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29-316 W .•• s �• � �f2P •� oar o ul mg egul ions an tan ar s One Ashburton Plac - Room 1301 Boston, Massach setts 02108 Construction Supervisor License License CS: 70626 Restriction: 00 Birthdate: 8/21/1971 Tr# 3712 Expiration: 8/21/2009 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 Update Address and return card.Mark reason for change D Address ❑ Renewal Lost Card DPS-CA1 io 50M-07/07-PC8490 —. - - --- - - - -� 1 ons an tandar s Board of Building Regu One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement:Con ractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2010 Tr# 264937 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE 160 OLD LYMAN RD SO. HADLEY, MA 01075 Update Address and return card.Mark reason for change. Address Renewal E] Employment � Lost Card DPS-CA1 0 5OM-07/07-PC8490 v�oe„v..o�n.r..e. rw,ay.wo.raa� ....me���s...raairavns+siwrae. o.. ersaweieay..w�.e..ewmwnav,..�eay.r+a.eevna�eao®nw�,.m�.we..m�.ose. �C j" STATE OE CONNECTICUT + DEPARTM NT OF CONSUIV�ER PROTECTION ! t Be it known. at ADAM QUEN -EVILLE 1G0 OLT3 L ROAD 0,U,` 01075-2632 s: J \ . i is certified b�tihe Depart Er t b�,Con m r'P'rotection_as:;at egistered' i Y } L HOME IMPRV �ONT.RACTOR i `R1srd ## 520 t ADAM �QIIENNEVILLE ROO.FIN �'�NSr,4,r- ]Effective:'12%01/2007 77 Exp.i�atlanll/30%2008: - Aug-01-2008 01:42 I'M KeMl tiara insurance 1.4 -DJo-UUlU DATE(MMIDONYYY) ACCORD GERTIFICATE OF LIABILITY INSURANCE . A,AMQ- 1 08/01/08 PRODUCER THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON..Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard IusuranCe Agcy, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 79 Lyman Street AL ER THE COVERAGE AFFORDED BY THE POLICIES BELOW, South Hadley MA 01075 Phone: 413-_i38-7862 Fax:413-538-7179 INSU�ERS A FFORDINGCOVERAGE NAIC# INSURED INSUR RN AIM Mutu'L Rums—ce Co P"y INSUR RB: Travelers Ina. Co. Adam Quenneville Roofing & INSUR RC: Scottsdale Ins Co. Siding Inc 160 Old Lyman Road INSUR RD; South Hadley MA 01075 INSUR RE: COVERAGES . THE POLICIES eF INSuRANCE LISTMFORDED W HA EN ISSUED TO THE INSURED NAMED ABOVE F THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CO N OF ANY CO CT OR OTHER DOCUMENT WITH RESPECT 0 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE WSURANCE BY THE POLI ES DESCRIBED HEREIN IS SUBJECT TO ALL HE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS MAY HAVE BEEN 9EDUCED BY PAID CLAIMS. nwSK LTR NSR TYPE OF IN URANCE POLICYNUMBER• DATE(MN DD BATE MMI00lYY. LIMITS GENERAL LIABILITY "' '' EACH OCCURRENCE S 1000.000 C X COMMERCIAL ENERAL LIABILITY CLS1517923 06/ 3/08 06/23/09 PREMISES(Eaoocurence) s 50000 CLAIMS MA E 'OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY 5 10 0 0 0 0 0 GENERAL AGGREGATE s 2000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2000000 POLICY 1ECOT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000000 B ANYAUTO BA745OL94607 11/ 1/07 11/01/08 (Em accident) ALL OWNED AUTOS BODILY INJURY (Per person) S X SCHEDULED AUTOS X HIRED AUTOS - - BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO - OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE S. S DEDUCTIBLE S'y RETENTION $ S WORKERS GOM PENSATION AND X TORY LIMITS x ER EMPLOYERS'LL4BILITY A ANY PROPRIETORIPARTNERIEXECUTIVE AWC7012861012008 04/, 9/68 4/29/09 E.L.EACH ACCIDENT S 1000000 OFFICEFJMEMBI'-R EXCLUDED? EL DISEASE-EA EMPLOYEE S 10 O O O O 0 If yes,describe Intder SPECIAL PRO\A41ONS below E.L.DISEASE-POLICY LIMIT S 10 0 O O O 0 OTHER _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT I.SP CIAL PROVISIONS. CERTIFICATE HOLDER CANCELLATION ' SHOt LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1 DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WREN NOTI E.TOTHE;C . IFICATE HOLDER NAMED TO THE-LEFT,BUT FAILURE TO DO SO SHALL IMPO E NOO IG , ON OR LIABILITY OF ANY IND UPON THE INSURER,ITS AGENTS OR REP E E � AUTH R )3RF,yjRE5E15SJFTIVE°- Ste hen E. Radon ACORD 25(2001ID8) ©ACORD CORPORA'TIOIV 1988 Office of Investigation 600 Washington Stree !`! Boston, MA 02111 A; wr .mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ onti-actors/Electricians/Plumbers Applic:alnt Informa8ion _ Please Print L!j bly Name (Bus inesslOrganization/Jndividual): Address:__ \J City/State/2ip:_ 1 t� M,, ,`�1 dldl� Phone A,rr 0 an employer?Check the appropriate box: ` Type of project(required): 1.E I wn a employer with_ i 5 4• ❑Tam a genera]contracto and I 6 ❑New construction employees(fiill and/or part-time).* have hired the sub con actors 2.❑ I am a sale proprietor or partner- listed on the attached sh et. $ �- E] Remodeling ship and have:no employees These sub-contractors h ve 8. ❑Demolition worhudg for:me in any capacity. workers' comp.insuran e. 9_ ❑Building.addition [No workers' comp.insurance 5. ❑ We area corporation ar d its required.] officers have,exercised err 10.❑ Electrical repairs or.additions right of exemption per GL 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work - � p p C. 152, 1(4),and we It ve no myself. [No workers' comp. § 12. oof repairs insurance recliured.]t employees. [No worker;' 13.❑ Other comp.insurance requir d.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners w o snbrait this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors thatIcheck this box must attacbed an additional sheet sbowing the name of the su ntraciors'and their workers'comp.policy information. I am an emploo i yer that is providing workers'compensation insurance for y employees. Below is'the policy and job site information. 1 ) J Insurance Company Name:_ alci Policy#or Self-ins.Lic.#: Expiration Date:_ t✓f r `�� . 3 /'�( � � C� �� City/State/Zip:x/014 Job Site Address: Attacb a.cop'y of the workers' compensation policy declaration page(s owing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 c in lead to the imposition of criminal penalties of a fine up to$1,1500.00 and/or one-year imprisonment,prisonment,as well a civil penalti s 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 tatement may be forwsrded.to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certify under t pains and penalties of perjury that the informationproviiied/abov)e is true and correct Si grt Date: ature: ,�! q _ Phone#: � Official. use only, Do not write in this area, to be completed by city or town official City or Town:_ Permit/Li ense# Issuing Autlioirity(circle one): 1.Board!of Health 2.Building Department 3. City/Town Clerk 4 Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: I hone#: p %YPA _ V f QUENNEVILLE ROOFING & SIDING, INC. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1-800-NEW-ROOF • 413-536-5955 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 Building&Trade Association Member of the Better Business Bureau P.P.C.38710 I i Proposal Submitted To: Date Phone#'s Work: _� f, -`_r.-`1 Cell Street Mail To: City, State,Zip Code Special Requirements �! , '�. r 1' - ��� � SIC•- , .LJ p_;JL�_ '- IV Proposal to furnish and install the following ❑ Re-Roof ] Tear-Off ❑ Gutter Complete Roof Preparation Home exterior and landscaping to be protected p Entire existing roofing material to be removed to existing decking, including flashing, etc. Site to be cleaned everyday with roll magnet debris removed at project completion Q Deteriorated existing decking replaced at$2.89 per sq.ft. Brown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only Q New flashing will be installed where necessary(see Special Requirements) ❑ Install new pipe boot flashing New lead counterflashing to be cut into chimney F1 We shall acquire all appropriate permits etc.for all roofing work Complete Roofing System P GAF-ELK Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north) 0 GAF-ELK Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas E] GAF-ELK Leak Barrier installed at all Rake Edges 21 Install (15 pd.felt/S _underlayment installed over entire decking area Shingles: Shingles ❑ 25 year b 30 year ❑ 50 year Color Continuous GAF-ELK Snow Country Ridge Vent will be installed GAF-ELK ridge cap shingles Warranty Options: We guarantee our workmanship for 10 fully ars (see our warranty co rage) . n We Propose�e�' y to furnish materials and labor-complete in ac a?tce w Mae specif cations for the sum of: Total Sale rice ` t Down P ment$ <_ `"' ' ' Up/n Completion$ ACCEPTANCE OF PROPOSAL:The above prices,sp cifications and conditions a satisfactory and are hereby accepted. You are authorized to do work as specified.Payment '1 be 1/3 down upon ' ing,and balance due upon completion. Unpaid balances shall accrue with interest at 18%per an Purc 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. Date: Signature: Phone# ! J' Date: ,�� � '� Estimator's Signature: Estimates re honored for thirty(3i))drays from#6ve 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 and Sidings will not be responsible for debris or dust in the attic or storage areas. - I � L' J:I €�L'J.4�Jf1;Y:5L 'wTk�la�' f� Y� ^w'.•4iiq.,'t•' 8 1 Licensed Construction Supervisor: Not Applicab ❑ Name of License Holder : 70 Adam®uenneWle Roofing&Siding, Inc, License Numb 160 Old Lyman Road Address Expiration Date Signature Telephone R ;fe "o >a ou Merit fr51FI a fare- "" Not Applicab ❑i ,y2 � ✓� - Company Name 180 Old Lyman Road Registration Number South Hadley,MA 01075 - Address / p Expiration Da Telephone .... - ,�t4T���,ci =.-;:�'.::.�_. - _ ,,,�y;.-,N,:: , ri r 1_:.,�i�!" iC ��:..::�i6r -},,:.,�...,:. ';4 �''i�;;SP-,•aijk, 1,.,,. .4•' AI. - �* ..:��. #da�,� ,: :� :c`•;_L�...�:��•M:' +.iii„,�-;,:.,.+ �ic�-.6,:.P�•,� ,. �.a.,t., :;:,'�:,yna:•. ,;i.;,:,„�:;an:�V;' -& l7 A; AIF� ,.15' , :r .t�'':,� t•..r.!!.?R'".F7?.!'..;'"::�'B.F 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...... ❑. The current exemption for"homeowners”was extended to include Owner-occupied Dwellings of oiie(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. DeSnitioii 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 su h!:use and/or farm structures. A person who constructs more than one home in a two-year period shall not be consi.',ered a homeowner. Such"homeowner”shall submit to the Building Official,on a form acccptable to the Building Offici ll 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, uring and upon completion of the work fix which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Lial,ility of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you m ly 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 Bu ling Code,Ciry:of . Northampton Ordinances, State and Local Zoning Lags and State of Massachusetts General Laws Ai notated. Homeowner Signature i j • I New House O Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors O Accessory Bldg. ❑ DemolitionO New Signs [ ] Decks [ ] Sid ig[ ] Other [ ] Brief Description of Proposed Work: �''�� � 0 �r 1?11 Alteration of existing bedroom Yes No Adding new bedroom Yes o Attached Narrative 0 Renovating unfinished basement Rs No Plans Attached Roll O • Sheet 0 P n ffflfrom tr ex�l�stnngbhc 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 co.nstructien. bimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Nun I ber of each g. Energy Conservation Compliance. " Masch,eck :Energy,Complia,nce form att (hed? h. Type of construction i. Is construction-within-.100 ft. of wetlands? Yes _ No. Is construction within '100 yr, fl¢odplain Yes No j. Depth of basement or cellar floor'below finished grade k. Will building conform.to the Building and oning regulations?, Yes Na, 1. Septic Tank City Sewer Private we1,1._ City water Supply oil b: 0a t y ME-10"I'll � � R , 1� � iit .�aN-"„°, - � .•,r.r..2nxu .�x'rrr, r �!r d;!�^'k8�a!c M'!, a a,n�`k` s:,s� ,,.:!F!v .....n,t,�.,.. ,!.:,�' +�!M:!1..�9i,'u,.: c!._:�s.1i,,,�.�oani441�:a.�rr_. I. as Ow pr of the subject property hereby authorize to act on my behalf, in all matter srelative-to work:authorized by this building permit application. Signature of Owner Date /7•� t/i Off'�'� � ---- as Ow er/Authorized Agent hereby declare that the statements and information on the foregoing lication are true and accurate to the best of my knowledge and belief. - Signed u der the pains and penalties of.perjury. �' Yyf (er Cyd'j V/ Print Name 0 0L Signature of Owner/Agent - . Date ilk �e City of Northampton ' 't Building Department : n 212 Main Street _ JZ _.'Room 100 ° Northampt'pn, MA 01060 > phone,413'5%7.12,,0 Fax 413-587-1272 , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING $ECTI(JNtl!- 51TEuf j WAIT P. r �. ���{�� �,)�[s�^sect�o �b� 4fl�". pC"e.}e°�d�b'�office�',�.�' �,� •�� . 1.1 Property Address: /7$ a//�+ , � r�� dry• :a � ,� ;���' °,�'r*�},,. C 3 r Zone . a; kµ yr .gx•�Vl �`� k �r a ^k ��� �r a3� ^4r .e•.�4 . . . !��EIrrS,t:��istcict l erc%�k+h• _.° �^ C' Dis�}�cf ��•^>�,,�' � � . . .• '.hG,,'p a"sF ,:k;,ycyy%l...J4�'�'_ -t' �`'.: I 7LL I S:EC PE �YQ1�VN'E 4P�/1''�A}U[T Oft Zy�'1'fAt..:EN P'l '' �?r=rs•',:�!7 -h;r� ,:1•rr_�r' D `•' IT _.. : . •;r : g.1 Owner of Record: /�, Q t'1'I(,�/� ins' 1 9/-tad/ s� � d %�` Name(Print) CL rr nt aiing, ddres Telephone Signature -- 2.2 Authorized Agent:- 4e— 90 0/ 1-7 If6l Name(Print) Current Mailing Address: �A Signature Telephone a''la"a° ua :'m r,;k ^� c•r F"51= 70�N3 . a111 A TeED.CO:N� �? �d. M�/y+���ygx"���Ty ';P.'`'--�'> :•ro._,:M..,_.:..,.__•rnnx�i�+:.nr Mm:::n:.,:^vc.r�I_rF s.::�—�'nl!nr:.+�wlr'a:�,:.rP a.R w:S �r� I i4. Item Estimated Cost (Dpllal S) to be 'J completed b permit a licant ...'Bi1'�"I.:P;•.`...•..: ,.X4 :e„�.,n,•y•,� .-. .. 1. Building / (a) Building PP TT.. Fee( 2. Elecincal Eti), stirn ted. To J= of _ Constructi.Oft;from; 5` 3. Plumbing Building Permit 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 +'2 + 3 +'4 + 5) 041 ly .Check..Number 7his.aect'ion'•;Fclr.Offi: ly. g.uildfng•,Pe'rrSirinNurnbe�` Date:lssued.: n� ,Ia ...-�:,;a rn.,••.�..r�. -.... .r a..'.: �t:: ..•_ ...•.� !.,a ' ,� .'.:. '.:a. ;' _.. �''„1 ,F ,'r.:r"•r'L;;�� :ya : A If „,',F Buiiding,,Gotimssionr,' Ln p�ctor_:pf Building a bake; T BP-2009-0524 GIS#: COMMONWEALTH OF MASSACHUSETTS ` 5 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-2009-0524 Project# JS-2009-000731 Est.Cost: $6099.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 120982 Lot Size(sq. ft.): 12632.40 Owner: JACKSON JENNIFER M& STEVEN ROMANOWSKI Zoning. URA(100)//WSP II Applicant: ADAM QUENNEVILLE AT. 123 BROOKSIDE CIR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.]]/]712008 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 11/17/2008 0:00:00 $35.0013650 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo