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24A-125 D A A lm VISA Masted D11C•VER QU E N N EV 1 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: ' )' y homes * / Ai /Z/ /a oe �„ 4149 H: k3)0 604c Cell: Street Email: City, State, Zip Code /� Special Requirements rCi �'A. //41 /Cn �f d �lC 40 /AA se /A VP. )n G rU44 Complete Roof System Nt We shall acquire all appropriate permits for all work 2 Home exterior and landscaping to be protected Entire existing roofing materials to be removed to existing decking a 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 IR Install (15 Ib. felt / nthetic nderlayment over remaining decking area Si Install Metal drip edge at eaves and rakes 8�' / 5 ") i.rown / copper) El Install manufacturers starter shingle on all eaves and rake edges [ Install new pipe boot flashing standar copper) Install new step flashing where necessary tandar copper) Qg Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) // /� G� f' Shingles ❑ 25 year E 30 year El 50 year Color 1/ trA- 'ems CA - Ridge cap shingles Warranty Options: Sa We guarantee our workmanship for 10 full years (see our warranty coverage) D3 GAF ELK System Plus warranty ❑ GAF ELK Golden Pledge warranty Chimney Options: si Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown 111 Metal Chimney Cap We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: /[ Total Sale Price $ 10 Down Payment $ (; 06 Upon Completion $ 3 0 (� 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: Signature: Phone # Date: 4, `f ` �0 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. 1/09 The Commonwealth of Massachusetts ,; Department i f Industrial Aex k -tlz., :fit , "t o a oftnvestigat s X 600 AWashington Street = .. , Boston, MA 02111 www mass.gov/dia Workers' Compensation prance Affidavit: Buitders&Coutractorrs/E ians/Plumbers Abut IRfur on Please Print Legibly i 1 Name ( ): rsi ! a, a e, ' . c - ` . .. a . "- , yic. Address: ) L 0 ()Id L A. - C • Is Is; 11 1114 ` Ai ` /t/f Phone #: 1 — 3 • - —• - Are you an employer? Cheek the appropriate box: Type of proms (mired): 1.38[ I an a employer with I S` 4. 0 I am a gencral contractor and 1 6. ❑New construction employees (full and/or part4ime ).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised thei 3.0 I am a homeowner doing all work 11.0 Plumbing repairs or additions right of exec per MGL insurance l t comp. c. 152, §1(4), and we have no l2 Itoaft+epairs employees. [No workers' - 13.[] Other gyp• insurance required] Any applicant that darks tax t1 most also M oat the section below !bowie their voodoos' caspanatien per' information. t Homeoase S VAID adroit this sabot indatingthey are dolgaa work sordihnhits outside mataama mast sohmitasear *Mat indiatiog.sech . sCootraAmsnst drat thie boomed h"--hedde alditioad drat sbowinathe sameoftbesohccaaanwiaa0d draherurnotthee gadder bat employees. ifthe sdrooatmetas have eaployece, they non provide their ' comp. policy per. lase at employer that ism workers' compensation issonwece for my employee= Below is the policy and job slie inl Insurance Company Name: A l /A A. u bill t s► rtt ht P_ Policy # or Self -ins. Lic. #: P W C.. r j o (A ( Z(o I 0 t Expiration Dom: 4 ja q /or 1 lob Site Address: 5 / iV O C�PGi'� f Voi QM j * on / M A City/:: ©/ 0 G O Attar * copy of** workers' cesupeasatsu pray declaration page (showing tit paw' mew 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 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 dry 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 alsom Ido hereby cart► muter Bee aeerpendkvofpeij gOM due befbrenothere prorktele .iv istrue entconece. Signature: Date: a'S - /0 Phone #: Lf 13 -53 to - Sq s Off / use only. Do not wale be tub are., W be completed by city or lt,wn Vidal City or Town: Permit/License # Issuing Authority (circle one) 1. Board of Headth 2. Builffing Department 3. City/Town Ctert 4. Electrical Inspector S. Plumbirg Inspector ° 6. Other Contact Person: Phone #: .1 , , C I / 1 e . , *= -4, & sO 1: u sing egul cans aria tans aros a' One Ashburton Place :Room 1301 . ;`,.„0 Boston, Mas 02108 . • - Construction'Supervisor License • License CS` 70626 • Restriction: 00 •I , ' . I _ .Birthdate: 812111 "' Expira tion: 8/21 /2011 Trit 3712 ADAM A QUENNEVILLE • •; . 1'60 OLD ' LYMAN RD •. - - -- S `HADLEY, MA 01075 ` . • • .., • • t.A.,,,,,,d,„,,,e4,. t°1 -60,....ta ,.______,_____ -,..„,, �e ►= Office of Consumer Affairs and usiness Regulation [_f 10 Park Plaza - Suite 5170 ;,_• Boston, Massa 'usetts 02116 Home Improvement __ `t . ctor Registration Registration: 120982 .—. Type: DBA r =e = ; s Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFIN M i,-. ;: ADAM QUENNEVILLE . 160 OLD LYMAN RD `- = ' SO. HADLEY, MA 01075 c � _ ,�„ �h \ 1 %%� — ,.., . v .''' Q Update Address and return card. Mark reason for change. - -' 11 Address E Renewal 0 Employment 0 Lost Card DPS -CAI is 50M- 04/04 - 0,101216 ' STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION t B e it known that. ADAYt QUENN "VIT T .F 160 OLD I, ROAD � • SOUTH •, 9 ..175-2632 ' ' is certified by the Dep. ' n A E : as a registered i 1 I HOME IMP e ,4 M NTRACTOR l f I Regis ,tea, �' 5 i . i ' : ?'R,atvsr� i ' , Ci7 . t , ADAM QUENNE`VILLE R 4 Effective: 12/01 /2009 Expiration :11 /30/2010 r - • Terry F arrell Tr.. Commissioner ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DM OATE(MMJODMYY) ADAMQ -1 06/24/10 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 BY THE POLICIES BELOW. South Hadley MA 01075 i Phone:413- 538 - 7862 Fax:413- 538 -7179 INSURERS AFFORDING COVERAGE 1NAIC# INSURED INSURER A: AIM Mutual Ineu:ance Company INSURER B: Travelers Ins . Co . Adam Quenneville Roofing & INSURER C: Fi rst Speciality Ins Corp Siding Inc & Guttershutter P Y , 160 Old Lyman Road ; INSURER0: Hanover Insurance Company 22292 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 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR• TYPE OF INSURANCE POLICY NUMBER DATE (MM/OD/YY) DATE (MM /OD/YY) LIMITS 1 GENERAL LIABILITY i, EACH OCCURRENCE $ 1000000 UAMAbt 1 U litltl I tU C X COMMERCIAL GENERAL LIABILITY Tin 06/23/10 06/23/11 i PREMISES(EaocCUrence) S 100000 CLAIMS MADE X OCCUR ' MED EXP (Any one person) $ 5000 I PERSONAL&ADV INJURY $ 1000000 I ' GENERAL AGGREGATE $ 2000000 GM. AGGREGATE OMIT APPLIES PER: PRODUCTS • COMP/OP AGG $ 200000 0 _ POLICY — 28-f 2RO Ti LOC AUTOMOBILE LIABILITY �^. I COMBINED SINGLE LIMI 51000000 B . ANY AUTO BA7450L946 11/01/09 11/01/10 i (Eaacddenr) ALL OWNED AUTOS BODILY INJURY ' X . SCHEDULED AUTOS (Per person) I S X HIRED AUTOS t BODILY INJURY (Per accident) S X NON•OWNED AUTOS PROPERTY DAMAGE • ■ (Per accident) I $ GARAGE LIABILITY • I AUTO ONLY • EA ACCIDENT : $ _ANY AUTO � OTHER THAN EA ACC ' $ • AUTO ONLY: AGG I S EXCESS /UMBRELLA LIABILITY i EACH OCCURRENCE S L f OCCUR CLAIMS MADE � AGGREGATE S $ —, I DEDUCTIBLE $ RETENTION $ $ 1 SiAIU• I WORKERS COMPENSATION AND TORY LIMITS I Ol ER H- A EMPLOYERS' LIABILITY AWC701286101 04/29/10 04/29/11 I E.L. EACH ACCIDENT $ 1000000 ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? i ' E.L. DISEASE • EA EMPLOYEE s 1000000 If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE • POLICY LIMIT i s 1000 000 OTHER D Equipment Floater IHN7140610 02/01/10 02/01/11 Rental ! Equipment $100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SERVMAG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTOO 0 REPRESENTATIVE —/ ACORD 25 (2001!08) © ACORD CORPORATION 1988 Oikk 100 OK i' .011 % 1, roc )11siottily. tivotait Ast etto toc6 KI 1 144) oq r•oim gostl 2,13to wro,!itt lut • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: M ,,, ' ,, D A j Not Applicable ❑ Name of License Holder : Adis QlIe6�CY1�C � & 7 0 W a 160 Old Lysu Road License Number Soli Hadley MA 11!75 - at - ( AddresG � f Expiration Date 413-53G -S95S Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ S • I I a o q � � Company Name � Registration Number 160 Old Lynn �Road �t 3 - as-- la Address South Hadley, MA 11175 Expiration Date Telephone 'It 3 -5 slIs 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 wvo,il 'for whir;h this: pctr it 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 Y t e ♦ Pt t , it SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) [J Roofing F Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [0] Brief Description of Proposed Work: S'''t P o nom+. ReS.a- Reg, c 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 I, PAA.A.∎n♦ Met aco,.1aVN , 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 Aim *writ & , 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. A \c. v.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 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 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 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 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 ® 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 k r,4 212 Street Sewer /Septic Availability S ee Room 100 Water/Well Availability North,,SmpIon, 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 S7 P co Spec-\-- S-t . Map Lot Unit NON'*.o "n,pNon Mtn O 1 C 60 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Nana Nu* o. ck..)Art S7 Pco Sptci - St. Nor -VIN. Lion n.otoro Name (Print) Current Mailing Address: 413 536 -S Telephone Signature 2.2 Authorized Agent: ACLInn Qve. onruit1L IC 0 t7 I L. toga" 9Na. S 1 .4. MA Name (Print) Current Mailing Addres . O 1 O7S 4 .13- 53G- Si Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building IO 1 9 OD (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) 4 10‘100.015 Check Number // 9C This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date +[ IJErjNEVILL.E ROOFINGS SIahN4G, lNC_ 160 Old Lyman Road, South Hadley, MA 01075 www.1800newroof.net 1 413 -536 -5955 I info @1800newroof.net D DE Q G r 3 generations of Service 9/21/10 City ofNorthampton Building Department 212 Main Street, Room 100 Northampton, MA 01060 To 'cthom it may concern: Permit that was sent ou4r.,57 Prospect Street, Nampton was sugnose to befor 57 Prsa.t Avenue in_Noi thamptcdi Sorry for any inconvenience this may have caused. Please call if you have any questions. Thank you, Timothy Boudreau Assistant Operations Director J� MA Construction Supervisors Lic. #070626 1 MA Home improvement #120982 Member of the Home Builder's Association of Western Mass. • . ()RECTA w °` BP- 2011 -0238 GIS #: COMMONWEALTH OF MASSACHUSETTS • ® 4'`.i 12'K 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 Pe�nrit# BP- 2011 -0238 Project # JS- 2011- 000401 Est. Cost: $10900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 9888.12 Owner: Tracy Gomes Zoning: URA(100)/ Applicant: ADAM QUENNEVILLE AT: 57 PROSPECT AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:9/16/2010 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 9/16/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner