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18D-062 A • ekE� S D A \ ) � j i c -{ 1., 5.4 \ V Bard `i' '; c-a DIJCIvER CI U E N N EN/ I 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. 8070626 MA Registration 8120982 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 S bmitted To: Date Phone #'s Work: (21)— / )� t_ 6 H: 7/3 . , 7�' Cell: Street Email: c r tgOC V-_b City, State, Zip Code Special Requirements Complete Roof System ® We shall acquire all appropriate permits for all work V@ Home exterior and landscaping to be protected ® Entire existing roofing materials to be removed to existing decking X 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 Z] Install (15 Ib. felt / ynt ) underlayment over remaining decking area N Install Metal drip edge at eaves and rake s{(S Y 5") / brown / copper) LX Install manufacturers starter shingle on all eaves and rake edges L 1 Install new pipe boot flashing flan / copper) • Install new step flashing where necessary ( (and / copper) N. Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: ( 6 nails per shingle) _ Shin g les ❑ 25 year K 30 year ❑ 50 year Color CO< /{ref to, 6r y -(�- -� Ridge cap shingles 11 Warranty Options: ❑ We guarantee our workmanship for 10 full years (see ou),: warrant},y wverage t _t}c,C l y Ail wc�ti ❑ GAF ELK System Plus warranty 111 rZle ❑ GAF ELK Golden Pledge warranty ` C) ,^,; 4' Chimney Options: (-1C4. C }�� Del Lead Counter Flashing ❑ Water S al & Tuckpoint ❑ Rubberized Irown ❑ Metal Chimney Cap We Propose hereby to furnish materials and labor - complete in accordance with above s iecifications for the sum of: c� G Total Sale Price $ ! 5 7J � , , Dowd Payment $_785 - --``� Us on Completion $ C}C)0 ACCEPTANCE OF PROPOSAL: The above pric , specifications and conditions ar: satisfactory and are hereby accepted. You are authorized to do work as specified. Pay ent will be 1/3 down upon sign' g, and balance due upon completion. Unpaid balances shall accrue with interest at 18% . Purchaser(s) w' pay for all costs, expenses and reason- able attorney's fees incurred by Adam Quenneville oofing and Siding, Inc • recover any sums due under this contract. „_,. DateO — Phone # j �� Signatur•: Date: ' Estimator's Si gnat - - - - - -- 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. Nov -08- 2010 06:00 PM Remillard Insurance 1 - 413 b38 - bUJU AD ® CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MMIDDlYYYY) � 11/09/10 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 policy(ies) must be endorsed. If SUB OGATION 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 (.UNi AL; I NAME: PHONE FAX Remillard Insurance Agcy, Inc ac, Na, Ext): _ (A/C, No): 79 Lyman Street ADDRESS: South Hadley A 01075 PRODUCER Y CUSTOMER I # D ; ADAM - Phone:413 538 - 7862 Fax INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: First Speciality Ins Corp Adam Quenneville Roofing & INSURER B: Travelers Ins. Co. Siding Inc. & Adam Quenneville — — — — - Roofing Inc & GutterShutter INSURER C: AIX Mutual Insurance Company Of Western MA 160 Old Lyman Road 1NSURERD: Hanover Insurance Company 22292 South Hadley MA 01075 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER: 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 f0 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7NSR- TYPE OF I NSURANCE - -- ADMLSOBA- -� FULLY of [ - POLTCTECP'� LIMITS - -- LTR INSR WVD POLICY (MMIDDIYYYY) GENERAL LIABILITY 1 EACH OCCURRENCE 8 ].000000 DA I U REN I tV A X COMMERCIAL GENERAL LIABILITY IRG98441 06/23/10 (06/23/11 PREMISES (Ea occurrence) $ 100000 _ 1 CLAIMS -MADE i X OCCUR MED EX. (Any one person) ( $ 2500 PERSONAL 8, ADV INJURY I $ 1000000 GENERAL AGGREGATE $ 2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 2000000 POLICY 1 J ECECT LOC $ 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 - (Ea accident) B I 1 ANY AUTO BA7450L946 11/01/10 11 /C1 /11 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X I SCHEDULED AUTOS - — PROPERTY DAMAGE ,K HIRED AUTOS (Per accident) $ X 1 NON•OWNED AUTOS $ ' UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE 5 - --- DEDUCTIBLE _ -.— S - - T - -- - RETENTION $ 1 $ - - - -- C WORKERS COMPENSATION AWC701286101 04/29/10 04/29/11 X ' WCSU- X O TH- AND EMPLOYERS' LIABILITY Y I N TORY LIMI E R ANY PROPRIETOR/PARTNERIEXECUTIV 1 E.L. EACH ACCIDENT $ 1000000 OFFICERIMEMBER N - ---- - - - ---- (Mandatory in NH) II E.L. DISEASE - EA EMPLOYEE $ 10 0 00 0 0 I if yes, aes under - -- --- --- DESCRIPTION OF OPERATIONS ouIow I E.L. DISEASE - POLICY LIMIT 0 10 0 000 0 D Equipment Floater IHN7140610 102/01/10 102/01/11 Rental j Equipment $100,000 DESCRIPTION OF OPERATIONS ( LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ADAMQUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Adam Quenneville Roofing & Siding AUTHORIZED REPRESENTATIVE 160 Old Lyman Rd. South Hadley MA 01075 ,/ �/ v a � ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD fil ' I' I dA I .I '' ✓I : - = � ins aria tanearls �� oar• o .0 �ing egu a ' D One Ashburton Place - Room 1301 If ` Boston, Massachusetts 02108 Construction Supervisor License License CS: 70626 Restriction: 00 • Birthdate: 8/21/1 Expiration: 8/21/2011 Trit 3712 ApAM A QUENNEVILLE .: 1 OLD LYMAN RD - S'HADLEY, MA 01075 -- bite ecviivino4uveaN ti g/11 _' Office of Consumer Affairs and usiness Regulation I 10 Park Plaza - Suite 5170 ;; Boston, Massaa-lusetts 02116 Home Improvement ,.ctor Registration --- .. Registration: 120982 _ *s —rte_- ) Type: DBA L o = Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFINC = r ADAM QUENNEVILLE ' _5 � I r l 160 OLD LYMAN RD �-\ ,r,,„ = SO. HADLEY, MA 01075 r v=1= - /< `.A; � Update Address and return card. Mark reason for change. `� Address El Renewal E Employment ❑ Lost Card DPS -CA1 et 50M- 04/04- G101216 STATE OF CONNECTICUT + " DEPARTMENT OF CONSUMER PROTECTION:: { Be it known that ADAM - QUENNEVILLE 1 60 OLD :: , d, RO. SOUTH ; i , r. ' i ..0 75 -2632 ,1 ; is certified by the Dep n J ('r 9" a " ry <, ; tection as a registered R HOME IMPR 1 44 ' O N T RACTO R i � ■4 Regis,. T d 4 0 i -, , _ c, ,:: ,,, r r#,, = ' ' ADAM QUENNEVILLE .ROOFING i i I Effective :12/01/2009 Expiration: 11/30/2010 d' , -- • The Cotnntonwealth of Massachusetts Department of Intinstrial Accidents =5,7 o,� ojl�rv� rig Investigations � , � 4 600 Washington Street =_`:' = Boston, MA 02111 AV S www r ass.govr/aha Workers' Compensation bsaraace Affidavit: Builders/Coutrsct bens Ent Iafntiwtiou Please Print Legibly 1 \ ' _..- Name ( ): sr i as e. ' 4 t ' ' $ a s a a 11C- . Address: 1 42 o (Ad L rri 0.h A_ City/S.:' -' .I) u! • 61 s [hi Phone #: ( - --• • Are your an employer! Check the appropriate box: Type of Proms (ro4uked): 1.X I am a employer with i 5 4. p I am a general contractor and 1 employers (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling • ship and have employees Tie sub - contractors have S. 0 Demolition worlcing for sae in any capacity. employees and have workers' 9 [] Building addition [No workers' comp insurance ' insurance 3 required.] 5. 0 We area corporation and its 10.0 Electrical repairs or additions officers have exercised their 3. ❑ I am a homeowner doing all work l 1. Phmmbirag repairs or additions right of exemption per MGL 120,Ronf repairs iusduanc c required.] t P- c. 152, §1(4), and we have no 13.[} Other employees. [No workers comp. insurance ] , , Any applicant that clucks Well most also fill oat the section below showing their wodors' compensation policy information t lion ___ who salmi this allidiarit iaeficathg they see doe* all wok aodthaslhin outside mororso s moats behave, affidavit indimtiog ich. sco arena st ea door Mt boxe ut attaehedwr additional shalt derwin the murk ofineaabointractoss and mite-whelhererect those entities have empioyem !fibs set oa.araaoes boo employees, they most provide their ' comp. ply samba. I art an employer that is providing woke s' compemation insurance* my employees. Below is tom policy Insurance Company Name: A t /kik A u. n l Tr,,s a rig n C P, P o l i c y # o r S e l f - i n s . L i c . #: A WC. ri O 1,V, (o I Q I Expiration Date: / 0Z 9 /ag61 i Job Site Address: '13G (3f ■�1� R� Noe�ka,,,pioft City/State/Tap: 010 Attach a copy of the workers' compensation ply declaration page (showing the policy member add expiratlett date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to S1, 500.00 and/or one-year iniprisoament, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a diet' against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcstigations of the DIA for insurance coverage verification. /do hereby cer1 ► wirer the asedpeasities sepals* that the won provkielabov e is bn a marcorrea 5ignature; Imo: Ma - -, — ‘ D ellniN #: '113-5310 -3 Official ease only. Do not write hi this area, to be completed by city or town offldaL City or Town: Permit/License # Issuing Authority (eirela one). 1. Board of Dada 2. Building Department 3. City/Town Cent 4. Electrical Inspector 5. Plumibimg Inspector — 6.Other Contact Person: Phone #: ',onto 1041 nig fad 1 1 . ),11411.tt tc, Iist; r! re4i 'pito !tit • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: c.,� Not Applicable ❑ Name of License Holder : Adam Qaennevdk Roofing & Siding, Inc. [ C,(i a C 16001d Lyman Road License Number Address South H MA 01075 V -A - ( ) f Expiration Date Signature A Telephone lid 3 -c 3G .x —ol SS 9. Registered Home I mprovement Contractor: Not Applicable ❑ Adam Queuncvilk Roofing & Sidi.:, Inc, t a� ci Q• 1_ Company Name Registration Number 160014 Lymaa Road ,. �t 3 - s- )} Address Sou& Hadky, MA 81075 Expiration Date -� Telephone 13'S34 S't 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 permit. Signed Affidavit Attached Yes I 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 6 Altut i*HAV Kstd Mt lor SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House E] Addition ❑ Replacement Windows Alteration(s) ❑ Roofing EVJ Or Doors D Accessory Bldg. ❑ Demolition El New Signs [0] Decks [p Siding [0] Other [I71] Brief Description of Proposed Work: Sit •1- R-e-\e ,ck; 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 Air *wile O hit hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 1a -7 -10 Signature of Owner Date Adsa Qu RAq & t71WsLt Inc, , as Owner /Authorized Agent hereby declare that the state ents ancd 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. Que-Afte -v 11 - 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 © DONT KNOW a YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW le YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES © NO 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 0 NO 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 212 Main Street Sewer /Septic Availability 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 This section to be completed by office 1.1 Property Address:: 1 3 , 6r� T� Map Lot Unit Noc+ 0-01‘ / " o► ® Go Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: v a��; R r - t 36, t N ¢- Rte , �oc�,o�f%p4r,A st-tA 0k 4 o Name (Print) Current Mailing Addr ss: 4 0C. Telephone Signature 2.2 Authorized Agent: Ada *mile & Sidig, o C c n„a Y, Qct. S o u -1A• Hadly, au Name (Print) Current Mailing Ad s: C)I o7�S q -SI Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building S — (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 6. Total = (1 + 2 + 3 + 4 + 5) 4I w I 4 7s oo Check Number /'9I 7 This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date BP- 2011 -0544 GIS #: COMMONWEALTH OF MASSACHUSETTS x 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-2011-0544 Project # JS- 2011- 000896 Est. Cost: $4875.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 14897.52 Owner: DARLING EBENEZER C Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 936 BRIDGE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/14/2010 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 12/14/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner