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23D-070 D • Ark (i*----1 y ^ca Al DIJC�VER QU EN N EVI L-L-E www,1800newroof.nei 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 4120982 Factory Certified Installers Member of the Horne Builders Association of Western Mass- CT Registration 4575920 Member of the Building & Trade Association Member of the Better Business Bureau P.P.C. 38710 Proposal Submitted To: Date T Phone #'s Work: / c L',. H:/ Cell: Street r Email: City, State, Zip Code Special Requirements f L' l �1 ,Co c n t as n Complete Roof System We shall acquire all appropriate permits for all work f � ` [ Home exterior and landscaping to be protected /IC ')"'"5e N' Entire existing roofing materials to be removed to existing decking ° ^� 1 j Deteriorated existing decking will be replaced at $3.47 per sq.ft. S' Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls • Install (15 Ib. felt /cyntheticfunderlayment over remaining decking area • Install Metal drip edge at eaves and rakes 01 5 ") whit / brown / copper) (SI Install manufacturers starter shingle on all eaves and rake edges 44 Install new pipe boot flashing standar• copper) y Install new step flashing where necessary (tandar copper) Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) C.4 _ _ ` Shingles El 25 year [g 30 year E] 50 year Color_ / / / 6-7 C F. _ 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: [ Lead Counter Flashing ❑ Water Seal & Tuckpoint 111 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 $� �� Z _ —_ Down Payment $ (Z(1 Upon Completion $ 7o)/(.7 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. f � J f � (, // t2 - Date, � �J .'��a Signature:_. :" "fir'' ` .Phone # ,� L /� -- -- Date l��o Estimator's Signature: -__� " 7 Gj; — 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. IAN Nov -08 -2010 06:00 PM Remillard Insurance 1 - 413 - 538 - hUlu (7( CORE) CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MM)DDIYYYY) �" 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 SUBROGATION 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 UUN I AL/ I NAME; PI-IONE FAX Remillard Insurance Agcy, Inc t Ert): (A/C, No): 79 Lyman Street ADDRESS: _ South Hadley MA 01075 CUS ID S: ADAM -1 _ Phone:413- 538 -7862 Fax:413- 538-7179 INSURER(S) AFFORDING COVERAGE NAICA INSURED INSURER A: First Speciality Ins Corp Adam Quenneville Roofing & INSURER Travelers Ins. Co. Siding Inc. & Adam Quenneville -- - -- -- — .... Roof ingg Inc & GutterShutter INSURER 0: dIM Mutual Iaaurance Company Of Western MA I NSURERD: H anover Insurance Company 2229 i60 Old Lyman Road p Y 2 ._ South Hadley MA 01075 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE oSTED 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH ^ - --- - DDLSUBF - -- - — POLIL.Y kPF POtrCYEXP LTR TYPE OF INSURANCE IIINSR WVD POLICY NUMBER (MMfDDIYYYY) I (MMIDDIYYYY) LIMITS GENERAL LIABILITY — I EACH OCCURRENCE �$ 1000000 -- - DAMAGE l u KEN] to A 7C 1 COMMERCIAL GENERAL LIABILITY IRG98441 06/23/10 06/23/11 PREMISES (Ea occurrence ) -_ . $ 10 0 0 0 0 CLAIMS - MADE 1 X I OCCUR MEDEXP(Any one person) l $ 2500 PERSONALB 1 $ 1000000 GENERAL AGGREGATE $ 2000000 i I GENL AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP /OP AGG $ 2000000 POLICY ; PRO - JECT p � LOC $ ~ I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ lOOO -- (Ea accident) B _ ANY AUTO BA7450L946 11/01/10 11 /01 /11 BODILY INJURY (Per person) $ ALL OWNED AUTOS — . — . - ...._ - -- BODILY INJURY (Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE 2( HIRED AUTOS (Per accident) $ X I NON -OWNED AUTOS $ — -- r $ UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 1 EXCESS LIAB CLAIMS - MADE AGGREGATE S DEDUCTIBLE _ -- 5 _ ^~ RETENTION $ $ ---- C WORKERS COMPENSATION I AWC701286101 04/29/10 04/29/11 X ST'ATU- 0TH• X AND EMPLOYERS' LIABILITY Y f N TORY LIMITS ER ANY PROPRIETORIPARTNEWEXECU IVI ry N /A j I E.L. EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDED? I I - — (Mandatory inNN) I E.L. DISEASE - EA EMPLOYEE $ 1000000 if yos, describn under '-- - - -'-- DESCRIPTION OF OPERATIONS below 1 i EL. DISEASE - POLICY LIMIT 5 10 O O O 0 O D Equipment Floater I IHN7140610 02/01/10 102/01/11 Rental f 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 WELL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Adam Ouenneville Roofing & Siding AUTHORIZED REPRESENTATIVE 160 Old Lyman Rd. South Hadley MA 01075 �/ le O` ©1988-2009 ACORD CORPORATION. All rights reserved, ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD • ✓ lw 1 E =t � e, fp r s o 1 1 ling ` egui io aril tan. ar • s - mei t One Ashburton Place - Room 1301 II_ 1 Boston, Mas>achusetts 02108 Construction •Supervisor License • ::: License CS: 70626 Restriction: 00 $irthdate: 8/2111'971 Expiration: 8/2112011 Trd 3 APAM'A QUENNEVILLE - - - - 1' OLD LYMAN RD - . - S "HADLY, MA 01075 - -- L 1oln4,104 4 / +'/+ "7 ,u -y Office of Consumer Affairs and l usiness Regulation =1_i 10 Park Plaza Suite 5170 Boston, Massa•I ?usetts 02116 Home Improvement ,l,,- ,, ctor Registration =-- Registration: 120982 +,1 _s* t _ Type: DBA z ..... i.�. 7/..4 =� Expiration: 3/25/2012 Tr# 293069 -.) ADAM QUENNEVILLE ROOFINC�M ----= ' = w \, ADAM QUENNEVILLE ro s { 160 OLD LYMAN RD =�` - " � /w 1 I SO. HADLEY, MA 01075 ' l 7C�'� mow+ . -. : ei/ Update Ad and return card. Mark reason for change. C] Address El Renewal Employment n Lost Card DPS -CA1 Cj 50M-04/04- G101216 hr STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION `�.. i Be it known that � _ ADAM QUENNEVIT:r 160 OLD 4 .tr 'ROAD SOUTH • ..._.r' 1. i J75-2632 x �:' .' ' 1 � is cer by the Dep _ nt ( ,G, n� tection as a registered I 91 HOME IMPR ®, , ,, 44 r O NTRACTOR I Regis- a. 520 i ; `RAWSr " 1 ADAM QUENNEVILLE ROOFING Effective:12 /01/2009 l'r* : Exp 11/30/2010 <`1` ' The Commonwealth of Massachusetts Department ofitahnarial Accidents : -,7-' Office of Investigations =-4 600 Was Street Boston, MA 02111 whvtee.waarsxgov / a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aparscant Iafonnation Please Print Legibly • N 1 • Name ( )� d t . % u ea ! A t - ' N • i i 1 11 C.- Address: NO ()t d L yPA err City/State/Zip: DO . • AA s S t r 7 Phone #: Are pm as employer? Cheek the apprtipr ee. box: TTPc of Pr's (required): 1.X I am a employer with 1 s 4. ❑ I am a general contractor and l and/or r• have hired the sub-contractors 1 6. ❑ New construction ( listed on the attached shed. 7. 0 Remodeling 2.0 I am a sole proprietor or partner= These sub-contractors have g Demolition ship and have no employees employees and have workers' 0 working four me in any capacity- 9. Q Building archon [No workers' comp. insurance nc a comp. insurance.: required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work • officers have exercised their 11.0 Plumbing repairs or additions right of exemption per MGL nsurance l t cep. c. 152, *1(4), and we have no 13.[} Other employees. [No workers' comp. insurance required.] *Any appritset that checks boat it most also 51 out the nuke below shorties their waters' wmpema0oa policy informatics. tHomeooaets oh* submit Ibis affidavit iochaemg lthathiaa■tsdeceett rmatrotsobmira rr .ffidari<odiradog k aaaeto that the *Min bums atttciease Without duet damitgthe aurae oft* aurora aadtane whethere not those Whin rove employees. 1f*c tob.eoahacloes have ampioyeee, they tart plovide their oveloms' mop- policy aaaircr. 1 acs net employer that is providing workers' con a salon hmuswsae for my essrployees. Below is the policy aid job site n 11 Insurance Company Name: I7 l P A u--u Q l riSi,i Y o h e°-. / P o l i c y # o r S d f - i n s . Lit. #: f } t C. 1 1 1 1 0 1 , 4 9 , ( 0 1 Expiration Dante: / 02 q /451 I Job Site Address: 1 1 1/Jacne-r S +, Flo 1; etcce- / M A city /swamp: 0(O ( Attach a copy of the waiters' compensation policy declaration page (shearing the policy number and enpiredsn date}. Faihne to secure coverage as regained under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1, 500.00 and/or one -year imprisonment, as well as civil penalties is the form of a STOP WORK ORDER and a fine of up to 5250.00 a day enst the violator. Be advised that a copy of this statement many be forwarded to the Office of Investiptions of the DIA for insurance cowslip verification. /do hereby ca t& .idtr the mat patellas efpafsay that the ixibtatotrox provided is bare tudcorrect She: Date: II t) - 1 O Phone #: 1 '(t 3-53(o-31s Official use only. Do mot write in this ate, to be completed by city or Own official City or Taws: Permit/License # Leman Authority (circle one): 1. Board °f lied* 2. Building Department 3. CityiTown Clerk 4. Electrical Inspector 5. Phunbiag inspector 6. Other Contact Person: Phone #: it • :!1!41!1:NtIl. AWN *IMP NOVI 7, ;10 luc Polo P�J togoi wpm Osect rove SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Ain * I �� � Not Applicable ❑ Name of License Holder : r0 G a 160 Old Lynn Road License Number Sod Hadley, MA 01075 91— t Address Expiration Date 13-53G — sq CC Signature Telephone .d� f 9. Registered Home Improvement Contractor: Not Applicable ❑ Amt Queue& Roo* & Sid*, Inc, (2 4 tia Company Name 160 Oki Lyman Road Registration Number South Hadley, MA 01075 Address Expiration Date Telephone 4I3 -S3 (p-S SS- 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 buildine 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 (0 KW* I f MO' IV YIPS 0 PIO I Alt' .1,K. • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [D Addition ❑ Replacement Windows Alteration(s) [ Roofing J Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [0] Other [0] Brief Description of Propose Work: 54-Vic acke SL∎ r I e-S 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 I, b n CO _ , as Owner of the subject property yrom& ' hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 1f/i7fio Signature of Owner Date & b In , 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. N1fv\ QuGAiVt V t \ Q Print Name 11117 �Io 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 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 00 DONT KNOW ip YES Q 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 ® , 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 ;t. 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit v 212 Main Street Sewer /Septic Availability 4 3✓ 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 lI'1 War (Vey s+ Map Lot Unit Flore.Ace M A ■OCo Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: britwak& C©+C_ 41 tuacn-e-c S+. nIot .ce 1 MA Oro6o. Name (Print) en Cu t M� ing Address: ' t -,3 3 IQY(? Telephone Signature 2.2A Authorized Agent: A A.0aVx Qve►n ` ∎ 1 ((0 Odd MO-V\ "�- Name (Print) , Current Mailing Address) 413 - 53( -5q5 Signature 7 Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 111%‘›S-.00 (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) fle6 S Check Number /! e6Jr' 035- This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 4"" BP- 2011 -0485 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- 2011 -0485 Project # JS- 2011- 000791 Est. Cost: $18625.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 20168.28 Owner: COTE PHILIP J,MABEL P,DONALD P JOANNE PARSONS & MARY STEFAN Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 42 WARNER ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:11/23/2010 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 11/23/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner