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23C-021 82 NONOTUCK ST BP-2017-0283 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C-021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit ft BP-2017-0283 Project# JS-2017-000477 Est. Cost: $9700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sa. ft.): 9104.04 Owner: VERDI PHILIP A Zoning:URB(100)/ Applicant: ADAM QUENNEVILLE AT: 82 NONOTUCK ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:9/1/2016 0:00:00 TO PERFORM THE FOLLOWING WORK REMOVE EXISTING ROOF AND INSTALL NEW ASPHALT SHINGLE SYSTEM 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 9/1/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only Li � '`•, City of Northampton Status of Permit \ �.yy' . ' Building Department Curb Cut/Driveway Permit n„." '4 o 212 Main Street Sewer/Septic Availability � • Room 100 WaterfWeli Availability J j� r.r. � Northampton, MA 01060 Two Sets of Structural Plans vj� wE phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans i, Other Specify APPLI r ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATION 1,1 Property Address: This section to be completed by office 82 Nonotuck St Map Lot Unit Florence, MA 01062 zone Overlay District I Elm St.District CS District SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT en $ 2,1 Owner of Record: , Philip Verdi 82 Nonotuck St. Florence, MA 01062 Name(Print) Current Mailing Address: 413-535-9577 Telephone Signature g.Z Authorized Agent: Adam Quenneville 160 Old Lyman Rd.South Hadley, MA 01075 Name(Print) Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _ 1. Building (a)Building Permit Fee $9,700,00 _.. 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) $9,700.00 Check Number 36 0 This Section For Official Use Only Building Permit Number Dale Issued: Signature: Building Commissioner/Inspector NEI/Waco Date Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: It: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) g or Parking Spaces Fitt (vela=&location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing.grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [l Addition ❑ Replacement Windows Alteration{s} ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [C7) Decks [CI Siding [0] Other[C7] Brief Description of Proposed Work: Remove existing root material and install new asphalt shingle system. Alteration of existing bedroom Yes X No Adding new bedroom Yes X Not Attached Narrative Renovating unfinished basement Yes _X No Plans Attached Roit -Sheet ea. If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other A 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. Masscheck 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Philip Verdi as Owner of the subject property hereby authorize Adam Quenneville to act on my behalf, in all matters relative to work authorized by this building permit application. See Contract Sjat It to Signature of Owner Dale 1, Adam Quenneville as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge belief. belief. Signed under the pains and penalties of perjury. Adam Quenneville Print Name ✓ I )a Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES $.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Adam Quenneviile CS 070526 License Number 160 Old Lyman Rd.South Hadley,MA 01075 8/21/2017 Address n Expiration Date ala-sas_Ssss Signature Telephone 9.Registered Home improvement Contractor. Not Applicable ❑ Adam Ouenneville 120982 Company Name Registration Number 160 Old Lyman Rd.South Hadley,MA 01075 305/2018 Address ,r Expiration Date Telephone 413-536-5956 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL.o. 152,§25C(6)) 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 ❑ 11. - Home Owner Exemption 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 qwner acts as supervisor.CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of and 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 he 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,von 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 D �•�• EBB QUENNEVILLE Winer of Om TORCEI LWAPO 1 11110 "" ROOFING F SIDING F WINDOWS 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1800.NEW.ROOF • 413.536.5955 Fully Insured Email:infole1 0Dnewnofnet Websae:www,l800newrool.net Factory Trained MA Construction Supervisors Lk.4070626 MA Registration 4120982 Factory Certified Installers rtawrdtOeerrmeemie?ssoc dWerarn Masa. CT Registration 4575920 Member of the BOrld'ing a Trade Ass°clannn P,P.0 38710 Proposal al-IIIM�Submitted To:t Datet''� Phpn&q's: C: 11 {� Street Email: •r...C. .ry;;.,<�., City,State Zip Code: Special Requirements: c .( n ;.iee . Ib, e1 ctzt:z ob€ CO Qle'redby9-2/-/E PROPOSAL FOR: ODS GARAGE OTHER COVSC H fic (or O STRIP RECOVER NEWGDITERS ;j CYT v\ c ( -E1r v:\l: } Layers: L 2 3 4 Plywood Included yes o Nog ( u Tear off SLATE gL SHAKES t( Let—conk C (14u. et' /: .r '�] c/ 1r-.. SNFr-1 :/I COMPLETE RQOF PROTECTION SYSTEM: CVO shall acquire appropriate permits for all work ✓il Home exterior and landscaping to be protected r Strip existing roofing to existing decking with full inspection 00 NOT 00: ✓Ali project waste shall be removed by dumuster(dumpsterfor contractor useaniy) (p1 yV tOrdlOrk I Deteriorated existing decking will be replacedacat$317 per sq.ft.after full inspection Custb tials: V'Gstali Ice&Water Barrier at ail eax s 3't 6v' vaireys.chimneys,pipes and skylights Yinstall 0.516.felt5yntheti underlayment over remaining decking area :stall Metal drip edge at eaves and rake/Si(white(mw'n) Vinstall manufacturers starter shingle on all eaves and rake edges utall new pipe boot flashing/vent accessories y' Install ridge ventSno i/Cobra rolled/4'Barged I Roll Shingles:standard 6 nails per shingle) FCt Shingles ✓2S year 30Year 50 Year ColocPPt3kP C. �•,11 C Ridge cap shingles e Y 7{yfit r Warranty Options: /' Vince guarantee sur workmanship for 10 full years(see our warranty coverage page) V�YYtetd t GAF System Phis Warranty ptiln}•it II GAF Golden Pledge Warranty V MORS Recommendations: 2 cc. c tE F•2' 1('„Cfo, Vead Counter Flashing -Water Seal&Tuckp nt' % ow`ubberized Cr ✓Metal Chimney Cape 'Z ;,_ Replacing old skylights a,wnyn muse snorted) te Mason work(or warov must be signed) Heated panel roof system Insulation Ventilation 4\444 _ Opted out of AQRS recommendations Customer Milian: ropose hereby to rurnbp rpatepals ppd'. -n !m Total D e ACCEP ANCEOP PROPOSM:She abovep- macbtfl ICA uuudbmu,ale DOwn Paymen1$ so,p satstMttory and are hereby Pucepted,Y uthoried tp do k as specified. Balance Due Upon Complete -1S 7 cFcc. Payment will be 1134 wn at start Wgod dbalance• pcompletion, Odd CfPC-0V t3C rl :Seri?.ar L-,CCC Date 1/#74//../4 Signature oate:91 IrS'- 1 (t Esttmamn Wrint Name) `V'.i'.v're Y 1 p,_(Sign Name) Estimates are honored for shry160)days from above date. ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the passibility of roofing debris or dust corning in through cracks of the wood.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas, Customer Initials' A�r� CERTIFICATE OF LIABILITY INSURANCE DATE(0.WMWYYYII 6/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Melinda Karakuls NAME: _ _. . Goss & McLain Insurance Agency PHONE (413/S34-7351 iFAx LNp Nok(413!$76-9203 1767 Northampton Street J2 s:mkarakulaitgcsemclai .com P 0 Box 1128 INSVRER(SLFFORDING COVERAGE ; AMC* Holyoke MA 01041-1128 INSURER A Nautilus Ins Company - .__ INSURED INSURERS AID Mutual Ino CO Adam Quenneville Roofing & Siding Inc INSURER C: 160 Old Lyman Road INSURER o: INSURER E: South Hadley MA 010Th INSURER 9: COVERAGES CERTIFICATE NUMBER:CL1662403220 REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWfTHSTANDING 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 ALI, THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INA AEOLIRByRC • POLICY ROO POLICY ESP [- OR TYPE OF INSURANCE IINSn I woo POLICY NUMBER I DAVEMIr(VYYI IMM'Du,YYY1 LIMITS X COMMERCIAL.GENERAL LIFa1LITY I CAE OCCURRENCE A 3,000.000 ACLNME'AADE R IIOCCUR O R-rNTEt3 190,000 _. DAMAGE i-j REjAGE5O WTLOntet 5 2M6253 42 6/23/2010 6/23/2017 MED EXP(Any onep6son) S 15,000 - - PERSONALBAOV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLES PER I 1 GENERAL AGGREGATE..- 5 2,000,000 I PR0. a POULY I EEC' LW a ( I !PRODUCTS-COMMA 2.900.000 OTHER. ( I Employee enefit&Mrs $S 1,000,000 I AUTOMOBILE LA/AMITY I I !COMBINED en! LIMIT $ IF ,ANY AUTO • ODDITY INJURY(Pm person) 5 ALL 01M1NtD 1 I SCHEDULED ALTOS Foo wu (PAr s T. ;HIRED ACRO_ t AUNQth4'cD I t+ROPERTY eill . i _y AUTOS I un r cured _.. F 1 UIkeMSu,N mGINI<1 m can $ I: UMBRELLA LIAR __ IUCCIIR EACH OCCURRENCE $ 1,000,000_ L, x EXCESS LAR X !CLAIMS-MADE I I_AGGREGATE E DED 1 X 1 RETENTIONS 10,000 t 1x030632 9/13/2019 a/13/201 I s • :WORKERS COMPENSATION - I I PER I 'OTH- ARDflWLOYERS'LIABHRY YIN. ( x STASLTE 2R ANY PROPRIErOI PARTNER/EXECLn VE ' I E.L. EACH ACCIDENT 5 1,000,000 D IOFFFICE MEMBER EXCLUDED, V NIA I ryln ryHl IAMC1007013flfi1-2016,0 14/29/2016 4/29/2017 EL DISEASE•EA EMPLOYEE S 1,000,000 DEsCResQNOer PERATION$4poW , EL DISEASE POLICY LIMIT IS 1,000,000 I Iii I l DESCRIPTOR OF OPERATIONS!LOCA1ONS I VEHICLES(ACQR0101 Additional Remarks Schedule.may be attached M moo space Is retorted} Certificate holders are additonal insured on the above captioned GL policy, subject to policy forms, conditions, and exclusions. Adam Quenneville, as an officer, is excluded from the workers Comp policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZEDREPRESENTATNE / I M Karakuls/MINDY 7744.41 �1// ,-V --LIU,4 . — GL 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSD2Sivuvu ,\ The Commonwealth of Massachusetts 1 L,�]_�L Department of Industrial Accidents el_ 7 Congress Street,Suite 100 {_{_ 7 Boston,MA 02114-2017 ' mar � www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organization/Individual): Adam Quenneville Roofing & Siding Inc. Address: 160 Old Lyman Rd. City/State/Zip: South Hadley, MA 01075 Phone#: 413.536,5955 Are you an employer?Check the appropriate box; Type of project(required): ylE11 am a employer with 15 employees(full anther part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in S. ❑Remodeling any capacity.[No workers'comp insurance required.] 301am a homeowner doing all work myself[No workers'comp.insurance required]* 9. ❑Demolition 4.0 l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Budding addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions lam a general Contractor and!have hired the sub-contractors listed on the attached sheet. ®Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.❑Other 6❑We are a corporation and its officers have exercised their r htofexemptionper MGL e. 152,$1(4),and we have no employees-[No workers'compinsurance required] *Any applicant that checks box ill must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities hate employees. lithe subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Insurance Policy#or Self-ins.Lit..#: AWC4007012861-2016A Expiration Date: 4/29/2017 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pg'ns and penalties of perjury that the information provided above is true and correct. S.>Signature: //�. Date: M I((o Phone#: 413.536.5955 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • .� Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-070626 Construction Supervisor ` ADAM AQUENNEVILLE ISDOLD LYMANRD.r f * ,2 SOUTH HADLEY MA A N1 zc Vl.� Expiration: Commissioner 08/21/2011 177be Thomrrrefrrrfe(//f r/r jjir.;.;rrrjrr.;e/ll Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 120962 Type'. DBA Expira5on: 3125/2018 Mt 419291 ADAM QUENNEVILLE ROOFING ADAM QUENNEVILLE 160 OLD LYMAN RD $0. HADLEY, MA 01075 Update Address and return card.Mark reason for change. $CAI a 201/Oral _j Address D Renewal L= Employment CI Lost Card +<r `C tip_ 1.a 1N -1a' •.t �C_ a �� :+,C' 4.f:' (s1" a k a V'Lai 'P y, t +iiia ist -it .t' STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ION II�" } Be it known that } ADAM QUENNEVILLE f 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075-2632 Iis cord lied by the Department of Consumer Protection as a registered t'kHOME IMPROVEMENT CONTRACTOR Registration # HIC.0575920 -0I ADAM QUENNEVILLE ROOFING a Effective: 12/01/2015 r(` Expiration: 11/30/2016In rthan A,P_ as {~.t ♦1. { {4 d .a'4 arti { is '{b „4 nr w {F w"' ar +'`+ d. ar"e d'i .`