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23A-163 (2) BP-2023-1340 106 BEACON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-163-001 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-2023-1340 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 27148 SIDING 070626 Const.Class: Exp.Date: 08/21/2025 Use Group: Owner: DOWNES JOHN FRANCIS Lot Size (sq.ft.) Zoning: URB Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance: 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 09/26/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: j'1614/ Ak-1 ‘.2 C Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner "'t J.: 'A Departmen u`se rY-r ,a City of Northampton �` ""= tit Rout*: �� —`-- ._--- Building Department Cur- Cur%riieyiray mit "� D t. 212 Main Street A :wer/Septic' ailab'ity i ' ` Room 100 U� '//aa ell A ailabi ty 20 23_-*10. 41, Northampton, MA 0 4060�z p p 'wo S s of truct al Plans T i phone 413-587-1240 Fax 413-587127 : .t/SitePlans }/ S , ( en rF tierSp fy + Nrr"a : NrNSP,CTrONS MA�i95D APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING J SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 106 Beacon St Florence Ma 01062 Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: John Downes 106 Beacon ST Florence Ma 01062 Name(Print) Current Mailing Address: 413-345-0798 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old LymanRd South Hadley Ma 01075 Name(Prixr�t� '""3°` "'` Current Mailing Address: Lldar'/'uennelllle 08/25/3833 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 27148.00 (a)Building Permit Fee 2. Electrical 0 (b)Estimated Total Cost of Construction from(6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) I 5. Fire Protection 0 6. Total=(1 +2+3+4+ 5) 27148.00 Check Number I / I e/ 1 141°' ` This Section For Official Use Only Building Permit Number: r®�`'�� ' ./ Date Issued: j \ f Signature: _i; ° .. ��; _ 3 Building Commissioner/Inspector of Buildings Date kaylee.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) n Roofing in 1 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding p] Other[0] Brief Description of Proposed new roof, remove&replace existing, new synthetic underlayment, drip edge,ridge vent, ice&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 I John Downes , 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 08/25/2023 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 08/25/2023 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Adam Quennville CS-070626 1 License Number 160 Old Lyman Rd South Hadley Ma 01075 8/21/2025 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 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 0 City of Northampton ., r N ft�rir s . . Massachusetts h --- el. )- ,„ , DEPARTMENT OF BUILDING INSPECTIONS % ! ,'-- 1 212 Main Street •Municipal Building �� ?� --'�'N O" Northampton, MA 01060 rsH.11' ..','(' 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: 208 North Elm St 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) Danz/zoz, Adaw/ auennevI((e 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. 4/(1.ar iihsW4Evr LiLIE �AWA��� t1//SA. Disc veR Maim 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:info@1800newroof.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: (413) 345-0798 John Downes 08/23/2023 H: W: Street: Email: 106 Beacon St JOHNDOWNES1@VERIZON.NET City,State,Zip Code: Special Requirements: Florence, MA 01062 15 pc 1/2" plywood included for rear PROPOSAL FOR: of main home to go over existing HOUSE GARAGE OTHER dimensional lumber STRIP RECOVER *Homeowner has old shingles in the Layers: 1 2 3 4 Plywood Included: Yes or No garage he would like us to I I Tear off SLATE or SHAKES dispose of COMPLETE ROOF PROTECTION SYSTEM: x We shall acquire appropriate permits for all work • Home exterior and landscaping to be protected xl Strip existing roofing to existing decking with full inspection DO NOT DO: Garage t All project waste shall be removed by dumpster(dumpster for contractor use only) x Install Ice&Water Barrier at all eaves 3'/6',valleys,chimneys,pipes and skylights 'l Install(151b.felt/Synthetic'underlayment over remaining decking area '1 Install Metal drip edge at eaves and rakes(8"/5")kwhite/brown) • Install manufacturer's starter shingle on all eaves and rake edges X Install new pipe boot flashing/vent accessories X Install ridge vent-Snow Country/Cobra rolled/4'Baffled/Roll Shingles: GAF Timberli ne HDZ Shingles Color: Pewter Gray GAF Ridge cap shingles Warranty Options: We guarantee our workmanship for 25 full years J GAF System Plus Warranty z4 GAF Golden Pledge Warranty Chimney Options: [Il Lead Counter Flashing El Water Seal&Tuckpoint O Rubberized Crown Egi Cricket Mason needed(customer provided) Additional material and labor charges may apply. x Deteriorated existing decking will be replaced at$5.19 per sq.ft.and dimensional lumber at $15 per linear ft., after full inspection. Customer Initials --( 7 I Je We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($27, 148 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 7,881 ) satisfactory and are hereby accepted.You are authorized to do work as specified. Balance Due Upon Completion:($ 19,267 ) Payment will be 1/3 down at start of job,and balance due upon completion. Date: 08/23/2023 Signature: t' Date:08/23/2023 Estimator:(Print Name) Ron Dion (Sign Na 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: A COR if)® CERTIFICATE OF LIABILITY INSURANCE DATE Y)T/22/2023 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 Lauren Eckhardt NAME: Clayton Insurance Agency, Inc. c (413)536-0804 FAX NO): (413)534-7874In/ No.Ext): 1649 Northampton Street E-MAILss: leckhardt@claytoninsurance.net P. O. Box 989 INSURER(S)AFFORDING COVERAGE NAIC N Holyoke MA 01041-0989 INSURER A:Nautilus Insurance Company INSURED INSURER B:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc. INSURERc:Gray Surplus Lines Insurance Company 160 Old Lyman Road INSURER D:AIM Mutual Insurance Company South Hadley, MA 01075 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:2023 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 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 EXPDI LIMITS LTR J4SD WVD POLICY NUMBER IMM/DYYYY) IMMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X 1 OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ X BI & PD DED $2,500 5N965983 6/23/2023 6/23/2024 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- F JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 20047429 6/23/2023 6/23/2024 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X 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$ GSL101401 6/23/2023 6/23/2024 $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 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 It 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 /22144,./ P ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ti The Commonwealth of Massachusetts am;IMMINIMP Department of Industrial Accidents '` �' Office of Investigations 600 Washington Street =�•= Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information nn � (1 rPlease Print Legibly Name(Business/Organization/Individual): AQeir' ULver v<..0 t t`t✓ IC.fJC1t t/d J 1 ,17y 1-e-t U � Address: ILO O 1 c Lyr.e, City/State/Zip: 50v'I 1 4�lc,6 (11►a Gaols Phone#: '-113 -j3C`5455 Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with 15 4. ❑ I am a general contractor and 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling 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. D We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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.E1 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 41'l'r1 (111 u lA�ueA 4 Policy#or Self-ins.Lic.#: A WC cf00 10 i age-f Expiration Date: 1/ V 93 Job Site Address: 106 Beacon St City/State/Zip: Florence Ma 01062 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 NA for insurance coverage verification. I do hereby certlfwtunderthe pains and penalties of perju— - - Won provided above is true and correct. Signature: Abe Q2uennel/rlle Date: 08/25/2023 Phone#: W )3 — 5 3C — 59 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: - — — - Commonwealth mMassachusetts Division of Occupational Licensure SOUTH HADtY NO Commissioner Board of Building Regulations and Standards THE COMMONWEALTH OF MAS8ACHU8ETTS Office Of Consumer Affairs and Business RegU|8dOO 1O00 Washington Street - Suite 71O Boston, Massachusetts 02110 Home Improvement ContractorRegistraUVn Type: Corporation � � ��g��a�nn� 181088 ADAM QUEmmEV�LE ROOFING AND O0|NG. � INC.� Expiration: 0302/2024 15O OLD LYm*wRD. SO. HADLEY. MA 01075 Update Address and Return cum.