Loading...
30A-063 A+ B R mBBB C from QVENNEVILLE Winner of the 2010 m BB US N S J TORCH AWARD ROOFING ' SIDING ♦ WINDOWS 160 Old Lyman Road • South Hadley, MA 01075 1.800.NEWROOF 413.536.5955 Clalms.AQRS @gmail.com MA Construction Supervisors Lic. #070626 MA Registration #120982 CT Registration #575920 HOME EXTERIOR AGREEMENT Name A► V') fl') . j. .I,' Date . 'LP_ ILA rm. Claim #�5 ;7 � Addr s 'L g ot • Ph o O q5) % !CO Fx -- t.OY" -P_ 0(e. rR 01 b(o a Staff Adj. If A • A. & - - X, 71O Phone #'s H t4(358 Y7'1 C Ind. Adj. Email C1 td i jOhn @ C,DrYiC1S+ _ 1'1e-4 Proceeds Roofing Materials Roofing $ 1 (/ NU C, .'D Brand of Shingles Y—O Color Dr I tw0ad Siding $ Style of Shingles AirCA1 G utters dLIMMI $ c,9 AO + 03 Sq. of Shingles I $b Ridge Cap $ Tear Off: yes ja, no L 1 3 g do , d, • $ , Underlayment i S' 14 f ' R idge Vent 't•-}5 t TOTAL $ Leak Barrier c, All supplements approved by the homeowner's insurance company are to be Drip Edge 1 Aluminum: / brown LF included into the Total of the contract agreement and must be paid to Adam Fleshings 0 t Quenneville Roofing & Siding, Inc. Permits Fumished: 3 (6 nails per shingle) Decking $ • /sheet Homeowner's initials ALL Checks Payable to Adam Quenneville Roofing & Siding, Inc. We will pick up all debris throughout the building process. We Payment Schedule will roll your yard with a magnetic roller. All debris will be removed, hauled away, and recycled whenever possible. Deductible Check: $ (from Client) Date Check # Amount Siding Materials First Insurance Draft: $ Brand of Siding (from Client) Date Check # Amount Style of Siding Dutch Lap ❑ Clapboard ❑ Color Supplement Draft: $ Amount of Siding (from Client) Date Check # Amount House Wrap yes ❑ no ❑ Itel Report yes ❑ no ❑ Fascia LF Color: Upgrade Payment: $ Soffit SF Color: (from Client) Date Check # Amount Eaves % Vented % Solid ❑ Rakes Solid . Gutters & Downspouts Aluminum, LF Company's Limited Warranty: 2 years on full replacement contracts and Color Downspouts 2" x 3" ❑ 3" x 4" repair contracts. No warranty exists until this contract is paid in full. Leaf Protection Contract is contingent upon insurance company approval and limited to the Job Details amount and scope of that approval. Customer agrees that Adam Quenneville Roofing & Siding, Inc. will perform all home exterior work approved by the insurance company above. Any additional out of pocket expenses must be agreed upon before work begins. Homeowner's Initials: General Contractor: Homeowner acknowledges Adam Quenneville Roofing & Siding, Inc. as a general contractor and as such will be entitled to 0 A , 0 Alp ustomer _ Date Adam uenneville Roofing & Siding, Inc. Representative Date W Z / Customer Agreeme�' D. - • •nags .7"" �l111.1■ Date This contract is subject to final approval from authorized management of Adam Quenneville Roofing & Siding, Inc. Adam Quenneville Roofing & Siding, Inc. reserves the right to deny any contract within 48 hours of the date on this contract. If contract is denied all monies paid by customer shall be returned within 48 hours of the date on this contract. This contract consist of this page and the reverse side of this pages and shall be considered the entire contract by the parties involved U. /Ut. LULL: WEL) L4: �b FAX 41 373S60.10 Rernillara Ins. Agency LOU U . 0U.: - "'••"1 ADAMQ -1 OP ID: LL AC R° CERTIFICATE OF LIABILITY INSURANCE DATE 02 /08 /YYVV) 02108112 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 CONTACT 413.538 -7862 NAME Linda Landry FieldEddy Insurance a HONE -._- - -`_. FAX 79 Lyman Street 413 -538 -7179 gVC No r 413.538 - 7862 1 l ag Nap 413 - 538.6010 South Hadley, MA 01075 EMAIL ADDRESS: lindalandry@fieideddy.com • RIA Agency Financed Accounts INSURERS AFFORDING COVERAGE NAIC 11 INSURER AIM Mutual Insurance Company INSURED Adam Quenneville Roofing & INSURER B : Hanover Insurance Company 22292 Siding Inc 160 Old Lyman Road INSURER C: South Hadley, MA 01075 INSURER D : INSURER E : li INSURER F : 1 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'ADDL SUER 1 POLICY EFF I POLICY EXP _... _. _... LTR TYPE OF INSURANCE , rl _ -- POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE i COMMERCIAL GENERAL LIASIL;TV UAMAGE-TCYRENYED - - - - -- PREMISES L urrence) $ i I CLAIMS-MADE h l OCCUR MED EXP (Any one person) $ _. PERSONAL & ADV INJURY $ � PRO- ( I GENERAL AGGREGATE $ GF N'l. AGGREGATE LIMIT APPLIES PER __. 'PRODUCTS - COMP/OPAGG 1. $ -_ �._.. i POLICY i . (KT LOC � -- ---- -- --_. --- --- --- -- -- — — - $ ;AUTOMOBILE LIABILITY I i COMBINED SINGLE LIMIT ---- I (Ea accident) l $ ANY AUT I I BODILY INJURY (Per person) I $ i . AL t. OWNED 1 I SCHEDULED BODILY INJURY (Per accldenti l $ AUTOS _ AUTOS NON_ -OWNED ! PROPERTY DAMAGE $ -- -- - -- - - 106 _,_. � (Per accident) i.._ 1 HIRED AU OS 1 UMBRELLA LIAB u i (--- --.—__ . 1 1 OCCUR I i EACH OCCURRENCE � $ 1 ff EXCESS LAB i 1 CLAIMS MADE i AGGREGATE $ ! AN O D EMPLOYERS' LIABILITY ONS __ 1 DED I RETENTION COMPENSATION , X TQ WC SI MIT S X ER RY )JMIT ER i rNl ANY PHOPRlEIOWPAR7NEWEXE(,UIIVL ! AWC701286101 04/29/11 04/29/12 ! EL EACH ACCIDENT $ 1,000,00• A OF.10ER /MEMBER EXCLUDED. - - - - -- — (Mandatory In NH) i i L L DISEASE EA EMPLOYEE $ 1,000,004 B 'IEgUlpm j 1E.L. DISEASE - POI .ICY LIMII $ 1,000,00* I( es, describe under _ DESCRIPTION OF OPERATIONS below 1HN7140610 01/01/12 01/01/13 1 Rental 100,004 1 I I !Ded 501 1 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD At Additional Remarks Schedule. if more space is required) CERTIFICATE HOLDER CANCELLATION __ _. WINRESI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .; vY.A■0 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD • k The Commonwealth of Massachusetts Department of Industrial Accidents I *l:- - -- --'�'� Office of Investigations t 1 �: . 600 Washington Street '• ..,7 Boston, MA 02111 <:: a .0 www. nurss.gov /dia Workers' Compensation Insurance Affidavit Builders/ Con tractors /Electricians /PIumbers Applicant Information / Please Print Legibly Name(B : A tit 1 4 ( . ?L&M -V; I Le R4® I t Sr d j 0 , j_YIC- Address: Cr U V 1 J 1 1 vn a rl 4/ . ' c;tyisratrIZip: 5ea,.141 k"ad , MA- 0/07Pho3De #: 1 - ' -6q SS Are you an employer? Check the approp ' to bog Type of project (required): 1 . VI I a m a Y em t o er with [ � j 4. E l am a general contractor and I P have hued the sub-contractors 6 " ❑ New construction employees (full and/or part-time).* listed on the attached sheet 7- ❑ Remodeling 2. Li I am a sole proprietor or partner- ship and have no employees These sub - contractors have 8_ ❑ Demolition working for me in any rapacity_ employees and have workers' 9 ❑Building addition ['}TO workers' comp insurance comp_ insurance 5. ❑ we are a corporation and its 10.1 Electrical repairs or additions required.] have exercised their 11_ Plumb" 3. ❑ lam a homeowner doing all work h id ❑ Plumbing repairs or additions m sell: o workers' right of exemption per MGL 12 g insurance ] t C. 152, § 1(4. and we have no Roof repairs employ- [No 13_❑ Other camp. insurance required"] Any applicant that clerks box III must also fill out the section below showing their workers' compensation policy isdoriattion. t Homeowners who submit this affidavit iadi� they arc doing all work[ and than hire outride wubactars truest submit a new affidavit mdieatiog such :Contractors that check this box mast attached an additional sleet showing the name of the cob -contractors and stale whether or not those unities have employees. If the subcontractors have runployees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy anal job site information_ _ Insurance Company }Tame: RIM I I y� t u tu Q. _.l- --7- fl Six fa n e"k. Pole, it or Sclf -ins. Lic. #: A- ID e, '101 ;cc-6 /1)1 Eviialiun Pate: Li - a q j6ia. Job Site Address: ( 9 ) I or f— _ AO i - e v i u 2 . . . city/slide (m 0 /66 ,9\ Attach a copy of the workers' cadapensation policy declaration page (showing t11e policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositiwi of aim nai penalties of a fine up to S1,500.00 and/or one -year imprisomnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S2S0.00 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 do hereby calif}+ under the pains and penalties of perjury that the informatth n provided above is true and correct. Slgnatvre: �� Date: / / Phone #: L Y l 3` 6 6 6 q 6.- Official use only_ Do not write in this arra, to be completed 6y city or town of i lot • City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: - -_ —_- _ Phon # : SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ I _ Name of License Holder : f j� f(1Lt r/Yl Otte G 1 KA (1; a." 7 ° License Number j (w D /ct L ri � r.� ' ' u.`MMi d Aress Expiration Date 536 -5 Sign ,_ Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam QaennevilleRoofmg& Siding, Inc. 0-e e Company Name 160 Old Lyman Road Registration Number Address South Hadley MA 01075 Expiratio 5= -O 1 c9- Telephone tf /3 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 ji( 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing -fg. Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [Q Siding [0] Other [0] Brief Dscr ption of Proposed jj Work:. i f c X 151-1,1 3.- � t, t a r 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 ENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ■ TA n rn i l) d 1, , as Owner of the subject property Adam (fi �r 8 Siding, Inc. hereby authorize Adam Quenn ' oollng & Sidmg� I to act on my behalf, in all matters relative to work authorized by this building permit application. 4 e .P ( t V - I ' Si nature of Owner Date I, Adam Quenneville Roofing & Siding, InG 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 citL al 4Sul L7 b id' V i' J/e Print Name �� t Signatu er /Agent Date p • CEtV Department use only ity of Northampton Status of Permit: ise 1, 201? : uilding 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 1.1 Property Address: This section to be completed by office 54 Flo ✓- )'l & keza 1 Map Lot Unit f -e n L / v � A Ci 10 6' `a` Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: —Toll n � - 3 7 r �� I 'dot_ t. - Flo rk2ti62j MA b Name (Print) Current Mailing Address lYw >u C ilf.�l' • 2 .4 Telephone 0 Sig at rt ure 2. A�& �n Agent: Ado � uenneville Roofing & Inc, t Ca U Old 1,9 main . 5o_ 1 1 ""c Name (Print) Current Mailing Address: t ir3 - 53G - 5/s s Signaturri' Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building II, &F U q . 3 (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) l /, / U e1 r / 3 Check Number olJ J K9 3 This Section For Official Use Only Building Permit Number. Date g Issued: Signature: Building Commissioner /Inspector of Buildings Date 234 FLORENCE RD BP- 2012 -0917 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A - 063 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2012 -0917 Project # JS- 2012 - 001602 Est. Cost: $11609.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 46173.60 Owner: BODY JOHN M III Zoning: URA(100)/WSP(100)/ Applicant: ADAM QUENNEVILLE AT: 234 FLORENCE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/24/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P & 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 4/24/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner