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28-026 (7) BP 2022-1 168 6 O'DONNELL DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 28-026-001 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-2022-1168 PERMISSIONIS HEREBY GRANTEI TO: Project# roof Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 3699 SIDING 070626 Const.Class: Exp.Date:08/21/2023 Use Group: Owner: ALLEN, KEVIN &RANOVA, ELITZA S. Lot Size (sq.ft.) Zoning: WSP Applicant: ADAM QUENNEVILLE ROOFING &SI ING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON:09/19/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: 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 NORTHAMPTON UPON VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: LtkiA,_, >9 514, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only City of NorthamptoCE J j tatus of Permit: Building Department rb,Cut/Dr¢veway Permit �1 212 Main Street SEP Sew -/Septic Availability ' Room 1.00 T 2022 Wat r/Wel!�Availability .�,. Northampton, MA 01.060 Tw Sets pf Structural Plans phone 413-587-1240 Fax 4,3 Plo Site!tans ?rHA rfnuvc rrvsaF� r Sp cify Main, �_ APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DENtOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be M�completed by office 6 O'Donnell Dr Florence Ma 01062 Map A v Lot it' Unit Zone Overlay District Elm St. District _ CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Elitza Ranova 6 O'Donnell Dr Florence MA Name(Print) Current Mailing Address: see832-433-4431 contract Telephone Signature 2.2 Authorized Agent: Adam Ouenneville 160 Old LymanRd South Hadley Ma 01075 Name(Prirlt1 Current Mailing Address: L1�lar�/C2uennel/lle 09/11/20]1 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3,699.00 (a)Building Permit Fee 2. Electrical 0 (b)Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical (HVAC) 44' /� 5. Fire Protection 0 6. Total=(1 +2+3+4 +5) 3,699.00 Check Number f ati This Section For Official Use Only Building Permit Number: " s?.? t1� IIs ate fssued: /. 2/Signature: / 9"/� Z�Z Z Building Commissioner/Inspector of Buildings Date kaylee.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 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 YE1-1 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW X 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? YEF—I NO X 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 n Addition ❑ Replacement Windows Alteration(s) n Roofing X Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [[J Siding [El) Other[El] Brief Description of Proposed remove existing ridge vent&cap&install new, reroof garage slope&new aluminum wrap on damaged fascia 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 Elitza Ranova 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 09/14/2022 ............................_.._. Signature of Owner Date Adam Quenneville I, , 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 09/14/2022 Signatur f wner/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 Sign ure Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Quenneviile Roofing&Siding Inc 191093 Company Name Registration Number 160 Old man Rd South Hadley Ma 01075 3/22/2024 Address 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 ❑ „ ►cur, City of Northampton vt fir` ��5 frr p1lf Y Massachusetts e f �i. r, r DEPARTMENT OF BUILDING INSPECTIONS ..E w 40 !�`"” ' � 212 Main Street •Municipal Building `3�, <.'' r� ,"r* Northampton, MA 01060 'P'sF•y., �;�f‘ 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: 6 O'Donnell Dr 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) 41an/ auenfle lle in v.-:,eura:rvn« VII 09/1</)03J iii\-- 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. l7 zXCf7, QYENNEVILLE .,' AWARD ,J/i pI C/� 551"R y�2,a., ' t2 2 0 E S t d Y'x ,,:� f 3 e Y :' .,«. .If 2V'0• ,NNER 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: 832-433-4431 Elitza Ranova 09/09/22 H: W: Street: 6 O'Donnell Dr, Email: Kallen.kpa@gmail.com City,State,Zip Code:Florence, MA 01062 Proposal to furnish and install the following: -Pull all appropriate permits -Remove ridge cap and ventilation on main house,dormers, and back addition -Install new Snow Country Ridge Vent and GAF Ridge Cap Shingles. -Strip damaged garage slope. -Remove damaged section of aluminum wrap on fascia board. -Re-shingle slope(includes drip edge, ice/water barrier, synthetic underlayment, starter strip, GAF Timberline HDZ Shingles, Snow Country Ridge Vent, and GAF Ridge Cap Shingles. - Install new white aluminum wrap on fascia board on damaged section - Includes all haul away and disp•sal. Any deteriorated fascia b• • ill b- eplaced • for to installation of metal wrap at a price of$15/ft. Deteriorated existing d o iii "A II • - replac:. at$5.19/sq.ft. and dimensional lumber at$15/linear ft. Customer Initials: , kir- Shingle color and Ridge Cap color: Weathered Wood Total: $3,699 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 o •st coming in through cracks of the wood.Please remove any lawn ornaments or yard furniture.Adam Quenn• `1,ofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: i / We propose hereby to f materials and labor—complete in accor ance with above specifications for the sum of: Total Due:($3,699 ) ACCEPTANCE OF PROPOSAL:The above prices,specificatio onditions are n Payment:($ 1,200 ) satisfactory and are hereby accepted.You are authorize d ork as specified. 2ntl P ment at Start Job:($1,200 ) Payment will be 1/3 down at signing,1/3 at start of j nd ala Balan ue Upon Completion:($ 1,299 ) upon co;Ili AV. Date: Signature: o - 9/9/22 anner Natal Date: Estimator:(Print e) (Sign Name Estimates are honored for sixty(60)days from above date. A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/23/2022 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(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 CONTACT Sarah Premo NAME: Clayton Insurance Agency, Inc. PHONE (413)536-0804 n/c,No): (413)534-1874 INC.No.Extl: 1649 Northampton Street E-MAILADDRESs: spremo@claytoninsurance.net P. O. Box 989 INSURER(S)AFFORDING COVERAGE NAIL if Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURER B:Green Mountain Insurance Co Adam Quenneville Roofing a Siding Inc. INSURERC:Gray Surplus Lines Ins. Co. 160 Old Lyman Road INSURERD:AIM Mutual Ins. Co South Hadley, MA 01075 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:2022 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR 1NS0 WVD POLICY NUMBER (MM/DD/YYYY) (MM/OD/YYVY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ , 1,000,000 DAMAGE RENTE A CLAIMS-MADE X OCCUR PREMISESO(Ea o currence) $ 100,000 X BI 6 PD DED $2,500 NN1263315 6/23/2022 6/23/2023 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-JECT LOC PRODUCTS•COMP/OP AGG $ I, 2,000,000 OTHER' _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED 20124137 6/23/2022 6/23/2023 BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) - UNINS/UNOERINS MOTORISTS $ 100,000/300,000 X UMBRELLALIAB OCCUR EACH OCCURRENCE S 5,000,000 _ — C . EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ 002428191 6/23/2022 6/23/2023 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICD (Mandatory MBER nNH)EXCLUDED? Y NIA AWC4007012861 4/29/2022 4/29/2023 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT $ 1,000,000 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 6 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/FMT /72W,m,, P • 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 1s Commonwealth of Massachusetts \,F • Division of Professional Licensure Board of Building Regulations and Standards Constro t4ttlil bPervisor s CS-070626 ' i F,..pires 08/21/2023 ADAM A QUEI'4NEVI i�r�}0 1 ,,• ?Ark.'is `' kj • 160 OLD LYMAN RD , .1 t �, iris SOUTH HADLH*Y MA r �" 4s , il1 _{ iii //Ar)1ti'''... 0 i :' r Commissioner d0 K. D641cV1a. C��Z<.- / 1. ; •' �(.7C�JlC•l%Z'C�IZ�C/PCrL.�.�I, C.� 0�1'(.f.1;1:1'ad•lls1ee1%1• 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: 03/22/2/2022 SO.HADLEY,MA 01075 Update Address and Return Card. SCA 1 0 mr.t.ororr .u.,�.,,p •I't:d•:a.•1' •Y, -r •t' •1. .p ,:..,�.:.p .t. : r..1. .1.. .1 .1. .1. .�;. .! .t. .t. .1 .,f.•. n t5e l:., 1-;` e� fftM n.. Yi••; .rY :oi:: <;',.•,: i^a .'1 d+:,,•;,'1' fin; :i•'. 'I'•tT,:'.. ",; gg �, tti�tt ,y t s/ " s4 t i y! 1I ,. isllul� �.!!# 'i' T7 11 +11k �' T !taa t ,f .�z f STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECT ON ;' ?< I Be it known that '. r 'k ADAM QUENNEVILLE i "u.,, a ,,..=, 160 OLD LYMAN ROAD to fY SOUTH HADLEY, MA 01075-2632 ; 1 has satisfied the qualifications required by law and is hereby registered as a �, '_ `' I HOME IMPROVEMENT CONTRACTOR r' fo • ':} Registration # HIC.0575920 I " ' ADAM QLTENNFVII.,LE ROOFING ;'r Effective: 12/01/2021 4 `f.. .1. 144/41 � 7`-_... . ._ ._-..._ . -sExpiration: 03/31/2023 r t MichelleScegull,Commisvioncr eiii C/ i J ' P N • liq _ a • ro • �ryqy " rF71C �+ 'I. .Yi � +�,: I \ rt \ t) � � � ' ', Y`,•; '' f°r /, a ..., 1. :J..,r, ••,. r.l. y .:.1A4.... �.nt%.,,,s. Ka ,. JI, t. � :rlr t,.rh,.A: . : .'ZM''1 r1 1" ,. ..': 'i .5:'1. � The Commonwealth of Massachusetts I ' "' "" I Department of Industrial Accidents _,; Office of Investigations 1= 600 Washington Street ==f� • Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly Name(Business/Organization/Individual): ,4 1C&w1 Qv t'rtr`�11 tat- Lot (I' �Z�I'1 Y (I.-inc., Address: ILO 0 c. Lr U City/State/Zip: 501+% 140 11t-6 Olio 01&') Phone#: r 3 -53(-`5(15S Are you an employer?Check the appropriate box: Type of project(required): 1.tKi I am a employer with 1.5 4. [] 1 am a general contractor and C 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 1 ant a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [I Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.: required.] 5. We are a corporation and its 10.❑ 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 I2.E1 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 N l 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. 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: A1.'rh M u i uckk 1,/15 0 W C � tc.+�t.C— / Policy#or Self-ins.Lic.#: A �� I age- L ( Expiration Date: I/d 1q1 a 3 j Job Site Address: 6 o Donnell Dr City/State/Zip: Florence Ma 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirati n date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pena ties 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 ORDE 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 eertisfwaundenttf pains and penalties of perjury that the information provided above is true and correct. Ada»7 C2uenne �e 09f14/2022 Signature: �,-- Date: Phone lk '1l3 ` 53L - 5 Iq 5c 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#: