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D Aft • ....... V � aru DIlG.VER QU EN 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 �' 1 Phone #'s Work: KA/ f- I /- Ott i� /a.45/i � H 6 z / / . 3 ) s 136/0 Cell: Street Email: as Sf C "ity,, State, Zip Code Special Requirements / 0 6c _� � ( ( 2J Complete Roof System t is. We shall acquire all appropriate permits for all work • Home exterior and landscaping to be protected 54 Entire existing roofing materials to be removed to existing deckin iii Deteriorated existing decking will be replaced at $3.47 per sq.ft.d 4 • Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls R Install (15 Ib. felt Synthetic underlayment over remaining decking area l& Install Metal drip edge at eaves and rakes Q / 5"((;/;_19) brown / copper) Install manufacturers starter shingle on all eaves and rake edges r& Install new pipe boot flashing / copper) gl Install new step flashing where necessary (standard copper) 'II Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) / / G -4F Shingles ❑ 25 year X 30 year El 50 year Color S' '7 c' 6 F Ridge cap shingles Warranty Options: y We guarantee our workmanship for 10 full years (see our warranty coverage) • GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney Options: X 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 $ ,._._ ? C� r l Down Payment $__p? S �' Upon Completion $ 5 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. Date: "1 Signature: 1 w' �I j, Phone # �( $ y-2_6 / Date /0)/ /0 _ Estimators 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. i 1■,1 Nov -0B- 2010 06:00 PM ,Remillard Insurance 1- 413- b38 -bU1U « � C° ?1 CERTIFICATE OF LIABILITY INSURANCE OP ID LL DATE(MMfDQYY1Y) ,,, ..� " 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 (.UN I A(, I NAME: PHONE FAX - -. -- -- Remillard Insurance Agcy, Inc - �:MA IC No, Ext): (PJC, No): 79 Lyman Street AD SS: South Hadley MA 01075 CUSTOMER ID#: ADAM -1 Phone:413 -538 -7862 Fax:413- 538 -7179 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: First Speciality Ins Cor• Adam Quenneville Roofing & ER INSURB: Travelers Ins. Co. Siding Inc. & Adam Quenneville - - — --- Roofing Inc & GutterShutter INSURER C: AIM mutual Inuesance company Of Western an MA INSURER Hanover Insu Cor 22292 an 2229 160 Old Lyman Road P _____ South Hadley MA 01075 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FIAVE 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, r XOLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBp - _ .--- POLICY E.F PotjCY t_TR TYPE OF INSURANCE INSR WVd POLICY NUMBER IMMIDDJYYYY) I(MM /DDJYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ SOOOOOO I EACH I() HEN I EU 1 ....._. ' 06/23/11 PREMISES r $ 100000 A X ' coMMLRCIAL GENERAL UABa I IrY IRG98441 06/23 to CLAIMS -MADE 1 X OCCUR l MEDEXP(Any one person) $ 2500 _ PERSONAL &ADVINJURY $ 1000000 GENERAL AGGREGATE $ 2 0 0 0 0 0 0 G°_N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2 0 0 0 00 0 1 POLICY 7 !Ea- LOC $ 'IF '_ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000 (Ea accident) 13 1 1 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 ---- X I HIRED AUTOS (Per accident) $ X 1 NON•OWNEDAUTOS $ __- 1 ---LLA � I B - MB OCCUR , I EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED'JI.TIEL RETENTION DL E $ ( ' -- - -- $ -- S C WORKERS COMPENSATION ' AWC701286101 04/29/10 04/29/11 X WCS1'ATU OTH• - X AND EMPLOYERS' LIABILITY Y / N TORY LIM ER ANY PROPRIETOWPARTNEPJEXECUTIV5 E.L. EACH ACCIDENT $ 10 000 0 0 5 / A OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) EL. DISEASE - EA EMPLOYEE $ 1000000 yy DESCRI' ON OF OPERATICtaS below I E.L. DISEASE - POLICY LIMIT $ 10 0 0 O 0 0_ Equipment Floater I7140610 02/01/10 02/01/11 Rental I 1 Equipment $100,000 DESCRIPTION OF OPERATIONS 1 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 ` C� ,cnaGr ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD *� oars o •uL•Lng egul tans an, tans are s ( One A Place - Room 1301 Boston, Mas>achusetts 02108 Construction Supervisor License • License CS: 70626 Restriction: 00 • • • Birthdate: 8/21/1'971 Expiration: 8/2112011 Tr# 3712 I AQAM A QUENNEVILLE 1 OLD ' LYMAN RD S MA 01075 • - -- *__= JA' °l = 1 Office of Consumer Affairs and usiness Regulation - - Iii=--= 10 Park Plaza - Suite 5170 -*,, ' Boston, Massa usetts 02116 Home Improvement ' .:9,_ actor Registration = -- Registration: 120982 r11 -* - ! Type: DBA 0z 0' 0' c (fib' Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFINC� - -_ �, w ADAM QUENNEVILLE b _ �; \ 160 OLD LYMAN RD \ -i Win _ �, SO. HADLEY, MA 01075 4 0 ME% .l / , '' "tiff Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal Employment ❑ Lost Card DPS -CA1 Cr 50M- 04/04- G101216 { ` STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ... ti 1 Be it known that ? ADAM QUENNEVI T :T 4E . 160 OLD tfar ROAD I SOUTH m r i1075-2632 i ' is certified by the Dep ' n (a;,' u l .1t. tect as a registered I HOME IMPRC(A. , M P NTRACTOR k ji Rego S; - ti r9 Anrsri � 1 ADAM QUENNEVILLE ROOFING I Effective: 12 /01/2009 I � Ex rationll 30 2 . 1 , p / / 010 <`'�` ! The Conmwnwealth of Massachusetts Department nj'Industrial Accidents k a,t =q,=p Owe of Investigations � ' " 600 Washington Street —.-f Bogor, MA 02111 www.moss.govidia Workers' Compensation Insertuce Affidavit: Itunders/Contractors/Electriciansffliumbers AnDalat I*fiir ' fion Please Print Leribly Name ( ): A ri yv R r v%1 (‘e et ly. 1 ( 13 4- 5 L 3 1-0C -. Address: 'to 0 ()l A Ly in tv f et City/S :n '1.: 111.s a r f h7 Phone #: 1 - • " ~a ___ - Are pan an employer? Cheek the appropriate ho:: TYPe of P (require): 1.X I stn a employer with J S. 4. ❑ 1 am a gem contractor and I have hired the sub - contractors construction employees (full and/or part-time).* 6. ❑New 2. ❑ I am a sole proprietor or partner- listed on the sheet ?. ❑ R g ship and have no employees sub-contractors have S. ❑ in working for mein any capacity. employees and have workers' 9. ❑ B addition [No workers' comp. insurance comp. insurance.: requited.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions [No ' gyp. right of exertion per MGL 122Roofrepairs insurance ] t c. 152, §1(4), and we have no 13.❑ Other employee& workers' cramp, insurance required.] 'Any appliam Rate checks bane #1 mast also lilt oat the section below showio6 their vtodsars' caapCeution privy aatbstoutoo_ t Homoautatas who submit dais s03darit naming they sea doioaall weafc aod drat biro =adds metoeson mast whodunit./ affidavit aadicetitogracb. Vomaetossthat d o & this bureau attat>irodan additioest duetalowinatbe mesa otlbeaobaoeuaatcta sod seste thudrcrenvoi tote c a es have mployeee. If the sahanteaaoss brae employees, they mutt provide the wodams' annoy- policy comber. 1 air es employer Met Is providing worker? compessation lasorsoce for my employees Below is the pommy and job site Insurance Company Name:_ tj,=1 A g rjA Q l j a jai At P P o l i c y # or S e l f - i n s . L i c . #: A IJC . 7 0 (�9-, (o [ C' ( Eamon Date: Vacioqoi 1 lob Site Address: a2 wo.cneeC SA Nks, ec...v�. ri_ocx ` M A City/State/Zip: D 10G )., Attach a copy of the workers' mampensaden policy declaration page (slowing limpidity amber and dote). Fai ne to secure coverage as required snider 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 in the form of a STOP WORK ORDER and a fine 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 io hereby cam► sinter lke mndp ate that the p above is true mudcaorrect. Sis k i Date: 1. -15 - N6 Phone ft: zit 3 -,53 to - 59 s --- c - Officio, use only. Do not white be this area, to be by city or town offidai City or Town: Peraeit/Idcense # Issuing Authority (circle one): 1. Baird of Health 2. Bailin Department 3. Cityll'own Clerk 4. Electrical inspector S. Plumbhtg inspector • 6. Other Contact Person: Phone #: . . . • • - '':'-'''''j' ft.'''-it• '.,..N 4.C.3.,,i:- IfilIN 6114100 ;1`f,. iiT1 7 '10,fui.' p' f. 11 ' IL: 104 or t i l irld if ',lig! 004:41itftillt4 V•ii,ift , , SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ((��,.. & Not Applicable ❑ Name of License Holder : Adam QK"* Roofing & Inc' r o ‘ e2 (o 160 Old i ysas R� License Number Seth OYwul+ ,MA 01075 Address Expiration Date ( 1 . 13 -S3 G - SAS Signature � Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam QuceNevilk Roofsg & Siding, Inc, 1)4)40. . Company Name 160 Old Lyman Rood Registration Number South Ilodley, MA 01075 3 - Address Expiration Date Telephone t/1 3 - 53C - 11 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 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 Mc iigivot4 ftfoTis cf ''iliki.' iii An *Of PAK) 7 *ail': 0' SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing am- Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [ID] Other [0] Brief Description of Proposed Work: .5.1-(` P or" Z t Sln: ntla 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 k & k © , as Owner of the subject property *ode authorize QI I & Sidin Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. la -IS-ID Signature of Owner Date Ads """" Re efs; & Siding, 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. c\a�cn Qu ehinev � A \ � e- Print Name Ia"s- co 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 0 DONT KNOW diP YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW AD 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 ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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. WiII 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 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 Cj;t7 212 Main Street Sewer /Septic Availability \11 Room 100 WaterNVell 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 Properly Address: This section to be completed by office as wo.cner- s} Map Lot Unit /J ov4 L vAci , 0 WC a Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: KocAktu 0 i (12 ► a w 04''ruz -c- - Po smkt - r AAA m i OGA Name (Print ).-+ Current Mailing Address: qi3- SIN - 361i Telephone Signature 2.2 Authorized Agent: Ado Qom& Roofing & Siding, Inc, 1 G o old i ivta rt_ Rz s o 0 w. t Sao to ? s Name (Print) Current Mailing Addrests: 4 13 - 53G — Sgs 5— Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building a° d (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) I g�DO,00 Check Number /9 r,( _ 'f This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date BP- 2011 -0556 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 -0556 Project # JS- 2011 - 000915 Est. Cost: $8200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 10236.60 Owner: O'NEIL JOHN F & KATHLEEN B Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 22 WARNER ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/16/2010 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 12/16/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner