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17D-036 (5) CSR RL DATE(MWDDIYYYY) ACORD_ CERTIFICATE OF LIABILITY INSURANCE „DAM _1. 10110106 PRODUCER THIS CERTIFICATE IS 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: 413-538-7862 Fax:413-538-7179 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Scottsdale Ins CO. INSURERS: Arbella Protection Ins Cc p�a� IZuennevill Roofin & INSURER C:. A r-eoa>. .m- Cc-w--Y SidinQ 'Iac (Resf dentialy P 0 Sox 612 INSURER D: South Hadley MA 01075 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEIINSURED 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 IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FUL iNbK LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM DATE MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIALGENERALLIABILITY CLS1274790 06/23/06 06./23/07 PREMISES Eaoccurence .$50000 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $ 5000 PERSONAL 8 ADV INJURY $ 1000000 GENERAL AGGREGATE f.2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2 0 0 0 0 0 0 PouCY !. ESC LOC AUTOMOBILE YABILFTY COMBINED SINGLE LIMIT $ 1000000 $ ANY AUTO (Es acddent) ALL OWNED AUTOS 54906400002 11/01/05 11101106 BODILY INJURY X SCHEDULEDAUTOS 54909400002 11101106 11/01/07 (Perpsrson) $ X HIRED AUTOS BODILY INJURY. X NON-OWNED AUTOS (Per ecddent) $ PROPERTY DAMAGE S (Per acddent) i GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE $ S P] DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND X TORY LIMBS I I ER C EMPLOYERS'LIABILITY ! AWC7012861012006 04/29/06 04/29/07 EL EACH ACCIDENT $ 100000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 100000 Desdescribe under CIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION RAYNONI) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATI LABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. --spa agae ':AUTHORIZE Ste hen don ACORD 25(2001108) ©ACORD CORPORATION 1988 9� Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 120982 Type: DBA Expiration: 3125/2008 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE P.O. BOX 612 - ---- SO. HADLEY, MA 01075 Update Address and return card.Mark reason for change. 3-CA1 Ca 50M-04/05-PC8698 0 Address E] Renewal 0 Employment Ej Lost Card ' Board of Building egulations = One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 08/21/1971 Number: CS 070626 Expires:08/21/2007 Restricted To: 00 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 Tr.no: 3761.0 - tl..nr.tr.n fnr rnrnint anei nhanna of address notification. VAA I STATE OF CONNECTICUT + =DE' RT ENT OF CONSUIVIER PROTECTION # 13.e it known that t' { " r 1I DA, U. NNE1,,"T1`1.F 160`QT:I) h $O AA � x SO1J'I'H Z 075-2632 is certified b the De 1 f� ''moons ! tection as a re stered i Y )? { H;011 IM�'R '�E T NTRACTOR j - r , ADAM QtJ�N1�EVI1:.�.E ROO�II�T ���; t ` { QIJENNEVIL.L.FE 2 � ELKS ROOFING INC. he Premium Choice- 160 Old Lyman Road, South Hadley, MA 01 o75 l� M Are Licensed 1-800-NEW-ROOF • 1.800.4-SIDING 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 `O r 67 Phone#'s t'C©l L" e CJrr F ' H: oVo / Cell: Street Mail To: Sumfov V1� City,State,Zip Code Special Requirements fl\f U �C� 'P f,� O 't� 0106 ,-) ew C i „'1pI Proppsa� furnisliand�in�stall fhe following Re- oo`t� A TTear-Off f❑ Gutter Complete Roof Preparation [N Home exterior to be protected by tarps and plywood Shrubs, landscaping,trees to be protected ❑ 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 ❑ Deteriorated existing decking replaced at$2.50 per sq.ft. White/Brown 8 inch metal drip edge installed at eaves and rakes White/Brown 5 inch for re-roof only New flashing will be installed where necessary(see Special Requirements) KInstall new pipe boot flashing We shall acquire all appropriate permits etc.for all roofing work Complete Roofing System [ ELK Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north) [?( ELK Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas ❑ 15 pd. reinforced underlayment installed over entire decking Shingles: ELK Prestique®Series 30 year El 50 year Color °�U V� l� If Nailable ridge vent will be installed N'ELK ridge cap shingles Warranty Options: j kWe guarantee our workmanship ford full years ❑ ELK10-Year Umbrella Coverage Limited Warranty upgrade. V� �[ ELK15-Year Umbrella Coverage Limited Warranty upgrade. We Propose hereby to furnish materials and labor-comp in r c?- it above specifications for the sum of: Total Sale Price$ 4190`C7 Down Paym t$ U n Completion$ ACCEPTANCE OF PROPOSAL:The above prices,specifications and c ttions are satisfactory and are hereby accepted. You are authorized to do work ass cif' d.Payment will be 1/3 down upon signing,and balance due upon completion. Unpaid balances shall accrue with terest at 18%per annum. Purchaser(s)will pay for all costs,expenses and reason- able attorney's fees Incurred by A am Quenneville Roofing and Si g,Inc.to recover any sums due under this contract. Date: / 2.I Signature: �� Phone Date: Estimator's ignat e: Estim s r hono d for sixty(60)days from ahwvb 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. ?off ((1Tf11 TTf �17T}( cil1T }tlll - 9 - Ad fi�asrnrhnarlla' -- DL-PARTMENT OF BUIIDIRG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMTENSATION INSURANCE A LT (liars-JrcTniit ) ------- v:ith a principal place of businesshesideencce (Stn:t/ci t !zt�.idn do hereby ccrtily, antler dic pains ❑d penalties of perjury, dial: (�an emptoycr providing the followiIlt ++'OI'i_Cf5 eompetlsz6on coverage for my employees working on this job: (Inszu2.n=Coapany) (Policy Number) (Expiration Date) O I a_ni a sole proprietor, general contrcror or homeowner(circle one) and have hired the contractors listed beiow:-;,to have the Tolle'.,:rg workers compensation polices: (Name of Contactor) (Ia2rnc Company f olief Numb-T) (Lx;?sa icr.Date) (Name of Contractor) _ (lnssu once ComDi„y/Pc!icy Numtr:r) (Expiratioi Date) (Name of Contractor) (Insum nc:(--omp:myrtroliw Ni mb_r) - (r"_z�.ir coa Date) (Name of Contactor) - (1cmirance Compa_-.y/11oGcy Ntrmtrs) (Exai muo,Date) (ate cwt ad3itixJ ris-ct if r.!rcm-::n i:•c�!'r.i�i:r:n.:ice:�=:c::irr,':nil c:r._::::0:•1 (, ) I dill it Sole proprleiUC i-id have no mic'%:v'rl;liil for ale. ( I lilt i?lloIlle Oxvner im!'brltlltl all t'le wV0'.r'ni(scif P70"rE:plese be nwa:e ltu:•a mile tc<;e�w1r_:s<�vo r,:y-ploy pe:c�v�d>��;tc:unet ca.-ecn:Cim u,cpav..,�i:•�:E•.el!i:�or n«mocc than than oau•�inµi:idt the I>w.,,>:�u rci'�7. w«�:S,e C;•_:;�:,•r(•.:rtcranl thccto az n,:t earlally vx:��.::.'.:o ti cnployea u•iler the svocket'a ea;;•=;;etim Ft. (GI-152-:3](5)),ap;•l:=bcn by a hrx-nmwzw for a Gcc=cc p-rri:r_,+-.=.tree tl I rgal rtanu of cn a.pl.yw uodar ti.W«kor'r Co nu ,ion Act_ [undo-rtaad thac a copy of tlrir atate�:m e+.y bo(«w,vded to tLo Urtiartaxni of IeK6utriJ/,atiidrn:!OfGoo of _xu•nx C«Um oovatge vrsifictioa nad that failure to a�tr:mvcr-go ux•4.-„cc�,ion 23 A of l.IGL 132 can Icy d to the imposition o;r.'.�isl pce.all:rs 00mt5ting or a fine'orup to S 1}W.00 an9rx or up to cn:)car a;.l civil pc a Uc,in dx A—di Ste,,`Y-iF.ordc:rd a fm oCS100.00 a day ag•.insi m: , 7 For dcpa:urraaal uro ally J l Pcrrrut Nttmtx.r Map"" Lot ss 1 Licensed Construction Supervisor: Not Applicable /❑ Name of License Holder License Number QUENNEVILLE F,, �r Address 16U Uld Eyman Rd. Expiration Date So.Hadley,MA 01075 Telephone ?y S q c Not Applicable ❑ Company Name Registration Number QUEPNNEVILLE t�'t ��+i S _aS_ Address �Gi" `Y f f"'"� Rd.d. Expiration Date So. Hadley, MA 010755��s Telephone 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 o!.JLe building permit. Signed Affidavit Attached Yes....... No...... ❑. 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.CAM 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)ofthe 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 New House ❑ Addition 0 Replacement Windows Alteration(s)0 Roofing Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ) Decks [ ] Siding[ ] Other( ] Brief Description of Proposed Work: '� QA Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0-Sheet 0 ;1, n 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 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 finished grade k. Will building conform to the Building and Zoning regulations?. Yes No. I. Septic Tank_ City Sewer Private well City water Supply 0B P 6 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, _Mom Q,'ei' ' Ili 611'.--1 as Owner/Authorized Agent hereby declare that the statements and information oKthe foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties)I of perjury. ---�xa[ SYS . Print Name -d7 Signature of Own t -^""" Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Ironing This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R R Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved arUn #of Parking S aces Fill: volume&Location A. Has a Special Permit/Variance/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 need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES No IF-YES, describe size,type and location: -, \ City of Northampton i Buildin Department \s _ 212 Main Street R'om 100 Northampton, MA 01060 phone 413.587.1240 Fax 413-587-1272 APPLICAfON TO CONSTRUCT!ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING bEGfTI0N 1-SIt0iE Ak 1.1 Pro((p��erty Address: jit c11 m mtn wQ r+'" xy. ENT 2.1 Owner of Record: _P t a s __c Summer Q wz- )-(A- b JOL 2 Name(Print) Current Mailing Addre�s � �� U4 Telephone Signature 2.2 Authorized Agent: _ h&jr1,QVkeA uutL 1 blc�1 l,u Name(Print) Current Mailing Addre s: Sign re Telephone T. Item Estimated Cost(Dollars)to be OfficiIUle Qnj7 completed by ermit applicant ' .. 1. Building (a)Building Permit Fee H'M.Uv 2. Elecirical (b)E,stimati d.Total=Cosf:of Construction 3. Plumbing building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 9'too-V:� Check Number This S ction';For Offi6al Use:Onl B§dliding;PermifJU,mkel pate:lssued r. .' Building..Go missionerYl, pector of B,Nilding Dete BP-2007-1034 GIs#: COMMONWEALTH OF MASSACHUSETTS �� CITY OF NORTHAMPTON � �m 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-2007-1034 Project# JS-2007-001667 Est.Cost: $4800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Adam Quenneville 120982 Lot Size(sq. ft.): 4312.44 Owner: STEVENS NICOLE E&JEROME W Zoning:URB Applicant: Adam Quenneville AT. 27 SUMNER AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.5/1/2007 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 5/1/2007 0:00:00 $25.0010497 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo