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32C-140 ADAM QUENNEVILLE ROOFING & SIDING, INC. 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075 1- 800 - NEW -ROOF Local 413- 536 -5955 E -MAIL: info([�1800newroof.net WEBSITE: 1800NEWROOF.NET CONSTRUCTION SUPERVISORS LIC. #070626 CT REGISTRATION #575920 MEMBER OF THE HOME BUILDER'S ASSOCIATION Hampshire Property Attn: Pat Taylor Milbank Place Northampton MA PROPOSED DUTIES: 1) We will acquire all job related permits 2) We will repair any rotted on rear 10 x 10 section of roof in rear where leak is. 3) Install new .019 aluminum Drip Edge, white, to all eves and rakes 4) Install 6 Ft ice and water barrier to all eaves and valleys, and around all penetrations 5) Install Starter Shingle to all eaves 6) Install new GAF /ELK 30 year Architectural shingles (Color of Choice) 7) Install new pipe flanges to all plumbing stacks 8) Where the skylights are being replaced we will ice + water up all flashing runs 9) Install new Continuous GAF Cobra Ridge vent to all peaks 10) Install new GAF Ridge Cap shingles to match 11) Remove all job- related debris from site. Dumpster provided by us. 12) We will provide a 10 year written workmanship warranty WE PROPOSE: to hereby furnish materials and labor in accordance with above specifications for the sum of: Total cost for Go Over on All Units $ 30,400.00 NOTE: This quote may be withdrawn by us if not accepted within 60 days. Signature Adam Quenneville Date_ 3 — 03- 2010 ACCEPTED: 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 at start of job and balance due completion. P • • r sign one copy, state color requested and return. Date' %- natur•. ■ „ /, �: J& i olor ,, Phone# y/3 ► / 1 �► i �' / - / y ATTENTION HOME OWN y' S: ' e se co a is a sona i e s ngi gs i e attic�'6r storage areas a to the Possibility of roofing debris or dust comet. 41 through the cracks of the wood. Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DM DATE (MM / °orvrYY) 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 Phone : 413 538 - 78 62 Fax :413 538 - 7179 INSURERS AFFORDING COVERAGE 1 NAIC # INSURED INSURER A: AIM Mutual Inau:ance Canpany INSURER B: Travelers Ins . Co . Adam Quenneville Roofing & INSURERC: First S ecialit Ins Co rp , Siding Inc & Guttershutter P y 160 O Lyman Road INSURER 0: 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 REOUCED BY PAID CLAIMS. LTR INSR. TYPE OF INSURANCE POLICY NUMBER DATE IMMIODYY) DATE (MMIDOIYY) LIMITS GENERAL LIABILITY ! EACH OCCURRENCE $ 1000000 UAMAIat I tU C i I X COMMERCIAL GENERAL UABILITY ; TBI 06/23/10 06/23/11 PREMISES U ;E occ uence) $ 100000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000 r PERSONAL & ADV INJURY 151000000 GENERAL AGGREGATE $ 2000000 GEN. AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP/OP AGG $ 2000000 POLICY PRO. — OLICY LOG — JECT !AUTOMOBILE LIABILITY $ ANY AUTO BA7450L946 11/01/09 11/01/10 COMBINED SINGLE LIMIT 5 1000000 (Ea accident) ALL OWNED AUTOS BODILY INJURY ' X SCHEDULED AUTOS Per per I S X I HIRED AUTOS BODILY INJURY X NON•OWNED AUTOS 1 (Per accident) I $ PROPERTY DAMAGE $ (Per accident) I I GARAGE LIABILITY I I AUTO ONLY • EA ACCIDENT ; $ ANY AUTO • OTHER THAN EA $ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE 5 OCCUR t CLAIMS MADE AGGREGATE 5 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ITORYL)MITS I I A EMPLOYERS' LIABILITY AWC701286101 04/29/10 04/29/11 I E.L. EACH ACCIDENT $ 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE • EA EMPLOYEE S 1000000 If yea, describe under SPECIAL PROVISIONS below E.L. DISEASE • POLICY UMIT : $ 1 000000 OTHER D Equipment Floater IHN7140610 02/01/10 02/01/11 Rental Equipment $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I 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 EO REPRESENTATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 —\- J L; n /IA -I • f 4 �GY F _* � gv o ar o ul , Ing egui V ons an. tan • ar • s D One Ashburton Place - Room 1301 `,� Boston, Massachusetts 02108 Construction •Supervisor License • License CS: 70626 Restriction: 00 • Birthdate: 8/2111 Expiration: 8/21/2011 Tr# 3 ApAM`A QUENNEVILLE 1.60 OLD LYMAN RD S''HADLEY, MA 01075 - -- =-- J -� '7=4M — _ Office of Consumer Affairs and usiness Regulation AL. _ 10 Park Plaza - Suite 5170 Boston, Massa ?usetts 02116 Home Improvement ''._,1 •. ctor Registration Registration: 120982 ,T � "Mt=�'" i Type: DBA (r}L M:x s _ f Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFING ^'I ADAM QUENNEVILLE � .;, 160 OLD LYMAN RD SO. HADLEY, MA 01075 r "= /` - \! .. , . r� .fir \y ,- '' �,, � � Update Address and return card. Mark reason for change. Li Address El Renewal ❑ Employment L J Lost Card DPS -CA1 C 50M-04/04- G101216 I STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION j Be it known that I #1 ADAM QUENNEVIT.T 4F ] 160 OLD .L,, , ` ROAD SOUTH ',..9.-_ � ,, rb _175-2632 f l 1 ti , r i is cer by the D ep n 4 e1 f a 0 w „e:,, tect as a reg , ill:, ,1 .1 HOME IMPR(t,A °LL 'tDNTRACTOR I i c , >, . , f., r f Reg s - e I t o i I T RANSy lj f It ; ,f ' i ADAM QUENNEVILLE ROOFING ! • ' ' i Effective: 12/01/2009 i } Ex � I : iration:11 / 30 / 2010 - ► I p / / Cam _ __ The Conunonwealth of Massachusetb r Department of I Accidents ,.= t Office of Investigations ►_ 600 Washington Street 'i Boston, MA 02111 p www.moss.gow'di'ta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Mir& sat iafairai _ Please Print Lt iibly Name (g /prgaoiadon/ls vidual): I N� 1� t! P Vl h r y t 1 (to et b . �n r " S 1 N \ n! roc_. Address:_ tD ()id L d. cit S'! ,1..' Ic .,..Ai 1 0 t t Phone #: VI -5 s i0 - 9 5~` . , - Are pm u employer? Check the appropriate boil Type of Pro3ect (required): 1.)21 1 am a employer with J S. 4. ❑ I am a general contractor and I part-time).* hired the subcontractors employees (full and/or pa 6. ❑New construction 2. ❑ 1 am a sole proprietor or partner- minced on the attached sheet. 7. 0 Remodeling ship and have no employees sum have & ❑ Demolition working for me in any capacity. y h workers' 9. ❑ Building aeon comp. insurance. [No workers camp. insurance requital] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work • officers have eocearcised their 11.0 Plumbing replies or addih'oos myself. [No ' comp. right of exemption per 1ViGL 12 repairs insurance required] t c. 152, § 1(4), and we have no 13.[.} Other employees. [No workers' comp. basunince required.] *Amy whew the chador bona m e s a a l s o Moe the section below skewing t h e i r sweets' cos i t policy inform on t lien else s wha seise this admit atti g as dol ga! tooth madam hies onside mototaoa mat as6mita Weak iodiaoiogaucb. kept areomike dome tkis box neat atte dmine additional sheet showing the matte artbesabmntraclots ads atembetherarnot those entities lore employees. Nike ntb-ooamrattara Mara employes, they mt amide their woidteta' comp. policy umber I air eat employer that 1 s prorlibte worker' compensation Ia era ce for my employees. Below is time poiry arrd* site Insurance C o m p a n y Name: 4 OA A , L. rU C 1 T r E , U (A n e � ? - - P o l i c y # or Self -ins. L i c . #: f } L & C. 9 Q 1 aQ. h 1 D 1 Expiration Date: lifiQycQ61 r Job Site Address: 3,5 PieaSabn. -} Sk, NorkivawAR ha• ‘ lot tx. City/State/Zip: Zip: elk 0 is Attack a copy oft* workers' eumpasatien pony declaration page (showing the policy number aid **ration date). Failure to secure coverage as as:sp:ired tinder Section 25A of MGL c. 152 can lead to the imposition of a donna' 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 dap to $250.0O 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. Ile e hereby art& angler the amtpeawittes ofpe itay that the b,JJrrna tow prevfdet eoae is true and'aorecr. ajgnature; Date: (0 - �q - IC) Phone it: Lit 3-53 (n - 59 sc Official age wily. Do nett trite In this area, to be completed by city or time Oda City or Towns; Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Budi eg Deparbneat 3. CItyfTown Clerk 4. Electrical Inspector 5. Plumbing Inspector - 6. Other Contact Person: Phone ail: ()vow Ass *inn� 1 • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : of tO A. *mole Romig Siding, Inc. License Number 160 ad Lyman Road g -av- i l Address South Hadley, MA 01075 Expiration Date Signature Telephone 4(3_53 cot s. s 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quenaevilk Roofing & Siding, Inc. i ab qt ) Company Name 160 Old Lyman Road Registration Number Address South Hadley MA 01075 Expiration Date Telephone 4i3-$3c,- S tSt" 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 ON,Nti ii"1146 Imo OKThit,r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing p Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I] Siding [0] Other [0] Brief Description of Proposed Work_ ke. o vc-c Roo s u; , a h As p (aA-# S t+ n,o�lt -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 /� r1 I, 4 „v (. ¢ c7c ' ,/ yll,' /iiii thiA , 6 %' ( , w /t. a 4 s, as Owner of the subject property C hereby authorize R�"��pp b & Siding, Inc, to act on , y behalf, in all matters relative to work authorized by this building permit application. ...,.�.� /i .,w. (0 -1 a - ID Signa ure 4-Owner , Date I, Adis Qua Real & Siding, 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. Sign e the pains and penalties of perjury. //4 G*- `M aue"f\e0 ;(t Print Name �i� - to - aq -to 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 © DONT KNOW 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 , 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 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability OCT 2 9 2010 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: 3 This section to be completed by office r 10ek ic S+ , Map Lot Unit lVor��o�el mq, AAA V 1 171 p Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner � W of Record: r f �� / ' AI; llthi C Vac, a'r ((i14CPf'tt- ft . k / 6y ,s'6, /`) " o rk`J ` ) ';. Name (Print) Current Mailing Address: TGrl , lJ Telephone 2.2 Authorized Agent: Mawr eikJIAilevl lti kpeo OIL Lei Mci r \ SoUA ‘ (Al)te? Name (Print) Current Mailing Addres � �� t F t 3 Sign re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 30 T oc (a) Building Permit Fee 2. Electrical T (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) 30, , r ., o Check Number /P0/ y# /id • 4/, This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner /Inspector of Buildings Date BP-2011-0417 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0417 Project # JS- 2011- 000686 Est. Cost: $30400.00 Fee: $182.40 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): Owner: MILLBANK PLACE ONE CONDO Zoning: GB/URC/WP Applicant: ADAM QUENNEVILLE AT: 351 PLEASANT ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:11/4/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: SH 1 NG LE 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 11/4/2010 0:00:00 $182.40 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner