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39A-011 M v � Maste 1 " :; DIK•VER 'QUENNIEVILLE '/ www.1800newroof.net ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed APIA 2 f -dab- 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: a,r:r C H: Cell: `111- )7 Street `0 � Email: ci,,,r. co '5 - N1 f oil\ City, State, Zip Code p ' Special Requirements 77 < t V 0 L1 of wn�tdl S. C t , i C 1 , 5 r,.< a-o p. -1-i , r- c ,, , , ,,,,,- t I. / / n 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 RI .Dete.da:ated.,..ex decking- w(11-beereplaeed-at -$3A7 per -sgAt. G s t.3 1 2; `:;i-Er-cu - ;�� © Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls �] Install q6_11?" 1(�5 Ib fylt / Synthetic) underlayment over remaining decking area [ J Install Metal drip edge at eaves and rakes (8 ") ( hi / brown / copper) f Install manufacturers starter shingle on all eaves and rake edges p Install new pipe boot flashing (/copper) `7 ,[] Install new step flashing where necessary (Frd / copper) • Install Hand nailed rigid- bbaffied continuous ridge vent / Kc ) l t V • NT E] Install proper soffit ventilation Shingles: } (6 nails per shingle) . C s l - Shingles ❑ 25 year ® 30 year ❑ 50 year Color `> I f\ )P 4 Ridge cap shingles Warranty Options: K We guarantee our workmanship for 10 full years ,.(sge o wax n#y overage) ❑ GAF ELK System Plus warranty 0 t)'''‘‘ yi l-,...• El GAF ELK Golden Pledge warranty S 7 Chimney Options: Ct ' 7 - CC , C l I / l d� U -Ix Lead Counter Flashing ❑ Water Se.l Tuckpoint CI Rub eri a row II ❑ Metal Chimney Cap We Propose hereby to furnish materials and labo - complete in accordance with above specifications for the sum of: (2 r .' -j IC /- C,-(,-----, r-- Total Sale Price $ /a /� no-, Down P. ment $ ( 006 o omplet $ 7 & ) `. ACCEPTANCE OF PROPOSAL: The above prices, s tions and con ' s are s tisfactory and are hereby accepted. You are authorized to do work as specified. Payment r ill be own upon signing and balance due upon completion. Unpaid balances shall accrue with interest at per anha Purchas�er�s�( pay for all costs, expenses and reason- able attorney's fees incurred by Adam Que ville Roofing a�fdmg, n c. to recover any sums due under this contract. 1 Date: U — �1' I b Signature: : �, 11 Phone # e!�1 / Dat/ Estimator's Sig ,YT7r�? 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 'd. . 1 ', .k• •0 • . • ' ` a e lawns arcs tan. ar. s �� ° u i ulg � _ _ One Ashburton Place :Room 1301 1� • • Boston, Massachusetts 02108 . Construction�• License • License CS: 70626 . , • Restriction: 00 i . • 1 •Birthdate: 6/2111971 Tr# 3 h f Expiration: 8/21 /2011 I I .. AI M A:.'CCtUE�NNEYILLE - I + f ,I 'I 164 QLD � LYM N RD . s'I'NADL h MA,010�5 —�— • 1;::„' ' ' ' : . .,,,t,(4 0 ,,,,,,,,e , 1-w ), . Office of Consumer Affairs and Business Regulation %, = LE 10 Park Plaza Suite 5170 Boston Massa usetts 02116 1 - dome Improvement tractor Registration =_ = Registration: 120982 r\ a y _- ,�`�i Type: DBA t `` �� ' ; �` :, y ri Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFING' = ` ": -= \ ADAM QUENNEVILLE '1 —_, 160 OLD. LYMAN RD \,, SO: HAD.LEY MA 01075 " / v ~ ✓ Iv /� \er r ' }✓ 1 �i J/ `iii �f/ ,,� � \t/..:: Vi' W' tf/. W w y ti 4 „ f fir' le.' • (. 1 �t ;ill!! I Il F . i it A , ., I Ft '.J� l 1 If F F . _ j 5 jg fr f \ '''1 \ I I ?��l „;!'111,':'..11':;... ff l f f 1 :I F\ f lF r 1 r F\ W. jf� ,ll, r',.':..)414:. V ,' " �..� _ � �SG” � ,i . . �" '.'�,,ii '* ii ''k':. C -.:.. w•_!!'�..' /Y" �1, ,_. T, � ems (es . . 4''';;;-- \� S'J�A'r'E O]''' CONNECTIC --T + " DEPARTMENT OF CONSUMER PROTECTION .� ' Be it known that i �;_ 1 ADAM UENNEVILLE ,,, i'..----11i1; ! *: . '11 ' ' ' '1'. 1 • .' " 1 1 1:1 ' 160 OLD ',WAN ROAD -_: , i F O H S UT r , , is certified by the Depart ent' 8 E;v1511 k6 as a reg au qtr °Z' HOME' IMPR,ROV.I.N ; ONTRACTOR ' R c t H �b rs 0 . ui ppg ' 1'' ® UE I ILLE ROOFING 1 `. it , ' « $1 ' , , 1 'fect1ve:'1L2 /01/2009 � f ' a ` . .. � � �1 �t1an ► 11/30/2010 w _ _ ., Jerry Farrell, Jr., :.4.;1,1 i2.: v_ ACORD CERTIFICATE OF LIABILITY INSURANCE OPID LL DATE (MM / °DIYYYY) 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 Bf 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 . Col. _ _ Adam Quenrleville Roofing & Siding Inc INSURER C: S Ins 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 MAYBE 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 RY PAID CLAIMS. INSR'AT3B POLICY EFFECTIVE POLICY EXPIRATION —' LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DO/YY) DATE (MM /DD/YY) LIMITS – GENERAL LIABILITY EACH OCCURRENCE $ 1000000 UAMAGt I U KEN I EL) C X COMMERCIAL GENERAL LIABILITY CPS1034980 06/23/09 06/23/10 PREMISES (Ea occurence) $ 100000 - - - - -. CLAIMS MADE f " I OCCUR MED EXP (Ahy one person) $ 5 0 0 0 PERSONAL. &' ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS:- COMP/OP AGG $ 2 0 00 0 0 0 POLICY PRO JEC LOC _ I' AUTOMOBILE LIABILITY COMBINED 5INGLE LIMIT $ 100 0000 $ 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 accidenlb $ PeP PROPERTY DAMAGE ( 9 GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ • AUTO ONLY:; AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ - - - ----------._----- OCCUR L J CLAIMS MADE AGGREGATE $ • DEDUCTIBLE • $ ---- —_ '` -- -- --------------- - -- --- RETENTION $ $ WORKERS COMPENSATION AND WC i X TORY S LIMITS X O ER EMPLOYERS' LIABILITY . - -- A ANY PROPRIETOR /PARTNER /EXECUTIVE AWC701286101 04/29/09 04/29/10 El. EACH ACCIDENT $ 1000000 OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under j - - - -- ---- - - - - -- SPECIAL. PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1000000 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 50 SHALL SAMPLE ONLY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDIUPON THE INSURER, ITS AGENTS OR • REPRESENTATIVES. AUTHOf�ZEDNTATIVE_ J • ACORD 25 (2001/08) a ( © ACORD CORPORATION 1988 • The Commonwealth of Massachusetts * Department of Industrial Accidents � Dw� * Office of Investigations • =l! l= t st 600 Washington Street = , , = M t. ._ ,! Boston, MA 02111 . ,E www.mass.gov/dia W orkers' Compensation Insurance Affidavit: Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Y Name ( Business /Organization/Individual): gc\ .,nne,UL l e �a. Address: /(.r.0 CO n R .cJ Cit 1 '-e ! A 010 - 7 5 Phone #: 1 --/ 13 S 3C�.S Q,.. Are you an employer? Check the appropriate box: Type of project (required): 1. [BI am a employer 'with 15 4. E I am a general contractor and I 6. ❑ New constriction employees (full and /or part-time).* have hired the sub- contractors 2. [l I am a sole proprietor or partner- listed on the attached sheet. t 2 Q Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or addition 3, 0 I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or addition myself. [No workers' comp. c. 152, §1(4), and we have no 12. ' oof repairs insurance required.] t employees. [No workers' 13: III Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub- contractors and their workers' comp. policy information. I am an employer that is. providing workers' compensation insurance for my employees. Below is the policy and job site information. Y pq Insurance Company Name: � .,i`� O° . vhs0 cctrcP Policy # or Self -ins. Lic. #: A (, C - 701.3,$ 00I Expiration Date: L ` aq - a() 1 v Job Site Address: f () Le) Q iy1nV 3 i --- City /State /Zip: NOCOrictkAvka MA 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 lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a finT, 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: / Date: �' 1– f 0 Phone #: / 13 S (3k S 9 S6 Official use only. Do not write in this area, to be completed by city or town official 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 6. Other Contact Person: Phone #: SECTION 8- CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable F i v / ❑ r _ Name of Licetlse Holder : 0 a �.t� Adam Quenneville Roofing & Siding Inc. License Humber 160 Old Lyman Road -`" a) — 1 Address South Hadley, MA 01075 Expiration Date Signat Telephone ? j s _ 9 ., 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quenneville Roofing & Siding Inc.Q �' f 5 Company Name 180 OkI Lyman fioa j Registration Number , South Hadley, MA 01075 3 -a5 _ \a, Address Expiration Date t `f s65 Telephone 3 � 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 ›k:1-- No ❑ 11..,, Home Owner Exem 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 • • for'all`such work performed under the building permit. As acting'` Co n ction 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 Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding [0] Other [0] Brief Description of Proposed �` l �/� Work: Ctii�l �l�l� 1Le)v Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet Sa. 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 , as Owner •a orized Agent here y declare that the statements and information on the foregoing application are true and accurate, to the best of . ow e.. - and belief. Signed under the pains and penalties of perjury. 69.0 ,01 Print Name Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Perm Can Be Denied Due To Incomptete Information Existing Proposed Required by Zornng This column filled in by Building Department �--------------- _ ___� Lot Size �___--_----------'�---------------��----------------� Frontage Setbacks Front .---. ----- --- �---| F---] �--- r �--� �--� Side Rear `---� ---- -- Building Height Bldg. Square Footage Open Space Footage o �--� (Lot area minus bldg & paved parlcing) id of ParkingSpaces Fill: (volume &Location) `---------------`�---------------^ ----~ A. Has a SpeciaL Permit/Vanance/Finding ever been issued for/on the site? �� �� 0 NO V�� DON7KNOYV �~/ YES &_� T � |F YES, date issued: [___________� IF YES: Was the permit recorded at the Registry of Deeds NO =� 0 DONTKNOVY �~� ��! YES �-\ »�� ;� ----- � �'-- IF YES: enter Book � 9age[� and/or Document # 0 �� 8' Does the site contain abn��k body ofwa�ror �� NO �~� DON'T KNOW «_� YES �_� IF YES, has a permit been or need to be obtained from the Consery tion Commission? Needs to be obtained »r~� Obtained �~� Date|ssued' ----'� »�~� , Issued: C. Do any signs o�oton the pnoper� »�� property? YES NO »� �� � {�---''' IF YES, describe size, type and locatiom D. Are there any propose changes to or additions of signs intendeci for the property ? YES 0 NO 0 [ IF YES, descnbe size, type and Location: E. WiII the construction activity disturb (clearing, grading, excavation, o, filling) over 1 acre n,is it part of a common plan that will disturb over 1 acre? YES K � NO � � �� �� IF YES, then a Norlhampton Storm Water Management Permitfrom the DPW isrequired. Department use only .. City of Northampton Status of Permit; Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability`. Room 100 Water/WeII Availability Northampton, MA 01060 Two Sets of Structural Plans - 15.1)100 413 - 587 - 1240 Fax 413 - 587 - 1272 Piot/Site Plans Other Specify C 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 c4)cz. ` ��� A¢ Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: CCe'l Co l ay5 �s , R& w n -6 IC SSz Name (Print) Current Mailing Address: Telephone a S SS / Signature 2.2 Authorized Agent: Adam Quenneville Roofing & Siding Inc. 160 Old Lyman Road Current Mailing Address: Name (Print) South Hadley, MA 01075 3is 5- Signature Telephone SECTION 3 - STIMATED CONS TRUCTIO N COSTS Item Estimated Cost (Dollars) to be Official Use Only _ completed by permit applicant 1. Building (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 035- 6. Total = (1 + 2 + 3 + 4 + 5) / 0 (;�. 6 Check Number /7( ( This Section For Official Use Only Building ermit Number: Date 9 Issued: Signature: Building Commissioner /inspector of Buildings Date • OttlAvEl BP- 2010 -0969 GIS #: COMMONWEALTH OF MASSACHUSETTS _, t= • `, k 39A - O11 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 -0969 Project # JS- 2010- 001431 Est. Cost: $10685.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq ft.): 6011.28 Owner: COLBY CHRIS Zoning: URC(100)/ Applicant: ADAM QUENNEVILLE AT: 10 WRIGHT AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/29/2010 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 4/29/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo