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05-017 (3) AIM 01A oar o q mg egul ions a . tan ar s One Ashburton Place - Roo 1301 Boston, Massachusetts 0 108 Construction Supervisor License License CS: 70626 Restriction: 00 Birthdate: 8121!1971 Expiration: 8/21/2009 Tr# 3712 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 --- Upda a Address and return card.Mark reason for change (� Address Renewal Lost Card DPS-CA1 Co 50M-07107-PCB490 Boar o Bull- iri 'Re lat�ons a tan ar s VA g One Ashburton Place - Roo 130.1• Boston. Massachusetts 0 108 Home Im-provemerit-Qntractor Registration Repistration: 120982 Type: DBA Expiration: 3/25/2010 Tr# 264937 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE :. 160 OLD LYMAN RD SO. HADLEY, NIA 01075 Upda Address and return card.Mark reason for change. Address' QS Renewal. Employment Lost Card DPS-CAI Co 50M-07/07-PC6490 B.e It kliovm that ` ADAM. Q[TjI�TNV 1�0 5.2632 '� x 1• i`s cetrtiec�b th cite ti�h as axe I � stered i. IMP �RANST l =DADA Q�711'' EVLY.I R '4FtNC� y , ,s: ya/1 �/.'�/ •r ■�/'�■�' '' l 4 ,rn�n+vis-i W t�'4{�yq�� f N !�!;.0�yC''S' ��dr 3�+ '. b' i:: 3 �t19 i Y Mt�l5 R ,T"'� 9., 'F T •t k•r' • :c S +" " Gr A. ..ilnD�rf'1 .hr ,,,;i R/ }. .. i _ ,,; N. t, Qnlfh1591bnel ,� =. - Wil- � .,••arw�• • e • • • ♦. •. •'AIM°•. .....•.. + It A_=G4U/ 1lIII t, UU/ V1/ u U • , ... Aug-01.2008 01:42 ,PM Remillard Insurance 1-413-538-60'.0 1/1 ACoRD CERTIFICATE OF LIABILITY INSURANCE AM 1 DATE8/01/08 .ADAMQ-1 OB O1 08 PRODUCER THIS CERTIFICA E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON RS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER.THIS C RTIFICATE DOES NOT AMEND,EXTEND OR 79 Lyman Street ALTER THE COV RAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 Phone- 413-538-7862 Fax:413-538-7179 INSURERS AFFOR ING COVERAGE NAIC# INSURED INSURER A ATM Mu AL xusersuoe Conpeuy INSURER 8: Travelers Ins. Co. Adam Quenn villa Roofing & INSURER C: Scottsdale Ins Co. Siding Inc - 160 Old Lyman Road INSURER D: South Hadlay MA 01075 INSURER E: COVERAGES THE POLICIES OF tN6URANCE U8TED W HA N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P RIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CO ON OF ANY CO CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE ORDED BY THE POL ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXC US1095 AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS DWN MAY NAVE BEEN EDUCED BY PAID CLAIMS. LTR N5R °: TYPE OF IN URANCE POUCY NUMBER DATE MM/DD . .OA MMIDD LIMITS GENERAL LIASILI " ' "" '" EACH OCCURRENCE $1000000 C X COMMERCIAL FJJERAL LIABILITY CLS 1517 9 2 3 0 6/23/08 0 /2 3/09 PREMISES EsDooaXencel x 50000 CLAIMS MA E OCCUR MED EXP(Arty one Person) $5000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE 7 2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER:' PRODUCTS-COMPIOP AGG 62000000 POLICY JECOTT I IEI LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 51000000 B ANY AUTO BA745OL94607 11/01/07 11/01/08 (Eeeeddent) ALL OWNED AUTOS BODILY INJURY S X SCHEDULED AUTOS (PNA) X HIRED AUTOS BODILY INJURY S X NO"WNED AUTOS (Per accident) PROPERTY DAMAGE S (Par accldant) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S T � AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S 3 WORKERS COMPENSATION AND X TORY.LIMITS X ER- A ANY PR EMPLOYERV LwsB-m AWC7012861012008 04/29/08 /29/09 E.L.EACH ACCIDENT 61000000 ANY PROPRIETORIPARTNERIEJfECUTIVE OFFICIEWEMSER EXCLUDED? E.L DISEASE-EA EMPLOYE $1000000 IF qqECVU-PROVISIONS below ea,deeatbe under SP E.L.DISEASE-POLICY LIMIT 91000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISION V CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE NBOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE SSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE:TO'THE CES.MFICATE HOLDER NAMED TO THE.LEFT.BUT FAILURE TO DO 50 SHALL IMPOSE NO 0 GA. NOR UABIUTY OF ANY 12NO UPON THE INSURER,ITS AGENTS OR REP E AuTH t► a - _ Ste hen E. Radon ACORD 25(2001108) O ACORD CORPORATION 1988 Office of Investigation •• , • 600 Washington Stree Boston, MA 02111 M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders! ontrac ors(Elect:ricians/Plumbers A,ppUcanf.Xnfor)mation Please Print Le gib Name (Bu sincss/Organizadon/Individual): Address: v� L City/S tate/Zip:_ S2�z A- OCQ1� Phone#: ,. ��� ��..t,U•r-q5� .: Are yo am employer?Check the appropriate bdx:` Type of project(required): 4. ❑'Tarn a general contracto and 1 6. New constiucti.on. 1. I ain a employer with_,.f S ❑ employees(fiill and/or part-time).* have hired the sub.-con ct$s ❑ Remodeling 2.❑ I am a f ole proprietor or partner- listed on the attacbrd sh et. ship an have no employees These sub-contractors h ve 8. (]Demolition working forme in any capacity. workers' comp.insuran e. g, ❑Building,addition [No workers'comp.insurance 5, ❑ We are a corpQrati oh'ar d its 10.❑Electrical repairs or.additions officers have exercised . requir• d.] 11. repairs or additions 3.0 I am a homeowner doing all wotk . right of exemption per GL ❑Plumbing ep myselft[No worker s'-comp. c. 1.52, §'1(4),and we h ve no 1'2. of repairs [No works ees I employ . ' insurance recluired.] 13.❑ Othc�' comp.insurance rrquir d.] `Any applicant at checks box#1 must also fill out the scctiou below showing their workers' ompemation !icy information. t Homeowner o submit this affidavit indicating they are doing all work,and t .hire outsi a contractofs ust Bubp�it a new aff idavit indicating such.- . 1contraeton that cheek this bob must attached as additional sh6ot showing'thanamcaf ties ntracfois their workers'comp.policy iufocma[io4. ram:an employer that is providing workers'compensation insurance far y employees., mploy es.•Below is•the policy and job site information. Insurance Company Name: r ' Policy#or Self-ins.Lic.#: �� �b �� ��'( � Exp' tion Date:_ �,'" �-"� f _ ��/ ' Ci is t�z Job Site Address' 1 "1 �� �' . Attach a cop the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to se ure coverage as recruited under Section 25A of MGL c.152 c lead to f a imposition of c imilial penalties of a fine up to$11500.00 atld/or•onc-year imprisonment,as well as civil penalti inttLcfc'qma of a.STOP•WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised brat a copy of this tatement ay be forwarded.to the Office of Investigations of the DIA for insurance coverage verification. Z do hereby eHif}i under pairs and penalties of perjury that the info ' n pr ed above is true and correct Si ature: Date: 1 Phone :t. !�3 • Official use only. Do not •write in this area, to be completed by city.o r town offic L City or Town: Perniit/Lii ense# Issuing Authority(circle one): L Board!;of Healtb 2.Building Departmept 3. CitYfT.owu'Clerk 4 Electrica Inspector: 5.Plumbing Inspector 6. Other' - Contact Person. I hone#' Name Cust.# Date � QUENNEV�LLE " "'�� kr' ROOFING&SIDING,INC. Street Address City State Zip 1.800•NEW ROOF I T�U�U b�O�� I% L F 7> > N) rA (3 l 01` 413.536.5955 Home Phone# Work Phone# E-mail 1800NEWROOF.NET _ COMMERCIAL-RESIDENTIAL 160 Old Lyman Road•South Hadley,MA 01075 �? 1 hereby authorize you to proceed with the diagnosis for a minimum charge of$Z cJc cJ x,, �- StraightForward Pricing® F h)v Ti)2 r' n IV R ace 4 S�of shin le ,Stepflash/Countertlash 41'to 50'of wall,Replace 51'to 7 65'of valley,Reflash 17'to 25'chimney,Construct cricket and flash 3'to 6'wide chimney,or Roof clean up to 24 squares.(Add$50.00 per square if area is larger than 24 squares) Cover fascia or rake with Aluminum 51'-65'/Replace 22-30 slates. Quantity---L x$1637 ea = Replace 3 SQ of shingles,Stepflash/Counterflash 31'to 40'of wall,Replace 41'to 50'of valley,Reflash 16'to 20'chimney,Install 71'to 110'of ridge vent,or Roof cleaning up to 20 squares.Cover fascia or rake with Aluminum 41'-50'Replace 16- Quantity X$1277 ea = 6 20 slates. Replace 2 SQ of shingles,Stepflash/Counterflash 21'of 30'of wall,Install 51'to 70 of ridge vent,Replace 31'to 40'of valley,Reflash or replace up to 2 Customer 5 Supplied skylight(no interior trim work),Install 250'to 350'of drip edge,Reflash 13'to 16'foot chimney,or Roof cleaning up to 7 squares.Cover fascia or rake with Aluminum 31'-40'Replace 11-15 slates. Quantity x$839 ea = Replace 1 SQ of shingle,Stepflash/Coumerflash l l'to 20'of wall,Instal131'to 50' even,rnsta 2P to 30'-of valley,Clean 251'to 350'of gutter,Reflash 9'to 4 12'chimney(perimeter)or small stone chimney,Replacement of customer supplied skylight(no interior trim work). Tear off and re-shingle 2nd story bay window. Install 10l'to 200'of dripedge,Roof cleaning up to 10 square.Cover fascia or rake Quantity x$694 ea = with Aluminum 21'-30'Replace 7-10 slates. Reflash up to 8' perimeter chimney, Replace 1 to 2 bundles of shingles, 3 Stepflash/Counterflash 6'to 10'of wall,Install 51'to 100'of drip edge,Install 4 to 8 hat vents,Dryer hose connections,Replace up to 15'of valley,Tear off and re- shingle 1st story bay window,Install up to 30'of ridge vent. Minor tuckpointing and watersealing of chimney (<3' in height),Re-stepping and IceGuard 2'x4' skylight,Installation of curbmount skylight,Clean 150'to 250'of gutter,or Install 51'to 100'of drip edge. Cover fascia or rake with Aluminum 11'-20',replace Quantity x$539 ea 4-6 slates. Still boot replacement,Replace up to I bundle of shingles or up to 20 shingle tabs, Stepflashing/Counterflashing less than 5'of wall,Installation of up to 5p'of drip 2 edge,Installation of up to 3 hat vents,l0'or less of gutter/fascia replacement,Clean 31'to 150'of gutter,Reflash electric pole/heat stack,or Crop up to 30'of valley. Quantity x$367 ea = Replace 1-3 slates. Cover fascia or rake with Aluminum 10'or less. 1 Roof certifications of Gutter cleaning(up to 30') Quantity x$159 ea = Custom Request _ Quantity. x$ea: antity X$ea' _ Qua ity x$ea: _ L Recommendation a 1 hereby authorize you to proceed with the above StraightForward'Price!of$ 2 X k � Paid via: Cash, Check(# ) Credit Card Diagnostic Fee= MC,Visa,AE CC# Exp. Total Due today$ Work performed to my satisfaction Scheduled Arrival Time Actual Arrival Time Thank You! f ':.1N.'rt4V Y ld f'_-. ... .,i) .,.4.,,.h• � •r• H--.n11 rll 1.. Ps sl��t�flrr l.; „ 8 1 Licensed Construction Supervisor: Not Applicab e ❑ Name of License Holder : /`16) It✓��l QLJ ;e,'1 1,1 i" V/ lIr /`f d&�/��� — License Number 0 0 /c/ aw Rw gl -,2 Address Expiration Dab! 11_11-'" q 3-- S'3 Signature Telephone 'Ell 7e"40,0-78; _Not A licab e ❑X-;'z© Company Name Registration Number Address Expiration Date Telephone .?i-':I"'-"--�i' v.•i n +: r:"!. •:y'M1."n:r ii r:lr ..f'r-I.. -M l.Yhl:. .'i.'�i. j M .rrv::' �'�•. � ,_ € �. "R� 3n,'r .''��::'�'j ,Ili',. '4.'� ty ,4�:.- ..'�r'i=a,n•,S':. r,.:d furr -Workers Compensation Insurance affidavit.must be completed and submitted with this application. Failu e to provide this affidavit will.result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑. arm y.. The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of o e(1) or:two(2)families and to allow such homeowner to engage an individual for hire who does not.possess a license,nEgyj ed 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 sub'rnit to the Building Official,on a form acccptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction S.utiervisor 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 m iy be liable for person(s) you hire to perfonn.work for you under this permit. The undersigned "homeowner"certifies and assumes responsibility for compliance with the State Bu Iding Code,.City,.of . Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature i a. e :II .AYTeTWR:_Y a Omrr. TMII. :AHM x New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing , Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding[ ] Other [ ] > — (' Brief Description of P-roposed Work: 8 e� L7 L-'Pi 1/✓l � I/l? Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement es No Plans Attached Roll 0-Sheet 0 6a i l 6 eH a: a drlf n Me)-yVst i n�r rl-. eam p;te=e a,e`e foff-k'1>wosrIMERI< a: 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 1Noodstdves _Nbriterof each g. Energy Conservation Compliance. Masch,eck Energy.C6mplia.nee form atf ched? 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 Zoningregulations?. Yes No I. Septic Tank City Sewer Private well _ City water Supply , a��• ,.�:e �• ti a v 1 ��1 ..0 Y�� .� l��� !t.l•'i��f\�I 1���1.u�� �.r�M�aTI ,.�`x'�i- �`,a, - x,� �'�i� 2mfi�1'dl, ?1'm .r.�in'rel�lii=! yr�i�`e•'Brt wlS�'��w��a-a,"„F'caiiS:9f�xu... as Ow er of the subject property r hereby authorize _ to act on my behalf, in all matters relative to work:authorized by this building permit application. Signature of Owner i Date 1, ' c, ---- as Owi er/Authorized Agent hereby declare that the statements and information on the fore oin' knowledge and belief, g pplication are true and accurate to the best of my Signed un er the pains and penalties of.perjury. 7 r Print Name Lo Signature of Owner/Agent Date: ,. r — r I City of Northampton t Building Department 212 Main Street R` `Jl,L� Room 100 ; . r l�Jorthampton, MA 01060 ' phone 413.5:$7.1?40 Fax 413-587-1272 a ,APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING : . rL R'. ,,, .. .. R ,�'�'�h� '�eC�t•1;0�� rr. GO pf"et'e�d�b �officer�"� �"r' '�� 1.1 Property, Address: 4esx ,� �� �� aj��s4 }ryy, PI'�T],� `.f+'..j. `^'X�1�k �Y -��t�"f'✓L'7(4'y�,,r rt�f j. Loa • ?�ZOri" -.r-�. u ' �_ �v t� y Di .�tri.e� a �•+k"',�`���s,, x�ElrrSt.3Distrrct'�a,� r€�,'.�aa �r`'� C Drs�ricf '�-?�v�µ�'._•,�r ' •_ • ._ c—.—r—r.�r.�u.a.rrw s�,a r,......•..._. S__ECTI .Np2='P:FO;PEfjY�i`Q Hi Ul ,i_Qr IZiJ. ,'GEtJT. .�.,, r. / •i.Fy � ..'�::v�. .Vi.-�'r 1 i 'r ..,Q•� t.:..,:.+,..-:.:cr ... :.._ .e..... .....r ,.�... .r... .r.._: ..s_q'h7. =,�+^g.:^rvvra .......:.......c i.."ei Tr....,-.. .r — rc•r•�:r .., ii'1.l,.. _ ,,:;;.r^�':rrn.�;,�,,;:r:^ 2.l Owner of Record: w,1�' Name(Print) Gwrrent Mai ing;A• dtt sss'•• / Telephone Signature 2.2 Authorized Agent: Name(,Print Current Mailing Address: Signature telephone 1. ;c�Ta5•FFk1�,35 -. ,%._:.4 wGY'�' 'a' :��is.�Nd9;' 'I• '— - 5L f1 _� era:M =OfV=3.._:ES`t7+lt '�tTErD'm:CO.N'S�'C�R', °ZG... wT�mr�a"�til : ';Y- 4 ___ _ •r hl n*`^'I:.::^l,L'": ."r.TJ4.^ ..nPrlR:i:'b^_.' ,9b Item Estimated Cost(Dolls) to be :,TOff�eia1� se nf)n com feted b ermit applicant �Y ' 1. Building rI //�Vj//� / Via) Building Perrn'rt (7 2. V l M 2. Elecirical (b) `stimeted Tota'i Cdstsof Construction, 5` 3. Plumbing - Building Permit Fe's ~ 4. Mechanical (HVAC) S. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Seoafl 'r,F&r.Oft)cial Use'f5rily_ Buildings,P,.errhi€;N'iirii'b�e Y Date'il i ~ I, 4 , M ^+ti- iiNuxr�;a' r. .. :•. 1!:: J. imissioner/Inspector of•BVi.Idings„. „ ,`,; pane, - t BP-2009-0787 RD GIs#: COMMONWEALTH OF MASSACHUSETTS : k;05-x317 '1 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-2009-0787 Project# JS-2009-001171 Est. Cost: $2000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 120982 Lot Size(sq. ft.): 27834.84 Owner: STASZ JANE K&LEE C ROOT&KIMBERLY J BENJAMIN Zoning: RR(100)/ Applicant: ADAM QUENNEVILLE AT. 141 AUDUBON RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:313012009 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 4 SQ OF 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 si nature: FeeTy e• Date Paid: Amount: Building 3/30/2009 0:00:00 $35.0014396 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo