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29-478 D ISA and ",'` ,'„ DIJCOVER C� U E N N EV I L L E ROOFING & SIDING, INC. www,1800newroof.net 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1- 800 - NEW -ROOF • 413 - 536 -5955 Fully Insured Email: info@lBOOnewroof.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 // TPhoone #'s Work: L., /04 , /e H6 //j) - if Cell: Street Email: 5 gyjs P,"/ City, State, Zip Code Special Requirements r /G<r,rV .tit A 0/ 060,2 � ,�P,.u.,(� � v� ✓ n,. / S Complete Roof System / �C We shall acquire all appropriate permits for all work K Home exterior and landscaping to be protected Entire existing roofing materials to be removed to existing decking [ Deteriorated existing decking will be replaced at-$87:4 per sq.ft. 0/ 4zio • Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and sidewalls IK Install (15 Ib. felt / Sinthetic underlayment over remaining decking area (l Install Metal drip edge at eaves and rake ® 5 ") (white rown copper) [ Install manufacturers starter shingle on all eaves and rake edges I Install new pipe boot flashing copper) K] Install new step flashing where necessary ( andard copper) ® Install Hand nailed rigid baffled continuous ridge vent ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) / A F Shingles ❑ 25 year Est 30 year ❑ 50 year Color CA r 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: g 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 $ / * �l(} -__ Down Payment $ Upon Completion $ Q FCC 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. lcla ZO ' Date 1 Signature t' Phone # ______ Date: L.06 0 Estimator's Signature. !i / 1 _ 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 O P ID DM nrYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE ID D 1 0 DATE (MM /00(MM /OD 0 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 - 7862 Fax :413 538 - 7179 INSURERS AFFORDING COVERAGE 1 NAIC # INSURED INSURER A: AIM Hu tual Ineurance Canpany INSURER B: Travelers Ins . Co . Adam Quenneville Roofing & C: First Speciality Ins Corp Siding Inc & Guttershutter P y 160 Old Lyman Road :INSURER D: 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 REOUIREMENT, 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 /DD/YY) DATE (MM1DO !VY� `' v � LIMITS 1 GENERAL LIABILITY ! EACH OCCURRENCE $ 1000000 C 1 X COMMERCIAL GEN LIABILITY I TBI 06/23/10 06/23/11 I p EMSES(Ea 5100000 } CLAIMS MADE X OCCUR i MED EXP (Any one person) $ 5 00 0 f PERSONAL & ADV INJURY $ 1 000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP /OP AGG . 1 $ 2 00 0 0 0 0 POLICY PRO- T n LOC JEC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1000000 B ANY AUTO BA7450L946 11/01/09 11 /01 /10 I (Ea accident) ALL OWNED AUTOS BODILY INJURY S r X SCHEDULED AUTOS Per person) I F I X I HIRED AUTOS BODILY INJURY 1$ X NON•OWNED AUTOS (Per accident) I PROPERTY DAMAGE (Per accident) II' GARAGE LIABILITY I AUTO ONLY • EA ACCIDEN • $ • ANY AUTO OTHER THAN EA $ AUTO ONLY: AGG 5 • EXCESS /UMBRELLA LIABILITY I EACH OCCURRENCE 5 • n OCCUR . CLAIMS MADE AGGREGATE 5 5 L____ DEDUCTIBLE 5 RETENTION $ 5 WGrAIU• () E RI-W 1 WORKERS COMPENSATION AND TORY b LIMITS _ ' ER EMPLOYERS' LIABILITY A AWC701286101 04/29/10 04/29/11 I E.L. EACH ACCIDENT 51000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I ' E.L. DISEASE -EA EMPLOYEE $ 1000000 If yes, describe under I SPECIAL PROVISIONS below j E.L. DISEASE •POLICY UM(T i $ 1 000000 OTHER D Equipment Floater IHN7140610 02/01/10 02/01/11 Rental Equipment $100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 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 3 0 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 D REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 , .13-\-. Lghe oar sing laians are • tan • ar • s � l � o . u ! ing egu El One Ashburton Place - Room 1301 ^., Boston,. Massachusetts 02108 Construction Supervisor License • .' License CS: 70626 , •• • -..........-•• Restriction: 00 ' ' Birthdate: 8/2111971 . Tr# 3712 Expiration: 8/21/2011 APAM..A ' QUENNEVILLE 1'60 .OLD 'LYMAN RD . - — S MA 01075 ::., . " GTE -e04,14riciitet,eata , f / 4 1 1 .4 _* - I� Office of Consumer Affairs and usiness Regulation I(__ 10 Park Plaza - Suite 5170 _ � Boston, Massa'"? usetts 02116 Home Improvement -\\, ctor Registration _ * Registration: 120982 x Type: DBA r W= Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFIN ~ , ,,,�,,, ADAM QUENNEVILLE m =? 160 OLD LYMAN RD a �`= t .--- SO. HADLEY, MA 01075 ,- - ryC`'�`+;: -� g �� Update Address and return card. Mark reason for change. Address 11 Renewal E Employment 0 Lost Card DPS-CM Ca 50M- 04/04- G101216 STATE OF CONNECTICUT +' DEPARTMENT OF CONSUMER PROTECTION t; } Be it known that ADAM QUENNEVIT I.F 160 OLD , ROAt SOUTH q ,r, i J 75 -2632 l' i i i is certified by the Dep " _`ri" Y t ,: ti';-, tection as a registered I . HOME IM ® .. O�� � , m ®NTRACTOR Regis �. = �,� s 20 TRANSTU ' I ADAM .QUENNEVILLE ROOFING. ' 1 Effective: 12 /01/2009 I = 1rat1on :11/30/2010 r Ex p Jerry Farrell, Jr. Commissioner 1 " _ • The Conmtonwealtk of Massachusetts _ = Department of Inastrial Acci Office of Investigations = =on 600 Washington Street = = TA. Boston, MA 02111 5 ; wwrr.mass.govldia Workers' Compensation Insurance Affidavit: Bu ilders/Contractors/E bens Aialnt Information Please Print Legibly ti • Name ): . A . a. e. J . $ • s ` `~ el Address: I (,20 ()(d L L citylStacer,.: MO, a r t Phone #: [ - . - --. — • Are you an anpluye r? Check the appropriate bon: Type of Project (tequired): 1.181 I am a employer with i S 4. 0 I am a general contractor and 1 6. 0 New construction employees (frill and/or part-time).* have hired the sum 2.0 1 am a sole proprietor a partner- listed on the attached sheet 7. ❑Remodeling ship and have n o employees These s� have 8 0 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 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 adtfitions myself. [No workers' comp. right of exemption per MGL 12 Rooftepairs insurance l t c. 152, § 1(4), and we have no 13.[} Other employees. [No workers' comp. insurance required.] *Any appliomt that cbedrs box Si mast also SD out the section blow showing than weans' congleasstion policy iaboeomien tHoescosaieswhostbmitthisafBAeritiodiaitingthcgatedoiogall walkmdthn hioeoutside000toacmnmostsabmita ai indiatiogisach :Ca dreslotstboteiatthisbooatmanattaciedas sddilioodi slowing thenameoftbesohooetractemandaaase •witedorernotthoseentitiesbo e employees. if the sob- costmete a hoe employees, they moat psoovide their smokers' comp. policy moab= I art as employer that is povirling purl workers' cot ,ei same iasswaahae for nay employees. Below is the policy arid* site Insurance Company Name: A- k /A A. u -}-1,1 a . Y1SLi n t P1 P o l i c y # or S e l f - i n s . l it. #: p j Fl 0 (ag, to [ 0 I Expiration Date: Va..2 9��61 lob Site Address: - 76'3ut-Vs P: ikoctek Ciarencc. /c{,A City : oioG Attach a copy of the workers' compensation policy dtdaratioa page (sheer the policy munber endespirstien date) Fan7me to secure coverage as repaired under Section 25A of MOL c. 152 can lead to the won of crhninal penalties of a foe up to $1, 500.00 and/or one -year hnprisonment, as well as cavn penal des 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 col)) of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby caert ► wafer tk andparables ofpaJwy that the � Is we and S' f Date: IU _ 1D one #: L it 3 - 53to" -9S Offidrt cost only. Do not write in this area, to be conuplded by city or town offidaL City or Town: IPernaiiLieuse # Weiss Authority (circle one): 1. Board of Beath 2. Building Department 3. CilylTown Cleat 4. Electrical Inspector 5. Plumbing li ispe ctor 6.Other Contact Person: Phone #: ;te,} irti ()Ott/VC/sift }tilt pig f' K 'INN 0101911 tpt Vaiptift SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: A�� (may ot Applicable ❑ Name of License Holder : Adam Westville g & � Inc, r7 0 Co 6; 160 Old Lynn Road License Number Sad Hadley, MA 01#75 -a 1 Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Qnennevile Roefag & Siding, Inc. I 'aoctis Company Name 160 Old Lyman Read Registration Number South Hadley, MA 01075 3- a - a Address III yt Expiration Date Telephone lit - S3C- X45 S SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 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 s 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 '1411I1 1,11kitif0 ;,, ()1611 f(1,0Ufft (Jo s:; SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0] Brief Description of Propo ed Work: 5 ■• ‘/%.■ tcS 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, -Y\ k\ !, , as Owner of the subject property � & Siding, Inc, ing, hereby authoriz to act on my behalf, in all matters relative to work authorized by this building permit application. 10 - aa - !D Signature of Owner Date N i R & S nQ I Inc, , 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. /VI-arti Q uoit v1 11 L. Print Name tv 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 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO CJ DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 ® NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavat' , 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 2 `� � 212 Main Street Sewer /Septic Availability QQ ; \ 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 This section to be completed by office 1.1 Property Address: /I S'2C f3 `-\ S P / a C Map Lot Unit F p WANCei lkA o (Oro ;. Zone Overlay District Elm st. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: LAM S74 60v-}s ?I F‘Ooenc��aGG Name (Print) Current - �J Telephone Signature 2.2 Authorized Accent: Adam *nevi Rig & Silt Iic, lc, 0 ()ML tr. 4 . so„, 4A, H kf Name (Print) Current Mailing Addre c %o 7S 413 - Sass Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building G O (a) Budding Permit Fee D 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection //f 6. Total = (1 + 2 + 3 + 4 + 5) (11 Check Number / «3 t This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date BP-2011-0394 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-2011-0394 Project # JS- 2011- 000653 Est. Cost: $11080.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 35196.48 Owner: LALLY JOHN M & DARLENE A Zoning: SR(100) //WSP Applicant: ADAM QUENNEVILLE AT: 576 BURTS PIT RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:10/28/2010 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 10/28/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner