t! ' F` ' Boston, MA 02111 • ' ; . www. m ass.gov /dia Workers' C'ompensation Insurance Affidavit: Builders) ontrac ors/Electricians/Plumbers App Etc.= i InfonmatioD Please Print Le . Name ( Business /Organization/Individual): O ri 0).0 t?. n r'U 141 di • 11 Address: I. . • s • • i , • • City /State /Zip:_ ' ' to /AA Al Pi 0lQ1 Phone #, � \ 6 1 ks Are yo an employer? Check the appro b ' • ' ' Type of project (required): 1. I am a employer with .S , . 4. ❑ Tam a general contracto and I P 1 6. ❑ New construction. employees (fiill.andior part- time).* • • have hired the sub:—con.- ctors ' listed`on the attached s. et. I 7 . ❑ Remodeling 2. n I am a ale proprietor or .. ship an, have no employees These sub - contractors hive 8. ❑ Demolition workin for me in any aci workers' comp. insura $ Y ca P tY• n e. , 9. ❑ Building ;addition [No workers' comp. insurance 5. ❑ We are a corporation ..d its ' off icers have exercised heir 10. Electrical repairs or. additions • required.] _ . . 3. n I am a homeowner doing all work . right of exemption per I GL 11.0 Plumbing repairs or additions. myself [No workers' comp. • c. 1 '52, §'1(4), and we ..ve no 17.[Etknpf repairs insurance required.) t employees. [No worke ., 13.0 Oth? • .4 comp. insuran rGquir d.) i 'Any applicant ' at checks box #1 most also fill ll out the section below s)}ow their wo&ers' • . mpensation .. ]icy information. , t Homeowners o submit this affidavit indicating they arc,doing all woric and then•hue outsi. c contractors ..ust submit a new affidavit.indicabng such.' , ICootractors thaticheck this boa; must attached an additional sbcpt al o wing r the • name of the su. .ntraetois d their workers' comp, policy infotmatioq: I am: an r em er that is providing worlt�rsy compensation insurance ranee for employees.' Below is' the policy. and job site PPY din P g P I y P, � 1 information_ i Insurance Company Name: A) ).-i. J-10:+64..: i(.)•' U • • v,s .. Policy # or Self- -ins. Lie. #: PW C 7b 1 a.� El0.ia00 i l' 'Expiration Date: L'�'"' WI — •a< 1 0 lob Site Ad 1 1 a 1 k V ; - c w �. S A.) (f ' fit City /S ate/Zip. `, 1,1 ='^' 0 v Attach a coppr of the workers' compensation policy declaration page (s s owing the policy number and expiration date). Failure to sere coverage as required under Section 25A of MGL c.152 c.. lead to tie imposition (germinal penalties of a fine up to 5 and/or•onc-ycar imprisonment, as well as civil penalti . in the form 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 • tatementtray be forwarded,to the. Office of Investigation of the DIA for insurance coverage verification. •• . • • • II ' I do hereby t~etlifp under pains and penalties of pejuiy that the info • ". n provided above is true and carreei Signature: • 1 °� - Date: 3- . - ��dt l) . . Phone ,#: i fr'L , >t ifd 1 ,3 • . , Official u on. Do not write in this 'area, to be completed by city town official • ' City or Town: • Permit/Li sense # _ Issuing 4 ntb rarity (circle one): • • • 1. Board "of Health 2.Buil(iingDepartment 3. City%Town'Clerk 4 Electrical Inspector 5.Plumbipglnspector 6. Other' ' • Contact Person: • I! 'h one #: , • 3 ` A D A M - VISA Mase °... DIJCOVER . / CPU ENNEVILLE 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 i Pro osal Submitted To: Date Phone #'s Work: 1 p 4 i t S 1 0vhds .2 l& 0 H: 4 03 -1 / 4 // — 5? Cei Street Email: 31 1� ` etv gJ"i ' City, State, Zip Code Special Requirements a /oh /V/ D /�l it.th L /e fs iit"0oc/ Complete Roof System [XWe shall acquire all appropriate permits for all work X Home exterior and landscaping to be protected V 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 K Install (15 lb. f Synthetic underlayment over remaining decking area X Install Metal drip edge at eaves and rake L, 5 "), 4 �1D•rown I copper) [X Install manufacturers starter shingle on all eaves and rake edges 131 Install new pipe boot flashing andar I copper) X Install new step flashing where necessary . ndar. copper) yi Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles; (6 nails per shingle) n e k-- �r / Shingles El 25 year "30 year El 50 year Color /I, U te- >t i at 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: A Lead Counter Flashing El Water Seal & Tuckpoint ❑ Rubberized Crown El Metal Chimney Cap • We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: 0 r , f Total Sale Price $ 10 . o D own Payment $ C/ nail e-- Completion $ • ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down 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 Quenneville Roofing and Siding, Inc. to recover any sums due under this contract. Date: I /Signature: ;, G0 L�'�� M�1� V Phone # G Date:7 .— /(J Estimator's S' nature: �> 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. SECTION 8 - CONSTRUCTION. SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : (1/4) a 4 License Number R 0titittf at(idt, , 1 - a .0 Address `tio Oki F Cl`lll4fi 40 ;ii { - Expiration Date ' ature Telephone mo t, 3 ( c q 5 r,C 9.' Registered Home Improvement Contractor: Not Applicable ❑ 1 )095 Company Name , Registration Number E �. ±:�;�� r p..Ty+�.t ..xt�kstf, �(}i�eFPits '� o6c> rib ( 80 Oki Lyman Raa 3 � - Address • y sr t -' Expiration Date Telephone 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 ❑ 1 — Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (I) 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing [ye' Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C7 Siding [O] Other [0] Brief Description ) of Proposed Work: l, F-h„- - -e P(70 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet Ga. 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 I AaCtYY1 4�rlQ l� c )t r, , as Owner/ thorized C A - g - 4 hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my ge a�i belief. Signed under the pains and penalties of perjury. sa Print Name Signature of Owner /Agent 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 parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW 0 YES Q IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES 0 W YES: enter Book Page. and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES tQ 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit r \0 212 Main Street Sewer /Septic Availability I Room 100 Water/Well Availability Nor tha mptorr MA 01060 TWO Sets of Structural Plans phone 413 -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 Map Lot Unit 31 r ev t tc)) �'^ Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: JCt S durtCLS I raieW\ek, i\)3 - v1 /(� Gi)t,o Name (Print) Current Mailing Address: Telephone Li Li y �5 U Signature 2.2 Authorized Auent: Name (Print) r . 'n.ta4da9(E6 "Nt4l'It1 : ali t ".`c Current Mailing Address: 60 Old Lyman 4oPi 6 4,54sS Signature td Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee l t7, svv 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) 10 500 Check Number ,) This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date BP- 2010 -0765 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 -0765 Project # JS -2010- 001145 Est. Cost: $10500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 5532.12 Owner: FOUNDS JAMES Zoning: URB(l00)/ Applicant: ADAM QUENNEVILLE AT: 31 FAIRVIEW AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:3/4/2010 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 3/4/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo