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32C-295 (9) 30 VALLEY ST BP-2018-1308 CIS 4: COMMONWEALTH OF MASSACHUSETTS Man:Block:32C-295 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category ROOF BUILDING PERMIT Permit BP-2018-1308 Proiectft JS-2018-002329 Est,Cost: 515000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sa.R.): 7187.40 Owner: MAHER JOHN zonine:URC(100)/ Applicant: ADAM QUENNEVILLE AT: 30 VALLEY ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.•611212018 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: Q& 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 6/12/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVEU y of Northampton it I `j}M11.iyr�,v+�yytl2`,tt+€, ,�, a B ilding DepartmentI( � JUN > > 2018 12 Main Street Room 100 jNo ampton, MA 01060 DEPT Or BUILDING INSRFfl 3- 7-1240 Fax413-567-1272 �* f NORTHAMPTON.IAA��g APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO�FAMILY DWELLING SECTION 7 -SITE INFORMATION CJv 1.1 Property Address: � This section to be completed by of ita 30 Valley St Lup� Lot Unit Northampton,MA 01060 Zone Overlay Dlstricl Elm St DIMAM CO District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: John Maher 30 Valley St. Northampton, MA 01060 Name(Pnno current Mailing Address. 413-563-0146 See Contract Telephone Signature 2.2 Authorized Anent: Adam Quenneville Roofing & Siding Inc 160 Old Lyman Rd South Hadley, MA 01075 Name(Pnng1 Cunent Mailing Address: �(//^—/ 413-536-5955 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building $ 15,000.00 (a)Building Permit Fee 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) $ 15,000.00 Check Number This Section For Official Use Only Building Permit NumbeDate Issued: Signatur BuildingC issionedlnspedow 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 Dcpanment Lot Size Frontage --- Setbacks Front ' Side L:-R.._. L:. R: Rear _.. .. Building Height Bldg. Square Footage Open Space Footage (Iw,t area minus bldg a payed -- arkin #of Parking Spaces -- Fill: _. volume&Lociumi - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'TKNOW ® YES O . .. ...... ........... ..... IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® YES 0 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 Q NOWY 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 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 ❑ Addition ❑ Replacement Windows Alterationjs) Q Roofing X� Or Doors ❑ Accessory BMg. ❑ Demolition ❑ New Signs [o] Decks I❑ Siding l❑1 Otherl❑I Brief Desc lion of Proposed Work'. inemove existing roof material and install new asphalt shingle system Alteration of existing bedroom_Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet Sit if New house and or addition to existing housli comcleft 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 g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Is construction within 100 ftof 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_ Pnvale well_ City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT John Maher as Owner of the subject property hereby authorize Adam Quenneville Roofing 6 Siding Inc to act on my behalf, in all matters relative to work authorized by this building permit appli anon. See Contract (o'� ��� Signature of Owner Dale I, 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 /I p lD I7 Ito Signature 6fOmer/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Helder Adam Quenneville CS 070626 License Number 160 Old Lyman Rd. South Hadley, MA 01075 8/21/2019 Address n Expiration Dale �Y/•`— 413-536-5955 Signature Telephone A Reglatered Hill lmproyenu dContrlefnr. Not Applicable ❑ Adam Quenneville Roofing & Siding Inc 191093 Company Name Registration Number 160 Old Lyman Rd South Hadley, MA 01075 3/22/2020 Address rl Expiration Date I11'`�' Telephone 413-536-5955 SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,$25C(s)) 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....... X 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 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 thejob site will be required from time to time,during and upon completion ofthe 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 persons) 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: 30 Valley St Northampton, MA 01060 The debris will be transported by: USA Hauling & Recycling Inc The debris will be received by: USA Hauling & Recycling Inc Building permit number: Name of Permit Applicant Adam QQuueenneville Roofing & Siding Inc Date Signature of Permit Applicant pYE\NN_�VNLY � Ar V/SAS^i 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF a 413.535.5955 Fully Insured Email niof lBCOnewrOOLnet Website:www.1800newrooLnet Factory Trained MA Construction Supervisors Lic 8070626 MA Registration#120982 Factory Certified Installers aremberWMehwneeullaels.alwaawa Maas. CT Registration#575920 Member 1,ra sulrie B Tado sol PPC 38710 Proposal Submitted To: Date: PhoneWs: C: John Maher 6/5/2018 H: 413-626-7690 W: Street: Email: 30 Valley St. johnmaher@protonmail.com City,State,Zip Code: Special Requirements: Northampton MA 01060 plywood on middle section and back PROPOSAL FOR: of front only GARAGE OTHER not putting new boot on gas pipe STRI RECOVER rs. �2 3 4 Plywood Included:Q�pr No ❑ Tear off SLATE or SHAKES COMPLETE ROOF PROTEMON SYSTEM: We shall acquire appropriate permits for all work Home exterior and landscaping to be protected ✓✓✓K Strip existing roofing to existing decking with full inspection DO NOT DO: All project waste shall be removed by dumpster(dumpster for contractor use only) Install Ice&Water rat all eaves 31 Oalleys,chimneys,pipes and skylights lK I nstall(151b.felt nthetic nderlayment over remaining decking area Fl Install MetaldripedgeateavesandrakeQS") 1 ei brown) F Install manufacturer'ssgner shingle on all eaves and rake edges [( Install new ipe boot Rashi /vent accessories Install ritlgevent now Country Cobra rolled/4'Raffled/Roll Shingles:(standard 6 nails per shingle) GAF Timberline Shingles Color: Slate GAF Ridge cap shingles Warranty Options: V, 1 We guarantee our workmanship for 10 full years ❑ GAF System Plus Warranty L GAF Golden Pledge Warranty Chimney Options: ILead Counter Flashing 0 Water Seal&Tuckpoint El Rubberized Crown O Cricket O Mason needed(customer provided) Additional material and labor charges may apply. Q� Deteriorated existing decking will be replaced at$3.77 per sq.ft.and dimensional lumber at$7.00 per linear ft., after full inspection. Customerloitf wewaPoaahwvistof iahmamnae aid labor-mrapinilaaawuanawahasocir Ped ....mane:.mar mtil0ue:1515, 000 1 ACCEPTANCE OF PROPOSAL:the above Prkes s=,.:,dni awMltlons are Down payment.IS 5,000 ) .11daaary-it are herebvaaumea.rou are aurhoama to aowwa aupe<Inee. Oalance Due upon Completion:(S 10,000 1 Payment will be 113 down at start M Joel and haNnce due upon wmplaon. Date: ) a Signature: Date: 6/5/2018 Estimator:IPri rvamel Dust in Peters (Sign Name) ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,gaage or storage areas due to the possibility of roofing debris or dust coming In through cracks of the wood.Adam Que ev111e Roofing will not be responsible for debris or dust in the attic or storage areas. Customerinftials All CERTIFICATE OF LIABILITY INSURANCE °"TE'MMI°°"" ' rIasi05/0112018 THIS CERTIFICATE IS ISSUED ASA 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: Highs certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 thecertificate holder in lieu Of such endorserrand ). PRODUCER CH.ONTACT E' Mel'mda Karakul. GossS McLain Insurance Agency vxonE (413)534-7355 �No. (413)536-9286 Arc xo Exl: 1767 Northampton Street gooXEss: mkarakula@gossmclain.com P O Box 1128 INSURER(S)AFFORDING COVERAGE NASA Holyoke MA 01041-1128 INSURERA, Nautilus Insurance Company ...USE. INSURERO: Nautilus Insurance Company Adam Quenneville Roofing B Siding Inc INSURER O: AT M.Mutual ins Co. 160 Old Lyman Road INSURER o: The Bond Exchange,Inc. South Hadley MA 01075 /INSURER In COVERAGES CERTIFICATE NUMBER: CLIB5104974 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. /ITAN R TYPE OF INSURANCE INSD AND POLICY NUMBER MWDDMYY MMIuivareY LIMBS x LONMERLULGENEMLLIABILITY EACH OCCURRENCE S 1000,000 DAMAGE OREmED CLAIMS MACE OOCCUR PREMISES Ea mener S 100,000 MED EXP(Any we Person) S 15,000 A NNS22755 06123/2017 0612312018 PERSONAL a ADV mNRY S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENEMLAGGREGATE S 2000,000 POLICY 0 jECo-i LOC PROOVLi$-COMPIOPAGG E 2,000,000 GTRER. Employee Benefits E 1,000,000 AUToliffi ELIABILITY LEOMe6LINEISINGLE LIMIT $ ANY AUTO BOUTY INJURY(Per cannot IS OWNED SCHEDULED BODILY INJURY finer acc4enU $ AUTOS ONLY AUTOS HIRE° NONuOWNLY PROPEftiYDAMAGE S AUTOS ONLY PULSES ONLY Peracc4anl Underinsured motorist Bl s UMBRELLA LIAO OCCUR EACH OCCURRENCE S 3000,600 B EXCESS DAO CLAIMS MADE AN030622 0811312017 08113/2018 AGGREGATE $ 3,000,000 Oen RETENTION S 10,000 $ WORKBOB COMPENSATION XOT AND EMPLOYERS LIABILITY ^ STATUTE-F-FH YIN 1.000,000 C ANY PROPELETORPARTNERIEXECUTIVE Y❑ fit, AWC400]012861-2018 04/2912018 04/2912019 EL.EACH ACCIDENT S OFFICERMEMBER EXCLUDED? 1,000,000 (Mandatory In Nm EL.DISEASE-EA EMPLOYEE S Nye,.dobe under 1,000,000 DESCRIPTION OF OPERATIONS Saline EL.DISEASE-POLICY UMrt S Bond Amnt 20000 Surety Bond- ASS ARJiate ou O 3364848 04119/2018 0411912019 DESCRIPTION OF OPEMTION51 WCAPONS I VEHICLES RECORD 101,Addiumal Someone scMGu e,may be insured N more apace Is reyulredl Certificate holders are additonal insured on the above Captioned GL policy;subject to policy forms,renditions,and exclusions.Adam Quanneville,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 Adam Quennaville Roofing B Siding,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESEMATIVryryVEn ®1986-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1 CongressSuite 100 Boston,MAA 02 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 1'0 BE FILED WITH THE PERMITTING AUTHORITY. Applicant I [ f 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 Ar<yon an employerT Cherk me appruprhul be.: Type of project(required): I. lam aemployer with 15 employees(ran and/or pim-tme)t 7. ❑New construction 2.❑l am a wle p...... ror panncrship and hevenoemployers working formeln $ ❑Remodeling any capacity.[No workers'comp-insurance requiad] 3 lamahomeowner doin Il workm If No workers'comg a yse I p r 9. El Demolition suranca regmr d]' 401 an a homeowver and will be hiring contractors or conduct all work on my property. 1 will I B❑ Building addition ensure that all contractors ember have workers'wmpensanon insurance or are sole I1.❑Electrical repairs or additions prop mbi swith no employeev 12.M Plumbing repairs or additions 5 1 and a general contractor and I base hired the subcontractors listed on the attached sheet. 13.E]Roof repairs these sobwntmcmrs hevc cmployces end have workers wrap.insurance.: 6 We area corporation and at officers have exercised their right ofexemption per MGI.c. 14.❑Other 152,k I(4),and we have no employees[No workers'comp.insurance required.] *Any applicant that checks his"I must also fill out the saction below showing than workerscompensation policy information. I Homeowners who tabour his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContonrors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have cmployces. His,sub contractors 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 lite policy and job site information. Insurance Company Name:AIM Mutual Policy#or Self-ins. 7Lic.#1:AWC4007012861-2015 Expiration Date:4/29/2010 Job Site Address:"7� bre U ` City/State/Zip: I\'(si F+�'Y7.1'Y1 q top, 'p, Attach a copy of the workers' co ensation policy declaration page(showing the policy number and expiration date). C)iCkeo 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 ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy ofthis statement maybe forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certify under thepains and aloes ofperjury that the information provided above true and correct. S' Date- � �7 1 Phone it.413-536-5955 Official use only. Do not write in this area,M he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City![own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone k: Commonwealth of Massachusetts ®� Division of Professions l Licensure Board of Building Regulations and Standards Construptlon Supervisor CS-070626 Expires: 08/21/2019 ADAM A QUENNEVILLE 160 OLD LYMAN ROAD SOUTH HADLEY MA 0011676y� Commissioner C4 (� '/&fi:J�r�/iiJi/fi Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation ADAM QUENNEVILLE ROOFING AND SIDING,INC.. Regpiration: 191093 160 OLD LYMAN RD. Exxpiration: 03/22/2020 SO.HADLEY,MA 01075 Update Address and Rectum Card. .A 1 o mu-csn STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Be it known that ADAM QUENNEVILLE 160 OLD LYMAN ROAD SOUTH HADLEY, MA 01075-2632 I e i I is certified by the llcparrmeat ofConsumer Protection as a registered HOME IMPROVEMENT CONTRACTOR Registration # HIC.0575920 ADAM QUENNEVILLE ROOFING Effective: 12/01/2017 /��, Expiration: 11/30/2018 Mkbelk Sn[al4 CanmWoeer i I '