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31A-211 (7) BP-2022-0532 35 HARRISON AVE COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 31 A-21 1-001 CITY OF NORTHAMP ON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERE CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0532 PERMISSION'S REBYGRANTED TO: Project# ROOF Contractor: License: ADAM QUENNEVILLE RI /FING & Est. Cost: 30099 SIDING 070626 Const.Class: Exp. Date:08/21/2023 LELIEVRE ',OBERT ARTHUR & LISA JANE Use Group: Owner: CLAUSON T'.USTEES Lot Size (sq.ft.) Zoning: URB Applicant: ADAM QUE VILLE ROOFING & SIDING Applicant Address Phone: Insurance: 1600LD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:05/16/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHA PTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I I A . ) Fees Paid: $40.00 • 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ne — Department use only tstisTt�r,4- City of Northampton - ‘7--11._Li q/ c Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street�Ar Sewer/Septic Availability 1 k',. 1 t:. .AI') Room 100 2022 1Nater/Well Availability ' e Northampton, MA 01 0 Curb Sets of Structural Plans y�,,-„E.1;44 phone 413-587-1240 Fax 4�(;�'�Sa7m -��--- Plot/Site Plans take4,On, FCTioNS 4A 01060 Other Specify APPLICATION 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 35 Harrison Ave Northampton Ma 01060 Map 3 (1— Lot c // Unit Zone Overlay District r Elm St. District CB District_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Bob LeLievre 35 Harrison Ave Northampton MA Name(Print) Current Mailing Address: 617-474-9131 see contract Telephone Signature 2.2 Authorized Agent: Adam t uenneville 160 Old LymanRd South Hadley Ma 01075 Name(Prin)verxlednyPdfFiner Current Mailing Address: �ar//Overnel/(e :� / 413 536 5955 u5,iu'ruzi Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 30,099.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Constr uct.on from (6) 3. Plumbing Building Permit Fee 43 4. Mechanical (HVAC) �o 5. Fire Protection 6. Total = (1 +2 + 3 +4 + 5) 30,099.00 Check Number ( 2( 26 ��//�� y- This Section For Official Use Only BuildingPermit Number: Cam'" 01 O 3)-- Date Issued: Signature: ///72 5" /6 ZOZ7 Building Commissioner/Inspector of Buildings Date operations.aqrs @ gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[P] Other[El] Brief Description of Proposed New roof, remove&replace existing, install new,underlayment,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 Bob LeLievre 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 applicatin. see contract 05/10/2022 ..._...____.___.____..... 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 05/10/2022 Signature of 0 ner/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 8/21/2023 Address Expiration Date 413-536-5955 Signature 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 3/22/2024 Addressk.., ,,, Expiration Date Telephone4 13-536-5955— 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 i►:1-rirlt , Massachusetts `.1. f; :;')( S �l 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: 35 Harrison Ave Northampton 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 pdffilier Aficre Quennevu/le r' 05/10/2022 L ' V / S (b (v Signature of Permit Applicant or Owner Date If, for any reason, the debris NNW not be disposed of as indicated, the A p!icant or Owner shall notify the Building Department as to the location where the debris will be dispos d. a itJfilsmillrasltlirsis.a.its 0f)rrl1, 'ASAA" OtgC: vr.Y All 160 Old Lyman Road•South Hadley•MA 0107S We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email • Website:www.1800newroof.net Factory Trained MA Construction Supervisors tic,0070626 MA Registration 6120982 Factory Certified Installers Member of the Nome Auikler's Assoc.of Western Mass. CT Registration*57502.0 Member of the BuiMing S Try 1 Assnrution >,P.C.:f8710 Proposal Submitted To: Date: Phone It's: C: Bob Ls l e:;vre H: W: Street: Email: , Harmon ).,)i1 r )7`.l't::itr.'sil.(.,t3{l' City,State,Zip Code: Special Requirements: "1clrtbamptor: ;Mass 010-60 -- Plywood +nclutiNi on date Area MEOW E.Q8; HOUSE • GARAGE OTHER Front Porch Not tricludet STRIP RECOVER Layers: CD 2 3 4 Plywood Included:rin.r No Tear o SLATE r SHAKES COMPLETE ROOF PROTECTION SYSTEM: K 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 dum.. r(dumpster for contractor use omy) Install Ice&Water Barrier at all eaves ;a alleys,chimneys,pipes and skylights f Install(iSIb.felt 1,,TriltralT4 underlayment over remaining decking area k.. Install Metal drip edge at eaves and rakes 8 !51 521 brown) x Install manufacturer's starter shingle on ail eaves and rake edges si Install new pipe boot flashing/vent accessories X Install ridge vent Snow Country/Cobra rolled/4'Baffle /Roll Shingles:(standard 6 nails per shingle) GAF Tiarbe.rin,e s Si' Shingles Color: T;n o4,,"'" C-Z Ridge cap shingles Warranty Options: l:4 We guarantee our workmanship for '`'_ full years GAF System Plus Warranty GAF Golden Pledge Warranty Chimney Options: lead Counter Flashing Water Seal&Tuckpoint C ;Rubberized Crown I._:.)Cricket i..:: Mason needed(customer provided) Additional material and labor charges may apply. x Deteriorated existing decking will be replaced at$5.99 per sq.ft.and dimensional lumber at$7.00 per lin ft., after full inspection. Customer Initials: 12L- 4v.s txotwsr hereby to h,rnisn materi.:is mod labor-complete in accord:me with above s eotec rsnis for the sum of: Total Due:(S3Q,099.00 I ACCEPTANCE OF PROPOSAL:The above prires,specifications and conditions are Dawn Payment:(510,033,0p I satisfactory and are hereby accepted.You are authorized to do work as specified. 2""Payment at Start Job:($10,03;.00 1 Payment wHI be t/3 down at signing,1/3 at start of job,and b,Owice due Balance Due Upon Completion:($10,033,00 I upon tomtits ion Date: 5 it'2.0) Signature: ?+ ' i 7 Date: )r i`1r<j Estimator:(Print Name) l v Derek (Sign Name) r) r_... f, 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: 17L. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY) `------- 4/15/2022 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 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 Ileu of such endorsement(s). PRODUCER CONTACT Sarah Premo NAME: Clayton Insurance Agency, Inc. IN No.Est): (413)536-0804 FAX NoI: (t 13)s11-7O 4 1649 Northampton Street EMAIL a remo@cla toninsurance,net ADDRESS: p y P. O. BOX 989 INSURER(S)AFFORDING COVERAGE NAIC C Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURERB:Arbella Insurance Company Adam Quenneville Roofing & Siding Inc. INSURERC:AIM Mutual Insurance Company 160 Old Lyman Road INSURER D: 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 REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLITY EXP LTR TYPE OF INSURANCE INS') WV') POLICY NUMBER (MMIDD/YYYYI (MM/D /YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ NN1283315 6/23/2021 6/23/2022 MED EXP(Any one person) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X J l POLICY n PROECT- ILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea sodden!) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 1020107995 6/23/2021 6/23/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON•OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) _ UNINS/UNDERINS MOTORISTS $ 100,000/300,000 X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED I RETENTION$ AN1242102 6/23/2021 6/23/2022 $ WORKERS COMPENSATION X. PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ri N/A C (Mandatory In NH) AWC4 007012 0 61 4/29/2022 4/29/2023 E.L.DISEASE•EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 160 Old Lyman Rd ACCORDANCE WITH THE POLICY PROVISIONS. South Hadley, MA 01075 AUTHORIZED REPRESENTATIVE n� i Michael Regan/FMT IM P m, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2o14o1) Commonwealth of Massachusetts klilDivision of Professional Licensure Board of Building Regulations and Standards Cons�iluGt �i%iSp�ivisor i. CS-070626 fn i ppires:08/21/2123 ADAM A QUENNEVI t I f 160 OLD LYMAN RD 4' p SOUTH HADLEY MA F ! `t'O/Stirt:10 Commissioner dank K. i ndia. PJL.-2e wo #( wvirioitevect&A., o/C-?,/ • ottehM,e a Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 7 0 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Regi tration: 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 1 Co 20M.05/17 "..t`' , .4'1'',:v:tali 0f ",>;•1.7:'v}'.,,1'l'ki y,•t'r:: •t" 4 7^�;,:.1",,, >,,,•1 t 1 ;:p,•tom•:; t )j,•p .l t '•1 t -•1••;•,.•P •�` ,1( 4� Q t, 0::,'r4,.A_ 1 Writ�, '4''6Y.` +,• yx G,>,. r� ' '' 4�5 i' ti� .t'1 1 .� .'.•. ' n t -7 :\ . F•v l .�"a''(.''i i i rY •x it. t( ' i..:� ! 4 '71i. 4 Yk` -. `,7f `` 'v 1\, t`X,Jf,,: ti, 1 t iq i f F"i '.,, "sft 5 nY ?�>c T.� +• `' • �U d � ? �y(lt�j•�11 u,��1ltr.y"��y+lf�' a� "` � ` i _ ...._._. - _ -- _----- — — — - — _. — —___i z i - .• STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ' 1 Be it known that I ''"'a, . ADAM QUENNEVILLE , a,,;� yh,,: 160 OLD LYMAN ROAD I ,;: ',� SOUTH HADLEY, MA 01075-2632 i �:o i C ;"A",T▪i I rF;, ` has satisfied the qualifications required by law and is hereby registered as a • 1 '".4 j HOME IMPROVEMENT CONTRACTOR ' ` ' '¢ Registration # HIC.0575920 ;, 1 i t,!; ADAM QUENNEVILLE ROOFING f ''Le i Effective: 12/01/2021 , `. c { Expiration: 03/31/2023 iid i Z � '� � j "- ,,„,.:,. MIchelleScegull,Commissioner ! '4'�Z�. ',,c�s. i(` i i! ff if f r.�. N �r/ 1 4 4i .: " i�. ,i �R . h„ ` ;- i,, A .i 4.t Wc",i, �)§• i rely ` 'r t Ven C ti k t f�t' t" \ t ti7 r Ji t 1 { '. : '• ...: ...:..,1. ..7.t. .5.:,.t.�•ti. A. .:.)"t, ... ... .t,.l .9,,,•j, ,... 9,1..rv.(a. �. �/1i7.� .�'�,j.�L.���ij.�..r�( j .� i T,. The Commonwealth of Massachusetts I. Department of Industrial Accidents Office of Investigations �t�1= 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly /� Name(Business/Organization/Individual): f`i IGr"1 v!'r1�`C-U't��t.. (2—C4 n6 �1 1 r 1nt✓'1 C. Address: I GO 01 A L�v City/State/Zip: 5ov%h k d Of)Ka 0i e )5 Phone#: 1(13 —53C,5 455— Are you an employer?Check the appropriate box: Type of project(required): IK I am a employer with 15 4. ❑ I am a general contractor and I 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 g. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their 1 1.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant that checks box#I 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (It firl (h u t veil nS v%ntc Va91 Policy#or Self-ins. Lic. #: A W 900 0IExpiration Date: Job Site Address: 35 Harrison Ave City/ tate/Zip: Northampton Ma 01060 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 08,145)under the pains and p allies of perjury that the information provided above is true and correct. 41at i C2uennet/l/e /7L 05/10/2022 Signature: Date: 105/1o/2022 /" Phone#: '3 — 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#: