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38A-083
BP-2023-0038 48 CHAPEL STUNIT A COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38A-083-001 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-2023-0038 PERMISSION IS HEREBY GRANTED TO: Project# SKYLIGHTS 2023 Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 6398 SIDING 070626 Const.Class: Exp.Date: 08/21/2023 Use Group: Owner: C LARSEN, KATHLEEN Lot Size (sq.ft.) Zoning: URB Applicant: ADAM QUENNEVILLE ROOFING & •IDING Applicant Address Phone:, Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 01/13/2023 TO PERFORM THE FOLLOWING WORK: NEW SKYLIGHTS 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 3.3.115/ e, • V )2 . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Department use only �8;.Gl-rich City of Northampton Status of Permit: y Building Department Curb Cut/Driveway Permit 212 Main Street �/qA� 1 Sewer/Septic Availability Room 100 , 2 Water/Well Availability 3- m e fix` Northampton, MA'01,060 2023 Two Sets of Structural Plans `` phone 413-587-1240 Fax e41'3 87�2 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: 48 Chapel St Unit A Northampon Ma 01060 Map Lot Unit Zone Overlay District _ Elm St. District_____ ___ ____ CB District_ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 2.1 Owner of Record: Kathie Larsen 48 chapel St Unit A Northampton Ma 01060 Name(Print) Current Mailing Address: see617-233-5985 contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name(Prirp Current Mailing Address: l fatr QuenneVi((e '9 o o-z z,a`F, 413-536-5955 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 6,398.00 2. Electrical 0 (b) Estimated Total Cost of Constmetion from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical (HVAC) 1.4 5. Fire Protection 0 6. Total = (1 +2 + 3 +4 + 5) 6,398.00 Check Number I 4-(O V ��// This Section For Official Use Only Building Permit NumberV )i3- 3S Date Issued: Signature: /��/[� /- 13 ZOZ 3 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 DONT KNOW X YEF-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? YES NO X IF YES, describe size, type and location: E. Will the construction activity disturb clearing,gradin ex vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YE I 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 15 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EJ Siding ID] Other[Ell Brief Description of Proposed 2 New skylights, remove existing install new w/flashing kits, ice&water barrier and new shingles around 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 Kathie Larsen , 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 01/10/2023 Signature of Owner Date I, 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 01/10/2023 Signature of 0 r/ gent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Hoer: Adam Quennville CS-070626 Holder License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2023 Address Expiration Date 413-536-5955 Signat a 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 Address Expiration Date A.---- 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 0 i City of Northampton yl:Li.`,74(,/ 5 .`Sy% Massachusetts . � '''( bJ ;'yi:+ DEPARTMENT OF BUILDING INSPECTIONS si ' -'+ r`• 212 Main Street •Municipal Building 0,, _-.4.5 ,-- Northampton, MA 01060 1's'hl,, 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: 48 Chapel St Unit A 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) Atari auenneVi/le }p�j w»R4ba , ; A, lA 01,1J,2023 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. • QU$NNMEV$LLE a /AWAan . cast veR 0AtN > y VtSA,wate 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 Registrat on#120982 Factory Certified Installers Member of the Horse Builder's Assoc.of Western Mass. CT Registration#575920 Member of the Building&Trade Assoclatian P.P.0 38710 Proposal Submitted To: Date: 1/6/2023 Phone It's: C: Wildwood Court- Kathy Larsen H: w:. Street: Email: 48 Chapel St. Unit A kathie.larsen@gmail.com City,State,Zip Code: { Northampton, Mass 01060 Proposal to furnish and install the following: We will pull all appropriate permits associated with skylight installation Skylight will be installed in conjunction with new roofing system Yes/No We will remove and dispose of shingles around the perimeter of the skylight We will remove and dispose of 2 exisitng skylight(s) We will provide and install 2 Velux skylights&associated flashing kit Skylight will be Solar Venting-$3,199.00 Each Skylight model C06 We will install ice and water barrier per manufacturers instructions around skylight perimeter We will install new shingles around skylight perimeter Shingle color Closet Match-Weatherwood Skylight will have factory installed solar blind NA Federal tax credit eligibility .30 % Federal tax credit savings $1,919.40 Solar blind will be Light Filtering/Room Darkening No interior trim work is associated with the skylight installation Please clear and cover area directly below the skylight prior to work commencement { Ask us about affordable bank financing! ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust coming in through cracks of the wood.Please remove any lawn ornaments or yard, furniture.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: A'./se', We propose hereby to furnish materials and labor—complete is accordance with above specifications for the sum of: Total Due:($ 6,396.00 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 3,199.00 J satisfactory and are hereby accepted.You are authorized to do work as specified. 1 Balance Due Upon Completion:($ 3,199.00 ) Payment will be 2//3 down at signing,and balance due upon completion. Date: !d rJ 61ht+i 4.3 Signature: !t . - 6444 ' Date: 1/6/2023 Estimator:(Print Name) Steve/Derek (Sign Name) nit-'A% 0-6t %. Estimates ore honored for sixty(60)days from above date. o /'1 AC RD 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 Clayton Insurance Agency, inc. lucNo.Eat): (413)536-0804 FAX No): (413)534-,a,s 1649 Northampton Street E-MDRE AIL SS: gp remo@claY toninsurance.net AD P. 0. Box 989 INSURER(S)AFFORDING COVERAGE NAIC M Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURERB:Green Mountain Insurance Co Adam Quenneville Roofing & Siding Inc. INSURERC:Gray Surplus Lines Ins. Co. 160 Old Lyman Road INSURER D:AIM Mutual Ins. Co South Hadley, MA 01075 INSURERS: 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 ADDL SUER LTR TYPE OF INSURANCE ,�NSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDDIYYYY) (MMIDDlVVYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE I X I OCCUR PREMISES(Ea occurrence) S X BI & PD DED $2,500 N141263315 6/23/2022 6/23/2023 MED EXP(Any one person) S 5,000 i PERSONAL BADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I 1 PEC° LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - CO(Ea aBINEDl)SINGLE LIMIT $ ' 1,000,000 B _^ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 20124137 6/23/2022 6/23/2023 BODILY INJURY(Per accident) S AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ _ UNINS/UNDERINS MOTORISTS S 100,000/300,000 X UMBRELLA LIAB OCCUR } --- EACH OCCURRENCE S 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE f 5,000,000 DED RETENTION$ 002429191 6/23/2022 6/23/2023 $ WORKERS COMPENSATION _ ' AND EMPLOYERS'LIABILITY 1,/N X STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D OFFICER/MEMBER EXCLUDED? y N/A (Mandatory In NH) ANC4007012861 4/29/2022 4/29/2023 E.L.DISEASE-EA EMPLOYEE $' 1,000,000 It 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 II more space Is required) For Informational Purposes Only i 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 Michael Regan/FMT /92.W.4,.-/ P ,/,,,,, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Commonwealth of Massachusetts lir Division of Professional Licensure - ' Board of Building Regulations and Standards Constpirt*A*.rvisor ...., 'I CS-070626 E.,ipires.08121/2023 ..-- ADAM A QUIOJNEV 180 OLD LYMAN R*it SOUTH HADLEY MA 'f)trs. ,4310- Commissioner deefit K. VeinCiAlt. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ,o-', Type: Corporation Registration: 191093 1 ADAM QUENNEVILLE ROOFING AND SIDING,INC. ,----.7.. :4 1 , -, Expiration: 03/22/2024 160 OLD LYMAN RD. 7 SO. HADLEY, MA 01075 1,:i Update Address and Return Card. ,,,:,ap',vi.,,W'.-0:1'4t.,,,:in'r,,:!7•1,%',:a/ IW't'4.11,..;;I:hi: ;„11.Z:4;„,,,,,41:Y'l"'4,:'*'' ,::...V.:A.•4:',%W:'.','.',`")"'.,,',IV:,,'14,'N'''<'-' ""a;£4,,,A9,454.:444%,6**'*1.10":-AP::,,,,'":4.`4'' ,tlii•''''''. . flr--''' . 'L-.!1.4-.2*fr' .2.44.:._!SAL:S.A.L.L..t.LP__.4k — i ,101A . 1 STATE OF CONNFCTICU'I' + DEPARTMENT OF CONSUMER PROTECTION 444- ,, ., . Be it known that 1 •vi 1 ADAM QUENNEVILLE 160 OLD LYMAN ROAD : ye,,;••., ,•.,;•,...:-.4,f1 • ,A , SOUTH HADLEY, MA 01075-2632 .„.... 11 Itit''4'At-,4,• 1 ,- •-, ,1/4,,,., 'ItItIP has satisfied the qualifications required by law and is hereby registered as a - ilit4 .-.,...s., -4C',„411 HOME IMPROVEMENT CONTRACTOR I.. ... .,,,,....-.,_Registration # HIC.0575920 t ••=i,...,..s..= ,... ADAM QUENNEVILLE ROOFING . . .:4i-,..:;, ; Effective: 12/01/2021. 14 .0& ,.... , , Expiration: 03/31/2023 Michelle Seagull,Commissione --; 4 - -- _ . . :.,,,,,,,,.;....„..,...,„:,,,_,.!).,,,,,, ,,,,,,,,„: ;,,. .,,,,:„.2.: ,,,,..:..1,„..„:.44,et,smi.,, - ,-:4.,..,...,,,-,.4,..:,..,„,,,,..4..,...,k.-, .,,;24/,..,,,.-t.,.:6,,„-N-,,..f...:, .s.„ -,4„;.Ai, 4...,,,.-N. :,:?„,,,7sa. ,:....,;.;,...,:. -40,4•;); 41,';',.,W.-,WK5., The Commonwealth of Massachusetts --� Department of Industrial Accidents ANN Office of=FilleIMO be 600 Washington Street i_ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information nt n (1 Please Print Legibly Name(Business/Organization/Individual): r1•lOr� ven�`�U k`1�t- ICJJUt 1'l f ;#' �j l L Address: ILO 01 A L-.. Le__ City/State/Zip: 50v1\-\ (111z 010157 Phone#: L(t 3 —531—`5455— Are you an employer?Check the appropriate box: Type of project(required): 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 r t listed on the attached sheet. 7. El Remodeling 2.Li I am a sole proprietor or partner- 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.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 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.ffi 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 ft 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 indicalin 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 h ve 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 the information. + (h oiuexl 1 n5 u�Gncc� Insurance Company Name: ; �/ al Policy#or Self-ins.Lie. #: A�C t[�G0-1 0 (aTL( Expiration Date: + o I Job Site Address: 48 Chapel St Unit A City/State/Zip: Northampton Ma 010 0 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 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 certifviwide' the pains and penalties of perjury that the information provided above is true and correct j { �adJ Quennetr�Ie °^,nW,�yw °Mr -01/10/2023 Signature: �/ mno�»>, Date: Phone#: 11 t 3 — 5 3c - 5 1q 5 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#: