38B-289 278 SOUTH ST BP-2017-1143
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:388-289 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# BP-2017-1143
Project# JS-2017-001939
Est. Cost: $2733.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq.ft.): 13460.04 Owner: WATERS NANCY
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 278 SOUTH ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:4/12/201 7 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP AND REPLACE SMALL LOW SLOPE
ROOFS ON FRONT AND RIGHT SIDE, INSTALL NEW ROLL ROOFING
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 if 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:
FeeTvpe: Date Paid: Amount:
Building 4/12/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
�City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
c QQe 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
No13 587-1240, MA 013-0 Two SetsPlaf ns ural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Pmns
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 1 P 1' 7-fly 3
1.1 Property Address: This section to be completed by office
278 South Street Map Lot Unit
Northampton MA
Zone Overlay District
Elm SL District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nancy Waters 278 South Street Northampton MA
Name(Print) Current Mailing Address:
See Contract d01-sag-1896
Telephone
Signature
2.2 Authorized Agent:
Adam Quenneville Roofing 160 Old Lyman Rd South Hadley MA 01075
Name(Print) 4 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
2733.00
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) 2733.00 Check Number fin° 74"
This Section For Official Use Only
Building Permit Number: Date
Dated:
Signature:
-ia
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be 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)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES 0
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 O 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 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [0 Siding[O] Other(O]
Brief Description of Proposed
Work: Strip and replace small low slope roofs on front and right side.Install new roll roofing.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, complete the following:
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
9. 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Nancy Mekown , as Owner of the subject
property
hereby authorize Adam Quenneville Roofing 8 Siding Inc.
to act on my behalf,in all matters relative to work authorized by this building permit application.
See Contract 4\h']7
Signature of Owner Date
MIIIIIIIM
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
and belief.
Signed under the pains and penalties of perjury.
Adam Quenneville
Print Name
1/4-1 )1 )17
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Adam Ouenneville C5070626 U
License Number
160 Old Lyman� Rd South Hadley MA 01075 8/21/17
Address I — Expiration Date
�� 413-536-5955
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
Adam Ouenneville Roofing 120982
Company Name Registration Number
160 Old Lyman Rd South Hadley MA 01075 3/25/18
Address _ Expiration Date
Telephone 413-536-5955
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.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 )a( No 0
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 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
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 278 South Street Northampton MA
The debris will be transported by: USA Hauling&Recycling Inc. 15 Mullen Rd Enfield,CT
The debris will be received by: USA Hauling&Recycling Inc. 15 Mullen Rd Enfield,CT
Building permit number:
Name of Permit Applicant Adam Quenneville Roofing&Siding Inc.
Hi ll�,
Date Signature of Permit Applicant
te
L\1 _ c� Name
iraA .MC KtoW4 `1/7/17
QUENNEVILLE +(y Stree6j
ettAcklre
ROOFINGS SIDING IF WINDOWS BHB ` r GA'._ YTh5T
7.809.NEVf ROOF —C_ CAH . I m.1..% Zip
7 aro i Il9.
413.5363955 Whiner of the florae Phony» ori a t
18OONEWROOF,NET TORIC AWARD / ''lJ3j — 5gy- yjps Pleb > .
RESIDENTIAL = COMMERCIAL Email ����rys�/��
ISO G'O Lyman Road•Sept Hadley,MA01ms ... (Df •/ 'i:'. PfNt%1"
L.
StraightForward Pricing® "A
�i Story _2 Story 3Story
/Y'"Renals•&Rejlace 3 SQ of Shing) StepflasWmmt
Coen�sh 41'to 50'or Wall or Chimney,
Remove&Replaceu to e luta ley.lnca 121'm 460'of Drp&dge.InsW%71 to lar
of Ridge Vont&Ridge Cap Shingles Waffled or Rolled).Lead Flash Chimney1S'to 28'
perimeter,CLEANING Roofer Siding 2CkI I Wft-3.WJ sq ft.Constmel Cricket and Flash
Replaacewla5Q off vslan qr-ase,Faun oy Rake withAFmx*ure,R wr& Qty..I x$1997 ea=$ 1727
r Remove A Replace 2 SQ ofshinglcx StepflmWConnterfash.1'*40'of Wall or Chimney.
Remove&Rcpia:e31'w40'ofV1Mytasolt 91'm iA'W@ip Edge.i ulIst io to
or Ridge Vent&Ridge Cap Shingle(Baffled orRolledl.l<wi Rash Chimney 19'tvi 23'
perimeter,CLEANING Roof of Siding 1501 sq R to 2,000 ft.Cover 41'to 50'of Fascia
.77 Rake wdh.Vnminum.Reitiov-and Riipiace I SQ el Walt SidQg Qfy_x$1392 sec$
5 Remove& r
Replace l SQ of Shingly_ pli numeMaP 21'to 30'of Wall N chimney)
Remove&Replaw 21'to 30'of Valley, til to Al'of Drip Vie,Ynwll 3l'to 50
of RidgeS%nt&Ridge Cap Shingles Oluttledor RMtedttlead FlashCWmney 14'm IV
anmtwr.CLEANING Roofnr Siding 1401 sq flw 1.500 (Leaver Sl'to 40'of Fascia of 1'Lz
Rake with Aluminum.Minor Yudgiointiug and Watersealing of Chimney 5'b 9'in height cityx $922 ea=$
Remote&R p1.•.e 2 Rendka of Shinnies.StePflaahCoumerflect 1r to S'of Wan or
Chimney.Remove&Replace I I'to 20'of Valley.Stall SPE 70'of Drip Edge,Install 21'
in 30'of Ridge Veal&Ridge Cap Shingles(Baffled or Rolled). tad Flash Chimney 9'In 13'
p»trcrzr.CLEANINGR.nfnr Siding 501 sgft to 1 W h,Cove,xi'W3u'oiFambm
Rade wild Alumimmm,Clean 2S I'm 340'of Cana.Minor Tod7pointing and Waterriing of
Chimney less than 5'in height,Suip-off and Re-Shingle 2nd Salty Ray Window Qty x $763 ea=$
Ramme$Rec!as pto t 3,3tas6.46..4.46.6c,42.6IIaxh6EW ll�
FE.A6 .
3 Chimney.Redmw&ReplaceuprMIM oft/alley,Hata 31'tat SOedfk&ildge awil pro -'Ecu
of Ridge Vent&Ridge Cap Shingles(Bagkd or Rolled).Lead fled Coimaynpto 8.Perimeter.
CLEANING Roof or Siding up to MOH&Cover WHEY ofFaciaof Rake w'dhAbwiaan,
freatl Dryer Rate C+ ion&fladt duttegit Rwf,Snipofmd RtShmgk is mg Bay
Wiabw,Clem lol'w 250'of Gutter.Insuti3 SE to 100'of Ice&water Balder Qty_x $612 ea=$
Remove&Replace opal l 277ndk o}SNngks.SRR&'NCrowaWd.e5'ofWad orChnmey,
Install up m 30'of Drip Edge.1(7 or tete of Gutter or Fascia Repiacenxnt.Clean S I'to ted'
of Goner.Cover 10'ix less of Fascia w Rake with Aluminum,Inman Rubberized Crown on
Chimney Cap.Install Stainless Steel Cover on Chimney Eke.natall 21'to 50'of Ice&Water
earner,Remove ll Rrmuell!Soil Rat Otyx 9427 ea z$ _,,,,_
1 ReefCNhfations.(tuner Cleaning upas 311'.Muni upas 20'of Ice&WarBarrio. Qfy.,x $179 ea a$ ,...
JReplace Rotted+Damaged Decking,as needed,to S3.47/fit ft Qtyx$3.47 s$
Shingle-CLOSEST MATCH: Root Pitches greater than 6/12
Brand:—.. Excess Build-Up of Moss&Mold Add 30%=$ _.._
Color: (intp 3rd Story Roofs Add 20%=
Other Services:_ &W u I f DOWN SS 1021:0101} $
on) R41' PoiF Co • 44.1 ®d1n. �$ _32Y
$
Notes: Ige, 03
OGt )246F -Pi r — -340
6)*C17 S r/ .r . M Sub total$
R)s.scouk APP rttoork, Diagnostic Foe$ ' fie'
t(41.1$901),„„CF N'F0pp r[�6
[TotalDue
9
s 233
QownPaylRentDueTaae $ 933
—... : Balance Due upon Completion of Jobs 1800
I hereby authorize you to proceed with the above StreightEorward Price'
X �7. ,_.__- ,/ At
Specie st Print Name: V -3Nr9�Gg
1113- 7-7-1 -Y7321 Thank You!
i A a CERTIFICATE OF LIABILITY INSURANCE DATE!/ 4 DO
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: It the certificate holder is an ADDITIONAL INSURED,the poiky(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions at 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 JAdEAcT Melinda Karakuls
Goes k McLain Insurance Agency PM NE 1413)534-7355 Rv1_ul]13Le-flee
1767 Northampton Streetam sS�mkarakulaggosamciain.c
W 0 Box 11.28 MsURERIS)AFFORDING COVERAGE ' NAIC#.
Holyoke MA 01041-1128 INSURER a Nautilus Ins Company _
INSURED INSURER AIM Mutual Ens Co _
Adam Quenneville Roofing & Siding Inc INSURERC: _ _
169 Old Lyman Road wsRERD: I
INSURER E:
South Hadley MA 01075 INSURER F: 1
COVERAGES CERTIFICATE NUMBER:CL1662403220 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANOING ANY REQUIREMENT,TERM OR CONDITION OF MY 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR ADDU UiR 1 POUCYE POLICY EXP i
SZR' TYPE OF INSURANCE Taco Vvu' POLICY NUMBER .IMEVODTY IMMDDIYYYYI LIMITS
X I COMMERCIAL GENERAL LIABILITY I1,000,000
I--—t EACH OCCURRENCE_ IS _
A `_ I CLAiv'V /ADE % OCCUR I P9AUMGETDREN6272 I5 100,000
_ XP(A C96FrEnei .._
11:NE85342 6j13[RO3a 5(33j2P14 MEG EXP(Any o Pnr 5 15,000
% E LIMIT APPLIES PER'. IG E
I I PERSONALa ADV INJURY $ 1,000,000
_ GENERAL AGGREGATE 5 2.000,000
G-N' AGGREGATE ppRRpp
POLICY , JECT , - LOC PRODUCTS-COMPIOP AGO S 3,000,090
OTHER. Empbyee Renc5Is 5 1,000,000
AUiOMO8119 UASILItt
I . - 1 CGMGINED SING26LIMIT e
accident} _ _
r_ ANY AUTO 0ODILY INJURY(PPrpnrsnn) IS
ALL OWNED SG IEMIAEO BODILYINJURY(F6r-03ce ) 5
_y AUTOS O AUTL-0WNEO PROPERTY DAMAGE 5
HIRED Amo9 IAUTOS I(Per accrdelq_ i,_
gms:redmo1&lREMOC s
I UMBRELLA OAS1 OCCURI .EACH OCCURRENCE 5 1,000,000
G X EXCESS UM) ISR cLAIM6.MTOEI _�5
OED X rETEN➢Ocie 1p,pop M.1030632 8/13/3016 _ B/13/4P1'I AGGREGATE IS
WORKERS COMPENSATON X STATUTE ERM
AID EMPLOYERS'CABIUtt Vitt, I
ANC'PROPRIEETORRARTNERJEXE^.UT1VEEI.EACH ACCIU_ENT i5 1 009,000
I OFfICERRAEMHER EXCLUDED? Y �--"
'INtA
D
:Mandatory NNl ?MCA pOlO1R8oi-¢piSA 4/09/2018 4/2 9/2019 EL OIEEASE.FA EMPLOYEES 1,000,000
E .deSCh
IDESCRIPTION OF OPERATIONS Wow EL.DISEASE-
POLICY LIMIT I.$ 1,000.002
I 1 I
DESCRIP110N or OPERATONS/LOCATIONS/VEHICLES IACORD 101,Additional Remarks ScIIed'N.may he attached Irmere space is required)
Certificate holders are additonal insured on the abate captioned GL policy, subject to policy forms,
conditions, and exclusions. Adam Quenneviller 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.
AUTHORIZED REPRESENTATIVE �/,'�/
I M Karakula/MTNDY /v/ _ STILd.-lt�
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025+PImm”
The Commonwealth of Massachusetts
.._lf Department of Industrial Accidents
e 1 1 Congress Street, Suite 100
14 VWBoston,MA 02114-2017
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 tl3usine siOrganizationnndividuat): Adam Quennevilie 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):
LEI I am a employer with 15 employees(MI and/or part-time)` 7. 0 New construction
2.01 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workms'comp.insurance required) 9.
(-�
3.0 1 am a homeowner doing all work myself.[No worker:comp.insurance required.]T t-I Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will IO Building 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
5❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs
These sub-contractors have employees and have workers'comp.insurance t
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther�
152,§1(4),and we have no employees.[No workers'comp.insurance required]
`Any applicant that checks box k must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they arc 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 sub-contractors and state whether or not those entities have
employees. Ie Cha sub-contractors have employees.they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for nip employees. Below is the policy and job site
information.
Insurance Company Name: AIM Mutual Insurance
Policy#or Setf-ins. Lie.#: 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 MOL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains y td penalties of perjury that the information provided above is true and correct.
Signature: rY7 - )ate: It i
Phone#: 413.536.5955
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: • Permit/License#_,
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
• _ Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-070626
Construction Supervisor
ADAM A QUENNEVILLE:.-
164 OLD LYMANRD , r
SOUTH HADLEY MA; JIn
rs-1.in lam_ Expiration-
Commissioner // 0812112017% //
CT)/e� tt/ 'O>n/7aolit(recrctf rytY �(c.;.lr7c/Itrtie//i
of Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 120982
Type' DBA
Expiration: 3/25/2016 Tr4 419291
ADAM QUENNEVILLE ROOFING
ADAM QUENNEVILLE __._.._ _...__..__...._..__.
160 OLD LYMAN RD -- —- -- _ `
SO. HADLEY, MA 01075 ---- ---- - --- -
Update Address and return card.Mark reason for change.
bc+ 0 20M 05/1; f Address LlRenewal f Employment ❑ Lost Card
.;
3 e t F 'F, P' R+,
...�i:� � �.L__•N 'Sb 4�•�S6 "RC !f �A �'11' *�L" +.L.'ea�� 1_ 'lP' .41S. lL—s1t�
STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ",
Be it known that .y
ADAM QUENNEVILLE
160 OLD LYMAN ROAD
SOUTH HADI:FY, MA 01075-2632
� tt
. is certified by the Department of Consumer Protection as a registered
�� HOME IMPROVEMENT CONTRACTOR
' f
Registration # HIC0575920
rt
ADAM QUENNEVILI.B ROOFING
tot_
'
y Effective: 12/01/2015
t
j Expiration: 11/30/N16 a+}—
J t$ n tlarris c Doff ✓ 9
,t e