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1 i1` � 1 Mastery DISCOVER QU ENNEV1LLE www.1800newroof.net ROOFING 'V SIDING V' WINDOWS We Are Licensed 160 Old Lyman Road • South Hadley, MA 01075 Fully Insured 1.800.NEW ROOF • 413.536.5955 y Email: info @1800newroof.net Website: www.1B00newroof.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 P.P.C. 38710 Proposal Submitted To: Date Phone #'s C: rr 1t r r .3;/( 7a /i)o.,.. p /04 r, H :& J) g / CoC.) W: Stredt Email: City,, State, Zip Code Special Requirements: // F( -�rwft ,44 A- o ,'o�, ). 6 / / f / P S,nnG,r.\ .c/( ".-wo e4.54 / C•/L.'n (/f/ ❑ Recover ® Strip 0 Layers ,4y do C�.1 A. �/ Complete Roof System IX We shall acquire all appropriate permits for all work XJ Home exterior and landscaping to be protected Strip existing roofing to existing decking and dispose of. Do not Do. IK Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. 1 Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights X Install (151b. felt heti underlayment over remaining decking area 6] Install Metal drip edge at eaves and rakes(/ 5" )�hite brown /copper) [ Install manufacturer's starter shingle on all eaves and rake edges BBB �l Install new pipe boot flashing to laar copper) / vents ❑ Install Snow Countrt or Cobra rolled vent ridge vent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) AO 7 Shingles ❑ 25 year r5 30 year ❑ 50 year Color t `'/.-t Y y 6k Ridge cap shingles f / Warranty Options: N. We guarantee our workmanship for 10 full years (see our warranty coverage) ❑ GAF System Plus warranty LS GAF Golden Pledge warranty Chimney Options: � netYSSnAy 11 Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ /e9` Vf $ ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ ‘CO 0 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 upon completion. Balance Due Upon Completion ($ f 2 N t/k Date: U Signature: v ,:.�, w ,4 Date: It' f. '41. Estimator: (Print Name) F .'c, / ( / ,�h".. (Sign Name) L � Estimates are honored for sixty (60) days from above date 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 will not be responsible for debris or dust in the attic or storage areas. • t_ ."tI.assacturietts - Dcpa tmen_ of Public Seer:. • , Bturn of 3usltiin0 Re_ina:1011S :Intl ±tandaros License: CS 70626 ADAM A QUENNEVII I 1 / , a 160 OW LYMAN RD ,' S HADLEY, MA 01075 ...-2--......d..._. '�� Expiration 8/2112013 Conunis■ioncr Tr=: 21002 _w2.- , gge -62,9,...aa iy#,...,,,44,4.0 I� a Office of Consumer Affairs and usiness Regulation Will 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2014 Trft 222024 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE — "— 160 OLD LYMAN RD SO. HADLEY, MA 01075 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal [1 Employment (J Lost Card oPs -nal i., 50M- 04/04- G101216 y t I 1 � 1 4 V f - }. f !? 7 J �'. 1 1 .i 11 r db:. /s a �5. �4a S,F (,. - . ' 4 lk s: STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION � �� Be it known that ADAM QUENNEVILI.F ' - 160 OLD LYMAN ROAD a P 1 SOUTH HADT.FY, MA 01075 -2632 . is certified by the Department of Consumer Protection as a registered HOME IMPROVEMENT CONTRACTOR, Registration # HI.C.0575920 st A ii_:. r. • " ADAM QUENNEVILLE ROOFING (= Effective: 12/01/2012 a `# ,.; Expiration: 11/30 /2013 William M. Rubenstein, Commissioner �� `'`� " CERTIF OF LIABILITY INSURANCE DATE(MMATOT!/YY) 6/21/2012 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 15 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 cT LyTtne Methot:, EXt _ 1 D2 Foley Insurance Group Inc. 37 Elm Street NANIR PHDNE (413)214 - 7474 Fa IAIC No. Ban: (AI C. 5(913, 214 -7447 ADDRESS: = lmeth @foleyinsurancegro INSURERS) AFFORDING COVERAGE NAIL A test Springfield MA 01089 -2703 Adam Quenneville Roofing & Siding Inc. INSURERA Ireerless Insurance Compan 4198 INSURED INSURER B :Safetp Indemnity 3619 isuRERC:Scottsdale Insurance Co. 260 Old Lyman Road INSURER AIM A/R INSURER E: South Hadley MA 01075 -2632 INSURERF COVERAGES CERTIFICATE NUMBER:CL12 621 0 64 3 5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW,THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L ( 77RR TYPEOFINSURANCE IM P SINN POLICY NUMBER Im560DW ( D NY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERA UABIUTY •T I'�r' �7'7y� �• 0 2 . $ 100,000 A .■ CLAIMS-NAOE I X I OCCUR 6912267 6/23/2012 /23/2013 MED Exp (4.Y onepemen) $ 5,000 ■ PERSONAL B S 1,000,000 GENERAL AGGREGATE s 2,000,000 GENLAGGRE UNIT APPUES PER PRODUCTS- COMPIOPAGG $ 2,000,000 POLICY Fri JFR"Cr n 1 LOC 3 AUTOMOBE LIABILITY _ ( COMED I SMGLE LIMIT 5 1,000,000 B ANY AUTO BODILY INJURY(Periseon) 3 III ALL OWNED I{ SCHEDULED 6215480 • /1/2011 . /1/2012 BODILY INJURY(Pera¢iderd) 3 AUTTxS H —I NO NED PROPERTY DAMAGE ill esde S HIRED AUTOS AUTOS I PIP-13ase S UMBRELLA LIAB X occu8 - EACH OCCURRENCE _ $ 5,000,000 C © EXCESS LIAB ■ CLAIM$MAOE AGGREGATE - $ 5,000,000 DED RETENTIONS 10,00' S0080268 6/23/2012 6/23/2013 s D WORKERS COMPENSATION X I ' Y WC_ S . TATU- OTH - . AND EMPLOYERS LIABILITY YIN L.D "^ IIMnSI I ER ANY PROPRETOWPARTNF Clmir6I N I NIA EL EACH ACCT °ENT $ 1,000,000 Mandatory In NCH, ExCL187ED? 7012861012012 ' /29/2012 ' /29/2013 EL. DISEASE -EA EMPLOYE 5 1,000 ,000 'ryes. W desrn7+e , enter - 06CRJPTION OF OPERATIONS below E.L. DISEASE -PODGY UMIT 5 1 , 000 , 000 DESCRIP i0N OF OPERATIONS / LOCATIONS) VEHICLES (Attach ACORD 101,AdN0o^al Remiss Schedule. ir mom space is required) - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEWERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AOTHOR¢ED REPRESENTATIVE Brian Foley /LYNNE ----"Z-. ...:'-' ° ACORD 25 (2090105) t J 1988- 2010ACORD CORPORATION. All rights reserved. INS025emnm 91 The a rf1n name and insn are re.rietemd ma.rr <nI Arnim The Commonwealth of illassachusetts ' Department of Industrial Acciifents - Office of Inv Qations —_ . ,_; . 600 Washington Street • a — , - Boston, MA O �',-' - www massgov /die Workers' Compensation Insurance Affidavit: Builders/ Contractors /EIectricians/Plumbers Applicant Information " Please Print Leolblv Name ( Business /Organization/Individual): • Adam ()nomadic R & Siding. Inc, Address: / (e 0 - o I i 1, --.1 j1i n . i bad _ - City /State /Zip: -0' / h il i / 1 M /4'- 0/0 #: W3 Saar 6`7 55 I Are you an employer? Check the- approp ate box :. L Type of project (required): �_ I am a general contractor and 1 6_ ❑New constntction � I am aetnployer with- ]yam ❑ employees (full and/or part- time).' have hired the sob- conuactors _ _ 2__n. I arm- sole proprietor orpartner don the attached sheet 7: 0 Remodeling ship and have no employees These sub- contractors have 3_ ❑Demolition wor for me in an act employees and have workers' � Y capacity. 9_ ❑ Building. addition -[' h � rkers' &Imp. insurance • - - •- comp. insurance - .._ - • - - required) 5_ ❑ We are a corporation and its 10.0 Electrical repairs or additions 3_ El am a homeowner doing all work officers have exercised their 11-0 Plumbing repairs or additions myself o workers' comp_ right of exemption per MGL mys [N 12.[Roofre� airs insurance required] -T - - - - c_ 15 > _§ 1(A), and we have n_ o employees_ nc e required] workers' comp: 13.� Other S% r s ftt] ✓p n� . - insuranc ✓ it Any applicant that checks box ;VI must also fill out the section below showing the workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doingall work and then hite outside contractor must submit a new affidavit indicating such 'Contractors that check this box must attached an additional sheet showing the none ofthe sub - contractors and sate whether or not those entities have employees. If the sub-contractors have employes, they mustpmvide their worker comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees Below is the policy and job site information. ) . Insurance Company Name: A ,) nn - - t • I ° p� 1.1 hi i lt ! 1_41 Sara Y) & - Policy g- or Self-ins. Lic. m ;/ 1 W [� : r_701 916, r 6, 10 Expiration Datee: LI — a q -, 1 0 3 Job Site Address: t ? 5 ?)r d.Q l .'i rd Cit /Zip: rtC((?(X t fl' C 1 U 0 Attach a copy of the workers' compensation policy declaration page (showing the;policy number and expiration date). Failure to secure coverage as required under_Section 25A of MOD c. 152 can lead -to the imposition of criminal penalties of a fine up to 51,500.00 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 DLAfor insurance coverage verification. - - I do hereby ce n'd the pains and penalties ofperjury that the information provided above is true and correct Simrattrre: i C/ / Date: / //1-0// 7 , _ Phone # 0 — S3 {o— qss Official use only. Do not write in this area to be completed by city or town official! - -_— amity bi Town: - _ -- -- - -- - _ • _ _ Permit/License it`-- - - Issuing Authority (circle one): 1• Board of Health 2.BuildingDepartment 3. City/Town Clerk 0- Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: - Phone #: .I SECTION 8- CONSTRIJCTION SERVICES 8.1 Licensed Construction / Supervisor: / Not Applicable ❑ Name of License Holder: Ad av14 V s l la License Number 1 o ld , a v d S cc� � d , n1 A 3- (9-1 0 5 Address Expiration Date lam- L i/ 3 -6 5 Sig re Telephone '9 'Racists ed:Iiomealmprovemen ontractor. : � _'. ; ' }� _Z I __=: Not Applicable ❑ Adam Quennevile Roofing & Siding Inc. 0-6 t k�- Company Name 160 Old Lyman Road Registration Number South Hadley, MA 91875 ' ac. Address j / Expiration Date Telephone 03 -SECTION FIDAYIT (M G L - -,:m - 152-1 - 25C(6)) LO- WORKERS' COMPENSATION INSURANC •: _.. -..,.. r_�,� .. _. ; -- ._ _ -- •- +r mot._ -. 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 X No ❑ 11. Hdme Owner Sze mf on 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 1083.5.1. 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-vear 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 • qq ='SECTION S- DESCRIPTION OF PROPOSED:WORK (checkall- applicable)_ N ew House ❑ Addition ❑ Replacement Doors � Windows Alteration(s) n Roofing J. Accessory Bldg. ❑ " Demolition ❑ New Signs [O] Decks [Q Siding [l 1] Other [0] Brief De cription of Proposed Work: ''r A - t X I / ft 11 - i N . of of 6€tb1Uo Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. �[ i�7" �w.. Frouse�a�cF�xor- �iddifiornto .�x�stinq:housfnq,.com� p e e t�ie ollowiq: 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? fj Method of heating? Fireplaces or Woodstoves Number of each ' gl Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1» Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth of basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulations? Yes No . Septic Tank _ City Sewer Private well City water Supply SECTION 7a OWNERAUTHORiVION 7O'BECOMPLETEQ WHEN DWNERS A&ENTOff GDNTRACTOItAPPElWg9 9 IT i _; cum 4 J' f 8(.t (i a ya/ , as Owner of the subject property 'J J hereby authorize Adam Quenneville Roofing & Siding, Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. Q (c?ir17' C t 'pill z Signature of Owner Date Adam uennevifie oofing & Siding, Inc, - , as Owner /Authorized A 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. _ Print Name Signat ru a of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing , Proposed Required by..oniii This column to be filled in by Building Department Lot Size - i i 1 1 1 i r Frontage 1 , i : Setbacks Front 1 1 1 1 i 1 Side !---; 1 R:f L:i R: 1 1 1 1 1 ! I Rear ---1 I Building Height = 1 _ i 1 Bldg. Square Footage % 1 1 _ , — Open Space Footage . .. °/n -- (Lot area minus bldg & paved _ I 1 (_! parking) - I # of Parking Spaces 1 -- 1 _ Fill: �i 1 (volume & Location) I 1 A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:1 1 IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW' 0 Y6 Q IF YES: enter Book i Pagel 1 and /or Document # B. Does the site contain a brook, body of Water or wetlands? NO Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be-obtained from the Conservation Commission? Needs to be obtained Q - Obtained Q , Date Issued: 1 C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: 1 1 D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: I { , 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1. Lt--� r ... � ..... � ►� Departm only I . City of Northampton Status o fPennit - U`.' . , 2012 .i u ilding "Department C urb cutfDrrveway Per i 212 Main Street Sewer /SepticAvailability = : DEPT OF BUILDING IN •SPECTIONS Room 100 Wa #er/Well AvaiFabihty" f NORTHAMPTON, MA 01060 orthampton, MA 01060 Two S of Structural Plans ▪ _ L _ phone 413 -587 -1240 Fax 413 - 587 -1272 Plo ; Other Specify • I APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S ECTION 1 SI TE INFORMATION ' Th is section to be completed by office 1.1 Property Address: Map F -. •_Lot _ { . ,. -p Unit: . d55 ,ct& c; rcl Q__ Zone ` • -<AOverlay District < -, _ �- k ri _E Im fSt..Djstrc 'r " C B D i ▪ s tract .t , :SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ` Tc) i`q 4 Jr)/ P ) rIih a/n �?� 5 n�,i��a <:i rC i + I3 E?fl P, ry Name (Print) Current Mailing Address: I c � ^ (4(3. - ?� (aa Sia ( Orrtr (C,j Telephone • Signature 2.2 Authorized Aaent: Adam Quenneville R o o f in g & Siding, Inc, i i o o (/d G i , j ji u ki 10,d- , c - a a 7 1(' Name (Print) Current Mailing Addc ss: i "..—A .- 1 - ' �� f - 536 1214- oof74 Signature v" Telephone • i-= E STIMATED CO .COSTS : Item Estimated Cost (Dollars) to be = Official U Oniy = 1 completed by permit applicant _ _ . _ _ _ - .. _ - _ _..- _ _ .__. 11. Building (a) Building Permit Fee if3, q� 6' r v o - 2. Electrical (b) Estimated Total :Cost of - :,,Coristru..} -(6) _ - . - -- 3,' Plumbing Burldng"PermrtFee - 4 Mechanical (HVAC) _ ti' = , 5 Fire Protection i. m ,,,, r , - 6 Total (1 +2 +3 +4 +5) 1 (..(,r Chec N umb er . -_- -. - T.. This:Section-Forbffic alllse-'.Onl uildrng P ermrt . Nu m b er Date � ` s Issued � r 3 , -- _ • s f- s a - , r E s c t t �. s S rgrra fure 1 - a V= Budding coirimr 1t"i ertinspector of Buildings ▪ :: , _ , _ .,.Date 1 • 255 BROOKSIDE CIR BP- 2013 -0538 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 -125 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- 2013 -0538 Project # JS- 2013- 000869 Est. Cost: $18448.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 16770.60 Owner: BURLINGAME EDWIN C JR & JILL P Zoning: Applicant: ADAM QUENNEVILLE AT: 255 BROOKSIDE CIR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:11/9/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & REPAIR SIDING 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 11/9/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner