23D-015 (4) 18 PARK ST BP-2019-0197
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-015 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:ROOF BUILDING PERMIT
Permit# BP-2019-0197
Project# JS-2019-000326
Est.COSI:
Fee:$182.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sp R.): 34717.32 Owner: FITZGERALD REALTY CORPORATION
Zoning URB(100)/ Applicant: ADAM QUENNEVILLE
AT. 18 PARK ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413)536-5955 n Workers Compensation
SOUTH HADLEYMA01075 ISSUED ON.811612018 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING ROOF MATERIAL AND INSTALL
NEW ASPHALT SHINGLES. INSTALL ROLLED ROOFING ON BACK PORCH AN DEDPM RUBBER
ROOFING SYSTEM ON ALL OTHER FLAT 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: O_I: 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:
FeeTvue: Date Paid: Amount:
Building 8/16/20180:00:00 $182.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
L5 t(p9-WE r1-)1Ve,si..I.7 Commercial Building Permit May 15,2000
Q it orthampton
ry
AUG 1 5 2018Bui Department
am Street
Ronn 100
Novimimiur MA 01
on, MA 01060
phone 41J-btJt-1Z4u Fax 413-587-1272
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION so-/// - 7
1.1 Property Address: This section to be completed by office
18 Park St Map ,R 34 Lot Unit
Florence. MA 01062 Zone Overlay District
Elm St.District Cis District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED
2.1 Owner of Record;
'Fitzgerald Realty 1,PO Box 60445 Florence, MA 01062
Name(Print) Current Mailing Address
(413) 835-5689
Signature �� Xitl
n(-f -Telephone
2.2 Authorized Agent,
Adam Quenneville Roofing& Siding Inc i :160 Old Lyman Rd South Hadley, MA 01075
Name(Print) Current Mailing Address:
F(413) 536-5955
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit s licant
1. Building $26,000.00 l (a)Building Permit Fee
i
L
2 Electrical $0.00 (b)Estimated Total Cost of
Construction from(6)
3. Plumbing $0.00 Building Permit Fee
4
5 FiMreecPrDlection hanical (HVAC)
- $0.001
-- ---
6 Total-(I -2-3+4+5) Check Number
This Section For Official Use Old
Building Peri Number Date
Issued
igna Al
BYding Commikslon opector of Buildings Date
V
Versiri Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repaint❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description ',Remove existing roof material and install new asphalt shingle system. Install rolled roofing on
Of Proposed Work: "back porch and EPDM rubber roofing system on all other flat roofs.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ElA-21:1A-3 Cl 1A ❑
A-0 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify
M Mixed Use ❑ Specify
S Special Use ❑ Specify. '',,
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group'. Proposed Use Group _
Existing Hazard Index 780 CMR 34):L... Proposed Hazard Index 700 CMR 34)
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1:, ,
_. 2`
4th
Total Area(so Total Proposed New Construction(so
i....._.
Total Height(h)
.. Total Height It . ._ _.
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public [-] Private 0 Zone ___ Outside Flood Zone❑ Municipal ❑ On site disposal system[]
Versionl.7 Commercial Building Permit May 15.2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This Munn to be filled in by
Building Department
Lot Size '..
Frontage
Setbacks Front
Side L. R:l. . L _. R:
Rear
Building Height
Bldg.Square Footage % - l�
r
Open Space Footage % _
[Lot arca minus bldg&paved
arkin
ofParking Spaces
Fill:
.ounne&Loentuo
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book I Page, and/or Document#'.
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES Q
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 0
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 O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
.._ .. _.._. _. Not Applicable ❑
Name(Reg,atea : - -
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Adders, Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
SignatureTelephone Expiration Date
9.3 General Contractor
_Adam Quenneville Roofing &_Siding Inc. Not Applicable ❑
Company Name
Adam Quenneville
Responsible In Charge of Construction
160 Old Lyman Rd South Hadley, MA 01075
Atltlress,t47�
(413) 536-5955
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Fitzgerald Realty as Owner of the subject property
_ .
Adam Quenneville Roofing & Siding Inc
hereby authorize - to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Ownerate
,Adam Quenneville
as OwnerlAuthorized
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 pe7ury.
!Adam Quenneville
Print Name
�A_ Q� 14 I,8
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction au oewlsor: Not Applicable ❑
Name of License Holder Adam Quenneville CS 070626
License Number
.160 Old Lyman Rd South Hadley, MA 01075 108/21/2019
Address A Expiration Date
r(413) 536-5955
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,5 25C(8))
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 O No O
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: (S Qatry— S'� IF1Qr4trNU- MAI 010102
The debris will be transported by: (�S\A tAn la l tna + L?"Ai 1w inc .
The debris will be received by: USR V�Ow6na a 2icur Itv 111 -
Building permit number:
Name of Permit Applicant Agam Ot t l l k t ill >?
Date Signature of Permit Applicant
pY�NN�VtLL� � A VISAO:
62
160 Old Lyman Road•South Hadley•MA 01075 We are Licensed
1.&OO.NEW.ROOF a 413.536.5955 Fully Insured
Email:in(pjal IWOnewrootnet Website:www.1900newmof.net FactoryTrained
MA Construction Supervisors Lir.#070626 MA Registration a120962 Factory Certified Installers
:riIn.I.—sell en—mwenern man. CT Registration#5)5920
Membvolihe auildly.&India Ase ion pPC U710
Proposal Submitted To: Data Phone Ws: C.413-835-5689
Fitzgerald Reality (Ted Boyer) 8/10/18 H W:
Street: Email:
18 Park St
City,State,Zip Code: Special Requirement
Florence Ma 01062 rolled roof on back porch.
rubber membrane with 1" ISO on all
PROPOSAL FOR: other flats.
OUS GARAGE OTHER rubber roof on rounded window roof.
TRIP RECOVER � install new metal over leaking tin
Layers: 1 2 3 4 Plywood Included: Yes o'L'a'/ section.
❑ Tear off SLATE or SHAKES
front building only
COMPLETE ROOF PROTFLTION SYSTEM:
We shall acquire appropriate permits for all work
fk�l Home exterior and landscaping to be protected
�p Strip existing roofng to existing decking with full inspection DONOTDO: any other buildings
IF All project waste shall be removed by dumps[er(dumpsterforcontractor use only)
® Install Ice&Water Barney at all eaves 3'-AI5valleys,chimneys,pipes and skylights
A Install(151b.felt yntheb underlayment over remaining decking area
® Install Metal drip edge at eaves and rakesg8/5" It /brown)
jdp Install manufarturel's starter shingle on al l eaves and rake edges
A Install new pipe boo flashing/vent accessories
41 Install ridge vent- unt Cobra rolled/4'Baffled/Roll
Shingles:(standard 6 nails per shingle)
GAF timberline HD Shingles Color: slate
GAF Ridge cap shingles
Warranty Options:
)§ We guarantee our workmanship for 10 fullyears
C GAF System Plus Warranty
G GAF Golden Pledge Warranty
Chimney Options:
® Lead Counter Flashing CWater Seel&Tuckpoint O Rubberized Crown )Cricket
:3 Mason needed(customer provided)
Additional material and labor changes may apply.
Deteriorated existing decking will be replaced at$3.77 per sq.ft.and dimensional lumber at$7.00 per linear ft.,
after full inspection. Customer Will =M—
we PmPosa hanba us lurnid,mrt.ri45eMlabor—aompltl.In Maoman:wm a..u-scidcne enh.spm M: Total Due:($26000 )
uRvrANCEMPROPosu:Theabwepaz;sPeamrenons snit mntlnlonsare Down Payment($ 8000 )
satlshnwy antl am M1ertbyampbd.Ypuare amhprhetlmde wa8aaapin ad. Balance Due Upon Completion:($18000 1
Paymen[wlll be 1/3 down ae start afpb,and belanu due open mmpletlan.
Datei* /P Signature: 4�
Data 8/10/18 Estimator:(Print Name)Robert Croteau (Sign Name) //fz�
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 Ouenneville Rodfing All not be
responsible for debris or dust in the attic or storage areas. Customer Label
seas.® CERTIFICATE OF LIABILITY INSURANCE
0626/2.18
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORIZED
REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT. If the cortlfkate holder Is a°ADDITIONAL INSURED,the policy les)must have ADDITIONAL INSURED provisions or be enclorsed.
If SUBROGATION IS WAIVED,subject to the trams and conditions of the Polley,certain policies may require an endorearnant. A statement on
ills ear ficoW does not confer rights to Me cerdficaM holder In lieu of such endorsement(s).
PRODUCER LANE: T Melinda Kenikula
Goa B McLain insuranceAgentyuE (d13)534-]355 Am Mid (413)535-9286
1)6]Northampton Street -MUL mkamkule®goasmdain.mm
AVDREss:
P O BOx 1120 INSURER 6 AFEpL01NG LOYESIGE NAICI
HdYOkQ MA 01041-1128 final NeURIUs Insurance COmpa1F/
INSURE. INSURERS: Naufilus Insurance COMPanY
Adam Quennevills Roofing B Siding Inc INSURER C. ATT Mutual Ins CO.
160 Old Lyman Road SM,OMSRp, The Bontl ExOtonge,Inc.
INSURER E'
SCUM Hadley MA 01075 NELSON F:
COVERAGES CERTIFICATE NUMBER: CL185104974 11 V ION NUMBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOVMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO YMICH THIS
CERTIFICATE MAYBE ISSUED OR My 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.
MISS TE TYPEOFINSURANCE IN POLICY NUMBER ndc! EFF MMNWYYYP, LIMITS
X COMMEMIALGENEIULUMIN ITY FAOHCCCURRENCE 6 1,000,000
.N.XACE 1X OCCUR PREMISES e_ MvS 100,000
MEDEXP(AMMlerersan) f 15,000
A NN952216 08232010 de232019 PERM .ADJMTs1 f 11000,000
GENLAGGREGRE LIMIT APPLIES PER: GENERALAGGREGATE f 2,000,000
POLICY[—]PR- tODO000
E
OTHER Employee Benels f 1,000,000
AUMO BILE LIABILITY COMSIQeDSINGLE LIMIT S
ANYA.TO BODILY INJURY(Fegertm) 5
OYr 101 6AOHEOULED POORLY IWURY(FI uWmU 5
AVTC60NLY UTpa
XI'Ed NOX�OValEO FROPEgTY DAWGE S
Al1TOSONLY AU ONLY e,es1MM
Underinsured motorist Bl f
X UMBRELLA/IAS OCCUR FACH°CCURRENLE f 3.000,000
B EXCESS UA9 culu.�Nuxl AN030622 0811312017 001132016 AGGREGATE s 3,000,000
OED X RETENTION S 10,000 f
WORMERS COMPEN 6APON X siRi,ITE OTIC
AND EMPLOYERS LIABILITY ylN 1UW 00U
L. ANYPROPRI TOPERSNEFOEECUTIVE O NIP AVrCd00]01286L EL EACXALCIceM f
OFFCERMEMBER EFcULDEDi 2018 0429I201B 04292019
IMeMsisn In NIR LOI6EASE EAEMPL°YEE E 1000000
NYee.EesafiM u,pe E
LESCRIPIIgY°F OPEMTIONa EYo-x E.L.DISEASE-PoULY IIMnA�BW
Surety Bontl-HSS AMIiate Bond Amount
0 3364840 0411912018 04/192019
DESCRIPIKKI OF OPERATONS I LOLAIpNS I WHOLES JACORD 1M,Atl0llbnel RwneM SebOss,mry le MMtle4lr mon eWw 15,eyYM1
Can?rate holden,are additonal insured on the above ciplioned GL pollry:subject to pdky fame,conditions.and exclusions.Allam Quennevi le,as an
officer,IS excluded from Me KMkers Comp poliq.
CERTIFICATE HOLDER CANCELLATION
SHOULDANY OF THE ASOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELNERED IN
LQ
avilie Room,B Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS.
AUMORI DREPNESENIATVE
0lMS 2015 ACORD CORPORATION. All rights resomed.
ACORD 26(2016103) The ACORD n....nd logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gop/din
R orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING ALI I'HORI'I'Y.
Applicant Information Please Print Legibly
Name (Business/organtrnbonflndisiduap:Adam Quenneville Roofing&Siding Inc.
Address:160 Old Lyman Rd
City/Slate/Zip:South Hadley, MA 01075 phone #:413-536-5955
Are you an employer?Check the appropriate box:
Type of project(required):
I l am a employer with 15 employees(full and/or part time)t 7. ❑New construction
2.❑l am a sole fornicate,pannershlpond have no employees working for mein g, ❑Remodeling
any capacity.[No workerscomp insurance required.]
I am a homeowner doing all work Noworkers'mm ed 0. ❑Demolition
3
_❑ ga } [ p_insumnce required_]'
4.❑ m I aa homeo cr er and will be hiring contractors to conduct all work on my property_ 1 will I O ❑Building addition
prture that all connotes either have wmoco'emnpensafaommorceo ,ne sole IL❑Electrical repairs or additions
oprlens,with no employees. 12.❑Plumbing repairs or additions
5.❑l am a general contractor and l have hired the sub emlracto¢listed an the attached short 13g Roofrepairs
Ibeas sub contrcems have employees and have workers'comp.insurance.
6❑We are a corporation and its officers have exercised their right ofexempbon per MGl.c_ 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.I
`Any applicant that checks box 41 must al sic fill out the xenon below showing their workers'compensation policy Information.
e homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Commons,that check this box must amselad an additional sheet showing the reme of the sub-convectors and state whether or not those entities have
employees ]fine sub contractors have employees,they must provide their worker'comppolicy number
1 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
Policy#or Self-ins.Li,.#:AWC4007012861-2018 Expiration Date:4/29/2019 I ,,
Job Site Address: is
O Pa a— a' City/State/Zip: �IOrPrd hu � MNOW—
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. t52,¢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$250.00a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify under the pain nd penalties of perjury that the information provided above is,trpue and correct.
S'enature Date' &�iy IN
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 It
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone k:
_ Co111rnonweadll of Mass1[M1u1elts
®' Dlvmlonol Prolesv nal Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-070626 11 Expires:0812112019
ADAM A QUENNEVILLIE
160 0LD LYMAN ROAD
SOUTH HADLEY MA 01075
QOTTISeIOner CA
.//IP t/J!W/I/Jln///!`P(C✓f�l �!/i)l!!1/!L-lC��i
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
ADAM OUENNEVILLE ROOFING AND SIDING,INC. Registration 191093
160 OLD LYMAN RD, Expiration: 03/22/2020
SO.HADLEY,MA 01075 -
Update Address and Return Card.
Sf0 i O 10.tOS„
STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION
Bc it known that
ADAM QUENNEVILLE
j 160 OLD LYMAN ROAD
j SOUTH HADLEY, MA 01075-2632
i
I e
is certified by the Department of Consumer Protection as a registered
i
HOME IMPROVEMENT CONTRACTOR
Registration # HIC.0575920
ADAM QUENNEVILLE ROOFING
Effective. 12/01/2017 / &
Expiration: 11/30/2018 �/LK
Mkbelle Sn6ull,Commesiener i