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24A-020 .53 B4C1c.WiltY LANE BP-2004-0998 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Alock:24A-020 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2004-0998 Project# JS-2004-1468 Est. Cost: $0.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Adam Quenneville 070626 Lot Size(sq. ft.): 21692.88 Owner: GOLDBLATT DEAN Zoning:URB Applicant: Adam Quenneville AT: 53 BLACKBERRY LANE Applicant Address: Phone: Insurance: P 0 BOX 612 (800) 639-7663 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON: TO PERFORM THE FOLLOWING WORK:INSTALL NEW 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. Certificate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 4/13/04 0:00:00 3520 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • City of Northampton S atus:�o PedaTr � • Building Department Cur• 614D,vewa #' Itt 212 Main Street Seer-ISefit cY Room 100 Water7_Weit va ' Northampton, MA 01060 Twa Se sof t c gal Pa►' = '��� � � �fr phone 413.587-1240 Fax 413-587-1272 Piot/Site Puns � s^� � `i Othzr rei� �Z APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This sectn to tecomleted b o tic 1.1 Property Address: P 'L[ ' eter V\ Ma Lott .. A- " may\- ^m 'd'Wiz'-,s+-'.`mF- a5 .? 5 Zones • - , erla istrrct Elm SLDistrict' z CS<D�s r►ct; � r� . SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT �((� - - i� + \vv' FE `; 2.1 Owner of Record: Destin Co1l6Itt 61 `r Name(Print) Current Mailing Address} Telephone L Signature DE�(Gr NORIniAttt UN,NA 9iLbi) 2.2 Abut-horized Agent: 11 Ff Name(Print) Current Mailing Address: V Signature Telephone ......_..__..._.. • SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant �+ 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from.(6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 4/2,S� 6. Total =(1 + 2 + 3 +4 + 5) ` Check Number ' 3S-aC) This Section For Official Use Only Building Permit Number: ,6 LcI"/ d 9 Q S Date Issued: Signature: v / Zoo Building Commissioner/inspector of Buildings Date • Section 4. - ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW _; 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 ?YES _ No IF•YES, describe size, type and location: SECTION 5= DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing V Or Doors 0 Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: �-hbj U IJ& h Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 ha if ; ewT ous"e a id 'oraaddltlon`to exexi-stln>?sho n cemp. e.�e the foll,owa:ng: 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. Mascheck 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, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Aat OV.Jeel,&%-e v R- k{`y , 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. ! (FA'Vl f/f tf�UG/Le— Print Name Signature of Owner/Agent Date w , SECT1ONB :CONS7RUCTION SERVICES 8.1 Licensed Construction Supervisor: Not �__,,__ Not Applicaable) ❑ • Name of License Holder : Aim tX).J�IlI'va t 1� W t /0G J License Number tat Pim\-vLSi Rd c> _� 1 HA o i u 5 (- i a.) l.,«>,)-- Address Expiration Date Signature Telephone Re s e:e. R orn W :ouement:Contra'ctor. a Not Applicable 0 iJam CsLefliNsz,uAe Ri (er I�',G9 ), Company Name . Registration Number PO ..x ( 1 3/15-l4� Address + Expiration Date i' Atrj a 0/U7� Telephoned)as IO 9 SECTION 10 WORKERS' CQMPENSATION 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 ll No 0 =� ors :'.. 3k c I. / o 1 1g 1. ,. 1' The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature a/ -- (!ifyr of ltn.tlJiunpttitt • $ 6 siiascachuactts. •= iP _ r— ^s m DEPARTMENT OF BUILDING INSPECTIONS 4 3=1. • 212 Main Street ' Municipal Building Northampton, Mass. 01060 tam s's WORKER'S COMPENSATION INSURANCE • AVIT (l ltxn_s_e/pc r mittce) with a principal place of business/residence at: • 77$ WeSi--tSkAiL .s�_.. .�ah —J.! _Oi 1 _(Phone'=)^` s) cl4a,4 (St ticity!c;,a p) do hereby certify, under the pains and penalties of perjury, that: - ( e.n an employer providing the following worker's compensation coverage for my • employees working on this job: UPI 1�fiva AU-)C. 701 s Iv o - (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company Polief Number) (Expiration Date) • (Name of Contractor) (1.asu ancc Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Companyr?olicy Ntunber) .. (Expiration Date) (Name of Contractor) (Insurance,Company/Policy Numbs) (Expiration Date) (r.tLLt ad3itioetal c8:--et iiro^c:z.r::n is c}xx i:fcraA:ioct._.:ir:g'c ell c:<:-c'tt:: • ) I am a sole proprietor and have no one tt:orkin for me. ( ) I am a home owner performing all the work myself. NOTE:please be ew-a c the while ltar<awttera who employ;w sc :to eit corcer:e:m or repair wovi:or.:dwelling of not snore than throe units in v.-Lich the I:7:x:w n re:io3 or or the P'�'::�apputec:nt that-to a.-e net Generally o.r.:id:tt :o be =play under the worker':ca .--cation Ac (GLI (5)),I.—Wi :ion by a homeowner for s l,ec:e cc p-rmi: legs!ctahu of an eeaployer under the Wake?'Con:par...lion Act • I undc-ztand the a copy of this etaten a ct may be fo,wnreied to the IYlieuunxnt of Industrial Accident,'Office of 1:t.-ur.ax for the coverage vcrifjctioo and that f:ilure to t!c re co ornge under mention 25 A of MGL 152 can lui to the imposition of r-niyl penalties coasi tirg of a funo of up to S I.500.00 nt .'cr it pri.osn.-:•1 of up to cr.:year a:d civil penalties in he fbnn of a Step Wort Order and a fine of 5109.00 a day cg.in.t m. • For dcautrstertsl use only permit Nttmtr r — .-----_ __ ap;'_ IA( _ I S f>_n iaturn of r ti • ' otiAMP2 `.144t * a, ;. (rztp of � i:el-ramp z = / iiitassachusetts•11 (��'�y"-'� DEPARTMENT OF BUILDING INSPECTIONS ___f I- ,-- INSPECTOR 212 Main Street • Municipal Building '`0,�4 v.., Northampton,MA 01060 . r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:.. sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location , , ,,to :_,.. 1 , , 7' � QUEN LLE NEVi p 2S `,; IF ' ELKC 1„Jn ROOFING & SIDING, INC. " _' The Premium Choice- 78 West State Street, Granby, MA 01033 We Are Licensed 1-800-NEW-ROOF • 1-800-4-SIDING Insured Email:agrnewroof@wmconnect.com Website:www.1800newroof.net Factory Trained MA Construction Supervisors Lic.#070626 MA Registration#120982 Member of the Home Builder's Association of Western Mass. CT Registfation#575920 Factory Certified Installers Proposal Submitted To: Date Phone#'s 6 i,i blc: . . -3o•cry H: , G - 66,1 W: Street Job Name 5- 3 _161.tck rr` LiA City,State,Zip Code Job Location iuV �.Y.�,t , M A Proposal to furnish and install the following • ' J YRe-Roof LI Tear-Off f-1 Gutter ❑ _.,Repair hia z5t-./ Complete Roof Preparation \ __a ��� Li Home exterior to be protected by tarps and plywood t,0 1,-� Shrubs, landscaping,trees to be protected from damage ' j FAt,"k-S f,,1o.tt e S -e O Entire existing roofing material to be removed to existing decking, including flashing, etc. 6041 , V Site to be cleaned everyday with roll magnet debris removed at project completion A,?(' )/y 1f-1- LI Deteriorated existing decking replaced at$50 per sheet of plywood r I h r . (./';:)&'i writ" A Metal drip edge installed at eaves K Metal drip edge installed at rake edges ir 7 `f 't '`'y 7` A O New metal step flashing will be installed where necessary HNh j'ft� New plumbing vent flashing will be installed and flashed Ask us about Z.Shingle valleys will be installed affordable bank financing QNew metal flashing will a Installed around all chimneys , C7 We shall acquire all appropriate permits etc.for all roofing work l-f -TE U. CuS4 SP c'u Complete Roofing System ' se(- 1 et,,,,, -1 5 , .tX.ELK Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) 7 ELK Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas • 15 pd. orce un er ayment installed ov king Shingles: 7d) I e ELK Prestige®Series ,lam 30 year 50 year Color w)p.n h,/ CAI C O% s Nailable ridge vent will be installed ,C ELK ridge cap shingles Warranty Options: P We guarantee our workmanship for 5 full years O ELK10-Year Umbrella Coverage Limited Warranty upgrade. EK ELK15-Year Umbrella Coverage Limited Warranty upgrade. -1IL. DIrc•VER We Propo a hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: �// / aa QC-� tux+z),�;t G G?i,�' �----- dollars 'a 0 ). Cc''0Pok1 0t , ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are saticto and are hereby accepted. You are authorized to do work as specified.Payment will be 1/3 down at start of job,and balance due upon completion. Date: 3/ 3 t, l ° / Signature: / Phone# 13 - Z('' KO Date: �f..t)/U� Salesperson's Signature: / Estimates a honor d f sixty( ays from above date 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. ACORD CERTIFICATE OF LIABILITY INSURANCE CSR RL DATE(MMIDDlYY) AMQ-1 11/10/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 INSURERS AFFORDING COVERAGE Phone: 413-538-7862 INSURED INSURER A: National Fire & Marine Ins. Co INSURER B: Hanover Insurance Company Adam Quenneville Roofing INSURER C: AIM Mutual Insurance Company P 0 Box 612 INSURER D: South Hadley MA 01075 I INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION ILTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 72LPE687487 03/19/03 03/19/04 FIREDAMAGE(Anyonefire) $ 100000 CLAIMS MADE X OCCUR MED EXP(Any one person) $ 50 0 0 PERSONAL&ADV INJURY $ 10 0 0 0 00 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ $ ANY AUTO AFN604546005 11/01/03 11/01/04 (Ea accident) ALL OWNED AUTOS BODILY INJURY $250000 (Per person) X SCHEDULED AUTOS • X HIRED AUTOS BODILY INJURY $500000 (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ 100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ INGS $ I WORKERS COMPENSATION AND X TORY LIMITS ER C EMPLOYERS'LIABILITY AWC7012861012003 04/29/03 04/29/04 E.L.EACH ACCIDENT $ 100000 E.L.DISEASE-EA EMPLOYEE $ 100000 E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION ENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _IL_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Remillard Ins. Agcy. , Inc. ACORD 25-S(7/97) ©ACORD CORPORATION 1988 _: 9 Board of Building Regulations an tan ar s -, =« One Ashburton Place - Room 1301 _� Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2006 ADAM QUENNEVILLE ROOFING _--_— ----- --- -- — ADAM QUENNEVILLE _ _ — - P.O. BOX 612 ____ __ — — _ SO. HADLEY, MA 01075 - Update Address and return card.Mark reason for chang Li Address j J Renewal C 1 Employment fl Lost Card 6/ ,.07--/te -67 Board of Building Regulations � One Ashburton Place, Rm 1301 "'. Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 08/21/1971 Number: CS 070626 Expires:08/21/2005 Restricted To: 00 ADAM A QUENNEVILLE 121 AMHERST RD S HADLEY, MA 01075 Tr.no: 3682 Keep top for receipt and change of address notification. „ ill' (rF14, S R..., Jr .^ .r .,,, f£ f rf ss iIP f,iF� .�_, "IN r l a^ _� �. w� ��w` �►/� � � �lw �� �ly''_�.� '�►;N�` �:l� '�IY':..� �` '�,lw'" ''w�,� �IV• �,p„. '��' �,�,; ;,�` , �, ry, 'i STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION % �` Be it known that:it4 :11...f:.,,.:.. z: ADAM QUENNEVILLE . 121.: 'HB ALW?X�Y S g: a SOUTH 1+ tEV.,-i'f'A 01-975 "' i: r has been certified by the Depalrtit of ,t siner Protection as a registered HOME IMPROVIVENT CONTRACTOR DBA: ADAM' QUE EVILL `ROOFING . `. Reg Ist�raat 20 ti:110; 7 Effective: 12/01/2003 " ' Expires: 11/30 At it,c, 2004 Jr _..Edwin_R..Rodriguez�Commissioner- "•'•%-_:r