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29-192 (4) A AA, l N Masai •F I DIICOVER C3 U E N N EV I L L E 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 'roposal Submitted To: Date / Phone #'s Work: 9,4w, C zera,pe■ z o∎C 7/2/ 10 H: ji3 = 6y • yo Cell: Street n (� 11 ! Email: 13,5 bee rf e f,�� ;ity, State, Zip Code Special Requirements Ftdtev e /A QIu6 L • 2 S�+re 01 e'ywoo� • 5 k7 l i J rce lac ed omplete Roof System C We shall acquire all appropriate permits for all work 10 dr.. v' olet C o Home exterior and landscaping to be protected c„S t r; • - Entire existing roofing materials to be removed to existing decking ] Deteriorated existing decking will be replaced at $3.47 per sq.ft. 9 Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls Install (165 Ib. felt / Synthetic) underlayment over remaining decking area ] Install Metal drip edge at eaves and rakes (8" O brown / copper) 1 Install manufacturers starter shingle on all eaves and rake edges Install new pipe boot flashing standar. / copper) Install new step flashing where necessary standar. / copper) ] Install Hand nailed rigid baffled continuous ridge vent C.obro Install proper soffit ventilation hingles: (6 nails per shingle) GA F Shingles ❑ 25 year IXg1 30 year ❑ 50 year Color /✓1rsS r Dti 8 fE.7 (F}F �(k _ Ridge cap shingles larranty Options: We guarantee our workmanship for 10 full years (see our warranty coverage) ] GAF ELK System Plus warranty fp nn ] GAF ELK Golden Pledge warranty uw„ himney Options: r Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap 'e Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: 2kk ttal Sale Price $ 7/ 7 5 °s ' Down Payment $ Zy oo Upon Completion $ 5 7,'CEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. >u are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion. npaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reason- )Ie attorney's fees incurred by Adam Quenneville Roofing and Siding, Inc. to recover any sums due under this contract. ate: - 1 I 7.4 lc. Signature: 4 n � Phone # ate: 7 / Z � a Estimator's gnatur . �•1_ rTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage areas due to the >ssibility of roofing debris or dust coming in through cracks of the wood. Adam Quenneville Roofing and Sidings ill not be responsible for debris or dust in the attic or storage areas. 1/09 R.X Date /Time 06/24/2010 10:08 1 413 538 6010 P. 001 Jun -24 -2010 09:45 AM ' Remillard Insurance 1-413-538-6010 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DM ()ATE (MMfDDIYYYY) 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 -78 62 Fax :413-538 -7179 INSURERS AFFORDING COVERAGE i NAIC # INSURED INSURER A: -I AIM t1utua1 Insurance dampeny INSURER B: Travelers Ins . Co . Adam Quenneville Roofing & NsuRERC: First 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. cNSH RUU POLICY EFFECTIVE POLICY EXPIRATION LTR )NSRDI TYPE OF INSURANCE POLICY NUMBER DATE IMMIDDIYY) DATE (MMIDDIYY) I LIMITS I GENERAL LIABILITY I 1 EACH OCCURRENCE $ 1000000 I U I U K ItU C - 3C l COMMERCIAL GENERAL LIABILITY 1 TBI 06/23/10 6/ 23 / 1 0 0 6/ 2 3/ 11 � PREMISES (Ea occurence) 5 100000 CLAIMS MADE X OCCUR ' MED EXP (Any one person) $ 5000 i PERSONAL BADV INJURY ;$ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2000000 POLICY 7 PRO• 1 1 LOG JECT AUTOMOBILE LIABILITY • r._ 1 ,COMBINED SINGLE LIMIT S 1000000 B : - : ANY AUTO BA7450L946 11/01/09 , 11/01/10 I : (Eaaccidenl) � ALL OWNED AUTOS BODILY INJURY ' X : SCHEDULED AUTOS (Per person) 1 X I HIRED AUTOS NON -OWNED AUTOS 1 BODILY INJURY 1 X (Per accident) I ;PROPERTY DAMAGE i - • (Per accident) $ • I GARAGE LIABILITY I AUTO ONLY • EA ACCIDENT 5 I I ANY AUTO OTHER THAN EA ACC $ — AUTO ONLY: AGG 5 EXCESS /UMBRELLA LIABILITY 1 EACH OCCURRENCE $ n OCCUR 1 I CLAIMS MADE I 1 AGGREGATE 5 5 ^^ DEDUCTIBLE $ _ T RETENTION 5 5 WCSTATU• OI 1 H- WORKERS COMPENSATION ANO 1 TORY LIMITS I ER EMPLOYERS'LIABILITY A AWC701286101 04/29/10 04/29/11 I E.L. EACH ACCIDENT 51000000 ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBEREXCLUDED? I E.L. DISEASE - EA EMPLOYEE 51000000 Ir yes, describe under SPECIAL PROVISIONS below I I I E.L. DISEASE •POLICY LIMIT i $ 1000000 OTHER D Equipment Floater I 11111014061 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 ServiceMagic Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Jill IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER, ITS AGENTS OR 14023 Denver West Parkway Golden CO 80401 REPRESENTATIVES. AUTHO ED REPRESENTATIVE 4ilea ACORD 25 (2001/08) © ACORD CORPORATION 1988 The Commonwealth of Massachusetts Indus trialAccidents • —? ( Department of Office of Investigations W' :1 � :1 - c 0 -t10 Washington Street • ,u; Boston, MA 02111 -_ _ -�'' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant information Please Print Lesibly Name ( Business /Organizationllndividual): l A. I r 4 - • g L t1- " a ' V1 d Address: 1 1 0 (d L1 AA o C d. ' ' '- 4 - - -- ■ �j � i 7 Phone #: _ ( __ � City /State/Zip: � _ Are you an employer? Check the appropriate box: Type eneral contractor and I of project (required): 1.M I am a employer with 1 4. ❑ I am a 8 employees (full and/or part- time).'' have hired the sub - contractors 6. ❑ New construction 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 8. 0 Demolition working for mein any employees and have workers' g y ca a t 9. 0 Building addition [No workers' comp insurance comp. insurance. required.] 5. ❑ We are a 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 myself. [No workers' comp. right of exemption per MGL 12 Roof Tepairs insurance required 1 t c. 152, § 1(4), and we have no employees. [No workers' 1 Other comp. insurance required.] _ *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this afdsrit indicating they ate doingall work andthm.hire outside contractors mast subniita.oew affidavit indicmingsuch. /Contractcas that check this boxmtut scathed an additional sheet showingthe mmnte oftheanb actors and state whether or notthose entities have employees. HIM sub - contractors have employees, 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 and Job site information. 11 Insurance Company Name: A- k / l,C' l a l ins ld i2'(ln 6 e .. • Policy # or Self -ins. Lic. #: 0 WC, PI o fact, ('o[ 0 t Expiration Date: / Q 9 /cc1 Job Site Address: / e ( Peed' T e 1 d O ri✓�e �/ d (etib City /State/Zip: A1/ O/ o 6o9 J Attach a copy ofthe workers' compensation polity declaration page (showing the policy number 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 $1,500.00 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 do hereby certify under the pains and penalties ofperjury that the tnJormallon provided above is true and correct Signature: 4< -7 , --'..----- Date: 7 /✓ -- /O Phone #: zit 3 - 53 (0 ` .5q 5 S Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CityJTown - Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: pmt . ,' /, / � ' _� I AA a a tan • arts e ula ions ri f x. o . u 1 1n g g +� One Ashburton Place - Roorn 1301 .,� Boston, Massachusetts 02108 Construction Supervisor License License CS 70626 Restriction: 00 •:.... rthdate• 8/21/1971 Expiration: 8/21/2011 Tr# 3712 ADAM •A ;QUENNEVILLE .. 160.OLD 'LYMAI RD . - -- ,`HADLEY, MA 01075 . -- ._litte -6 , ill 4 ' / 4 P i --E-:ripw-gt Office of Consumer Affairs and usiness Regulation m__Ir I f ( 10 Park Plaza - Suite 5170 _� Boston, Massausetts 02116 Home Improvement o tractor Registration t w Registration: 120982 i ` 1 Type: DBA tX1 � jj° Expiration: 3/25/2012 Tr# 293069 . ADAM QUENNEVILLE ROOFIN ,,/ P = a :- ?» - l " 7 ,. ADAM QUENNEVILLE 160 OLD LYMAN RD !\ =n- . r - = : ' '' SO. HADLEY, MA 01075 \. . . , . ' . � Update Address and return card. Mark reason for change. " -- --- [II Address El Renewal ri Employment Lost Card DPS -CA1 Co 50M- 04/04- G101216 « F STATE OF CONNECTICUT T + DEPARTMENT OF CONSUME P I , i • B,e:it known that a ' ADAM 'QU 1 ' 160 OLD L ROAD i SOUTH A D . .) 01Q75 -2632 I r' \� • r il , � I ' 3� " 1 I I� , E is certified by t Deparf -eri • iif. ( `s t t a registered rf 6. HOME IMPRC w .T ONTRACTOR 1 Re a.,-Z G _ y 1 ADAM >:QUENNEVILLE ROOFING : "' . r Effective.�12 /01/2009 1 , • r« 1 Expiration: 11 /3 0/201 0 I, et Farrell, Jr. ' _ si one . w. J �' i Jr., - 1 - • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : I , 1 1 7o 11 � i - License Number 160 Old Lyman Road Address South Hadley, MA 01075 Expiration Date 3- 57 4 S9 SS" Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ o�o9 Company Name Adam Q1te111ivville Roofing &Si Inc. R egistration Number 160 Old Lyman Road 3 - as /a, Address South Hadley, MA 01075 Expiration Date �.� Telephone_ 9/3 -53 6',S?53 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House C] Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [o] Brief Description of Proposed Work: s - 1 - r ■ p oikel recn sre r r o o rep la c am . 1. sky I I '� h Alteration of existing bedroom Yes .( No Adding new bedroom Yes > No Attached Narrative Renovating unfinished basement Yes Di 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 la - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, v d kCr Czec Q Q 0 u )\ (2_ , as Owner of the subject property u hereby authorize Ado Queue* Roofing & Siding, Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Adam Queuue& Roofing & Siding, hit , 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. ©j II en n Print Name 745'/0 Signature of Owner /Agent Date Section 4. ZONING Atl 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 DON'T KNOW 1, YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES 0 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 ® Obtained , Date Issued: C. Do any signs exist on the property? YES Q NO r� � IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO 40 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 20 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 X35 Deerfield Or, Q _ Map Lot Unit H OT - et/CC / 14 Q /C(op`. Zone Overlay District EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: :TA) vt Czera eni,j ; Gz. /3. (Pr; Ye- Name (Print) Current Mailin Address: Telephone Signature 2.2 Authorized Agent: Adam Quenneville Roofing & Siding, Inc. 160 Old Lyman Road Name (Print) South Hadley, MA 01075 Current Mailing Address: y/ -5310-5953 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 7 /7 `- (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) 7 ■ / 7S Check Number /re"lJ 2 j1/45 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date b00 • BP- 2011 -0049 GIS #: COMMONWEALTH OF MASSACHUSETTS M ap :Biock: 29 ' ,1 2 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 PERMI3` Permit # BP- 2011 -0049 Project # JS- 2011- 000094 Est. Cost: $7175.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 16814.16 Owner: CZERAPOWICZ JOHN S & MICHAEL E Zoning: URA(100) //WSP/WSP II Applicant: ADAM QUENNEVILLE AT: 135 DEERFIELD DR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:7/20/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P & SHINGLE ROOF * REPLACE 1 SKYLIGHT 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 7/20/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo