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38C-005 (2)
• V Pl�i ii90air ./ 'Ii 0 /4A/ • 4',.4 * == ' s o ui '. m' e ul ons an. tan' ar s s - g g . � = - One Ashburton Place - Room 1301 1_ • Boston, Massachusetts 02108 Construction Supervisor License • License CS: 70626 Restriction: 00 • • .. • Birthdate: 8/2111971 Expiration: 8/21 /2011 Tr# 3712 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 • • :' - -- Update Address and return card. Mark reason for change • El Address ❑ Renewal [] Lost Card • )PS -CAI tit SOM- 07/07- PCB490 I ' • • • c_ � gi - 6 7 ; 0 is . it •Boar. o Bu Iding Re lat4o an' t arr - = One Ashburton Place - Room 130:1.. ' . ..... Boston. Massachusetts 02108 Home Improvement: Contractor Registration :. Registration: 120982 • • Type: DBA Expiration: 3/25/2010 Tr# 264937 ADAM QUENNEVILLE ROOFING . .....::: . ,.......,. s ..:••••••......,:,........: . ... ••• ADAM QUENNEVILLE • • 160 OLD LYMAN RD SO. HADLEY, MA 01075 • • • Update Address and return card. Mark reason for change. DPS-CAI C, 50M- 07/07- PG8490 El Address ' ❑ Renewal 0 Employment Lost Card �{ ..' a ` ge It kI1 th ' 'n om /\Sf � �ziT• 1.' I D _ • f r SO13 +{ / ' x ;5_' 04 0757,232 y r " 14 : • 1 „ 3 ! i r W .r,x. - :`,•' .7,r•. - i - � - 4 9 �' ,is c e b the O:e� r fi I ertifi y P } tY �t er z?Cs te tti �fi'�s a s e p�stred' i { i rr 4•• I { 1 :{ V t h r� L C~ 7 �. f: •' / iii. s- a • i • f. `> �. �: ,R _ u- I ' A n , srJ, f at.:' f� ..rc: t• r _ . S' I I 1 r ��II I lJ'•• 'L I ., AU ,� V � � E R40.F N Y i 7 �+� `� M1 F . i . .. a -. ... �ffeci:i�e. � I' .; IIL.: .,le .. - r ::.. , ,:.:. . ..., t " . :.�. ^, .. �S.' I' " 1 :f. ":";:"-,t' e 11::-::::f.........: ... . .. . .. . . . .. ... I. .. ,. , . .. . -: V u .. : �•. �:�L.' Y.. u�Wr -, n .f. -. 1 9 � f4 1t c: ,,.� _ M I, .S. ^ „ ":: �I"i :f h., ,• °:d.,�. t•I�sa:r•f ::- I,1.L�+", ^'k� a 1� . 7 , 1 l!�� *t r ;,� Ai' (n ``�►► !w `"�y,a.. 7rti r4„ re., IPY- � .,. J ,x, e ',•. aw”: I'J jj f : ` 'L•.GItlO i`: 4 . jtj . iO J . °,: �'.,.r t "u' u.. +.!,:7,•r il. r ` � :f .: . �, � � . • �,•r• M: ^.:Ir.Y�K,:a � a '�' L P, r a,24 4r wr � n '♦ < r r' l - : i , ..r . r_ . .,.'-'�'. ,..i,ii• ;.t 4Al .: ,,,.- • ' ' t ,' _ ,.. ' .. .. . ':�•' 't i i::. fyrF'r fFtl ' Y, .111:1;) ;ir RA U:iLe/ 11111e U9 /U9 /LUU9 1L:UL 1 413 7 P bUIU P. U U1 . Sep-04-2009 01:44 PM Remillard Insurance 1-413-538-6010 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MMIODIYYYY) ADAMQ -1 09/04/09 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 NAIC# INSURED INSURER A: Scottsdale Ins Co. Adam Quenneville Roofing & INSURER B: Travelers Iris. Co. Siding Inc INSURER C: Ana Mutual Tnsuranco Company 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 PAID CLAIMS. IN�R�n PAN POLICY EFFECTIVE POLICY EXPIRATION LTR Ir4SRR TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 51000000 A X COMMERCIAL GENERAL LIABILITY CLS1034980 06/23/09 06/23/10 PREMISES (Ea occurence) 550000 CLAIMS MADE IT] I OCCUR MED EXP (Any one person) s 5 0 0 0 7' PERSONAL&ADVINJURY 51000000 • GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 52000000 I POLICY n JECT 1 LOC AUTOMOBILE LIABILITY B ANY AUTO BA7450L946 11/01/08 11/01/09 COMBINED SINGLE a 1000000 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY 5 C 0 X NON -OWNED AUTOS (Per accident) H I° PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S _ - OCCUR n CLAIMS MADE AGGREGATE $ 5 ' DEDUCTIBLE 5 RETENTION 5 3 WORKERS COMPENSATION AND • X ITV Y LIMITS I X O ER C EMPLOYERS' LIABIL ITY AWC701286101 04/29/09 04/29/10 E.L EACH ACCIDENT s 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE • EA EMPLOYEE 51000000 If yes. describe under SPECIAL PROVISIONS below E.L. DISEASE •POLICY LIMIT $1000000 ( OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION PYNCHON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION C. 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 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. _,_ ALIT 0 E SENTAT ' J ( „ 6"1114 ACORD 25 (2001108) 0 ACORD CORPORATION 1988 - 600 Washington Stree . 'Boston, MA 02111 VW V f AVM,/ •:.' . `MOW .,:, • wi. mass.gov/tha ass.go vldia Workers' Compensation insurance Affidavit: Builders/ ontrac ors/Elect .. Applicanfinfonmatiop • • Please PrTht Lezibly . . . . . • , , N a m e 03usincssi6rganizationandividual): . 1. 111 ,, n J uAIM Aro"' , • \ . Address: I 1 • .. , Li ,.....- City/State/Zip: ' I ii. AAA -._ • all Pi- 01151S Phone #: , . . , Are yo an employer': Check the appropriate bps: . Type of project (required): 1. I am a employer with I .S" , 4. El 'I 'am a general Contract° and I 6. 0 New construction ' ) emplo (fall .antlf or part-time).* .. have hired the sub ..: ctors 7. 0 Remodeling 2. Ej I am a cile proprietor or partner- listed on the a.ttached sire. 1 ship an,d have no employees These glib-contractors hive 8. 0 Demolition working for me in any capacity. . workers' comp. insuran e. .9. 0 Building,addition [No -workers comp. insurance 5. El we are a corporation is d its ' . 10.0 Electrical repairs or. additions • requirr.1.1 , • ofacert have exercised E. ir - . . . . 3. ri 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 §1 (4), and we h. ve no 12.[a1r3of repairs • insura4ce required.] t . [No worke .' 13.0 • . • i . comp. insurance requir d.] . ■ Any A pp ii c n t checks box 41 must also fill out the section below showing their workers' ompensation "lin) information... . . . . t Here eowners o submit this affidavit indicating thy arecloing all :work and thcn.pc otrtsi • c contractors "ust submit a new aitpaylt indicalingsuch: 1 Conti - actors that check this bcr4 must attached an idditio abet 1;13;J-wing b.,3'srh el?' t6 Ica: . .litiacieis . .. 4 their workers' comp. policy inforrnatioo. 1 -2- • I ant an empipyer that is providing workers compensation insurance for y employ em Beldw isl the policy. and job site • . . . . . information. 'I, ' ! . . . • Insurance Coil Name: II ) H . • ,...4 . . .. • ii " r oi-otil • • -- 1,-,,s • • ... , . . i • Policy # or SLf-ins. Lie. #: AtA) C - 20 ta,61(3A,c0r6-. • "ail" : ti on Date: L IT - D• P Job Site .A.ddiess:__ ! 0 . ...41We.... S1 . , i ' ' City/S .te/Zip: .C)... H oi eie 0 . 1 . . . 1 • . Attach a copp of the workers' compensation policy declaration page (s s owing tb :. policy number and expiration date). Failure to seOlre coverage as required under Section 25A of MGL b. 152 c: . lead to old imposition pi ciirtigi al penalties of a fine up to S14500.00 an.d/or•onc-year imprisonment, as.wen as civil penaiti . in the fo .. of a.STORIWORIC ORDER and a fine of up to :52.50.00 a day against the violator. Be advised that a copy of this • tatement ;lay be forwarded to the Office of Ltivestigatiort of the DIA for insurance coverage.verifiCation... . • • , . Ida herebyertifil under t ' pains andpenalties; ofpdu:ry that th't info . .,n pr, ', ed abOve 4 0 and correct. .: ...le ... , . . . . • . • I . . 5ignature: li ,, • Date: 1 i 2 9 - o q • • . . , 1 .....:-. . • 1 • phcme#: iy it .. IS -- 3 • .. • • . . . ,I . ---- . .. INMEN/MNIN/Na • . . , . Official are on. Do notivrite in this * area, to be completed by city tonM offic , L ... . , • , . City or to-vvn: „ . . Permit/Li . ense # . ' • . , Issuing Intbarity (eirde oi3e): . • . . . ! • . . ' • 1. Er•oard„of Health 233viliding Department 3. CitY/Tow.ti 'Clerk • 4 Electrica Inspector 5. Plu to t „ g spec or 6. °thee . . f . . • • . . . . • , . . , I Contact i'erson: • 'II one #: i 1 . • . . .. • • ' . 1 . . : - . . • ., • . . - - - . • ' . . „ . . . . . • • • • . . • . . . • • . . . ' . • . . • • • . . . • A D :M VISA Ma sfeeE DIIC•VER CPU Ohl N EvI LLE 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 Proposal Submitted To: Date Phone #'s Work: c 5• 'l e/ i f / l/ - .323'0‘7 H: ��J 56 / -- -1 4/ 7 Cell: y/,3 _7 Street Email: 1610 6i^r'v e City, State, Zip Code Special Requirements 4/ 0/ 4 f h anip (W O` P 0 = 1 a f � ' 9 0/ 0 ti )-1/5 teas C 4' ni (A r se Complete Roof System (� '� S LJ 7Lt / .i L ` We shall acquire all appropriate permits for all work J t cg Home exterior and landscaping to be protected �� Ni Entire existing roofing materials to be removed to existing decking g Deteriorated existing decking will be replaced at $3.47 per sq.ft. Z. Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls g Install 5 Ib. fel Synthetic) underlayment over remaining decking area O Install Metal drip edge at eaves and rakes (8" " whit brown I copper) .,Install manufacturers starter shingle on all eaves and rake edges vi Install new pipe boot flashing sta arO copper) • Install new step flashing where necessary , andard copper) 2. Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shin les: // (6 nails per shingle) L ,L ` / I k L � Shingles ❑ 25 year $.30 year ❑ 50 year Color / ��© 9 G CLf�t' Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years (e warranty coverage) ❑ GAF ELK System Plus warranty 3, 111 GAF ELK Golden Pledge warranty , (( ~' i i Chimney Options: DK Lead Counter Flashing ❑ Water Seal & uckpoint ❑ Rubberized Cro , n ❑ Metal Chimney Cap We Propose hereby to furnish materials an la o - co plete in accord with a e sp-, ifications for the sum of: Total Sale Price $ _ _ q ow Payment $ J _2 4/ Uvon Completion $ [ 7 ACCEPTANCE OF PROPOSAL: The above prf es, specs 'cations and condition are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will • - • . own •;cser ng, • d balance due upon completion. Unpaid balances shall accrue with interest at 18% • er g ;,- m`° • • s ;Qr' p , or all costs, expenses and reason- able attorney's fees incurred by Adam Que !.,^�� tng and din, f• • er any sums due under this contract. Date: / G'' - 3 `' /Signature: ` _ 1f Phone # / � '2 l/ j L Date: / £ Y 2 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 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : C5 4¢ GL t Adam uenneville ilootl14t 6 License Number 160 Old Lvmaf o f South 1-farllp4 Address Expiration Date `` < Sig Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ aO Company Name i t idaiiliOVllle Hooting & Sidle i iN Registration Number 160 Old Lyman Ron a :> - j c� Address Expiration Date Telephone 5 3 S , 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 ermit. 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [D Siding [0] Other [0] Brief Description of Proposed, c Work: .112�� i �Shi -d‹ \\O1 zck,C 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 , 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 r t NCkWN GUeV1fleA/AL ' hJ , 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. MaArt CL Print Name Signature of O gent 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 Special Permit /Variance /Finding ever been issued for /on the site? NO O 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 # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0 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 0 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 Q NO Q 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 _ Cr" \ 212 Main Street Sewer /Septic Availability a J,1 - Room 100 Water/Well Availability Northampton, 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 O v 0 ` 0 ‘ )Q- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I L( Gtos, t Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Adam Quauuevitte Ranting & Siding if Name (Print) 180 Old Lyman Road Current Mailing Address: ��. Solnth1-#1ti!UE `4'Ir rtlf)7, 62. .s >S5" Signature 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 099,s Do 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) _ At--13S _ ot, Check Number /be/ 5 . 35- -- This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date ``ate _ BP- 2010 -0539 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 -0539 Project # JS- 2010 - 000757 Est. Cost: $2495.00 Nee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 41686.92 Owner: REMILLARD FRANCIS J & MARILYN Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 160 GROVE ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:11/17/2009 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 11/17/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo