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23B-061 D jut VISA Mas •E artl' E Ore DIJCIVER M iQU E N N EV I 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: . 6 , / "/ � ,� H ; 1f _) ;"' u Street E r �' x_r "' ' / ' 7 1 1 City, State, Zip Code Special Requirements a 4 i "1 r''l 7 t f 7 C Complete Roof System L' ' \„,° d 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 Deteriorated existing decking will be replaced at $3.47 per sq.ft. Q Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalis 1111 Install (15 lb. felt « S ntheti underlayment over remaining decking area Q Install Metal drip edge at eaves and rakes t8" / 5 ") (white)/ brown / copper) Ei Install manufacturers starter shingle on all eaves and rake edges El Install new pipe boot flashing fstandar / copper) [l Install new step flashing where necessary standarC / copper) II Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years (see our warranty coverage) O GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney Options: d 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 Sale Price $ r i2 Down Payment $ �7 y "'' Upon 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. • - / � � .« ` i � r! Date ' i Signature: � Pl �! - � -r'` Ph one # �� «. ! ., .. r J : te r". _. Date r , 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. 1109 NL ?H10 i)h : 0i) PM ReTili i I l and I n-;ul'clrl 1 41.1 "D38 h!)1U • CERTIFICATE OF LIABILITY INSURANCE 11/09/13 � ����� O ID LL DATE (MMICCf'^^fY) 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS i CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 1 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER MPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVEU, 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 zertificate holder in lieu of such endorsement(s). PRODUCER NAME; PHONE R - 6TMAI� " emillard Insurance Agcy, Inc ((�� ,fit 1 FAX NO 79 79 Lyman Street ADDRESS: _ South Hadley MA 01075 C USST T Q - OMERIDd: ADAM1 Phone.:413- 538 7862 Fax INSURER(S) AFFORDING COVERAGE NAIL INSCREC INSURER A: First Speciality Ins Core Adac. ennev111e Roofing & INSURER 0i Travelers Inc. Co. Siding Inc. & Adam Quenneville -- — Roof ingg T. nc & GutterShut ter INSURER az» Mutual Inner c company Of Western MA I _ IINSURER D: Hanover Insurance Coman 22292 16C Old Lyman Road -W -� ��o � South Hadley MA 01075 INSURER E. Il_ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 13 "'Cr FT ".LAT THE POLICIES GE INSURANCE LISTE0 SELO. I - I is SEEN ISSUED TO TFIE INSURED NAMED ABOVE FOR THE POLICY PERIOD h "E 7 O,NIT,- 'STANDING AN1 REQUIREMENT, TERM OR CONDITION Or ANY CUN IRAO' OR OTHER DOCUMENT WITH RESPECT TO WIRIC11 THIS , Fir IFICATE NIA' EE ISSUED DR MAY PE69001 THE INSURANCE AFFORDED BY 'HE PC:.ICIES DGSCRISED HEREIN IS SUBJECT TO ALL THE' ERMS, r`X • !S10 V4 AND I:011 171015 OF SUCH POLICIES LIMITS SHOWN MAY HAVE 5053 REDUCED BY PAID CLAIMS. ,t7R -- —_ -. F ADo1 SUBS POLTCY POLFCYEXP ' � I R PIPE OF INSURANCE �iNSR WV DI POLICY NUMBER IMMfDOIYYYY) I(MMIDDfYYYY) LIMITS GENERAL LIABILITY i I I, 1 , i EACH OCCURRENCE $ 1000000 - DAMAGL- I 0 RkN I kU — T A X ..::IMMHRCI 3FNERAL . 0ABILIT, ' IRG98441 56/23/13 ; 06/23/11 IPREMISES (ouxcurence, I$ 100000 CLAIMS-MADE X OCCUR PERSONAL SAOVI $ 1000009 GENERAL 1 $ 200000 �- -- 'ONLAGGREGATEL;17IrAPPLIES PER: ! PRODUCTS - COMP/OP ACC , $ 2 000 000 F - -- ' POLIO • �I JE� I LOC - AUTOMOBILE - - -.. r— - - -- OMOBILE LIABILITY T COMBINED SINGLE LIMIT aA Occident) ' 5 1000000 3 63) AJIC BA7450L946 11/01/10 !11/01/ i -- � BOD lY INJURY (Per per an) 1 $ : 4 - OVAL) AU105 !- - '- - --- — T -._.. BODILY INJURY Per aoc ACM) 19 X _,; SCHEDULE. AJTDS'. Por a cor. ODAMAGE .... -- .. _.. .X HIRE') U OS $ X ' N'ON VNEDAUTOS I — I $ 5 UFIBRELL.A 0100 OCCUR j �—� (. EA i OCCURRENCE S EXCESS LF05 -,'1 CLAIMS - MADE. ! AUGREGAT L _ . 0 OFKERSCOMPENSATION I AWC701286101 104/29/10 04/29/11 i X WTA1U- xI01N r 4 I w a;�S AND EM LOYERS' LIABILITY Y t N TORY LIMITS 1 033 I \Y PRDPIIIE,OWPARTN fZF XEC UIIV � I ' • L ( c.R I/MEA9I3R tXI.LUi).-D7 Y I , ti' � � I ;Mendatc n EACH ACCIDENT $ 1000000 A in NF,) , E L . DISEASE - EA EMPLOYEt 9 1000000 " NS cscr u �o nm c ESLRIPT ON OF OPERA — 1 _ hn; w _ 1 ' 9 L DISEASE - POLICY Limn 1 $ 1000000 D Equipment Floater I} 07140610 02/01/10 , 02/01/11 I Rental — I y -- ^ — � -i— Equipment $100,000 DESCRIP'.ION OF OPERATIONS ! LOCATIONS , VEHICLES (Attach ACORD 101, Additional RonerNt Schedulc, 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. A<ldni 2ucrrnevi1 e Roof & Siding __ _ _ _ g _ _ AUTHORIZED REPRESENTATIVE 160 Old Lyman Rd. South Hadley MA 01075 y ©1988- -2009 ACORD CORPORATION. All rights reserved. ACORD 25 12009109) The ACORD name and logo are registered marks of ACORC 0 44 0 • .4 ''' 'l • : .t 7: ",=•:-.: : • • . .'.7 oars 0 :u sing ' egul ions an. tans art s One Ashburton Place - Room 1301 W Boston. Mas 02108 Cons:ruction Suijer.visor License License CS: 70626 _ - .. , Restriction: 00 Birthdate: 8/21)1 Trl 3712 Expiration: 5/21120 ADAM A QUENNEVILLE - ____--- ----- --- 160 OLD LYMAN RD . S 'HADLEY, MA 01075 . : • _ L ...., ', - - 1 ite --eozin/nwitweivA f tAr/J/.4-acitu(sel6 Office of Consumer Affairs and usiness Regulation •,.. ,,,,,.-.. ''' 10 Park Plaza - Suite 5170 ''',_.--,‘•:,,'-,'' Boston, Massusetts 02116 Home Improvement..:2 I , ,ctor Registration RegIstration. 120982 ------—Th al Type: DBA Expiration: 3/25/2012 Tr# 293069 F.7 ,.. ' :=. ■,-,- ADAM QUENNEVILLE ROOFING - --.-: ..-- , ----..,_, ADAM QUENNEVILLE ,,,, . -...., 160 OLD LYMAN RD SO. HADLEY, MA 01075 --,,) ,___ %II.— ,,:.-,,- 1 ,--- E1— '7( , \-,-- - ', Update Address and return card. Mark reason for change. Address 1 Renewal 1 Employment - 1: Lost Card c, 50M-04,04-6101216 S TATE S OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Be li known that . 1- :,-- 4 • i ! ':' ADAM U QENNEVILLE , to • -: 160 OLD 4 A,/ -: ROAD ,,,-.. •:, , ?7 , yrey e l ; ti . 1c SOUTH, 14 I v.... ' i J75-2632 ..- ' 1 1 ,I a;‘,. 7 k''t ,‘■ , 1 , 4 is certified by the Depairtent t t,,,'' '.: :4; tection as a registered ! .4c .• ;i • ... .•::- . i HOME IMPRO.0, hde. 9'ONTRACTOR ., ,. ._,-4 .--,, „,„,.. ., , .■ i' ' . ''-' k R egl,S la • . _.'.":. ' . 7 0 '.....:, 1 \ ■- -' - i : t j Z • ;zy'' ' t I ..-: ( i'fit• `-'------- - 4/7 - , ",,,-,...,_ • ? :' ADAM QUENNEVILLE ROOFING Effective: 12/01/2009 Expiration: 11/30/2010 T &e Commonwealth of Massachnsetty Deportment of Industrial Accidents *,= oar of Investigations 600 Washington Street =- = Boston, MA 02111 p www ntass.gov/dia Workers' Compensation Insurance Affidavit: Buiidera/Contractors/E ' ' bers Anoka* laforlaatinn Please Pellet Legibly 1 \ 1 Name ( ): a ►' AA t 1 . 1 • ' I • s s. ..' i ✓I(... , Address: J ai) n t A Lk eL C i t y / S t a t e i Z i p : "' sit a ' i _ ,. S ib . . . f _ you an employer? Check the appropriate boa: Type of project (required): [ S 4. ❑ 1 am a general contractor and I ❑ .1% I am a employer with 1 employees (full and/or part-time).* have the subcontractors 6. New construction 2. ❑ 1 am a sole proprietor or partner- listed on the attached shut 7. ❑ Remodeling ship and have no employees These sub- contractors have 8. ❑ Demolition working f.me m any may. y h waiters' 9. ❑ Building addition comp. insurance. [No workers ' comp. insurance required) 5. ❑ We area corporation and its 10.0 Electrical repairs or additions officers have exercised their 3. ❑ I am a homeowner doing all work 11. Plumbing repairs or additions myself. [N ' gyp. right of exemption per MGL 12 Roof repairs insurance .] c. 152, §1(4), and we have no 13. [} Other employees. [No workers' 1 comp' insurance required] . 'Any applicant that decloc boa 11 mast also 91 out the section below showing their Wodmrs' cempeaastion policy iofaemstion. I Hom el= Who submit this atSdorit incirating they me doing all Work asdthco him onside a memrson most sohmita new aSidaait iediatiegsech. SOdetreaast of disco this team* aaaehwi o Whim! to showing the none oftheisheoenaclas aadt sorwhethrern%those entities here employees. if the whoarrnetots hews employees, they mast provide emir mss' comp. poky somber. I atw tarn employer that is providing workers' coo tea Warsaw far my employees. Below is the mid __ - s __._ -. P'�3' .� silt Insurance Company Name: /4 1/-A , i lA-t l li t TY1SU rci Yl °i_ / Policy # or Self -ins. Lie #: A titC,. 1O (eV, 6) l C t Expiration Date: /a q jcQ61 I lob Site Address: 33 DeckSI,; Ave F[O(Gelce / I &l� City/state/4: O to ` Atbaai • copy of the workers' compensation ply declaration page (showing dee policy ovanber and expiration date). Failure to sesame coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51, 500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a dtty against the violator. Be advised that a copy of this statement may be forwarded to the Office of Inver of the DIA for insurance coverage verification f to hereby cat y resin tits saponifies ofperfary that the hrfonsotkra preview' is Aare arrdcorreet. Sigiugure; , Date: 3//61/ / _ #: L i{ s � r� sg � Cfficid use only. Do Rot write let this ono, to be coatplded by cBy or town of pTaL City or Tows: Pereait/Lice j # Issuing Authority (circle one): 1. Botts of Beath 2. Ronan 1lepaaroneat 3. City/fawn Clerk 4. Electrical inspector 5. Plumbing lansperter 4 Other Contact Person: Phone #: )11 114 i'frAti34 Hgqt 1‘,11t)ti f 10 K ipif! Knottj ,olti!ut, SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �-r Quenon* u,,',- Siding, ❑ Name of License Holder : Adam Quenn Roofing & Siding Inc. G 0 G a (p 16S OId Lynn Road License Number Address 1 South it MA 9W15 _ ► t ►( Expiration Date 6— q (3 536 - s`�SS' Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quennevile Roofing & Sidi Inc. 1.10 "Z Company Name Registration Number 169 Old Lyman Road 3- Address Sold thdky, MA 91075 Expiration Date Telephone 4 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 ❑ 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 T$h tjfititio tg: 11 06641 4 1 PIP# Mg' 111( SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House E] Addition ❑ Replacement Windows Alteration(s) J Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0] Brief D cription of Pro os d Work: � s ar� R.. .ka- �r. � s�, c� \e.S a4- R� ai Rvb i - P FPD N• 0 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 1, %G f; a- G\a -k , as Owner of the subject property Aim Qum. itodsti g,1stN hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 3 —[Co — t Signature of Owner Date Adam Q bag & ngf 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. / Orn t)e- rr`e. �; [ � -e 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 BIdg. 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 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O. YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 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 O 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 ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. IPA t . Department use only 0°\1 City of Northampton Status of Permit: ��� Building Department Curb Cut/Driveway Permit 2 `� 212 Main Street Sewer /Septic Availability 0s71, ortham MA 01060 Two Sets of Availability of t ctural Plans ci� s � e� • one 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 33 bak s4�; t� Map Lot Unit o Mtn Le - e H 010G a Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: otoG Cinc) -C C tc.v-k- 33 'Sec c-r___ ' Fk. enc- A4,4 Name (Print) Current Mailing Address: 1 .f /3 —rsrc — 037 3 Telephone Signature 2.2 Authorized Agent: Ada *wile R &Sidig,Inc 1 G ©Id So iN l kl� Name (Print) Current Mailing Addre Z 10 � tft3 -Scf Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building * 131 (a) Building Permit Fee I 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) `f1y _ Check Number c jogS?- IA 36 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 33 BERKSHIRE TER BP- 2011 -0756 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B - 061 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit# BP- 2011 -0756 Project # JS- 2011- 001249 Est. Cost: $14131.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 20429.64 Owner: CLARK JEANETTE A & RICHARD W Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 33 BERKSHIRE TER Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:3/24/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE & NEW RUBBER ROOFING 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 3/24/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner