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38A-082 (6) BP-2023-0733 48 CHAPEL ST UNIT D COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38A-082-001 CITY OF NORTHAMPTON Permit: lilts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0733 PERMISSION IS HEREBY GRANTED TO: Project# SKYLIGHT 2023 Contractor: License: ADAM QUENNEVIL E ROOFING & Est.Cost: 2548 SIDING 070626 Const.Class: Exp.Date: 08/21/202 Use Group: Owner: TRUS E VAN SCOY VIRGINIA E Lot Size (sq.ft.) Zoning: URB Applicant: ADAM UENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 06/06/2023 TO PERFORM THE FOLLOWING WORK: NEW SKYLIGHT 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: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissioner Version].7 Commercial Building Permit May 15, 2000 __'� <<„j Department use only �`�-� City of Northampton Status of Permit: JIM _ Building Department Curb Cut/Driveway Permit 6 2023212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability EST OFBuf�DING INSPFC Northampton, MA 01060 Two Sets of Structural Plans nN•Mq p�c� le 413 587 1240 Fax 413 587 1272 Plot/Site Plans 1_ Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN 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 D Northampton Ma 01060 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Virginia Vanscoy 48 Chapel St unit D Northampton Name(Print) Current Mailing Address: 413-695-3257 Signature See contract Telephone 2.2 Authorized Agent: Adam Quenneville Roofing & Siding 160 Old Lyman Rd South Hadley Ma Name(Print) Current Mailing Address: �� 413-536-5955 /Signature v Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,548.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 1 Lip 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 +4 + 5) Check Number ( �//� 4{Ci This Section For Official Use Only Building Permit Number Date bni7 - ] Issued Signature: 6AV/Jh91,73 C' Building Co issioner/Inspector of Buildings Date Version 1.7 Commercial Building Permit May 15, 2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other 1 new skylight,remove existing skylight and install new velux skylight sized to existing opening,install new ice and water barrier around Brief Description skylight perimeter and new shingles around skylight to match existing. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly CI A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st 0 1st 0 2nd 0 2nd 0 3rd 0 3rd 0 4th 0 4 h 0 Total Area (sf) Total Proposed New Construction(sf) Total Height(ft) 0 Total Height ft 0 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal systems Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes n No I nl SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 Virginia ,as Owner of the subject property Hereby authorize Adam Quenneville to act on my behalf, in all matters relative to work authorized by this building permit application. See contract 05/31/2023 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 05/31/2023 Signatur o Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville CS 070626 License Number 160 Old Lyman Rd South Hadley Ma 08/21/2023 Addres Expiration Date � 413-536-5955 Signature Telephone SECTION 13-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 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 48 Chapel St unit D Northampton The debris will be transported by: Adam Quenneville Roofing&Siding The debris will be received by: Adam Quenneville Roofing&Siding Building permit number: Name of Permit Applicant Adam Quenneville Roofing&Siding Y,nf.y by cd!F'b Acla4 Quennet/Ile °"" °" Date Signature of Permit Applicant - , ,.. ,....... , .,........,....„ ....,.." tittiiktl. , . . , „ ... ,i,. ::i i . , . J''.''...1-7.'•-!.:::---7. ::::;"!'.. i.".'.!.1!!!!'.:•7:::;:::::11. 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' ' - ' ,,,,.., -•,.,,,:;!1!.,:•!ti!,::i:1:::t?:!:::•,!,i:.•:."..:t!''!E•:'',',!',.f•::,:'-''''‘A,',:'','''?:',112?A7.,,V.',",:••',.,,,;4141024.*:;,r--,,,.:iioi.:Aioi-,A„Ri,i,i,40::0:,6 .ftifili:..';'; ,',.,'.::4:-;:',...,..,."..',`'.'i.,.., •:"46,',-.,:,••,'-'-'•, . ,........::::.•.• TE ACCPREP CERTIFICATE OF LIABILITY INSURANCE DAT/12/2O 3Y)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. lac NN,Extl: (413)536-0804 FAX No): (413)534-7074 1649 Northampton Street ADDRESS: spremo@claytoninsurance.net P. O. Box 989 INSURER(S) AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURERB:Green Mountain Insurance Company Adam Quenneville Roofing 6 Siding Inc. INSURERc:Gray Surplus Lines Insurance Company 160 Old Lyman Road INSURERD:AIM Mutual Insurance Company 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 W LIMITS LTR .INSD VD POLICY NUMBER IMMIDD/YYYY) (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE A CLAIMS-MADE X OCCUR PREMISES(Ea oc urrence) $ 100,000 X BI 6 PD DED $2,500 NN1423290 6/23/2022 6/23/2023 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 20047429 6/23/2022 6/23/2023 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS (Per accident) UNINS/UNDERINS MOTORISTS $ 100,000/300,000 X UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ GSL100712 6/23/2022 6/23/2023 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y D (Mandatory in NH) AWC4007012861 4/29/2023 4/29/2024 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!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) For Informational Purposes Only. Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance) . The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. 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 I22,47 P ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) The Commonwealth of Massachusetts 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 I' Please Print Legibly Name(Business/Organization/Individual): A cle,^1 ( .uen v i at, 2.uc4116 �1 ..1 n f `> el�- Address: ILO 01 c L� Z U (Q1 City/State/Zip: 50t,' - (,t V-6 (hi() CA 0-15.— Phone#: k t 3 -53`-5 95T Are you an employer?Check the appropriate box: Type of project(required): I.-K I am a employer with 15 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have worke s' P tY 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. Roof repairs insurance required.]t c. 152,§I(4),and we have no employees.[No workers' 13.❑ Other comp. insurance required.), 'Any applicant that cheeks box h t 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: A Arh (v'1 u 1 ucA l n5 u f Ac.c- Val/ Policy#or Self-ins.Lie. #: AwC 40Q-10 I ` -TL( + Expiration Date: a 3 Job Site Address: 48 Chapel St Unit ; City/State/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 S1,500.00 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 eertifounderrte pains and penalties of perjury 5i3,;x 3,.: ation provided above is true and correct �atr7 C2uennet/��e -05/31/2023 Signature: Date: _ Phone#: 41 1-3 — 5 3C, — 59 5 S 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#: Contnnonweatth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construtttt� r ik'plovisor CS-070626 ' _ Tres:08t21f2023 ADAM A QU>hoN 160 OLD LYMAN A SOUTH HADLEY MA ,x *a Commissioner doeil i ler Ern THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING, INC. Expiration: 03/22/2024 160 OLD LYMAN RD. SO, HADLEY, MA 01075 Update Address and Return Card. ' .`-'4 iVx ? Xg t+ }"r>t a r:*t+ R'A it r,.S','c+ s t l .1,..,..*k�S'' v 1. f .' 'fi', x +i x.+f; "44 i,,•..'..; ` 1.:a..3,5 ''',,et, ,firt.,,t..x 4r;:' .,rn ? .. : 'hf..z�j„ ,. A<4 ra."',.! , 4:,>0. A m.C.,::4: av fi,U' '' .r«> 5y%1„ ,7'411 '' ;; ' ', ... ,Ii 44 ,7`.: , 1 STATE OE CONNECTICUT 4 DEPARTMENT F CONSUMER PROTECTION i y f Be it known that Ny i ADAM QUENNEV xLLE I Wit= r 1 160 OLD LYMAN ROAD it SOUTH HADLEY, MA 01075-2632 k":::::::;q'':4:111:1 i has satisfied the civalitications rcquued bylaw and is hereby.registered as a It F ` HOME IMPROVEMENT CONTRACTOR i , ADAM QU ENNEVIILE ROOFING .6 Registration #: HIC.0575920 i ' X i Effective: 04/01/2023 •..1.'-, '' ' i 411Z .41:20.7e.ie 1 li.1 Expiration: 03 31 2024 NichelteSeagutl Cammcasioner ..'':, r , ' arc ... 4y, ,_w� h ,a b x�, w s.n t *a ,.'° a f , ts" .. .. > ' r i°. .,,.A •., �,. w,ti r Hwy y aye Z- f ;.i .' e, ''., v a� 3 ''„' - a ti t ,,I `� ` i' "1 .r , '•,, ..�; �. <ta 5�{t,�. ai. `'� a + �a �_r,�� ,. .'I. �t�3 q.'.wsr��+ z: �� �`s�'�''r�cv.j,.• • � v. 1;' .,. atw. t. -.fir U, wv ,.:. i.4�, ;. St '+ /{.''`a.,�2:�