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32A-187 (4)
BP-2024-0422 23 POMEROY TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-187-001 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-2024-0422 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: ADAM QUENNEVILLE ROOFING & Est. Cost: 5685 SIDING 070626 Const.Class: Exp.Date: 08/21/2025 Use Group: Owner: ZIMNOCH FREDERICK S Lot Size (sq.ft.) Zoning: URC Applicant: ADAM QUENNEVILLE ROOFING & SIDING Applicant Address Phone: Insurance. 160 OLD LYMAN RD (413)536-5955 AWC4007012861 SOUTH HADLEY, MA 01075 ISSUED ON: 04/10/2024 TO PERFORM THE FOLLOWING WORK: NEW ROOF FRONT PORCH ONLY 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: 772- Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner „,,t'k,.1,,.‘, The Commonwealth of Massachusetts 4 1 �, Board of Building Regulations and Standards �9 FOR y 9 MUNICIPALITY llr Massachusetts State Building Code, 780 C1C�IR ��Q r. USE Building Permit Application To Construct, Repair, Renovate` s,pemolis a ,Revised Mar 2011 One- or Two-Family Dwelling ,,,j,, ' //�� This Section For Official Use Only oY'v,,is Building,Permit Number: 6/�..5 54,�'� - Date Applied: /(VIL) a55 //: y- ID.ZoZy Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 23 Pomeroy Ter Northampton Ma 01060 1.1a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: _Fred Zimnoch Northampton Ma 01060 Name(t-rmt) City,State,ZIP 23 Pomeroy Ter 413-230-6254 zimnoch@crocker.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building id Owner-Occupied 0 Repairs(s) l ' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other IX Specify:_ Brief Description of Proposed Work: New roof on front porch only,remove existing roofing,material,install new duro gaurd fan fold on house,install new durotuff membrane new drip edge around perimeter,and termination cap on walls SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 5,685.00 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Feess.hoq Check No. f"1 heck Amount: ” I Cash Amount: 6. Total Project Cost: $ 5,685.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-070626 8/21/25 Adam Quenneville License Number Expiration Date Name of CSL Holder 160 Old Lyman Rd List CSL Type(see below) U No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) South Hadley Ma 01075 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-536-5955 _kaylee.aqrs@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 191093 3/22t26 Adam Quenneville Roofing&Siding Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 160 Old Lyman Rd kaylee.aqrs@gmail.com No.and Street Email address South Hadley Ma 01075 413-536-5955 City/Town, State,ZIP Telephone SECTION 6: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 [ No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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 04/03/2024 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 04/03/2024 Adam Quenneville Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 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: 23 Pomeroy Ter Northampton Ma The debris will be transported by: Adam Quenneville Roofing&Siding The debris will be received by: Adam Quenneville Roofing&Siding @160 Old Lyman Rd South Hadley Building permit number: Name of Permit Applicant Adam Quenneville 04/03/2024 Avlar✓l Quennedle Date Signature of Permit Applicant QUENNEVILLE vi 4,1 00 F<" '3,. w ,.,cD wG 6.e AWAKED VISA t�iw"°'. o vnt i iiiii 160 Old Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW.ROOF • 413.536.5955 Fully Insured Email:in foO18pgnewroof.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 Pr sal Submitted To: Date: torte if s. C: olmnoch, Fred 4/1/24 l: (413) 230-62541 w: Street: Email: 23 Pomeroy Ter zimnoch@crocker.com Cit ,State,Zip Code: Northampton, MA 01060 Proposal to furnish and install the following: Front Porch location of flat roof if applicable we will pull all appropriate permits for work. we will remove all roofing material down to decking and dispose of yes / no we will go over existing roof yes / no we will install Duro-Guard fan fold onentire flat roof / no we will install ISO insulation board on entire flat roof yes / no inches we will install Durolast / Durotuff membrane on entire flat roof color Black we will install PVC coated aluminum C6 drip edge around perimeter of roof color White we will install termination bar up walls and chimney we will install lead counterfiashing around chimney yes I rim we will install termination cap around chimney yes / no color we will install termination cap on walls yam/ no color we will tie membrane up under shingles yes / no shingle brand and color we will install PVC boots around all pipes we will install new skylights yes / no (see skylight contract) Alt *notated Of rotted wood will De replaced at SS 49tsq ft arvi der+errsiooai lumber at$t 5eit Ail wood needed for code requirements will be replaced at$4 99isq r: 20 year AQRS labor, material and workmanship warranty. special requirements Project includes 6 sheets 1/2 CDX plywood Any rotten rafters will be sistered at $5.99 ft. Ask us about affordable bank financing! ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust coming in through cracks of the wood.Please remove any lawn ornaments or yard furniture.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: jfryvvt,,A We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 5685 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 1 876 ) satisfactory and are hereby accepted.You are authorized to do work as specified. 2"i Payment at Start Job:($ ) Payment will be 1/3 down at signing,1/3 at st zt-ee#--job,an ante due Balance Due Upon Completion:($ 3809 ) upon comgl1724 �( 'o' Date: �F� Signature: Date: 4/1/24 Estimator:(Print Name) es Melaas (Sign Name) Estimates are honored for sixty(60)days from above dote. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d= 600 Washington Street � Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� nn ,�, ( Please Print Legibly Name(Business/Organization/Individual): A� ({eAr� en•�w t t(t- 2.>'JUt 1'16 7 c. Address: (GO O 1 A Lys,a, City/State/Zip: 5014 14c tc-a rt 01057 Phone#: 1113 —53(.`5g55_ Are you an employer?Check the appropriate box: Type of project(required): I.4<1 am a employer with 15 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, El Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance.t required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL I2.Yi 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 tit must also fill out the section below showing their workers'compensation policy information. I 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: n u t ueA n5 v�G�L Policy#or Self-ins. Lic.#: A W C.9001 O I -3"(..1 Expiration Date: 04/29/2024 / I Job Site Address: 23 Pomeroy Ter 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$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 nertif under;t'he pains and nenalties of oeriu v.fi<dDyux ,:.r ttlon provided above is true and correct. �ar/J CZuennet/i��e 09'03'2029 04/03/2024 Signature: C� _ Date: Phone#: '1 1 3 ` ✓3c — 59 55" 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#: ACORODATE(MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 8/22/2023 /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. (A/C,No.Eat): (413)536-0809 F(A/C,No): (413)534-7874 1649 Northampton Street E-MAIL leckhardt@claytoninsurance.net ADDRESS: P. O. Box 989 INSURER(S) AFFORDING COVERAGE NAIC# 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 INSURERD: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 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ X BI & PD DED $2,500 BN965983 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 POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 20047429 6/23/2023 6/23/2024 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) UNINS/UNDERINS MOTORISTS $ 100,000/300,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ GSL101401 6/23/2023 6/23/2024 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? y N I A 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 I 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 ACCORDANCE WITH THE POLICY PROVISIONS. 160 Old Lyman Rd South Hadley, MA 01075 AUTHORIZED REPRESENTATIVE Michael Regan/FMT i cosrr.I P ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(z014o1) . .,,..,, ....... _ . . „., . - - itCommonwealth of Massachusetts Division of Occupational Licensor° Board of Building Rerlations and Standards ‘,.. 41*ni rlAit.,viv is(,r CS-070626 lEx„pires: 08/21/2025 ADAM A OttEr-NNE tit ' 7:, SOUTH HA04111/1,A‘ya., ' ; Pt, S, Commissioner THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington,,I... Str-eet - Suit.e. 7 1.O!, . ,. ,,, ., Boston, Massachusetts 02118 Home Improvement Contractor Registration mer 041=1=:0, , r"~"'".'r t-f4.4„,„Ai, •.'I Type: Corporation Registration: 191093 ADAM QUENNEVILLE ROOFING AND SIDING, INC:"?--"7:` — .,_ Expiration: 03/22/2026 160 OLD LYMAN RD. ,,-- --...,;.,.. SO. HADLEY, MA 01075 ''' .... ,AA,A. '*,14t 17; Update Address and Return Card. .T.,,,,t-.k,,, ,,,..-1,- ,,..: ,.-,.,.:.-.7-.''..,','"'"C:—.:"•,*7.77->,'i-7---:,,,-"::::-",',-....,.,,,:tt r'n,',"v.iti:'?",.41,„,,,d,.,::., „:7-7.7.,-., ,s.',,, •t,-,-....,.:,,N1-4...;*%,,,,;t.-,4,...,..,,,.fri 6-,..N;,..----. ,,, .7.:-N.:/-.7,-.3,..,:j.,..,;.::::. * * lisp * it * ii 4,ir 4 Iv 4 * w * 4 * * ii * * * It' 4k,_..4r • e • * .9,,? „ 4 ....,.! ,. ,,....-..,,,, • STATE OF CONNECTICU1 + DEPARTMENT OF CONSUMER PROTECTION ...,,, ,4`,:i• 444 Be it known that ADAM QUENNEVILLE ,4 160 OLD LYMAN ROAD r'-' '--• i SOUTH HADLEY, MA 01075-2632 . 4 ' ,t, • O....A I ..,,," ''' 4 •:;:':';‘`' I 1 has satisfied the qualifications requirtd by law and is hereby registered as a :...--4...,... ' HOME IMPROVEMENT CONTRACTOR '17' .• •i*,74.\":! 1 1 '''.;%'- ADAM QtJENNEVILLE ROOFING z.,..•, i lev.-A, 1 Registration #: HIIC.0575920 1 ,- ,,,,d ...-....7{1' Effective: 04/01/2024 .f:...f...r.' t4, .'•,.•,:" , Expiration: 03/31/2025 B„,,,T.C.dierelli,Conunissitmcr 1 10 i ;:;•:c. ;••,—.--- —