15B-013 BP-2021-2026
574 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
15B-013-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2026 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
ADAM QUENNEVILLE ROOFING &
Est. Cost: 4095 SIDING 191093
Const.Class: Exp.Date:03/22/2022
Use Group: Owner: BATURA JOSEPH J& BARBARA E
Lot Size (sq.ft.)
Zoning: URA/WP Applicant: ADAM QUENNEVILLE ROOFING & SIDING
Applicant Address Phone: Insurance:
1600LD LYMAN RD (413)536-5955 AWC4007012861
SOUTH HADLEY, MA 01075
ISSUED ON:10/14/2021
TO PERFORM THE FOLLOWING WORK:
NEW FLAT ROOF ON FRONT PORCH
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.
Signature:
I ;If 9 (T-
•
I +
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Buildine Commissioner
�� Department use only
,,� .1,1.4: City of Northalc ton h^ Status of Permit:
k Building Departme OC ` • Curb Cut/Driveway Permit
1� A , 212 Main Street l Sewer/Septic Availability
Room 100 °r Water/Welf,Qvailability
� „ e-10 Northampton, MAC `-- Tw/SetsyffStructural Plans
" `� � phone 413-587-1240 Fax 41315 , ZZ2 ot/Sitc/'Plans
, ' \ , OtheOpecify
1;,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVA1 6 DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
574 Spring St Leeds Ma 01053 Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Lisa & Barbara Batura &Tara 574 Spring St Leeds MA 01053
Name(Print) Current Mailing Address: 413-588-8354
see contract
Telephone
Signature
2.2 Authorized Agent:
Adam Quenneville 160 Old LymanRd South Hadley Ma 01075
Name(Pri Current Mailing 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 4095.00 (a) Building Permit Fee
2. Electrical (h) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) 41 o
5. Fire Protection //��,
6. Total = (1 + 2 + 3+4 + 5) 4095.00 Check Number I (J"! CiCi
This Section For Official Use Only
Date
Building Permit Number: b/�A- PZ'r a70dA i Issued:
Signature: �� id-iy ZOZ r
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 IX 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 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 ? YE5 NO be
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 II 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 Alteration(s) n Roofing
Or Doors El
l�
Accessory Bldg. I I Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[( J
Brief Description of Proposed New flat roof on front porch, remove existing roofing install fiber board and new EPDM Rubber roofing
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
Lisa &Barbara Batura&Tara
I, 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 10/0462021
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 Quenneville
Print Name lv
10/06/2021
Signature of Owner/Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Adam Quennville CS-070626
License Number
160 Old Lyman Rd South Hadley Ma 01075 8/21/2023
Addre Expiration Date
413-536-5955
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing & Siding Inc 191093
Company Name Registration Number
160 Old Lyman Rd South Hadley Ma 01075 3/22/2022
Addr ss Expiration Date
Telephone413-536-5955
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 ❑
ir* / i p.
QU$NN EIRIMJ* ' ``, # A AIR D VISA asc vea
12 0 0 f I N G h 1 I) 2010 WINNER .:J
1.60 Old Lyman Road•South Iiadley•MA 01075 We are Licensed
1.800.NEW.ROOF • 413.536.595S Fully Insured
Email:inftt(+ililtOQnewroof.net Website:www.1800newroof.net Factory Trained
MA Construction Supervisors Lic.8070626 MA Registration 8120982 Factory Certified Installers
Member of the Home Builder's Assoc,of Western Mass. CT Registration#57592.0
Member of the Molding&Isaac Association P.P.0 38/10
Proposal Submitted To: Date: 1,42,6 f Phone#'s: C:
Lisa Batura H: W:
Street: Email:
574 Spring St junol7@comcast.net
City,State,Zip Code:
Leeds, MA 01053
Proposal to furnish and install the following:
location of flat roof if applicable Front Porch
we will pull all appropriate permits for work.
we will remove all roofing material down to decking and dispose of 0 no
we will go over existing roof yes( 0)
we will install fiber board over entire roof ,,,:e3ino
we will install ISO insulation board yes(tl o inches
we will install EPDM rubber membrane on entire roof.
we will install hitbrown C6 drip edge around perimeter of roof.
we will install cover strip over all drip edge.
we will turnbar rubber up all walls and chimneys.
we will counter flash chimney with lead Kilo)
we will tie rubber up under shingles ye lna) shingle color
we will install new rubber boots around pipes.
10 _ year AQRS labor, material and workmanship warranty.
all rotted or deteriorated decking will be replaced at $374/sq ft
$4.20
special requierements:
Whole Home Tune-up $495
Ask us about
affordable bank
financing!
ATTENTION HOMEOWNERS:Please cover all personal belongings In the attic,garage or storage areas due to the
possibility of roofing debris or dust coming In through cracks of the wood.Please remove any lawn ornaments or yard
furniture.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas.
Customer Initials: ;
We propose hereby to furnish materials and labor—complete in accordance with above spec fications for the sum of; Total Due:($ 4,0 9 5 )
ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are Down Payment:($ 1,365 )
satisfactory and are hereby accepted.You are authorised to do work as specified. 2"d Payment at Start lob:($ )
Payment will be 1/3 down at signing,1/3 at start of job,and balance due Balance Due Upon Completion:($ 2,7 3 0 )
upon completion. • t f��yj '
,
Date: 9- 7- II Signature: !ti I f 1i/ r (+..)
Date: 09/21/2021 Estimator:(Print Name) Ron Dion (Sign Name��J�"�.�.!�
Estimates are honored for sixty(60)days from above date.
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building ddd�cc
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:
574 Spring St Leeds Ma 01053
(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)
/04[)-1
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.
'- pD DATE(MMl00lVYYY)
„�` o!zo CERTIFICATE OF LIABILITY INSURANCE
6/24/2021
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 art ADDITIONAL INSURED,the policy(les)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 CONIAUI Sarah Pram
NAME
Clayton Insurance Agency, Inc. PHONE (413)536-0804 FAx an ,e sla- ta
INC.Ne.EMI; (A/C,Nof:
1649 Northampton Street E-MAILss;spremo@claytoninsurance.net
ADDRE
P. O. Box 989 INSURERS)AFFORDING COVERAGE NAIC s
Holyoke MA 01041-0989 INsuRERA:Nautilus Insurance Company
INSURED INSURER 8;Arbella Insurance Co.
Adam Quenneville Roofing & Siding Inc. INSURER C:AIM Mutual Insurance Company
160 Old Lyman Road INSURERO:
South Hadley, NA 01075 INSURERE'
INSURER F:
COVERAGES CERTIFICATE NUMBER:2021 MASTER 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS
IP
LTB TYPE OF INSURANCE 'ACM...WV VAR- POLICY EFF POLICY POLICY NUMBER IMMIDD/YYYY) (MMIDPP'Y YI LIMITS
LTR INRfI„yW0
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS.MADE X OCCUR DAMAGE TORR --� 100,000
♦r,S PREMIS IE FcuRanctl) S
NN1293313 6/23/2021 6/23/2022 MED EXP(Any one person) $ 5,000
PERSONAL&AOV INJURY S 1,000,000
�GEN'LAGGREGATEUMITAPPLIESPER; GENERAL AGGREGATE 4 S 2,000,000
1 POLICY n JPRECoT n LOC PRODUCTS-COMP/OP AGO S 2,000,000
f OTHER: E
AUTOMOBILE LIABILITY �OINd SiN�LAW( ; 1,000,000
BODILY INJURY(Per person) $
B _ strufJO
ANY AUTO ALL OWNED ,_X SCHEDULED 1020107095 6/23/2021 6/23/2022 BODILY INJURY(Per accident) 8
AUTOS AUTOS PROPERTY DAMAdE
�— NON-OWNED a
X FARED AUTOS X AUTOS (Pe/eccs$rtl
�. UNINSAINDERINS MOTORISTS $ 100,000/300,000
I
X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 5,000,000
A a EXCESS LIAR _CLAIMS-MADE AGGREGATE $ 5,000,000
DEO RETENTION$ AN1242102 6/23/2021 6/23/2022 S
WORKERS COMPENSATION - X PE'RfUTE ORH
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT 6 1,000,000
OFFICER/MEMBER EXCLUDED? Y N I A
C (Mandatory in NH) AWC4007012861 4/29/2021 4/29/2022 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yen.describe under E.L DISEASE-POUCY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS below
i 1 l 1 I I 1
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may he attached I more apace Is requited)
For Informational Purposes Only
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Adam Quenneville Roofing & Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
160 Old Lyman Rd
South Hadley, MA 01075
AUTHORIZED REPRESENTATIVE
'
Michael Regan/I:I-IT ?' ,� n -^
1
ID 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025(2a14011
The Commonwealth of Massacnusens
`•r... Department of Industrial Accidents
_ Office of Investigations
=r. 600 Washington Street
; �e=c Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information n �1 Please Print Legibly
Name(Business/Organization/Individual): A cew, ✓CrlwU)i'�t- (2_C4c t 1( 44' Tl cl►'Z y �lc
Address: I GO 0
City/State/Zip: 50vT IJcAtcd (^tic) 0105- Phone #: Li 13 5 45 5—
Are you an employer?Check the appropriate box: Type of project(required):
1.K I am a employer with 15 4. [] I am a general contractor and [
employees(full and/or part-time).* have hired the sub contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers' comp. insurance comp. insurance.1
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their ILO Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL l2 _Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box I#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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: A V VG� �,n5u c. c-
Policy#or Self-ins. Lic. #: C 9007 0 1 `-TC ( Expiration Date: 0 1/a
Job Site Address: 51 y 5?(") )-T City/State/Zip: Le-As P14
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DR for insurance coverage verification.
I do hereby certj under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: /CY( )/
Phone#: 1 f 3 - 5 3L ` 59 55 T
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#:
' Vr Division of Professional Licensure
Board of Building Regulations and Standards
Cons(ei,ytst��jr�t6llpprvisor
CS-070626 'llc lres:08/21/2023
ADAM A QU14/JNEV:1 Ir1', i
160 OLD LYteliN •Ifi "�'
SOUTH HADLQY 1141r4 r. ,
"t•M' a �,
JN`5•I�t 1\ V
'
Commissioner datIG K. Ilea.i.tu_,
PY2e W049?/,120/12ittealdOP-�'l/(.CZ.4Clad LL6eafl
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. Regipiration: 03/ 2/3 22/3
Expiration: 2022
160 OLD LYMAN RD.
SO,HADLEY,MA 01075
Update Address and Return Card.
SCA I 03 20M•05/17
.i,. . i�I,: ., .t' :\t:. t' ::q.C•}'. r' .�•�,_•.t: .. . .t. +'^':i•t.
�� 11f ?`) T•.�jb:• },'. :iti i':, :: .t. ,'err• • /vv.• .-iq;, .l.: •t. ..I,:' .t. 'ra J..•I• fit>• ',�., .1. •C
;!1* 40 '11►': 'a. ' 41A "./r 1v 144: k'*`-_:! :'_.t_k _.!i*. 1t�'_ 4 _1t_..,_1�"_.._14:i__ti'._!11�_ 1f'
STATE OF:CONNECTICU'T + DEPARTMENT Q "CONSUMER PROTECTION
I 'Belt known that /%;,
ADAM QU,ENNEVILLE >;
160 OLD LYMAN ROAD . . ' f
,g is
'_ SOUTH HADLEY, MA 01075-2632 I r {
, i
k:: i i 4�ti
' , ; has satisfied the Buell icatloiis required by law and is hcrr:by registered:Is a
'}• 1 HOME: IMPROVEMENT CONTRACTOR i :,.
;' I Hk
Registration # HIC.0575920
ADAM QUENNEVILLE ROOFING i ,
i •
I Effective: 12/01/2020 I - 0.
, . Expiration. 11/30/2021( itill I ' Y.
t
Michelle Seagull.Commieeioner 1 rye