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29-449 (6) 16 CRESTVIEW DR BP-2020-1258 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-449 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-2020-1258 Project# JS-2020-002116 Est.Cost: $2000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(s9. ft.): 10018.80 Owner: CATUOGNO-REWIS ANNE onina: Applicant: ADAM QUENNEVILLE AT: 16 CRESTVIEW DR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.-611912020 0:00:00 TO PERFORM THE FOLLOWING ORK: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: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY TIRE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS Certificate of Occupancy Signature: FeeTyim Date Paid: Amount: Building 6/19/2020 0:00:00 $110.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner c.. nr r Department use only - City of Northampton Status of Permit: i y Building Department Curb_Cut/Driveway Permit f V A 212 Main Street Sewer/Septic Availability r" ( Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify kPL 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 oqMap Lot Unit 16 Crestview Dr Florence Ma 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Anne Catuogno- Rewis 16 Crestview Dr Florence Ma Name(Print) Current Mailing Address: 413-657 5467 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville Roofing & Siding 1A0&Yi4 y"t At 6Rfiih1R7& Siding NameT-- Current Mailing Address: sdamQuenneville Roofing & Siding Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,000.00 (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) Check Number a This Section For Official Use Only �� S Building Permit Number DateIssued: Signature: (!�" ! &2(/ Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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. R. 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 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 Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing O Or Doors (] Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C[ Siding [O] Other[O] Brief Description of Proposed Remove and replace shingles,drip edge,vent ridge,pipe boot flashing. Work: 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 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 I, Anne Catuogno-Rewis as Owner of the subject property Adam Quenneville hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. see contract 6/16/2020 Signature of Owner Date l 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 6/16/2020 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam QuennVllle CS-070626 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2021 Address Expiration Date ,V 413-536-5955 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quenneville Roofing&Siding Inc 191003 Company Name Registration Number 160 Old Lyman Rd South Hadley Ma 01075 3/22/2022 Addres� 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....... X No...... ❑ City of Northampton Massachusetts ( � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building of Northampton, MA 01060 €•°�y y AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units..�.or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Ouilding not owner-occupied ther(specify): �&F)NG OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FO APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent.of the owner: L Iq ICA3 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts - z A W , DEPARTMENT OF BUILDING INSPECTIONS , 212 Main Street •Municipal Building �5 Northampton, MA 01060 Debris 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. The debris from construction work being performed at: I (-Y L26-,t ,) I)&It 101� (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Adam Quenneville Roofing&Siding 160 Old Lyman Rfi South Hadley Ma (Company Name and Address) LaI ��I�a Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. 1 ■� . L � AWARD VISA DISC VER 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:info@ 1800newroof.ne-t 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 PRC 38710 Proposal Submitted To: Date: Phone#'s: C: 413-657-5465 Anne Catuogno Rewis 6/12/2020 H: W.. Street: Email: 16 Crestview Or ray.catuogno City,State,Zip Code: Special Requirements: Florence MA 01062 Shed roof only PROPOSAL FOR: Composite fascia complete shed HOUSE GARAGE OTHER $TRIPRECOVER Layers:O 2 3 4 Plywood Included: Yes or No J Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: -1q 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: House All project waste shall be removed by dumpster(dumpsterfor contractor use only) Install Ice&Water B at all eaves 3'/6',valleys,chimneys,pipes and skylights .ae Install(151b.fel Synt underlaymver rem fining decking area Install Metal drip edge at eaves and rake S" white brown) Install manufacturer's starter shingle on all eaves and rake edges Install new pipe boot flashing/vent accessories Install ridge vent-Snow Country/Cobra rolled/4'Baffle ./Roll Shingles:(standard 6 nails per shingle) GAF Shingles Color: Shakewood GAF Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years I GAF System Plus Warranty J GAF Golden Pledge Warranty Chimney Options: 0 Lead Counter Flashing 0 Water Seal&Tuckpoint O Rubberized Crown L-1 Cricket E71 Mason needed(customer provided) Additional material and labor charges 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 Initials: We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($2000.00 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are pd e/e Down Payment:($ 600.00 ) satisfactory and are hereby accepted.You are au prized to do work as specified. I 2nd Payment at Start Job:($ ) Payment will be 1/3 down at signing,1/3 at7t rtf job,and bala a du Balance Due Upon Completion:($ 1400.00 ) upon completion. Date: 6/12/2020 ff f r ,z' Signature: Date:6/12/2020 Estimator:(Print Name)Scott Sedlak (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: A A��R" CERTIFICATE OF LIABILITY INSURANCE FDA E(MMI 20 OYY) THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 Fe' Trudell NAME: Martin J Clayton Insurance Agency, Inc PHONE (413)536-0804 Ext: (413)536-0804 FA C,No): (413)534-7874 1649 Northampton Street E-MAIL ftrnrfcl I Omni l Ayton.r om ADDRESS: P. 0. BOX 989 INSURER(S) AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURER B:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc INSURERC:AIM Mutual Insurance Company 160 Old Lyman Road INSURER 0: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:2019 MASTER 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. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1AMAA CLAIMS-MADE �OCCUR PREMISES(E.oc ED 100,000 PREMISES Ea occurtence $ X Y NN1000129 6/23/2019 6/23/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICYRO- II JjECT F LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ee ABI EDtSINGLE LIMIT $ 1,000,000 B ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 20030465 6/23/2019 6/23/2020 BODILY INJURY Per accident $ AUTOS AUTOS X Y ( ) NON-OWNED X PROPERTY DAMAGE HIRED AUTOS X AUTOS Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ 1 IAN069764 6/23/2019 6/23/2020 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X I STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE AWC40070128612020A 4/29/2020 4/29/2021 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N I A C (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers' Compensation benefits will be paid to Massachlsetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other thar Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. Thi: certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance) . The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verificatior Search tool at www-magc_qr/Twri/c:orkarg-rinmnena-t.nn/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR PERMITS ONLY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Regan/FMI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(7nl4n1) Hie Conrrrionwealth ofAfassachrisetts x Department Iitdustr•iat Accidents 1 Congress Street,Suite 100 i Boston,M4 02114-2017 v =`` iviv.v.rnassgovldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERrfrMA;AUTHORITY. Applicant Information Please Print Let?ibly Name (Business/organization/Individuaq: Adam Quenneville Roofing & Siding Inc Address: 160 Old Lyman Rd CityiState/Zip: South Hadley, MA 01075 Phone#: 413-536-5955 Are you an employer?Check the appropriate box: Type of project(required): I.r�dramactnployerwith�5_employees(full andlorpa—tune).* 7. New construction 2,❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp_insurance required.] 9_ ❑Demolition 3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.!t 10E]Building addition 4J7_1 I am a homeowner and will be hiring contractors to conduct all work on my property. i will ensure that all contractors either have workers'compensation insurance or are sole 1 i.❑Electrical repairs or additions proprietors with'no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.dRoo f repairs These sub-contractors have employees and have�&,orkers'comp.insurance.z 14.f__J Other 6_Q We are a corporation and its officers have exercised their right ofexemption per IvIGL a. 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that cheeks box#1 must also fill out the section below showing(heir 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. If the sub-contractors have employees,they must provide their workers`comp.policy number. 1 aril art employer that ispravidirrg workers'compensaiioit insurance for my ennployees Relorp is the policy and job site information. Insurance Company Name: AIM Mutual _ AWC40070128612019A 4129/2020 Policy�or Se[t=ins.Lric.#: E;tpiration Date: Job Site Address: t 6 C^'S4V,1 r A � City/State/Zip: tu" r v - ri 0 Uro - Attach a copy of the workers'compensation policy declaration pane(showing the policy number and expiration date). Failure to secure coverage as required under VGL 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. 1 eta hereby certify under the paints and penalties of perjury that the irtfarntatiari provided above is true artd correct. Signature //L Date- LO, Phone#: 41 3-53615955 Official use only. Do Trot 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 lf: Board of auiiding Regutatiens and Standards Constr4jcfi7i. SdjwrAsor CS-070626 ltpires:Od/2il2QZt ADAM A QUEIr1F! t' r 160 OLD LYMfAN it SOUTH HA DL Y � ' Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M usetts 02118 Home lmproven a htractor Registration =-' Type: Corporation Registration: 19f093 ADAM QUENNEVILLE ROOFING AND SIDttG`kri t #, Expiration: 03/22/2022. 160 OLD LWAN RD. - =; SO.HADLEY,MA 01075 Update Address and Saturn Card. SCA 1 03 ZaM-M'7 ' Air o C0NNE CTIC U,T + D EPARWNM.T a ii PROTECTION Beit know th*t 10,OLD SOU g,t ', ;j I S� £t Inas satisfied tyre . ".+� qpa�'�� . � �:p` a�td is.Fxerebp'regFst€xcd as a f4 HOW 1. WE . 'ACTOR _ r ROO 11 ,i3 F:w Q VUJ E R 00MG � k Effeedve 12/0/2019t: Expi at ton: 11 f 3a/20-2Q 1 `MichdtaSegutt.@onroie�ioeer