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16A-016 (4) The Commonwealth of Massachusetts Department of Industrial Accidents cl B ....W� Office of Investigations wiiit' 1 Congress Street, Suite 100 •="l� w-��; Boston, MA 02114-2017•.. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Adam Quennev[ile Roof ig&Siding,Inc, Address: f L 0 01 J t1}m4.r1 _ "ROC((-1 City/State/Zip: __ tai ('O___ . ,---II. . 0/0 25 Phone#: y l3'`�3(0- SciSS Are you an employer?Check the appropriate box: Type of project(required): 1.[ti' I am a employer with 15 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance.2 required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Am applicant that checks box#1 must also till out the section below showing their workers'compensation policy intonation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the 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. (� _ insurance Company' Name: A / i { �1Li .t.lLt.` -1-1)3L (Cl.n6 - — Policy#or Self-ins. Lic. #: PfLOC—t-{O(Y`]Old SL i a 01 3 A Expiration Date: 4)aci ) /4 Job Site Address: I31 Sp'1- 3 - _ _ — City/State/Zip: 2 , , O/ '?-- 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 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$2.50.00 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 'nsnalties of perjury that the information provided above is true and correct. Signature: Date: /O ia1 l.5 . Phone#: 413-53 to_5g55 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t Ace d CERTIFICATE DATE IMW°°^ I OF LIABILITY INSURANCE 6/24/2013 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 BEPRESENTATIVE OR P ODUCER,AND THE CERTIFICATE HOLDER.UTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED I IMPORTANT: tf the ssrtlflcate Nokia' Is an ADDITIONAL INSURED, the pullcy(Ies) must be endorsed. if SUBROGATION IS WAIVED,subject to 7 the terms and condttlons or the policy,certain policies may require an endorsement. A statement on this certlricate does not confer rights to the certificate holder In lieu of such endorsement(s). asocumet CONTACT Lynne Ldethot, Xxt. 102 Afims Foley Insurance Group Inc. - �:lr-. . . (413)214-7474 M.N.,:ui3lai4-74.- 37 Elm Street f,,,, , ,lmathotefoleyinsuranoegroup.cos West Springfield MA 01089-2703 )Apr�o�I COVERAGE N4ri west A;Peerless Insurance Company 24198 *gums, American Fire & Casualty 24066 Adam Quennevillo Roofing G Siding Inc. ,mu cOhio Casualty Insurance Co. 24074 160 Old Lyman Road MAW D Alid AIR POMP , South Badl MA 01075-2632 ,.,..1: r: COVERAGES CERTIFICATE NUMBER C7 1362407069 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 AF FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PMD CLAIMS. SIttR remelt PISURANC! -11::1:7 rOUCY►aldlstNt AZADATVAMEX,1 L1hSTa aMIIAL WSILRY paps OCCURRENCE = 1,000,000 OAMASPE© CONMERCUIL GENERAL UAMUTY PR E TORE/4M., I $ 100,000 A cuums MADE n OCCUR 6912267 6/23/2013 /23/2014 MEDEXP(AA/one wean) 's 5,000 PERSONAL 8 ADV WARY $ 1,000,000 1_ GENERA.AGGREGATE f 2,000,000 GERM AGOREEGATE LIMIT APPLIES PER: PROOJCTS-oOMPaP A00 8 2,000,000 1 POLICY�1 -1 LOC ,_ AUTOMOSPJ LASUTY a>+�L€oR 1,000,000 B ©ANY AUTO SOOILY INJURY(Per parson) $ �D it:vi 5622645 /23/2013 /23/2014 BODYN.ARYPe.ovid.0)$m HMO AUTOS _ p0 �DAMfAGE $ PIP.S..k _PROPERTY uAS �_`occuR EACH OCCURRENCE = 5,000,000 C © EX UAe CIA NAAOE AGGREGATE $ 5,000,000 . . • ;. r,,tr,. 03055622645 6/23/2013 6/23/2014 $ 0 ANC aw or COMMINSKI1ON Y X TOO Limit ER , YIN OF'i�EXCLUOEO� I l NIA E.L.EACH ACQDENT $ 1,000,000 (fMry.Y.rywrMt) 1414C40070128612013A 14/29/2013 4/29/2014 EL a8EA$E•EAwpw,,,EE$ 1,000,000 M d..ab.und.r IfOgairPth0N OF OPERATIONS below 1 I El asEASE•POUcY LM4fr $ 1,o00,000 I l ) DScRIPTION OF OP Al ONS!LOCATIONS I VtS1SCLt1s (Resell*CORD 151,Addlltonsi Rowse Schedule,It mom some is r.quir.d) The certificate holder named below is included as an additional insured for general liability coverage for ongoing operations if required by written contract, permit, or agreement executed prior to a loss. CERT1FICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Permitting Purposes AUTHOR2ED REPRE*INTAT't Brian Foley/LYNNE ''-- - "" '— _-X--.. ACORD 25(2010/05) ®1988-2010 ACORD CORPORATION, AU rights reserved. INRtT2Arxnrvx.m The 0(^(1lin norm.snri Innn sr*ronie erorl mwrir%Al Or rllifl us Vlassacimsens 2e mf-- ,..- -, •-. c ‘-wl 3.0.-4-..1 -:- 3,., -1 :.:; ^-',"ng 1' 'S, ,7 73'a-:-..,:.-us c,.:••,s e CS-070626 ADAM A QUENNEVIII.F: - 160 OLD LYMANAD S HADLEY MA 01075 9: ...., 08/21/2015 - , ,_. ....--, t.°771ge --6--204rtmoouveata 0 ,f,y7,,a,oaciteaeitzt Office of Consumer Affairs and :usiness Regulation 1. ---,P 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2014 Tr# 222024 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE _ 160 OLD LYMAN RD 50. HADLEY, MA 01075 Update Address and return card.Mark reason for change. 71 Address ri Renewal C1 Employment D Lost Card RS-Ciii 0 5om-a4/o4-olo1216 „.....:..1,,ic;,,,:is :4„,„. ,,,,z:14,..f„,,,,,,,,m,..,:tw.„t.:.ofe, ,,i,.,52,e.,,,v,:e4.,,,,,,y,. ,j,, ,,,„,,:in:4,.7,41:,,,4.,,A4,74.6.:„ . „,,re,i,.,..: ,,,1 .,,:,. .„, ,,,,,1,s „,, ,,r.:..',...'.1:;', 1";",,?'•,- ,--t, P:.:It-1.--:,.:... . ,. ., ,..- ,,.,,. - .,....,,,. t, :-...,:„.. .v .,.....f,,v.- -t'P..:9.,s.>.P gr,.'`',:V4 :1',:Zii:P, V-,-4:,,e,„. ,,,Z.,•4(9,4; -,§•;:s1,::4,1%-%T.:?:4.:.---,,::.4.f.P.,=-.2-i 4-- ::.0,- .:,.0.,-',N“e„,.,.,' ,,,,,,,,,,,',k,o, , :w-,;.-,,,,y,%-,,,,,,-. STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Be it known that f--Az--- -i ADAM QUENNEVILLE 160 OLD LYMAN ROAD SOUTH HAD”-RY;MA 01075-2632 is certified by the Department of Consumer Protection as a registered .:,..,,..,1-i• , *. .4 HOME IMPROVEMENT CONTRACTOR rt t* it,-;A,■ Registiatio4.#Hit.0575920 ADAM QUENNEVILLE ROOFING 'El' •' - -- , --, Effective: 12/01/2012 , . tiaali ....' IC igvni ration: 11/30/2013 William M.Rubenstein,Commissioner :. 5N DJ v� ' 1 4 DISCOVER Q U E N N E V I L L E www.1800newroof.net ROOFING 'V SIDING 'V WINDOWS We Are Licensed 160 Old Lyman Road•South Hadley, MA 01075 1.800.NEW ROOF • 413.536.5955 Fully Insured Email:info @1800newroof.net Website:www.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 Buildings&Trade Association P.P.C.38710 Proposal Submitted To: Date Phone#'s fj�'J_ �t E(7 C: 4" ' 1, f-ry )VIII //3 H: 3a0� 3`1'x`' W: Stre Email: ���/ Spr Si r��i� /'n , z g;Tirc' comcciit,net City, State,Zip Code Special Requirements: f I,,e,„„-,„ / e ti+t,,t,A car',P 5-c w c-e i.p a4 O ❑ Recover ,.X Strip g Layers Complete Roof System Q We shall acquire all appropriate permits for all work ,® Home exterior and landscaping to be protected . 1 Strip existing roofing to existing decking and dispose of. Do not Do. _ C9 Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection. ® Install Ice ter Barrier at all eaves,valleys,chimneys;pipes and skylights • Insta (151b.felt/ nthetic)underlayment over re aining decking area O Install Metal drip edge at eaves and rakes(8" 5" le brown/copper) a C kl Install manufacturer's starter shingle on all eaves and rake edges BBB gii Install new pipe boot flashing standar copper)/vents --1-- 5_4—I nstal I Snow Country or Cobra rolled vent ridge vent Winner of the 2010 . - -__ .r. •. 'ation TORCH AWARD / Shingles: r ( 6 nails per shingle) ""-' Fe h,,) Q CA I _ Shingles [1] 25 year ❑ 30 y3ar Ar50 year Color bark V'OOc bi\t Ridge cap shingles Warranty Options: ,,. We guarantee our workmanship for 10 full years(see our warranty coverage) ❑ GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: ❑ Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap 5 9 QO.I)0 We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ , ,) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Down Payment($ ) 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($;S) ,C ) .c.„ '�" `Date: I U)1 b)i 3 Signature: ;f Date: Estimator:(Print Name) A_ 3,4'� (Sign Name) 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. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: '70 Adam Quenneville Roofing&Siding,Inc, License Number 160 Old Lyman Road Ex 7 /15 Address / / Expiration Date South Hadley,MA 01075 (/�3-s—A Svs-.S- Signature Telephone 9 Registered NomeimprovenrientContractor M .._._ Not Applicable £ A{�(app )�o941. Company Ffffi�'�"°ne R� Registration Number 160 Old Lyman Road dp-s—/1 51 Address South Hadley,MA 01075 / Expiration Date i Telephone i.3-c36' 1 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 t./£ 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 ❑ Addition Replacement Windows Alteration(s) ❑ Roofing EVI Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs`-'tni ' bObks [I Siding[D] Other[CO Brief D iption of Pro re i Work:�(9UC ,(?fI4-C..e k�i t 11U 5p t2 • Alteration of existing bedroom Yes No ( Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet Ba'1f New:house.and_or addition fo existing housing;±complete tt e.foilowmq: a. Use of building:One Family Two Family Other +t? .;;s'ai:+` ,. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l 11/; ! f • ,as Owner of the subject property hereby authorize A. otair �Q il,�1n-� j to act on my behalf,in all matters relative to work authorized by this building permit plication. SR-t_ CANtAlek-j )0 ir}f)--1 3 Signature of Owner Date 1, , I �`Ci tifi ObetnitavialQR6d-; ,as Owner/Authorized Age t hereby declare that the statements and inforation on the foregoing application are true and accurate,to the best of my knowledge and belief. Sig ed under the ains and penalties of perjury. -tint Name iiOP - 113 Signature of Owner/Agent Date .w 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 I i i Frontage I ..._J _ ___.__ ' _._I L_L...._....__.__. I Setbacks Front F__i I 1 I I Side L:' R:__. — L:1. I R:t Rear = I 1 I. I Building Height I`_I LJ EJ Bldg.Square Footage I---I '• I % r -- 1 I Open Space Footage # ['''�'"' % hh ( (Lot area minus bldg&paved L _J l_.__......I E._.,..J L__..._,..1 parking) #of Parking Spaces ED 1 Fill: (volume&Location) A. Has a Spec' l Permit/Variance/Finding ever been issued for/on the site? NO `3 DONT KNOW 0 YES 0 IF YES, date issued:I I IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book _ i Page 1 and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO QDONT KNOW lam./ YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO h IF YES, describe size, type and location: ! D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO er IF YES, describe size, type and location: {{ ----] E. Will the construction activity disturb(clearing,grading,ex ation,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. -i..-iltgageolitottio"Ste! -- -•''''' \' -—-- . --. 7,7:1_•. ::•.1, l N1ktr.1t6:i41ta4-:1r0l_lt.v,,itaaalligaN City of Northampton 040" 4Yr*;• 1i%••ll:t.-i:t.8.* Building Department 14614titt14 ''-'kt'iA4e:!:00V1:4l0,001-46t,3iPP47dtots4i4l1rg6 12mainStreet r ttai.rli i t 1,,M0,,,,,,'79.AliTogretberi„'-AuMmird$90abtgAci,. .: "Aillitm 4 `L`g(3 : , Room 100 U Northampton, MA 01060 7— ------ 7--' 413-587-1240 Fax 413-587-1272 patermetoMas a I I ,-7'.7:=„,:wiz,:-...4.:i„,-,,,,,,i-F014-,,,Ti-wilot 'otiiiiNiiiref" 54444.--74.-P,Pi&-Inalm6Mte-it0',114,:% aVaii1)A06.,r....kr,trAiflosig,,t.R,y.F„...&.,...7,.......„.,„,,„....,,,,o,,9%,,,* zw6909401poriaTir.,-,Vill1151;i10:0g I eati&tatiatiikilt!.'4*NaillAteeill btgft4tAg;Stgg40: ritalaigtraA:.:5:' ogZ4.,,6:: APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH(VOIC.,TWO FAMILY DWELLING . . . . . . . .. SECTION 1 -SITE INFORMATION ..- ...... .. 1.1 Property Address: It.tlikAMPIR:11,M;iltiftv,f,'.41.74.1014,, .,F...10.1:„ !Eztp:ilfnitk',ini. alattikontgRAIRM-149 'ir.t. 1 Atlk.'.3/4r;;;:;_:ijtkiittinfg.1f*;t4.ArtMdk'Oflfggi*!D:S';::i'K:''.: :=- 115 1 --SPtCrij -S6-'11- fitIONSWORMISMOOmitp' v.2=4:::.;:.,:: ::: :,:s.L:,,,, ,.,:,:,: ii,'q,14:' •,:,;;;::;:iimi,41;1;21ictigima-a!iiatpAlip61,k,! .,, ,:,,,,:::; i::.,:;,1-, liregiditillAtntArati.420:0114** A-0-9-'-.--,-- Elm St , ..,...,... ... .. „ SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT i„ 2.1 Owner of Record: ti i ii),14-;i5 k-•i n fite/S2 ,../111- 0/0(o.)- n41a_ LI i• -r- 4-4-0 CurreritM;ing4‘d 1s:Ooto Name(Print) Stt CXYAArt-C}1- Telephone Signature 2.2 Authorized Agent , -1- 4/07C t4- )&o Old P Current Mailin ddress: ked) <. )- arent4 y, 1L4- A EA I' 1 I 41 ,! ,,L ..,, / #1..A.; ! o At 1 ... illra - ... Name(Print) • /f3 - ----- eel' 3-s3 L S' /,-- - Telephone elephone • . . . SECTION 3•ESTIMATED CONSTRUCTION COSTS Item , . .. . , . . . Estimated Cost(Dollars)to be Official Use Only.. • completed by permit applicant 1. Building 1 5(90006 (a)Building Permit Fee • - 2. Electrical -:.(13)Ectinnistt tuecc It i o T no t.far 01•Cm 76;at , • 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection -. 0 036- 900 6. Total=(1 +2+3+4+5) 5 6x) Check Number 7 g[71, i • • This Section For Official Use Only Date• . ' • , . . . Building Permit Number: Issued: • . . • • • • • „ . . . • . Signature: ' . • . . Date , • • Building CornmisSioner/Insp ectorot Buildings, " .• - - ;. .....,,, • ,.. 431 SPRING ST BP-2014-0510 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-016 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-2014-0510 Project# JS-2014-000872 Est.Cost: $5900.00 Fee:$35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 21431.52 Owner: EGITTO-JABLON ANDREA Zoning:URA(99)/WSP(99)/ Applicant: ADAM QUENNEVILLE AT: 431 SPRING ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:10/24/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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 10/24/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner