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24C-140 (3) 8 FOURTH AVE BP-2021-1102 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C- 140 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-2021-1102 Project# JS-2021-001862 Est.Cost: $12155.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 5924.16 Owner: LEVENTHAL TED Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 8 FOURTH AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/2/2021 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: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I• I ', y2 1, • Certificate of Occupancy sianature:I + 1 FeeType: Date Paid: Amount: Building 4/2/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �� Department use only or . . �M�o City of Northampton �� �_status of Permit: Building Department \\ I,`Curb Cut/Driveway Permit „A , 212 Main Street/ 4p9er)Septic Availability 01 Room 100 J Water/Well Availability � Northampton, MA 01060 (90a7 Two/Sets of Structural Plans phone 413-587-1240 Fax 413-5877/ Z2_, PIOt/Site Plans J - aspE:--- .other Specify �.4,,,, �cr, APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE*DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: / 8 4th Ave Northampton Ma 01060 Map 2(- C. Lot /7f Unit Zone /// Overlay District Elm St. District_ CB District SECTION 2 -PROFERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ted Leventhal 8 4th Ave Northampton Ma 01060 Name(Print) Current Mailing Address: 301-717-0990 see contract Telephone Signature 2.2 Authorized Agent: Adam Q enneville 160 Old LymanRd South Hadley Ma 01075 Name(Prim) Current Mailing Address: // 413-536-5955 Signatu e Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 12,155.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee / /.../0- 4. Mechanical (HVAC) 5. Fire Protection I�/y�r / 6. Total = (1 + 2 + 3 +4 + 5) 12,155.00 Check Number 1�L� �// /� `1 This Section For Official Use Only Building Permit Number: 6/4(. f I' �/( A Date Issued: Signature: /Z7Z 17" Z- 2OZ Building Commissioner/Inspector of Buildings Date operations.aqrs @ gmail.com 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 DONT KNOW x YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW x YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW x YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YE1 NO x IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, gradin excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YE: 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 El Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding QE] Other[DI Brief Description of Proposed New roof, remove and replace existing roofing, install new ice and water barrier,drip edge, pipe boot flashin 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, Ted Leventhal 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 03/30/2021 Signature of Owner Date 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 Quennev'le Print Name 03/30/2021 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Adam Quennville CS-070626 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2021 Addre Expiration Date 413-536-5955 Sig ature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 Adam Quenneville Roofing &Siding Inc 191093 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 0 City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS Y r 212 Main Street •Municipal Building . --� 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: 8 4th Ave Northampton MA 01060 (Please print house number and street name) Is to be disposed of at: Adam Quenneville Roofing &Siding 160 Old Lyman RD South Hadley Ma (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 Rd South Hadley Ma (Company Name and Address) 60(9- Signature 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. il1118.4llii Vr AWARD VISA e DISC,VER 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:info@l800newroof.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: Phone#'s: C: Alisa Ainbinder 3/23/2021 H:301-717-0990 W: Street: Email: 8 4TH Ave amainbin@gmail.com City,State,Zip Code: Special Requirements: Northampton MA 01060 PROPOSAL FOR: HOUSE GARAGE OTHER STRIP RECOVER Layers: •2 3 4 Plywood Included: Yes o No 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: P All project waste shall be removed by dumpster(dumpster for contractor use only) re Install Ice&Water Barrier at all eaves 3' 6Q',�alleys,chimneys,pipes and skylights Install(151b.felt nderlayment over remaining decking area XO Install Metal drip e.g- . -ayes and rake 5") j•rown) • Install manufacturer's starter shingle on all eaves and rake edges fyr Install ne pipe boot flashi /vent accessories o raro e Shingles:(standard 6 nails per shingle) GAF' HD Shingles Color: WEATHERW00D GAF Ridge cap shingles Warranty Options: p We guarantee our workmanship for 11 0 full years GAF System Plus Warranty GAF Golden Pledge Warranty Chimney Options: O Lead Counter Flashing O Water Seal&Tuckpoint O Rubberized Crown O Cricket Mason needed(customer provided) Additional material and labor charges may apply. pDeteriorated existing decking will be replaced at$3.77 per sq.ft.and dimensional lumber at$7.00 per linear ft., after full inspection. Customer Initials: We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 12, 155 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($finance ) satisfactory and are hereby accepted.You are authorized to do work as specified. Balance Due Upon Completion:($ Payment will be 1/3 down at start of job,and balance due upon completion. a Date: 3/23/2021 Signature: ` "'4 upLOA 4,,,_J 41313-38-332 Date: 3/23/2021 Estimator:(Print Name) Dustin Peters (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: NOTICE OF SCHEDULE CHANGES The contractor agrees that when delays become known to the Contractor,the Contractor will advise the Owner as soon as reasonable. DELAYS IN THE COMPLETION SURE TO HIDDEN CONDITIONS The Owner hereby acknowledges and agrees that in certain remodeling work,the demolition of portions of the pre-existing structure may reveal additional defects,conditions or the need for additional work,which must be repaired,altered or carried out in order to commence or complete the work described under the contract.In such case(s),the Owner agrees that the duration of the work and the scheduled date of completion may differ from the date on the front,and that such variation which is not avoidable by the Contractor shall not be considered to be a violation of the contract. ADDITIONAL WARRANTY INFORMATION All warranties for equipment supplied by the Contract under the Agreement shall be those given by the manufacturers of such equipment,which shall be and are hereby passed through directly to the Owner.Under such manufacturer's warranties,the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The warranty give the Owner specific legal rights,and Owner may also have other rights which vary from state to state.Under Massachusetts law,sale of goods carry an implied warranty of merchantability and fitness for a certain purpose.All material is guaranteed to be as specified.All work shall be completed in a workmanlike manner,according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over estimate.All agreements are contingent upon strikes,accidents or delays beyond control. SUBCONTRACTING Contractor agrees that,notwithstanding any agreement for materials and/or labor between Contractor and third party,Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in the Payment Section(front)for the reasons the he deems himself or the payments to be insecure.If,however,he deems himself to be insecure,he may require,as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in control of the Owner,shall be placed in a joint escrow that requires the signature of both the Contractor and the Owner for withdrawal. You agree to pay cash according to the terms shown above or,if we approve your credit,to sign a note provided by us for payment of the amount due.You also agree to sign a completion certificate upon completion of the work.If you fail to pay according to the above terms and have not signed our note,the entire unpaid amount becomes immediately due,and you must pay a collection cost equal to our actual collection costs up to 15%of the total amount you owe,plus attorney's fees and court costs.In addition,you understand that by failing to pay according to the above terms,the Contractor may have a claim against you which may be enforced against your property in accordance with the applicable lien-laws. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself,his employees or his subcontractors in the performance of,or as a result of,the work under this Agreement.Contractor agrees to carry insurance to cover such damage or injury. The Contractor recognizes his obligation to maintain a workers'compensation insurance policy to cover his employees.Contractor further recognizes the obligation of any and all subcontractor to maintain a workers'compensation policy to cover their employees. Contractor maintains a liability insurance policy with minimum coverage limits of one million dollars($1,000,000.00) CONSTRUCTION RELATED PERMIT ACQUISITION The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits.The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory permit granting or inspectional agencies, authorities or individuals. MODIFICATION This Agreement including the provisions relating to price and payment schedule cannot be changed except by a written statement signed by both the Contractor and the Owner.However,cancellation by Owner is allowed in accordance with the Notice of Cancellation. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void,deleted or not applicable,and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. COPY OF AGREEMENT TO BE GIVEN TO OWNER The Laws of Massachusetts shall govern this Agreement.It must be executed in duplicate,and an original,signed copy hereof shall be given to the Owner at time of execution.No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner a copy thereof. ARBITRATION In the event the Owner and Contractor have a dispute regarding any of the terms,conditions,provisions or performance of this contract,the parties agree to place the matter into arbitration before an independent arbitrator assigned by the American Arbitration Association to resolve their dispute.Owners acknowledgement of arbitration clause CANCELLATION Owner may cancel this contract within three business days of executing this document. Such cancellation must be in writing and delivered to the Contractor.Contractor reserves the right to cancel this contract at any time within thirty days of the date of this contract.If we cancel you will be promptly notified in writing by an authorized officer of Adam Quenneville Roofing&Siding Inc.If we cancel,we will promptly return any down payment(s)you have made. -A /z� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/23/2020 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 1 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 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 CONTACT Sarah Premo NAME: Clayton Insurance Agency,Inc. (A/O No,Extl: (413)536-0804 FAX No): (413)534-7874 1649 Northampton Street E-MAIL spremo@claytoninsurance.net ADDRESS: ' P.O.Box 989 INSURER(S)AFFORDING COVERAGE NAIC if Holyoke MA 01041-0989 INSURER : Nautilus Insurance Company INSURED INSURER B: Green Mountain Insurance Company 20680 Adam Quenneville Roofing&Siding Inc. INSURER C: AIM MUTUAL INSURANCE COMPANY 160 Old Lyman Road INSURER 0: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2062304009 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 BYTHE 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 IADDL S1Jdk POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) UNITS X COMMERCIAL GENERAL UABIUTI EACH OCCURRENCE $ 1'000'000 DAMAGE TO REN1ED CLAIMS-MADE XI OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NN1143748 06/23/2020 06/23/2021 PERSONAL&ADV INJURY $ 1'000'000 GEN'LAGGREGATE LIMIT APPUES PER: GENERALAGGREGATE S 2,000,000 POUCY IL XI Mr- ( (LOC PRODUCTS-COMP/OP AGG $ 2.000,000 $ OTHER: AUTOMOBILE LABIUTY COMBINED SINGLE OMIT AUTOMOBILE 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S B OWNED �/ SCHEDULED 20035707 06/23/2020 06/23/2021 BODILY INJURY(Per accident) S AUTOS ONLY /". AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY x AUTOS ONLY (Per accident) $ x UMBRELLA LAB OCCUR EACH OCCURRENCE s 5,000,000 A EXCESS UAB CLAIMS MADE AN088790 06I23/2020 06/23/2021 AGGREGATE $ 5,00,000 DED REIENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'UABIUTY -STATUTE Y/N 1000000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N/A AWC4007012861 04/29/2020 04/29/2021 EL EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY UMIT $ , DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) For Informational Purposes Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN Adam Quenneville Roofing&Siding Inc ACCORDANCE WITH THE POUCY PROVISIONS. 160 Old Lyman Rd AUTHORIZED REPRESENTATIVE South Hadley MA 01075 / fcs{�1 te,/ F' � _�,_ L ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Conunonwealtlz of Massachusetts Department offndustrialAccidents 1 Congress Street,Suite 100 1� Boston,MA 02114 2017 - a- www.rnass.gov/die Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH!HE PERMTITING AUTHORITY. Applicant Information PIease Print Legibly- Name(Business/Organized on/Individual): Adam Quenneville Roofing & Siding Inc Address: 160 Old Lyman Rd City/State/Zip: South Hadley, MA 01075 Phone#: 413-536-5955 Are you ari employer?Check the appropriate box: Type of project(required): t.�f am a employer with 15 employees(fuU andforpart-time]'° 7. ❑New construction 2.Q l aro a sole proprietor or partnership and have no employees working forme in $. Q Remodeling any capacity.[No workers'comp_insurance required.j 9. Q Demolition 3_Q I an a homeowner doing all work myself[No workers'comp.insurance required.] I0 Q Building addition 4_Q I am a homeowner and wilt be hiring contractors td conduct aft work on my property_ I wilt ensure that MI contractors either have workers'compensation insurance or are sole 1.I.[]EIectrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general'contractor and I have hired the sub-contractors listed oa the attached sheet 13 oof repairs These sub-contractors have employees and have workers'comp.insurancc.t 6_1 j R'e are a corporation and its officers have exercised their right of exemption per NIGL e 14.0 Other 152,§1(4),and we have no employees.[No workers'camp_insurance required.] *Arty applicant that checks box 41 must also fill out the section below showing their workers'compensation policy infommtion. t Homeowners who submit this affidavit indicating they arc doing aII work and they him 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 an:an employer that is providing workers'conzpensation insurance for my enrployee_s. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins.Lie.#:. ANC40070128612019A Expiration Date: 41/9.9 O Job Site Address: ' I '' AV C. City/State/Zip:tJ��I `��'�p '`� O 1°C 0 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.I52,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORD1aR and a fine of up to S250.00 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 der hereby cer jy under e pairs turd penalties of pedury that the inforrrurtian provided above is true and correct Signature: Date: 3/3 a - 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): I.Board of Health, 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts r Division of Professional Licensure Board of Budding Regulations and Standards Cor<Structilfiri%15pervisor CS-070626 },• L spires:08/21/2021 ADAM A QUENNEY''N 160 OLD LYMAN RQ SOUTH HADLEY MA •1 f Commissioner it4;.‘?y4 P_Re fowimmnwect&A t C-2164ztc tize11 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home improvement Contractor Registration Type: Corporation ADAM QUENNEVILLE ROOFING AND SIDING;INC. Registration: 91093 Exxpi ration: 03/22/2022 160 OLD LYMAN RD. SO.HADLEY,MA 01075 Update Address and Return Card. scA 1 A 2obi•o5117 .:�•.� ,///� //r J� a. .. •�� !•1:. ri•�¢t' �V� �✓':; Jig'.,...hYJt� �'��i�r�J`�% .74:'r{1L. :4rT,\, /^!',,:j "7-',�,/`' 7,\/.�•7:7-:'1 �7-", /.7 . T ..._. ,i_ 4 4 - 44_ 4 A_ 4?_ 44 +. w!. w 4..;, a..*: +✓�,. w ,. ay�, 4 IP_ ..a �: a iv' iv* w y 41 A, ' 4 AY .1 er- 1 i\ , j` STATE OF CONNECTICUT + DEPARTMENT O PROTECTION_ CONSUMER PROT CTION' I` Be it known that ` ADAM QUENNEVILLE i i 160 OLD LYMAN ROAD t l I SOUTH HADLEY, MA 01075-2632 i f , has satisfied the qualifications required by taw and is hereby registered as a i I r HOME IMPROVEMENT CONTRACTOR A t I Registration # HIC.0575920 f j i ADAm QUENNEVILLE ROOFING I Effective: 12/41/2020 ldl Expiration. 11/30/2021 ! I il Michelle Seagull,Commissioner ` 1 I � ; I I1 1 ' Z i X i 2 5 ,