29-130 (6) 111 Date/Time 06/27/2007 10;59 1 413 538 6010 P. 001
Jun-27-2007 09:50 AM - Remillard Insurance 1-413-538.6010 113
ACQW. CERTIFICATE OF LIABILITY INSURANCE CSR RL DATE(MM(D0rffYY)
ADAM -1 06/27/07
PRODUCER THIS CERTIFICATE 15 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•-53$-7862 Fax:413-538-7179 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER* Scottsdale Ins Co,
Adam Queunevill® Roofing & INSURER& AD[Yucual rneuxnana CcaaDaay
siding Inc INSURER C•r
P O BCI]C 612 INSURER 0:
South Hadley MA 01075
INSURER L.
COVERAGES
THE POUCIES 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 15 SUaJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF✓;UCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. F RA IN
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE M D1)M DATE MMA) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
RERTM-
A X COMMERCIAL GENERAL LIABILITY CLS 13 8 419 8 D6/23/07 0 6/2 3/0 8 PREMI5ES Ea omnmca 1,50000
CLAIMS MADE XX OCCUR MED EXP(Any one person) S 5000
PERSONAL 6 ADV INJURY 6 10 0 0 0 0 0
O r. ) GENERAL AGGREGATZ 1,200000D.
GEN L AGGREGATE OMIT APPLIES PER: 'v PRODUCTS-COMPIOP AGG 32000000
POLICY j&?� L OC
AUTOMOBILE LIABILITY
COMB
A AUTO
COMBINED SINGLE LIMIT
NY 6
ALL OWNED AUTOS
BODILY INJuRr s
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY S
NON-OWNED AUTOS (Per aaldenl)
PROPERTY DAUAGE 6
(Per ecddenl)
GARAGE UABIUfY AUTO ONLY-EA ACCIDENT 6
ANY AUTO
DTHERTHAN EA ACC s
AUTO ONLY: AGG S
EXCESSIUNIBRELLA LIABIUTY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE L
S
DEDUCTIBLE S
RETENTION S 6
WORKERS COMPENSATION ANO
EMPLOYERV LIABILITY X IT RV LIMITS ER _
$ ANY PROPMETOWPARTNENEXECUTIVE AWC7012861012007 04/29/07 04/29/08 E.L.EACH ACCIDENT 6100000
OFFICEMMEMBER EXCLUDED? LL,DISEASE-EA EMPLOYE 5 10 O 0 0 0
If yas,desarlbe under'
SPECIAL PROVISION$below E.L DISEASE-POUCY U W 1 6 500000
OTHER
DESCRIPTION OF OP&RATIONS LOCATIONS!VEHICLES I EXCLUSIONS AOOED BY ENDORSCMI NTI SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
AMBERCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WHr17EN
NOTICE TO THE CERTIfICATI HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SMALL
IMPOSE NO OBLI OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Lo p REPRESENTA
AU }�g16 IV -
Board of Bui ding ,Regina ions and Standards
One As burton Place - Room 1301
Bost n. Massachusetts 02108
Home Impr vement Contractor Registration
Registration: 120982
Type: DBA
Expiration: 3/25/2008
ADAM QUENNEVILLE ROOFING
ADAM QUENNEVILLE
P.O. BOX 612
SO. HADLEY, MA 01075
Update Address and return card.Mark reason for change.
PS-cry ca rr0W04ia,-PCa696 Address Renewal E] Employment E] Lost Card
oar o i in a u1Vns an tan ar s
_ g
One shbu on Place - Room 1301
Bo ton, Massachusetts 02108
t
Cons ruc ton Supervisor License
License CS: 70626
Restriction: 00
Birthdate: 8/21/1971
Expiration: 8/21/2009 Tr# 3712
ADAM A QUENNEVILLE
160 OLD LYMAN RD
S HADLEY, MA 01075 --
Update Address and return card.Mark reason for change
7, 7*777777-
! STA' E ®- ' CN1eICICiTT. + D + ARTP+'� NT,.QF C'sI�1SUlVIER P1iOT.ECTION
B it 079M*that
AM UENNEI .I,E
60 O T ROAD '
I SOU Ti ��
2632
is �emfiet b}�;te D part� d � onstr ,�dtectton as a register ed
0 IMY R ` rTT ONTRATOR
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Et .
ADAlVtTENNIT,•T F RO .�LNR,dNSr�,� 7 j
.�.... .. ...4 u.,<. :.. .,
E£ect�ve;
1006
EpIrat7n� � 20 y s i f
QU'E/VfVEV�L.LE cq1 t ELKtf
ROOFING INC. The Premium Choice-
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 Factor Certified Installers
Member of the Home Builder's Association of Western Mass. CT Registration#575920 y
Member of the Building&Trade Association Member of the Better Business Bureau P.P.C.38710
Proposal Submitted To: Date Phone#'s
Cell:
Street Mail To:
City, State,Zip Code Special Requirements
Proposal to furnish and install the following `�,tiL
a +.
Re-Roof Tear-Off ',Gutter -' ` `�
Complete Roof Preparation4�L �i 4' h cv;N,
!�"a f
Home exterior to be protected by tarps and plywood ' CC, o'? `r , f ;
❑;Shrubs,landscaping,trees to be protected ' ' / a 6,
-['_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
R Deteriorated existing decking replaced at per sq.ft. 'b(�j, C v i, �,�Iti
`? i
White XBrown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only
[ New flashing will be installed where necessary(see Special Requirements)
R;Install new pipe boot flashing
We shall acquire all appropriate permits etc.for all roofing work
Complete Roofing System
.['�ELK Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north)
❑ ELK_Leak.ardor-irasta4ed4n4a walleye-a nd-pertetratons mmid-chi eys&te•.pxatecLcriticaLar.eas
[1 15 pd. reinforced underlayment installed over entire decking
Shingles: '`
[ ELK Prestique®Series 0 year X50 year Color k - e.cp-t
Nailable ridge vent will a ins alled
0 ELK ridge cap shingles
Warranty Options: U
2 We guarantee our workmanship for$full years
❑ ELK10-Year Umbrella Coverage Limited Warranty upgrade.
❑ ELK15-Year Umbrella Coverage Limited Warranty upgrade.
visa
We Propose hereby to furnish materials and labor-corn Ivte igKordance with'above s ecifications for the sum of:
Total Sale Price$ /L'�'• 4 Down Paym t$ G (� f�Jpon Completion $ 7 ,f
ACCEPTANCE OF PROPOSAL:The above prices,specifications-and-Gdltiofis 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.
'y
t
Date f r i Signature. 1 (' =( .. Phone#
Date: ' c7k,Estimator's Signature:� i
Estimates areed 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,6raoolF f6f>t!4''W66 1.Adam Quenneville Roofing and Sidings
i
will not be responsible for debris or dust in the attic or storage areas.
r
.o� -fly Of �ltrlfll�ttlt}�fnll _____
4 � �r-1�lSa ACh It5Cll0
EPARTMENT ON BUILDD�G INSPECTIONS
12 Main Street ' Municipal I3u1ltling
Northampton, MASS. 01060
W0 RICE,R'S C I NIT ENSA770N 1NSUItt1.NCE AIr'FU)AVgT
I, --
(]icons°Jrf niiitcr)
It h a principal plact of bus' esshcsidenc,
do hereby ccr-dfy. under the ; ains atld penalties of prrjury, ;.hat:
( I am an employer provid in- the iollov.vino, .;c�rr_er's co1l1nenSa6on coverage for my
elllploVice$ worErig on tills j b:
( na=G' Compam) (?0LC:Nu..tbcr) -- (Expimi on Date)
( ) I and a sole proprietor, nPra Cxitnc-or or hen eo��ver (Curie one) and have iiirei
the contractors listed below-,,to h_ -the 't ok'VLng, -;:�orkers r�mpens�zaon
(N me of(Contnctor) (tnsumncc Come,:n}•,'Polio— Nu�.11bcr) (Lx::rr.icm. Datc)
(Name of Contnctor) - (Imsmmcc C01?ca„),1Po!ic; Number) (Fxrir tint Dale)
(Name of Contractor) l4 lll])1}'r) •X,i G>Date)
(Name of Contactor) (1nsurunc Colnrary/Policy Numbu) (Expi stir.Di(e)
C, I iUll a jole prap'ncLu!- c:',j have no 71: i)!liii` for ill".
am L'_ honle 0 ,'!lC• 't7Ci? 'l?]!n^ all i!i.
NOTE:plc_.ae t`e alrue Li x.t1 de Fc<rc:1,ir .',r�r... I y o<:� �_�
'rllncq!L.:'_r.:Ci YI Cf]tp alt 11,R 7:,M:
not UK< than throe uni+a ir,N%- icir:.hc f;crm . rn:w a-oc;11 �•;:�z�uti r ri ihcc o--s rxx
ploycz u.�ct thr 1w:�;cr s oc x--: :cn (C,L!52 'l(511,n .t;c::ic:;by a hntaroll s for a Lcex cr paa:i::::c
legal rtatue oFan employer under trio Wo ti .comT>v Lion Ac
I undc-ziAmd thi a co 7y of this cratci:=auy tc fcx,,do-; to tln 1),_Sxittn c:, of tnd»s ri_I Mils:f(?frcw of!: r e for lfx
mverz.gc vcificlioa and Oak L-.ilutc to! c eortr_;,,ut•,d:scrim 25A of 1.tGL I52 eta Icui to the Y Of fi tion !:r-si l or tl L:es
Consisting art fur of up to S 1,500.00 n &, o(:ia to rn:}- r r.-.j civil crultin in do 1<mn of S!c+`.L' ii O t;�e:d
frk"0(SIDUO i diy tg:_in:.1 rn
Fordcq:uvmtal u,o uily
Pcrrnit NIMAX:r ---
Map", i + "
§y N:xrlti{ Ai VA i "mp
SSG, ONxB Cd 1,5T tUGTI,ON SERVICES ('.
8.1 Licensed Construction Supervisor: Not Applicablerr�� p❑
Name of License Holder
License Number
QUENNEVILLE ROOFING&S N,'G,I'vC. O
Address 010 75 Expiration Date
So.Hadley,MA
Signature Telephone
R u Grie.n"0 orff a' :� Not Applicable ❑
Company Name AM Registration Number
QUENNEVILLE RWIIe SlDI11G,IN . �a5 O
Address 01075 Expiration Date
So.Hadley,Mk
Telephone L =1S:rf
lSEG�R� 101N RKE+RS'fiC0MP6NSATION aNS RANGE AFFIDAVIT(M G1L c I;52, §25Cr;6))
ry
Workers Compensation Insurance affidavit must De completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the bui ding permit.
Signed Affidavit Attached Yes....... o...... ❑.
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 individual for hire who does not.possess a license,provided that the owner acts
as su ervisor. CMR 780 Sixth Editio a Section 108.3.5.1.
Definition of Homeowner:Person(s)w o 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 fami y 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 erform d under the buildin 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 pe it is issued.
Also be advised that with reference to Cf apter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in D ath)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 Locz 1 Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
,
SE fi01 � R:OP„„OSED RK c cf 1a lira ale t�
'�"}��� .. ._ siNrv�.:h{ ri 'k�+P 5. 'x Fi^�.'M'�'N�v,”9� ,4'1.�6:� Slcil�.��•.
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: �i o IZOA lz Roof
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D - Sheet D
6a': ,_ fir ddsi n to a tin ~h n co I.e,e: ITMLI en
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. bimensions
e. Number of stories?
f. Method of heating? _ Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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 fins hed grade
k. Will building conform to the Building and Zc ning regulations?. Yes No
I. Septic Tank City Sewer Private well City water Supply
E � � RMA, TO 6 ''nC01VIP ETED.WHEN
I, as Owner of the subject property
hereby authorize to act, on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I' QL'�Onre 00 as Owner/Authorized Agent
hereby declare that the statements and inform ion 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 _
y-o
Signa of Owner/Agent Date
Section 4.
ALL INFORMATION M JST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LA(,K OF INFORMATION
Exist' ig 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/Varian e/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or n ed to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the proper y? YES NO _
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the prc,perty ?YES
No
IF-YES, describe size, type and location:
City of North mpton
Building De.p rtment
212 Main Street
Room 100
North`ampton, MA 01060
-phone,44 3.58 •1240 Fax 413-587.1272 f -w
APPLICATION TO CONSTRUCT, ALTE , REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE fNF:OIYtE,'tiTION
1.1 Property Address: r.
Zo r
"e
(��� ,�EIrStDAis#r;iet �° ,se ���6 D�set s
SEC71N 2 ROPERTY OYYNERSH4PEAUTHO r 1ZED gEN7
2.1 Owner of Record:
s
Name(Print) Current Mailing Address:
:z
Telephone
Signature
2.2 Authorized Agent: _
Name(Print) Current Mailing Ad Tess
Signa ure Telephone _
5.ECT10N3....E5;Ml IVIATED CANS7_RUCTfO.N.0 S:TS
..,
Item Estimated Cost(Dollars) to be Official+:Use Only
completed by permit applicant
1. Building (a) Building Pe'rrn4t Fee
Lt co
2. Eler_ rical (b) E.stimated Total Cost:of
Constructionfro;cri 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) `1C-/0G I Check Number p �
This Section for Official Use`OnY ..
d ing,T.. Number_ Date.l"ssued
_ -
Signature:
t
Building-:Q ommissionerYlnspector Dae .
...#0 A
`° BP-2008-0374
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-2008-0374
Project# JS-2008-000538
Est. Cost: $4400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Adam Quenneville 120982
Lot Size(sq. ft.): 81892.80 Owner: ROBINSON ELIZABETH M
Zoning. URA Applicant: Adam Quenneville
AT. 40 ALAMO CT
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.101512007 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 Sisnature:
FeeType: Date Paid: Amount:
Building 10/5/2007 0:00:00 $25.0011451
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo