Loading...
17A-288 (11) 340 BRIDGE RD BP-2020-1272 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A -288 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2020-1272 Project# JS-2020-002124 Est.Cost: $20000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 18774.36 Owner: BOYER TLD Zoning: RI(100)/RR(100)/ Applicant: A AM QUENNEVILLE AT: 340 BR DGE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON 6/19/2020 0:00:00 TO PERFORM THE FOLLOWING ORK.STRIP & SHINGLE 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si nature: FeeType: Date Paid: Amount: Building 6/19/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �r Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit k 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans 5 `!phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPUCATiQN TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot -D-E Unit 340 Bridge Rd Florence Ma 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ted Boyer 340 Bridge Rd Florence Ma Name(Print) Current Mailing Address: 413-£335-5689 see contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville Roofing & Siding 'ARPM4N"AWMI RbArt1g7& Siding Name(Print Current Mailing Address: �1�damQuenneville Roofing & Siding Signatur16 V Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 20,000.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =0 +2+3+4 + 5) CO Check Number pt h This Section For Official Use Only a Q" 02 `O� „ Date Building Permit Numb r: J �� Issued: Signature: �' I &ZO Building Commissioner/Inspector of Buildings Date 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 O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained G , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O 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 Alterations) Roofing O Or Doors 1771 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[O] Other[0] Brief Description of Proposed Remove and replace shingles,drip edge,vent ridge,pipe boot flashing. 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 roorns 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 Ted Boyer 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 6/16/2020 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 kl� 6/16/2020 Signature of 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 8/21/2021 Address Expiration Date /,N--' 413-536-5955 Signature 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 3/22/2022 Addres Expiration Date Telephone_ 13-536-5955 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...... ❑ City of Northampton � Massachusetts ��• _ �; r DEPARTMENT OF BUILDING INSPECTIONS 7s 212 Main Street • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.—or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: � �.� Est. Cost: 40 rpp .a' Address of Work: 'r( x,e� Date of Permit Application: �1'1 1ap-U I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(expla�n): Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: I11 �� �• ,y;�lr�.Cuhr��� , ' rV, Ott' �C) Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature rrrir. City of Northampton ' Massachusetts qtr DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building y j, Northampton, MA 01060 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: 34c; � ` eek (Please print house Mmber and street name) Is to be disposed of at: (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) t,/"Ix 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. �� v 100-0401-AMOK, y K.i1111if�MVit ili4N 'V' IiL I��'.. ` WA� VASAL DISC VER "7 160 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 4575920 Member of the Building&Trade Association P.P.0 38710 Proposal Submitted To: Date: Phone#'s: C:413-835-5689 Fitzgeral Realty Corp 6/16/20 H: W; ted Street; Email; 340 Bridge Rd City,State,Zip Code: Special Requirements: Florence MA 01062 1" ISO board with EPDM rubber PROPOSAL FOR: membrane on all flats i#C'US GARAGE OTHER remove back chimney �STR RECOVER Layers: 1 2 3 4 Plywood Included: Yes o No ❑ Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: We shall acquire appropriate permits for all work Home exterior and landscaping to be protected Strip existing roofing to existing decking with full inspection DO NOT DO: G6' All project waste shall be removed by dumpster(dumpster for contractor use only) Xp Install Ice&Water B at all eaves 3'/ ivalleys,chimneys,pipes and skylights J� Install(151b.felt ynthetic underlayment over rem 'ning decking area '1 Install Metal drip edg aves and rakes 1J8�/5" white rown) V Install manufacturer's starter shingle on all eaves and rake edges V Install new pipe boot flashing/vent accessories Install ridge vent-Snow Country/Cobra rolled/4'Baffled/10 Shingles:(standard 6 nails per shingle) Tamko Heritage Shingles Color: slatestone gray Tamko Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years ❑ GAF System Plus Warranty ❑ GAF Golden Pledge Warranty Chimney Options: PT Lead Counter Flashing O Water Seal&Tuckpoint ❑ Rubberized Crown O Cricket O Mason needed(customer provided) Additional material and labor charges may apply. J5 Deteriorated existing decking will be replaced at$3.77 per sq.ft.and dimensional lumber at$7.00 per linear ft., after full inspection. Customer Initials:r('L We propose hereby to furnish materials and labor—complete In accordance with above specifications for the sum of; Total Due:($2 0,0 0 0 ) ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 6 5 0 0 ) satisfactory and are hereby accepted.You are authorized to do work as specified. 2nd Payment at Start Job:($ ) Payment will be 1/3 down at signing,1/3 at start of Job,and balance due Balance Due Upon Completion:IS 13500 ) upon completio 1, Date: SignatureOf: Date: 6/16/20 Estimator:(Print Name)Robe r t" oteau (Sign Name) �L 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: ACOCERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) �.� 4/2/2020 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 CONTACTNAME: Fe' Trudell Martin J Clayton Insurance Agency, Inc PHONEo (413)536-0804 a/c,No: 14131 sae-7874 1649 Northampton Street ADDRESS: f rndal T Pmjn1 yton P. O. Box 989 INSURERS AFFORDING COVERAGE NAIC fl Holyoke MA 01041-0989 INSURER A;Nautilus Insurance Company INSURED INSURERB:Green Mountain Insurance Company Adam Quenneville Roofing & Siding Inc INSURERC:AIM Mutual Insurance Company 160 Old Lyman Road INSURER D: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:2019 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 ADOL SUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCEJ=WyD POLICY NUMBER MM/DDNYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE DA A RE ED 100,000 PREMISES Ea occurrence $ X Y UN1000129 6/23/2019 6/23/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY IC PEOT- F1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EOMaBINdEeDtSINGLE LIMIT $ 1,000,000 BANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS X Y 20030465 6/23/2019 6/23/2020 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ 8 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DEC ..H RETENTION$ AN069764 6/23/2019 6/23/2020 $ WORKERS COMPENSATION PER GTH- AND EMPLOYERS'LIABILITY YIN X TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE AWC40070128612020A 4/29/2020 4/29/2021 E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory in NH) It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers Compensation benefits will be paid to Massachlsetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claim; for benefits to employees in states other thar Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. Thi.- certificate hi: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 Verificatior Search tool at www.macs_any./7 wd/wo kara—c�am�arca ;or/;rvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR PERMITS ONLY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Regan/FMI :� r�•r i'' y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn25 rnnlanrn The Conurzonwealth oflMassachilsetts Depai tnzerrt.of Industr ialAccidetrfs 1 Congress Street,Suite 100 Boston,ALL 02114-2017 �., rvww mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED y41TH THE PM11TTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/]ndividaal). Adam Quenneville Roofing & Siding Inc Address: 160 Old Lyman Rd City/State/Zip: South Hadley, MA 01075 phone 9: 413-536-5955 Are you an employer?Check the appropriate box: Type of project(required): 1.Nd[am a employer with__15 5 employees(full and/or part-time).* 7. ❑New construction 2.[]I am a sole proprietor or partnership and have no employees working forme in $. E]Remodeling any capacity.[No workers'comp.insurance required.] 9_ EJ Demolition 3.Q l am a homcownerdoing all work myself.[No workers'comp,insurance required.]t 10 Q Building addition 4.a[am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole I LE]❑Electri cal repairs or additions proprietors with'no employees. I2.Q Plumbing repairs or additions 5.❑I am a general contractorand I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These suL•-contractors have employees and have workers'comp.insurance.t 6.❑we are a corporation and its officers have exercised their right of exemption per MOL c. I`i. Other 152,S 1(4),and we have no employees.[No workers'camp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing Iheir workers'compensation policy information. t Homeowners who submit this affidavit indicating diary arc doing all work and then Etre outside contractors must submit a new affidavit indicating such. Contractors that checkthis 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 air employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site Information. Insurance Company Name: AIM Mutual AWC40070128612019A 4/29/2020 Policy;#or Self-ins.Lic.#: Expiration Date: Job SiteAddress.24o 7?�OQ4,c S�- City/State/Zip:�� 0 .II T 0101va' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. I52,§25A is a criminal violation punisliable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations or the DIA for insurance coverage verification. I cla hereby certify unde t/iepains andpenalties ofperjury that the inforraatianprovitled above is true arta correct. Signature: Date: LP ) 7 ,-b Phone#: 413-53(f-5955 Official use only. Do not write in this area,to be completeet by city or toren offnclal. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Constr+aenor�f$tip+erfiso r CS-070626 , Upires: 08/21/21221 ADAM A QUE ON, 160 OLD LY Vty1N:3D SOUTH HADL�:r .a CommissionerWtfJ Office of Consumer Affairs and Business Regulation 1'000 Washington Street- Suite 710 Boston, M` �usetts 02-118 Home improvemert7G*tractor Registration Type.- Corporation 4X4 Registration_ 191093 ADAM QUENNEVILLE.ROOFING AND SID W-, a;' Expiration_ 03/99J2022 1:60 OLD L`MAN RD. SO.HADLEY,MA01075 :y'� "�' -v z' y t ..P •Syg,,y'' w ,�i Update Address and Ratum Card. SCA 1 0 20141-05/s7 tiA oAtup>kVU 1 . . .. ` X {4-0-101 4. - ++ yw�• ry� L 4 � .f � `M. U. . ` M1 t t �.N�i Deas sai 6d theqt li ins 1at��se�lsm,4.a a I ± `O► KOOKNG T� `11Sietitllle:3aptulf,Emhmis�tocar