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31B-145 (12) BP-2007-1158 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON ot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-1158 Project# JS-2007-001850 Est.Cost:$16420.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Adam Quenneville 120982 Lot Size(sq.ft.): 8058.60 Owner: YENNER WILLIAM Zoning:NB Applicant: Adam Quenneville AT: 114 KING ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:5/25/2007 0:00:00 TO PERFORM THE FOLLOWING WORK.:ST RI P & 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 ti 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 5/25/2007 0:00:00 $250010694 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo rCity of Northampton Building Department --,571 212 Main Street • h 4•C Room 100 Northampton, MA 01060 _ ,.phone 413-587.1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION x• SFEEFINEEIRMWQY • 1.1 Property Address. • fKU '�$ 'ki• fis t - x . . 1 JEI .D st ict FT4 SECTION•2- PROPERTY QWNEFF-SittlErAUTH1O RED!t''iENT. 2.1 Owner of Record: }�;)\ �gnneQ PD got 2 it Shd6,,tn fec6 /14 01370 Name(Print) Current Mailing Address: Ln� 4 as �9 ay 9 Telephone Signature 2 2 Athorized Aee h Alam 1W DIA L R !1A 91075 Name(Print) Current Mailing Address: `( 63(e Sass- Signature gs -Signature Telephone SEC- Orta Egillati D t iJ57iilr1E ON'C TSn Item Estimated Cost(Dollars)to be ,O{ficial U3elQrtly completed by permit applicant 1. Building IL I0O _ 00 (a) Building Permit Fee 2. Eler,rical (b) Estimated Total'Cost of Constructionfrom,'(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) L(, LaO Check Number This Section For Official Use,Only _ .BuiWipg-PermitNumber Date Issued: signature: - Building.Commissioner/lnspector'of Buildings .. Date; • Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) N of Parking Spaces • 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 IFYES, des&ribe size, type and location: � a 6 r Ted Xaa0 i 1 Tigp c' a Ie : tak4 ' li s`!�.' a`. New House 0 Addition 0 Replacement Windows Alteration(s)0 Roofing 1Y Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: 81 Lip t R.z SvbU eon!— Alteration Alteration of existing bedroom _Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll❑ • Sheet❑ 4` a;v: 1 Ii ;an o 7.4-'0-7 L Iff S1 : 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 finished grade k. Will building conform to the Building and Zoning regulations? Yes No , I. Septic Tank_ City Sewer Private well City water Supply li d,j1 9 1,4,"glZ -05:'. s'a.'CA J.ro RE ; i 1� _,w i le 'n"" n(? r '`yc�':3�iYE5t�.0 ..,PSH , 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, ' "�-vr'k nc t (I-f , as Owner/ uthorized Age hereby declare that the statements and information on the foregoing application are true and accurate, to t - - knowledge and belief. Signed under the pains and penalties of perjury. Qum C nnNeAA,Vf Print Name S a3-o� Signature er/Agen Date Fo u Y+j L si c N SEHvie_ Is' 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: (]-2 OUatt ADAM License Number Dl1Et!NEVILLE F.C:9 (7,17"11,190. g-�x-07 Address 160 Old Lyman So. Expiration Date So.Hadley,MA 01075 ,S3� S455, Signature Telephone =rde na31reffis in2i111011TYiteiaf•7ti"z"Yvn':-= ; Not Applicable 0 a098. Company Name ADAM Registration Number GUEMItE'1LLE RCL'71h:G&C.DI:11 INC. 3- - 0 a- Address 160 Old Lyman RU. Expiration Date So.Hadley,MA 01°75 GTelephone b3459a r„J,^ vs _ pE SA ION.iN R�NCtEr„F-1D'AY1T(M. 1..e,15:2 S 2n'b)) 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 b/ No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 t. - y' t, e,'a 4. (rite of 'Tcu1li<mtptuii b ""..11,4 UEPAATTtL1JT OF 2L11WING INSPECTIONS _MITI k�^ 212 Main Street • Municipal Building Northampton, Mass. 01060 WnWORKER'SCO,M,PENSATION INSURANCE AIT DAVIT Qi ccnsdrerneucc) with 1a principal place of business/residence a:-.� /t,(y,- ItC) Da t. C I &"1„)* 11/2 ,_-_(S1110_((bane':) . 53(4SS (strecUc lfluatehl ) do hereby eerily, under the paths and penalties of perjury, dtar. - (')flene an employer i vOdino the iollooine cor:ets co nnensauon coven-Go foe my emp!ovices working on this job: Al NL RSI _P (Jc7ola`r� 1o19(v-} �I-let-oma (Insurance Company) (Pole:Number) (Expire on Daze) ( ) I am a sole proprietor, generi CUUU CLor or homeowner (circle one) and have hired the contractors listed below who A.z a the folle:ting workers compensai;ion policies. (Name of Contactor) (t-nsu.mnec Company/Policy Numher) (Exp:mace.Date) (Name of Contractor) (insurance Comsav/Po!ie; Number) (Expiration Dae) • (Name of Compactor) (Insurance Com; nyiPolie: Number) (Ent;no:,Dale) (Name of Contractor) (Insurance Comcasy/Polcy Numbs) (E.xammon Date) O I run a sole proprietor end have no one working for me. O I am a home owner pert-ermine, all the v.c(k rraclf NOTE:pic sc be atrzte that t.aiic bccreowma,.:,-,o e.-,Icy,.�-a-.to.:t=AP' '‘..acceaceo Cr :pair,,..,..:::a d..Pui--' not muco then three unit,in utdt the 1.-o-ta r rosi.:oor _ye&—p“.43:h:*pa_vthaw.aw.cz na tatcrJle ccryitPt:to c e iployee under A-+wine+Cream/x(Gi,!51 u-,,(5)) +' cation by a homeowner < s.-.. or a Gct. cc perm __ -..ra e.. Iceal;tabu of m� u loy.r o6r{Ito Wolds Comps,-..tiu,Act • 1 undcnund that a copy of this aratci.t may he fnv:n d.d to tin n:1k,u.w of InAamid AmLoEt Office of l:�.nnrt for 0- cove gtvcrifatim eapvr faurr to eeur:m.;r-,p_wEer cc.ina2SANMGL.152 an Ica to the urpaitim elcr_ti::l pelfica co illing of.flax of up to 11_500,00 ityttYce L risxircn of.upthertywt.r.t civil kip in Sc form of Stc-v'Nek Ont_trA a Gro of SIoo,00 a thy+(.duct mt Fc ... iluw pity � _ Pgmri N tmba __..___I ET-7— . \(y IA; 1 HA Uate/TIge U)/:MGM 1):91 I BIC )De DUIU r. tun. May-012007 02:55 PM Remillard Insurance 1-413-538-6010 1/6 ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID 141 DATE ADAM-105/07/07 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 NAM Y INSURED INSURER AT my m_ apace PVRw INSURERS: Scottsdale Ins Co. Adan Quenneville Roofing &SInc INSURER<: PX0 Box e12 INSURER D: South Hadley MA 01075 INSURERS COVERAGES THE POLICIES OF NSUMNCE U61EO BROW RAVE BEEN ISSUED TO THE INSURED NAPPED ABOVE FOR THE POLICY PERp01NDICATEe.NOIWRILSTAPO G ANY REQLRENENT,TERN DR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT W ITN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR INT PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIED PERCH IS SUBJECT TO ALL THE TERMS.EXCLUSONS AND CONDITIONS OF SUCH POLICES.JJL{ppAGGREGATE WATTS SHOWN MAY HAVE BEEN REDUCED BY PAID GUMS. ��''FFj��EE LLTTRENSRC TYPE OF INSURANCE POLICY N°MBER IPAYIOE(PPEL'Ivt PBPTT'[MAN LNrts GENERAL LIASRGTY EACH OCCURRENCE 11000000 B A meatNU GENERALMGUTY CL81274790 06/23/06 06/23/07 RAISES(E menace' *50000 CLAIMS MADE ®OCCUR LED FSP(My Be P/rol,) *5000 PERSONAL•ADVItL Y *1000000 GENERAL AGGREGATE S.2000000 GENU AGGREGATE LLe. ARMIES PER: PRODUCTS-COMRVP AGG *2000000 f Y7 ELT 17 LOC AUTOMOBILE UAWIJIY /r ANY AUTO / �' PCU-sNPier*/MED TE LWT— S wLL OWNED AUTOS BODILY NRIRY - SCTIEWLEvwVT04 [Pt,WWI) — HIRED AUTOS p°ILYWNRY NONOWNED AUTOS (Prtuxk,rlll NW P NMIPERTYDAIMGE OO GMAC LIABILITY AUTO DItY-LA ACCIDENT ANY ACID EA ACC { AUTOOTHER THAN AOfi ESCESSVMGIRELLA LLABILITY \ EACH OCCURRENCE 7 OCCUR n GRAMS MADE AGGREGATE RDEDUCTIBLE RETENTION s WORID:RS GOMPENSAnON AND X R*ITORYUMTBEM DTR. ER A BMTNDrEnS LIABILITY AWC7012861012007 04/29/07 04/29/08 EL EACHACCI°EM 100000 ANY PRORUETORIPARLUOED?ECUTHE OFFICER/MEMBEREXCLUDED? EL DISEASE-EA EMPLOYEE 100000 Ng+. no1M`9;a1,9" Ns HiOWBN)N9 EMar EL OLRFA6E•PoLIOY NWT 500000 OTHER DESCRIPTION OF OPER/010NR/LOCATIONS/VEHICLES/EXCWSIONS ADDED BYFNDORSEMENT ISPECML PROVISIONS Roofing C' ap.. CERTIFICATE HOLDER CANCELLATION 1SHO LD ANY OF THE ABOVE OESCAIeED muCIEBBE wawa°BEFORE THE EVIRATIONOATETNFSFOF,THEIESWIG INSURER Will ENDEAVOR TO Will SO DAYS WRITTENC NOTICE TO THE CERTIFICATE HOLDER BLAMED TO THE LEFT,SLAT FAILURE TO CO W SHALL Ocp,} ( IMPOSE NO OBLIGATOR OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR \7/ REPRESENTATIVES. Aymara°REPRESENTATIVE/ AIA Agency FF I f . _:. AGGRO 25(2001/0S) •.� • altA120r1948 RPORATION 1988 g7LG :Soinwwiuoecz4 1 t / 4+ / I ' /I rr a sf Board of Building Regula ions and Standards if ' One Ashburton Place - Room 1301 -. . Boston. Massachusetts 02108 Home Improvement 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-CAI 0 soM-o4/osvc8698 ❑ Address 0 Renewal El Employment Q Lost Card / el 5' Board of BuildingRegulations �--I_• i_- •a One Ashburton Place, Ism 1301 "''NZ:, Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE >. Birthdate: 08/2111971 Number: CS 070626 Expires:08/21/2007 - Restricted To: 00 ADAM A QUENNEV1LLE 160 OLD LYMAN RD _-.. S HADLEY, MA 01075 '7r.no: 3761.0 ,_ v.-.......r.....r.mt end chcnnn of address notification. • 'a...._ '1p +.f' .'1P' '1.a' 1f, '1.k._ 1a"_ 1s' ',C 'P 1 f' Air 1f 1f` 1f` 'Lw 1f, "1�' 1C_ 1t gg a Y t 3Z 1+y ` ,D9 avr,�l�,�i ' (1� : T Et bx1*IV):TECTI{}N i g e- ' °Yitid-- ' s . h `"'iT '.. y,nt gw:::- tkR7 i f▪ t r: 11 IJ @1 z, ,,,e r1,t 'n�nYF 's'9.8 .v'P k .✓ ', .r y X �� K E E: it tri„ Qe+ +:e nEfaxti'a, MU4,T ,,Ie; a Cs Si EZ..- 1�„, s I P ae,fitr 'Y ,}y ,-iin„ e8r&1 ▪ p` 8' t ti �1 � & r fry F� �� �.4, T_ 1 ,i :c✓• a tt moi.. ttte k” . r �t , oil .174;;.; gaiN ark- ts:A:4, l {t.L . ' +i { ' N s- t k �a y ..c� e . -..4..--4,4,%:v--.- dt d+j �.SSC Y 5 s r b � -Y yd .1 v °` E + 17.s lt' FiS, .,e. ea ew r10 �. . . -, ' ' 'y { "r' t82 4.-.1/27.' "'� - , li es ,P r %a `� o n`ut i.' / a y -Ai-f--i: i ie .yr `+f Pa . 7, , `� tl Je , r....srsc'f,•cs : 4% ; - 5 let+r'Et g'1 r 'it frh '7a -'r3 ez` e 1 :5 Ft • r � y l r a .g a�Y' a c + °' f 4 r + L r a, • 2 . fly tp l "4 g, Bn S P„5{ i4 rr `y x k �, a r,,Ls! ,p n �� � t to "Fs' '3 �,"+�°` r sl+w'Y ti tii+.,_yY..m L.A+2:2YStn Jrvti. h )t , ;i :r : ' x .r'S7;N.°;..., ,� "y.a ._ 'r^ ' R% Date/Time 05/16/2007 17:35 4136258242 P. GUI 05/16/2007 18:27 4136258242 PAGE Ell/131 05/16/2007 13:ZB Adam flue:nevi11e roofing 15/W4135361445 ' P. 001 • i. QurnNEVitLE LLKE15,15 • ROOFING INC. The Premium Choice' 160 Cid Lyman Road,South Hadley,MA01075 We Are Licensed 1.800-NEW+ROOF • 413536.5955 Insured E niitgie00newnnt.nei - Wmwe:www.laooneemornm Factory Trained MA ConsuuTbn GpaMrm ucm70625 AMRsglln/an 7120902 Facie Certified Installers /amber et Sit Vane&Wort AODdB,n of Wagon N n,Mas CT RYAaa,/575920 ry Member of No BOOM&Ttl.nosenn Member dM Sew Overnees h,nr, .nc aw.o , MPI�r nN. Subded To: Dale - Ptnnetl's ' f PIP al yere.Wct y/o/al . H: 6 /S-WS, '•-cell: b)s-slayk .Street - ).4070.. ._., I LI k tile20n,A 7042ll ' imvil Qtly 01370 City,Sate.Zip C,Ws . opnn:al noqufements • if,rkInpn.��. Nis SO'A SLoc7 t)7 ply ;F vte s d� Proposal to hi nosh and Install the following ' ' Taystait rl.L F,Str bi.wa o., cyT lopes • O Re-Roof J$Tear-Oft ❑ Gutter rvrell .slec dvxw CP•O,M /LAS dye R... • Complete Roof Preparation HAT Sc rTi eva3 RI Flame exteriorte be protected by tarps and plywood • a'Shrubs,landscaping,trees to be protected Entire edsting.rcofing material to be removed to existing decking,Including flashing,etc: cit She to be cleaned everyday with roll magnetdebds removed at project completion ' g Deteriorated existing deciang replaced at$2.50 per sq.it ®'Wheel Brown a:rah metal MO edge Installed at eaves and rakes 0'White/Brawn 5 inch for re•roof only ,0 New flashing will be Installed where necessary(sea Special Requirements) Icir Ingle-II new pipe boot flashing la We shall acquire all appropdate permits etc.for all roofing work Complete Roofing Stem • ill ELK Leak Battier instead at all eaves to protect from Ito dams(and inset codes In the north) tZ ELK Leak Barrier Installed In all valleys,around penetrations,and chimneys to.protect critical areas • 1015 pd.reinforced underlayment installed over entire decking Shingles: . (� ELK Prestique•Sedas ❑ 30 year 0 50 year Color 'P.c._ 1,g�t a Reliable ridge vent will be Installed Y gf ELK ridge cap ehinglea Warranty Opt. - ' • We guarantee our workmanship for 5 NII years • • ❑ ELK10-Veal Umbrella Coverage Limited Warranty upgrade. . 0 ELK15-Veer Umbrella Coverage�aLimited Warranty upgrade. • �_,l�_y mm•vrr; iI a • We`ropose—1y--� ,to_ nb mn(p g dJmmplNe In e, ' -JM3M above epeeffc Dona lerThe um o4:LI tJ TotaliSald Prim$ 997C,Ou Y -OmenPymern$ a 97 S.0o upon Completion$ /7600.41V ACCEPTANCE OF PROPOSM:The alum pd sp.Cmcadons and mndwons W satisfactory end re heathy ecbemed. You am authorized to doarspecified.Pay ie" twT beltdown Won signing,and balance due upon completion. unpaid balances shall mono with beefed(418%per annum. Purchnedsl will Pay for all costa,aap•rumand reason- able asoneys fess barred by Adam Ouemevlle Floating and$. ..,Inc to recover sty sums due under this contract ' Dab: s% Signature' / __._ re Deb:9M Simmer's Signature: ' S� trS . / -I /1 e6smGm a. Iorebty'0)a' • above da . Y.�.0 r 1 ATTENNON HOMEOWNER&Please cover all personal belongings In the attic,garage or storage regia We to Me \U posamltyof meting debris r dust coming In avough racks of Me wood.Adam Ou•nneve•Roofing andEdmge r.\\�' will not be responsible for debris or dust In Me attic or mono?ands. • H% lists/I'I®e Will/alit 1):41 1 51.1 ))a o IIU r. u u I May-07=2007 02:55 PM Remillard Insurance 1-413-538-6010 1/6 Acorn?. CERTIFICATE OF LIABILITY INSURANCE OP IDDATEIW DAMnm ADAMQ- 05/07/07 PRODUCER THIS CERTIFICATE IS ISSUED ASA 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 HA 01075 Phone;413-538-7862 Pax;413-538-7179 INSURERS AFFORDING COVERAGE NAICa INSURED INSURER _ _ A menialmy cannel IN9uRnle Scottsdale Ins Co. Adast Quenneville Roofing a Siding Inc INSURER C; P 0 Box 612 INSURERD: South Hasley HA 01075 INSURER W COVERAGES THE POLICIES OF NSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO1WINSTANDING ANY REOUREMEHT,TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNICN THIS CERTIFICATE WY BE ISSUED OR WY PERTAIN.THE INSURANCE AFFORDED 9Y THE ROUGES DESCRIBED HEREIN IS SURIECT TO ALL THE TERMS.EXCLUSIONS AND CONDEMNS OF SUGI POLICIES.AGGREGATE WAITS SOWN MAY HAVE SEEN REDUCED EY PATO CLANS. LTR�{NBi.PD TYPE OF INSURANCE POLICY NUMBER PDLICY4�p VE yO�,iY IRATdI HI GATE(Nl4DMYi OA1 I Di WI CMTS GENERA.UARF PTV EACH OCCURRENCE 51000000 B X CDK$ROAL GENERAL LABILTY CLS1274790 06/23/06 06/23/07 NEMISEs(E¢ul`:IK.I 430000 CLAIMS NAME ®OCCUR LED EXP(MYmn:e.on) 55000 PERSONAL AADV INJURY $1000000 — GENERAL AGGREGATE S 2000000 GEML AGGREGATE AWLA3 PER PRODUCTS-WM%JP PSG $2000000 7 n 7LOC AVTOMO1512 UABNITY COMBINED SINGLE LUST E _AM AUTO Nm a0en0 XL OWED AUTOS BODILY INJURY saEAM1ED AUTOS (Per person) HIRED AUTOS 900LLY INJURY NON-OWNED NUNS Tor 5404•10 RIparOaccidentiFFRTY DPNAGE ,F� AUtOOMV- GARAGE LIABILITY LITDII'-�\) MDOOM.V-FAAGGOEM H ANY AUTO OTHER THAN EA ACC AUTO ONLY; AGG EMCESwMNRELLA I IA UHY EACH Dreww n OCCUR E CLAIMS MADE AGGREGATE RDEDUCTIBLE RETENTION S WOMSCOMPENSA1IONANO WLIIAIW IA W EMPLOYERS' MUTE x Rayon U[R A ,,M.���DIyPIEROIINE � M C70128E1012007 04/29/07 04/29/08 EL EACH AEGen 100000 OFFICERMEMBER EXCLUDED? EL DISEASE EA EMPLOYEE 100000 u W Aew OVIStC SPECML PROVL9bNS Warr EL DISEASE.POLICY WIT 500000 OTHER DESCRIPTION OP OPERATIONS,LOCATIONEP/64E5ES1 EXCLUSIONS ADDED BY ENWRSEe@M I SPECIAL FROVMIONS Roofing Cap v. CERTIFICATE HOLDER CANCELLATION I SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAnoM CDATETHEREOF,THE ISSIHMG UaURER WILL ENDEAVOR TO MNL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOWER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE E NO 08UG4Tma1MIY N OR UAOF ANT KIM UFOM THENSURER.RS AGENTS CR © �+ REFREBEMATmen. AU THOMSEN REPREFEMATM RIA Agencvjjj5 ACORD 25)2001108) RPORATION 1988 gfie eoz„..e v o�sadu aetela -_ e; 9' - Board of Building Regula ons and Standards 1. Ife One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement 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. rascal C. sowomosvicessa �p o Address E Renewal El Employment Q Lost Card °}71-ei o7nmonweahCt o/ acAuael fi » " Board of Building Regulations s el " Place, R < <It One Ashburton m 1301 L 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 7r.no: 3761.0 r address notification. -------1-r-,`,1V— ' s1--..a.....-....',.:+" r 1.e.' 1f' 1C 1C- 1f" '�' 1C' . 1t 1C "Lw 1e.+' V' 'J +1l`-1 r r' fS A5. 'te�SH las u'ytOLs" 8 S'i+q}1�thY, y..a'` T,QE.V7rL- ;' TIOlsif ry Oxy, fr £ - 1.2„ ,,_ .34-0. 5-‘,...-A _„y f y 4 k „, 4s iid*•u rs'mn j)wt ry ep 2t,4 g 1,1,—,,Y'(., �N c :e ' �'-t 14 k iIT r' 3r -;.--.%-f- , <-.2 °,1} "�te. ttki e.2` r c s7 eg 1 as +t I. ”r. . t _ Cr IiRs , l "+�l N°tett g -44.'40.,"&k '1 f< 5 . 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