The URL can be used to link to this page

17D-012 (67) Commonwealth of Massachusetts ? i Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-070626 Exp i res:08/21/2019 ADAM A QUENNEVILLE , 160 OLD LYMA.ti ROAD.. SOUTH HADLEY-MA 01075 , Commissioner t 1�1�' Ca�/l2�✓l2f'/LGI��z'.,�rG/��,/l�`CJCI.c.�r�GGCc1C'��% Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement-Contractor Registration Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING INC ?' Expiration: 03122l2020 160 OLD LYMAN RD. SO.HADLEY,MA 01075 ' ' s 5 r Update Address and Return Card. SCA t c"S 20M.05.117 ._ w..___.__... __. _.._.__..._.._...___....__._.___.._..-_..._. 00111 MOM Z STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Bc'it known that ADAM QUENNEVILLE 160 OLD LYMA.N ROAD SOUTH HADLEY, MA 01075-2632 has satisfied the qualifications requited by I=and is hereby registered as a HOME IMPROVEMIENT''CONTRACTOR Registration # HIC.0575920 ADAM QUENNEVILLE ROOFING Effective: 1.2/01/201$ 1 Expiration: 11/30/2019 mle1KNcseWll,Commtntlaner \ The Commonwealth of Massachusetts Department of Industrial Accidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia «'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly 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): l.E]I am a employer with 15 employees(full and/or part-time).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.L]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. Th13.❑Roof repairs 'Mese sub-contractors have employees and have workers'comp.insurance.: &F❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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 sub-contractors and state whether or not those entities have employees. If the 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 the policy and job site information. Insurance Company Name:AIM Mutual Policy#or Self-ins.Lfficc.y#:AWC4007012861-22018 Expiration Date:4/29/2019 n Job Site Address: `40 1 Br ic4 E � City/State/Zip: �IOrQnCQ W7� Attach a copy of the workers'compensation policy declaration pv&e(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 ins and penalties of perjury that the information provided above is t ue and correct. Si nature: Date: 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 5.Plumbing Inspector 6.Other Contact Person• Phone#• AC40 088!13120/13/2018 CERTIFICATE OF LIABILITY INSURANCE DAT 1YYYYy _ 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(les)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 the certificate holder in lieu of such endorsement(s). PRODUCER NAME Melinda Karakula Goss&McLain Insurance Agency PHONE E (413}534-7355 No): (413)536-9286 1767 Northampton Street ADDRESS: mkarakula@gossmciain.com P 0 BOX 1128 INSURER(S)AFFORDING COVERAGE NAIL# Holyoke MA 01041-1128 INSURERA: Nautilus Insurance Company INSURED INSURER B: Nautilus Insurance Company Adam Quenneville Roofing&Siding Inc INSURER C: A.I.M.Mutual Ins Co. 160 Old Lyman Road INSURER D: The Bond Exchange,Inc. INSURER E South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: CL185104974 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 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. LTR TYPE OF INSURANCE INSp POLICYNUMBER MMIDD E MMIDD P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT ET_ CLAIMS-MADE ©OCCUR PREMISES Ea occurrence $ 100'000 MED EXP(Anv one person) $ 15,000 A Y NN952216 06/23/2018 06123/2019 PERSONAL&ADV INJURY $ 1,000,000 ,GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY Q JECOT- �LOC PRODUCTS-COMP/OP AGG S 2.000,000 OTHER. Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COM Ea aBIccNED SINGLE LIMIT ident $ ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acc dent Underinsured motorist BI $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000.000 B EXCESS LIAR X1 CLAIMS_ DE AN055464 08/13/2018 08/13/2019 AGGREGATE $ 5,000,000 DED X I RETENTION$ 10,000 �/ $ WORKERS COMPENSATION /�► 3 ATUTE ERH AND EMPLOYERS'UABILITY C ANY PROPRIETOR/PARTNER/EXECUfNa N/A AWC4007012861-2018 04!29/2018 04/29/2019 E YIN E.L.EACH ACCIDENT $ 1.000,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Band Amount 20,000 Surety Bond-HSS Affiliate D 3364848 04!19!2018 04!19/2019 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more apace is required) 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 Adam Quenneville Roofing&Siding Inc. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 11 AWARDVISA40 DISCOVER 2010 WINNER 160 Old Lyman Road-South Hadley-MA 01075 We are Licensed 1.800.NEW.ROOF * 413.536.5955 Fully insured Email:info@1800newroof.net Website:www.1800newroof.net Factory Trained MA Construction Supervisors Lic.#070626 MA Registration#120982 Factory Certified Installers Member of the Home Builder's Assoc.of western Mass. CT Registration#575920 Member of the Building&Trade Association P.P.0 38710 Proposal Submitted To: Date: 7/11/18 Phone#'s: C: Meadowbrook Apartments H: W! Street: Email: 491 Bridge Rd-Building 22 City,State,Zip Code: Special Requirements: Florence,MA 01062 Resecure all gutters as needed with new brackets PROPOSAL FOR: HOUSI GARAGE OTHER PT MI RECOVER 1034 Plywood Included: Yes orF,01 G Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: • We shall acquire appropriate permits for all work • Home exterior and landscaping to be protected • Strip existing roofing to existing decking with full inspection DO NOT DO: • All project waste shall be removed by clu(Dvalleys, er(dumpsterfor contractor use.only) V Install Ice&Water Barrier at all eaves 3' chimneys,pipesa-d rL'kJ;@kf'c V Install(151b.felt=nderlayment over remaining decking area V Install Metal drip edge at eaves and rakes E)S") white V Install manufacturer's starter shingle on all eaves and rake edges V Install new pipe boot flashing/vent accessories ,V Install ridge vent-Snow Country Cobra rolled 4'Baffied/Roll Shingles:(standard 6 nails per shingle) GAF Timberline Lifetime Shingles Color: GAF Ridge cap shingles Warranty Options: V we guarantee our workmanship for 10 full years 7 GAF System Plus Warranty (' GAF Golden Pledge Warranty Chimney Options: 0 Lead Counter Flashing 0 Water Seal&Tuckpoint El Rubberized Crown D Cricket 0 Mason needed(customer provided) Additional material and labor charges may apply. V 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 Initials:- We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: Total Due:($15,125.00 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment: TBD satisfactory and are hereby accepted.You are authorized to do work as specified. I Balance Due Upon Completion: Payment will be 1/3 down at start ofjo d bal nce due upon com I tion. V Date: -Signature: Date: 10/26/18 -Estimator:(Print Name) Adam Quenneville (Sign Name) 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 Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: 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: y n e O OLODL The debris will be transported by: _HSA- }-na-lln!Q The debris will be received by: U SA FoLdl 64 Building permit number: Name of Permit Applicant aj'1,jOu-t�c l(-z- Date Signature of Permit Applicant 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 ® No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT IMeadowbrook Apartments/Poah Communities as Owner of the subject property IAdam Quennevtlle Roofing& Siding Inc hereby authorize _._ _., .... .,.__� _ . M _. _ __ _.M_............._n. _._a,_ne_ .......... Jo act on my behalf, in all matters relative to work authorized by this building permit application. 5,V-� C(!1 n t,��( _I �._ 1_�'.. _ Signature of Owner Date Adam Quennevtlle A 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 theains apd_pgnalties ofpe�ury• v„ !Adam Quenneville Print Name SignatureOwneNAgent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ -Adam Quenneville CS 070626 Name of License Holder.�.__ . ,,,.rn -------- License Number 160Old L Rd South Hadley, MA 01075 08/21/2019 Lyman Y�_. Addres Expiration Date (413) 536-5955 Signature Telephone SECTION 13-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 (E) No Versionl.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 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 13 r � Name(Registrant): -------------_,, I Registration Number Address - .... Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number _.._—------------------- ,._,,,.�_ Signature Telephone Expiration Date .. Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date t Name Area of Responsibility ! x Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number 7- 71 Signature Telephone I Expiration Date 9.3 General Contractor Adam Quenneville Roofing& Siding Inc I Not Applicable ❑ Company Name: JAdam Quenneville Responsible In Charge of Construction l60 Old Lyman Rd South Hadley MA 01075 Address 1013) 536-5955 Signature Telephone Version lJCommercial Building Permit May |5,2000 8. NORTHAMPTON ZONNF� Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage 010 (Lot area minus bldg&paved L #of Parking Spaces (volume&Location) A. Has aSpecial Permi[/Variance/Finding ever been issued for/onthe site? �� NO �~�� DON'T KNOW YES �~� |FYES, date issued: IF YES: Was the permit recorded atthe Registry ofDeeds? NO �� D «�� un / nmuvv YES IF YES: enter Book Page and/or Document#1 �� B. Does the site contain a brook, body ofvvaterorvvetiands? NO �~�� DON7 KNOW ��v YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained rDat e |ssued' C. Doany signs exist onthe property? YES 0 NO 0 | - --- |FYES, describe size, type and location: | D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO |FYES, describe size, type and location: E Will the construction activity disturb(d ing, grading,excavation, urfiUing)over1 acre oriaitpart ofocommon plan that will disturb over 1acre? YES ��K � NO K�� |FYES,then aNorthampton Storm Water Management Permit from the DPW iarequired. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 7 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑✓ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑� Change of Use❑ Other ❑ Brief Description !Remove existing asphalt shingles and install new asphalt shingle system. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h 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: i Proposed Use Group: Existing Hazard Index 780 CMR 34): j Proposed Hazard Index 780 CMR 34): i SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) Str---...m. ...e.... 1 st 1 1 2 n°; n e w 2nd e 3`° ; 3r° , u_ .� th m 4 { Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) v j Total Height ft ------ 7. _7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ -------- gooF IVersion 1.7 Commercial Buildin Permit Ma 15,2000 PA I � C ty of Northampton NOV 2 g 2018 B ilding Department 212 Main Street Room 100 DEPT OF DUILDING INSPECTION$�'0 am ton MA 01060 NORTHAMPTON,MA 01060 II`V� ampton, p one -587-1240 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 1 -SITE INFORMATION A "l �f 7 1.1 Proaertv Address: This section to be completed by office 491 Bridge Rd - Building 22 Map t19 Lot 0(2"' Unit ?Florence, MA 01062 Zone Overlay District --°--- ---- -~~--�----- -- Elm St.District CB Distract SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Meadowbrook Apartments � 491 Bridge Rd Florence, MA 01062 i Name(Print) Current Mailing Address: _n ;(617) 840-9812 Signature �n �LA Telephone 2.2 Authorized Agent: Adam Quennevtlle Roofing& Siding Inc 160 Old Lyman Rd South Hadley MAy01075 Name(Print) Current Mailin 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 $15,125.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of I Construction from 6 3. Plumbing _ Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection [ 6. Total=(1 +2+3+4+5) (N j, Ip ,� Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: /�/P /)- 3�-Jg Building C16mmissionerfinspector of Buildings Date 491 BRIDGE RD-#22 BP-2019-0647 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 17D-012 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-2019-0647 Project# JS-2019-001058 Est.Cost: $15125.00 Fee: $112.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq.ft.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP Zoning:URB(100)/WP(28)/ Applicant: ADAM QUENNEVILLE AT: 491 BRIDGE RD - #22 Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/5/2018 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 Deaartment 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: FeeTvve: Date Paid: Amount: Building 12/5/2018 0:00:00 $112.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner