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24D-280 (5) BP-2021-2045 165 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-280-001 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-2021-2045 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 7499 SIDING 070626 Const.Class: Exp.Date:08/21/2023 Use Group: Owner: NOVOTNY AMELIA CLAIRE ET AL Lot Size (sq.ft.) Zoning: URB Applicant: ADAM QUENNEVILLE ROOFING &SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:10/27/2021 TO PERFORM THE FOLLOWING WORK: NEW ROOF ON GARAGE 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: � 4, • - II • Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ------- ------ ,-ry r----___ _ __— Department use only (:( City of Northampt t 'C I VCSia s of E ermit: Building Dep met Cur Cut/f�riveway Permit � ;f► 212 Main S reet OCT 5 Se er/Se/tic Availability ' II Room 1 0 ���� Wa er/W II Availability " ' , '' Northampton, MhA Two Set of Structural Plans + "" phone 413-587-1240 �rax 413- �$ q'� 2 i,, , Plot/Site lens -- -- Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 165 Crescent St Northampton Ma 01060 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Claire Novotny 165 Crescent St Northampton Ma 01060 Name(Print) Current Mailing Address: 413-320-1692 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name(Print) Current Mailing Address: 413-536-5955 Signatur 1`� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7,499.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ff L''')D 5. Fire Protection �/i I ' 6. Total = (1 + 2 + 3 +4 + 5) 7,499.00 Check Number I t W`7 (1 This Section For Official Use Only 4 t u (� Building Permit Number: 6 0-- al `ok di-tS Date Issued: Z--/ Signature: k ie - )8 " ZOZ 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 DONT 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 ? YE'. NO x 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? YE I NO x 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 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [Ej Decks [❑ Siding t) Other[all Brief Description of Proposed New roof on garage, remove and replace existing install new drip edge, ridge vent, ice and water barrier 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, Claire Novotny , 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 10/13/2021 Signature of Owner Date 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 10/13/2021 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 Address Expiration Date 413-536-5955 Si nature 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 Addre 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 14, 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: 165 Crescent St 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) )°‘\t31 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. tQV1✓1NN WWI&LAE El rYr vs*ark VISAS :./ 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.595S Fully Insured Email:info@ 1800newroof.net Website:www.1800newroof.net Factory Trained MA Construction Supervisors loc.1070626 MA Registration 11120982 Factory Certified Installers Member of the Nome Builder's Assoc of Western Mass. CT Registration 1575920 Member of the Budding B trade Association P P C 38710 Proposal Submitted To: Date: Phone 0's: C: Claire Novotny 9/29/2021 H: 412)7,7-0 )w: Street: Email: 165 Crescent St. City,State,Zip Code: Special Requirements: Northampton, MA 01060 PROPOSAL FOR: HOUSE GARAGE OTHER includes wood&labor required to rebuild soffit STRIP RECOVER and repair the roof decking on dormer and right layers: © 2 3 4 Plywoodside of garage Included:�.r No Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: X We shall acquire appropriate permits for all work x Home exterior and landscaping to be protected X Strip existing roofing to existing decking with full inspection DO NOT DO: X All project waste shall be removed by dumpster(dumpster for contractor use only) x Install Ice&Water Barrier at all eaves 3'°alleys,chimneys,pipes and skylights X Install(isib.felt ♦ITilJPT44N underlayment over remaining decking area x Install Metal drip edge at eaves and rakes 81 /5") MD brown) X Install manufacturer's starter shingle on all eaves and rake edges X Install new pipe boot flashing/vent accessories x Install ridge vent•Snow Country/Cobra rolled/4'Baffled Roll Shingles:(standard 6 nails per shingle) GAF Timberline HOZ Shingles Color: To Be Determined GAF Timbeitix HOZ Ridge cap shingles Warranty Options: x We guarantee our workmanship for 10 full years .! GAF System Pius Warranty GAF Golden Pledge Warranty Chimney Options: n Lead Counter Flashing U Water Seal&Tuckpoint El Rubberized Crown Cl Cricket Cl Mason needed(customer provided) Additional material and labor charges may apply. x Deteriorated existing decking will be replaced at$5.9 .ft.and dimensional lumber at$7.00 per linear ft., after full inspection. Customer Initials: We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: Total Due:($ 7,499.00 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 2,499.00) satisfactory and are hereby accepted.You are authorized to do work as specified. 2n°Payment at Start Job:($ 2,500.00 I Payment will be 1/3 down at signing,1/3 at start of job,an. • due Balance Due Upon Completion:($ 2,500.001 upon coin t n. Date: ru 1., Signature: Date: 9,29/2021 Estimator:(Print Name)S. N11nKI' (Sign Name)iSZ ��luc.E�a.1 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 Quennevilie Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: 4 0 DATE(MMIDDIYYYY) ACORD 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 an ADDITIONAL INSURED,the pollcy(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 CUR-TALI" Sarah Promo .NAME. Clayton InsuranceAgency, Inc. PHONE (413)536-0804 AJC i4s3)43Q—Tal4 Y INC,No.E%SL' �(A C,No): 1649 Northampton Street ADIAREsg) spremo@claytoninsurance.net P. O. Box 989 INSURER(SI.AFFORDING COVERAGE NAIC I Holyoke Ada 01041-0989 INSURER A;Nautilus..Insurance Company INSURED INSURERS;Arbella Insurance CO. Adam Quenneville Roofing 6 Siding Inc. INSURERC;AIM Mutual Insurance Company 160 Old Lyman Road INSURER D: South Hadley, MA 01075 INSURER E: 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'10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AD0L"e0BR POLICY EFF POLICY EXP LIMITS LIR INSR,yWrO POLICY NUMBER - IMMIROIYYYY! IMM1DOI'VVYI X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S 1,000,000 n DAMAGE TO RENTED 100,000 A W CLAIMS•MAOE I A I OCCUR PREMISES 1E05 000Sr6ncal $ NN1.283315 6/23/2021 6/23/2022 MED EXP(Any one person) S 5,000 PERSONAL NAOV INJURY S 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE a 2,000,000 X POLICY I I,,EOY 7 LOC PRODUCTS-COMP/OP AGG S 2,000,000 5 OTHER: AUTOMOBILE LIABILITY I , '.( s� SINS LIMIT ; 1,000,000 ANY AUTO BODILY INJURY{Per person) 3 B ALL DINNED %SCHEDULED 1020107093 • 6/23/2021 6/23/2022 BODILY INJURY(Per accident) 8 AUTOS ,�,,.,, NON-O 'PROPERTY DAMAGE S NUTOS ED -IPW 6cc gfnI X HIRED AUTOS X AUTOS UNINSNNDERINS MOTORISTS $ 100,000/300,000 X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR �_ CLAIMS•MADE AGGREGATE S 5,000,000 DED RETENTION S AN1242102 6/23/2021 6/23/2022 S - WORKERS COMPENSATION X PER -0111 STATUTE ER AND EMPLOYERS'UABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT 4 1,000,000 OFFICERIMEMBER 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 yes,describe under DESCRIPTION OF OPERATIONS below E.L:DISEASE-POUCY LIMIT E 1.000,000 I I I I E I 1 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 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/G'HT 7y `',,,' P `,1_,' 1 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) The Commonwealth of Massacnuseus r Department of Industrial Accidents ! ;.— MOO ems' +� Office of Investigations =��= 600 Washington Street = � =c Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information //�� . Please Print Legibly Name (Business/Organization/Individual): AcAer, cuCt'!►c.x l t\� 1 nn CSl1� 5l ,i h y (1 ►1� Address: ILO 01 Lry L L City/State/Zip: 5ou1\ hoAkt6 ft ot0 c Phone#: '1 l3 -53C 5455— Are you an employer?Check the appropriate box: Type of project(required): I..I.4K I am a employer with 15 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 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' q El Building addition [No workers' comp. insurance comp. insurance.# 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 11.❑ Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL l2,n Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' I3.0 Other 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Q' (V)v l ve..t J,nS 0✓GAc� Insurance Company Name: ( ' + Policy#or Self-ins. Lic. #: A w C 4007 0 i agt i Expiration Date: Vacit a a Job Site Address: R 5 C�csc c.nv -i City/State/Zip:Not"t2MF'I0 Th1 Ol Q1,V 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 DIA for insurance coverage verification. I do hereby cent j under the pa' A.n...9enalties of perjury that the information provided above is true and correct. I 911 ')-( Signature: Date: Phone#: L i 3 - 5 3C - 59 5 9— 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#: FDivision of Professional Licensure Board of Building Regulations and Standards Cons`!tWtrdinlitSifp¢rvisor `i CS-070626 ;` `" :e., i t�pires:08/21/2023 ARAM A QU NNEV', °;•. .: 180 OLD LYI4N 0 i<<1. ' :`, .:-;: op SOUTH HADL 11 4 s, Commissioner ,iw8Qa K. Ga+ ,ta.., • Q72e (570422/MOWA a / acA€to a a'd Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING,INC. Expiration: 03/22/2022 160 OLD LYMAN RD. SO,HADLEY,MA 01075 Update Address and Return Card. SCA I 4 20M-05/17 If •• ?':. 'I. I • .t'St .t Za � � ' s Y L t )) �"��!S� �:n v I STATE OF CONNECTICUT + DEPARTM 'ENT Q CONSUMER PROTECTION . Be it known that h: • It a 1 ADAM QU,ENNEVILLE . yI. „ 160 OLD LYMAN ROAD , ' • •, ' SOUTH HADLEY, MA 01075-2632 ICI yy" � � ,, ;•�i% has satisfied the yuahtK ifioils required by law and is hereby registered as a ;', HOME: IMPROVEMENT CONTR. ACTOiiii .i.,..-:4;:= Registration # HIC.0575920 � : j ARAM QUENNEVILLE ROOFING , : = ''': ► Effective: 12/01/2020 , i :✓, t 41k Expiration. 11/30/2021 i i ?`',. Michelle Seagull,Commiuloaer i - •.;'