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30A-063 (4) BP-2022-0326 234 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30A-063-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0326 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 SIDING &INSULATION Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 8910 SIDING 070626 Const.Class: Exp.Date:08/21/2023 Use Group: Owner: BODY JOHN M III Lot Size (sq.ft.) Zoning: WSP Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (41 3)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:04/01/2022 TO PERFORM THE FOLLOWING WORK: LEFT SIDE -REPLACE SIDING WITH VAPOR BARRIER&INSULATION 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I I ' r . >9 - Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only � C":":144 City of Northampton Status of Permit: Building Department Curb CuUDriveway Permit { ; 212 Main Street Sewer/Septic Availability ' AL.1 tRoom 100 Water/Well Availability ,` �' Northampton, MA 01060 Two Sets of Structural Plans .' phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 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:234 Florence Rd Florence Ma 01062 Map O /�` Lot 063 Unit I Zone (,OS P Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: John Body 234 Florence Rd Name(Print) Current Mailing Address: 413-584-4781 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name(Pi{YYt)"od by pdfF;i€kr Current Mailing Address: Hdan 2uennel/"e ` 413-536-5955 IUJ/L9/1U/ Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 8 910 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 1.4061-2. 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) 8,910.00 Check Number -1' // i This Section For Official Use Only Building Permit Number: Pjp �—� -0i� Date Issued: i 7 — Signature: 2/- / -ZZ Z Building Commissioner/Inspector of Buildings Date operations.agrs @ 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 DON'T KNOW x YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW x YE4-7 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 ? YES NO x IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradin ex avation,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 ❑ Addition ❑ Replacement❑Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs g:J] Decks [❑ Siding [12] Other[0] Brief Description of Proposed New siding on left side remove existing, instal vapor barrier&3/8 insulation, then new vinyl siding 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 John Body 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 03/29/2022 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 A7 03/29/2022 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable D Name of License Holder: Adam Quennville CS-070626 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2023 Address n 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 3/22/2024 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 t , DEPARTMENT OF BUILDING INSPECTIONS 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: 234 Florence Rd Florence ma (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) Verified by pdfFiller 4104 Quennev lle (lei 13-a 03/29/2022 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. ALL UlbLUUNTb Ah 'L1r;U LAD AM * ,�� 2 QUENNEVILLE AaARt VISAS Disc yER I ,r ti . I � 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: JOHN BODY 3/26/22 H:413-584-4781 W: Street: Email: 234 FLORENCE RD BODY.JOHN@COMCAST.NET City,State,Zip Code: FLORENCE MA 01062 Proposal to furnish and install the following: 1) OBTAIN ALL PERMITS NEEDED TO DO PROJECT 2) SUPPLY DUMPSTER ON PROPERTY IF NEEDED 3) STRIP OFF ALL WOOD CLAPBOARDS ON LEFT SIDE (NORTH) OF HOME 4) REPLACE ALL WOOD WINDOW CASINGS ON THAT SIDE 5) WRAP THAT WALL WITH VICOR VAPOR WRAP 6) COVER WALL WITH 3/8/ INSULATION 7) WRAP ALL WINDOW CASINGS ON THAT SIDE WITH ALUMINUM COIL TRIM (WHITE) 8) SUPPLY AND INSTALL KAYCAN DAVINCI (CABOT RED) ON THAT SIDE OVER INSULATION 9) ANY ROTTED OR DAMAGED WOOD UNDERNEATH EXISTING WOOD SIDING TO BE REPLACE $ 165.00 PER 4X8 1/2 INCH SHEET 10) BOX IN GABLE VENT (LOUVRE) ON THAT SIDE AND COVER WITH INSULATION AND SIDING 11) WRAP RAKEBOARD WITH ALUMINUM COIL (WHITE) REPAIR CORNER POSTS AND J UP TO CORNERS 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 specifications for the sum of: Total Due:($ 8, 910 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 3, 000 ) satisfactory and are hereby accepted.You are authorized to work as specified. 2nd-aym: at Start Job:($ Payment will be 1/3 down at signing,1/3 at st of job, glance due Balanc Cue U•• ••• • . 5, 910 ) upon completion. z w� Date: 3/2 6/2 2 Signature: 3/26/22 DAVE AREL Date: Estimator:(Print Name) (Sign .me) _ I Estimates are honored for sixty(60)days from above date. 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. Do A� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDPYYYY) 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 certff!cate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain pollctes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER TtrwmcT Sarah Pram . MEt Clayton Insurance Agency, Inc. PHONE (413)536-0804 rAx s4131434-7a14 ..lt}Lr•ty4.ELM: t.UC,NOI: 1649 Northampton Street CJ4AIL spramo@ala toninsurance.net nensess: yp P. O. Sox 989 _ INSURERRSI.AFFORDING COVERAGE NAIL Y Holyoke MA 01041-0989 INauRERA:Nautilus Insurance Company INSURED INSURER B:Arbelia Insurance Co. Adam Quennaville Rooting & Siding Inc. INSURER O:AIM Mutual Insurance Company 160 Old Lyman Road INSURER0 South Hadley, MA 01075 INSURERS: _ 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 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 RECUCEO BY PAID CLAIMS iNsA !�'St'Ci•1Tt0)Y[ — POLICY OFF I POLICYEEP _ ..1z.1F1, _- TYPE OF INSURANCE I•,Ig4 )WD lI POLICY NUMBER (rMJ)1YYYYI OVIDONYYY1 UMITg X COMMERCIAL GENERALUAR1UTY 1,000,000 EACH OCCURRENCE 3 A — AsIAM CLAIM9.MADE 1—"X"'OCCUR P EM1 $Oteoq� t 9 100,000 _ 4 NNa.293315 6/23/2021 6/23/2022 MED EXf'(Ant one peraan) S 5,000 PERSONAL ,t ATIV INJIJRY 5 1,000,GOO OEM LAGOREGATEUMITAPPLIES PER, GENERALAGQREGATE S 2,000,000 dEC X POUCY )PROT. LOG PRODUCTS-COMpiOPAGG S 2,000,000 0-0.ti t 5 AUTOMOBILE UAaILITY 'CCMENEO SU•u.GLEL4M1T a 1,000,000 tEn a` }Ian11 ANYAUTO BODILY INJURY(Pe(po'son) 3 B ALL GAMED SCHEDULED �� � ,_„_,.,,AUTOS X AUTOS /020107095 6/23/202L 6/21/2022 BODILY INJURY(per accidonll $ X X NON-OVVNED PROPERTY iITA L,E $ r—_J HIREDAUT09 �.�AUTOS ,..IP0', "Pfeil a UNINB.NNOERINS MOTOR76T9 5 100,000/300,000 _ X J UMBRELLA LIES OCCUR EACH OCCURRENCE S 5,000 t 000 A excess LIAR ~J CLAIMS-MADE AGGRE(iAiE 5 5,000.000 r_ OFP RETENTION$ AN1242102 6/23/2021 S/23/2022 5 WORKERS COMPENSATION { :nog EMPLOYERS'UABILITY YIN % :nogER ANY PROPRIETOR(PARTNERIEXECUTIVE E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1' N I A C (Mandatory in NHl ARC400T01236L 4/29/202L 4/29/2022 EE.L DISEASE•EA EMPLOYEE $ 1,000,000 If yea,doatnbe under DE$CR;PTOON OF OPERATIONS low E.L DISEASE POLICY LIMITS 1,000,000 I _ I I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remark.Schedule,may 4a sttachad If mon apace is aqulnd) fro Informational Purpaaae Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Adam Quenneville Roofing & Siding Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 160 Old Lyman Rd ACCORDANCE WITH THE POLICY PROVISIONS. South Hadley, MA 01075 • AUTHORIZED REPRESENTATIVE l i-H.IhAs1 Regan/MTfr?�vGr�.I !' ... IS 1888.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS023(201401) L\X. The tommonweaun of ivJassacnuaeus Department of Industrial Accidents Office of Investigations ��1 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� n _. Please Print Legibly Name(Business/Organization/Individual): AWW,& (j�Cn t tit- `Z. e t?6 CP Y r-ic Address: ;GO 0 L) L L City/State/Zip: 5ov' ka oAtt-. M p O10 5- Phone#: t 13 -53 C-5 955" Are you an employer?Check the appropriate box: Type of project(required): .81 I am a employer with 15 4. ❑ I am a general contractor and I employees(fuI1 and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 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.t 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 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repirs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.-Other_ r; 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, t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Q _ Insurance Company Name: r ' \ u t vG� �n5 ti MG L Policy#or Self-ins.Lic.#: A W C,90010 Expiration Date: 4 l/9 Job Site Address: 234 Florence Rd City/State/Zip:Florence Ma 01062 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 oe tiku dexclhe pains and penaltie f perjury that the information provided above is true and correct Signature: �ae Cuennede Date: 03/29/2022 03/29irzz Phone#: — 5 3C — 5 15 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#: Commonwealth of Massachusetts `It'Alt Division of Professional Licensure Board of Building Regulations end Standards Constru tiffs litlpervisor CS-070828 ," ires:08/21/2023 ADAM A QUENNEV �� 7 180 OLD LYMAN R ,k' T1 ;^ " I. SOUTH HADLEY MA ', ti Commissioner e. 'cLejr2a s 6.74...im c r' '�,rrm,/nroo /,/let~rhh/ 7 cm ft.ie/ti 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: 13 160 OLD LYMAN RD. Expiration: 03/22/212022 SO.HADLEY,MA 01075 Update Address and Return Card. SCA 1 .0 dUM-G5717 ff c.`A• =-' t t , 7✓t "N ti,:. I wt t�" t' *t`�, .x,t, �.. t B *c� > i ;.s ''? 'I ht,, t i 44,, ' . . I 1, a ..ig i . ,, i yl � : '' dt ' ;� li __ ° 'k*.. '"R l4r ' '«. A � +� l' 4mot,. ::. �J . `, STATE OF CO,NNECTICUT + DEPARTMENT OF CONSUMER PROTECTION t ' ,, . - Be it known that 0` �• 4 ADAM QUENNEVILLE • , ,{ 160 OLD LYMAN ROAD ' ` >' ',' f l SOUTH HADLEY, M.A. 01.075-2632 ' xgl....y.• lit,„ il tc:..t. si1 1 9 has satisfied the qualifications required by law and is hereby registered as a -} r,_�ai 1, y '3 HOME IMPROVEMENT CONTRACTOR i 4 I r , ,� . Registration # HIC.0575920 I a� l /r„ rfi ADAM QUENNEVILLE ROOFING ! by iA F:1.: Effective: 12/01/2021 f*''V F,� i � ;'.', .1 it4;11Z 44,/-41 Expiration: 03/31/2023 l ' 'ck.:3'.. `'. Michelle Seagull,Commie%ioner y •,Or. x �r �/, t. 4' :7{., e ti 0.1-' 4 ° ibvti <�tA4 4T 4 4' `' .G r t '� .' v�" : :'::r k .t. ..i. =t, t .t, s2.;.i.t..�},�r t .;` km'�'+'* ri -`1�.. ' .t `;MI,.�r.�. 5.`�ik�,: ,Y. .�,1�;�`�-ti'k�,�` 7:''"�,�i•". +`