43-141 (6) •
BP-2022-0020.
26 LONGFELLOW DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-141-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair •
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUNDF (MGL c:142A)
BUILDING PERMIT
Permit# BP-2022-0020 PERMISSIONISHEREBYGRANTED TO: -
Project# 2022 ROOF Contractor: License:
ADAM QUENNEVILLE ROOFING &
Est. Cost: 20299 SIDING 070626
Const.Class: Exp.Date:08/21/2023
Use Group: Owner: THURSTON MICHAEL T& EMILY WOJCIK
Lot Size (sq.ft.)
zoning: WSP Applicant: ADAM QUENNEVILLE ROOFING & SIDING
Applicant Address Phone: Insurance:
160 OLD LYMAN RD (413)536-5955 AWC4007012861
SOUTH HADLEY, MA 01075
ISSUED ON:01/13/2022
TO PERFORM THE FOLLOWING WORK
REPLACE ROOF, WITH NEW DRIP EDGE, RIDGE VENT, ICE&WATER BARRIER t SIGy/6I j As'
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:
Gas: - Final: • Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
7-1
•
Fees Paid: $80.00
•
•
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
•
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APPLICMI N TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
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'2'`146:41iiry7OWNERSHIP/AUTHORIZED AGENT',...;':.,:',•;::::,::.:,.,•.°..,,,.,:z..,-.,:::,-,.:,-.,,-,,.„. „.. ... .„,
2.1 Owner of Record:
Emily Wojcik 26 Longfellow Dr Florence Ma
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.
Name(Print) Current Mailing Address: 413-695-6624'
see contract
Telephone [ . , •.
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Signature .
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2.2 Authorized Agent:. • , • 1 .
•
Adam Quenneitille ' 160 Old LymanRd South Hadley Ma 0107.5 ,
Name(Print) Current Mailing Address:
413-536-5955
.
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'• ECTION'' -,,:ESTIMATECitONSTRUCTION,COSTS:
,....,,...,. .. .. ,
Item Estimated Cost(Dollars)to be . iL:i.:q!ii;'Hi2:,',!:."1:,,.,.:;. ;,,,,:,‘': .,:'::,,.„,,,,,Official,,,,,,,,,,,,,,,,,,,, ,,,,,,i:i'..q:_,,,.:,::.,i;-,,,,:,.i.:.,,.,i:.,,,,..,':::1,,,:.,,.,,,•
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1. Building
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5. Fire Protection •
6. Total=(1 +2+3+4+5) 20,299.00 2
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operations.aqrs @ gmail.com
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EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
I
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 ._...m.. . .,.�. .....�:.... ... . _.. _...__
Frontage __. .__ �.
`Setbacks' Front - ---
Side L:�.., W,,..„.i R:ET L:= R:7 .
Rear En w, ...., - .
Building Height
Bldg. Square Footage % , E�.,
Open Space Footage % M rr
(Lot area minus bldg&paved , I „,,..,.,..t •
parking)
#of Parking Spaces ~~•
LJ
Fill:
(volume&Location) - ___ f°---- . . -•-•-------
• A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ' DONT KNOW X YES
IF YES, date issued: '
IF YES: Was the permit recorded at the.Registry of Deeds?
NO , DON'T KNOW X �YEf7.,z... .F..,
Page and/or Document#�• �j IF YES: enter Book �� j
B. Does the site contain a brook, body of water or-wetlands? NO DONT KNOW X YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
_____-.,_____,..i
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? YE! NO X
IF YES, describe size, type and location: _ m
E. Will the construction activity disturb(clearing,gradin excavation, or filling)over,l acre or is it part of a common plan
that will disturb over 1 acre? YE; NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required. '
'SECTION 5 DESCRIPTION'OF PROPOSED WORK(check allaapplicable) '
New House ❑" Addition ❑ Replacement Windows Alteration(s) Roofing• El
Or Doors D
AccessoryBldg. ❑ Demolition ❑ New Signs (A] Decks [❑ Siding ED] Other[M]
Brief Description of Proposed New roof, remove&replace existing roofing, install new drip edge; ridge vent,pipe:boot, 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
ca if NeWMuse and.or:addit:on.toaexitinq houslncvcomOlete.the followlnq:
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
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain' Yes No •
I
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
_ v w
:`SECTION 7a OWNER AUTHORIZATION -•TO"..BECOMPLETEDi WHEN ....
'OWNERS'AGENT OR CONTRACTOR APPLIES`FOR'BUILDING PERMIT;'
Emily Wojcik
I, . , as Owner. of the subject
property -
Adam Quenneville
hereby authorize
to act on my behalf, in all matters relative to work authorized by this buildingp'ermit application.
see contract 01/05/22
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 v
01/05/2022 ;
Signature of Own Agent Date
SECTION-8 :CONSTRUCTION.:SERVI.CES -
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 8/21/2023
Addres Expiration Date
413-536-5955
Signature Telephone
19:,RegisteredHome Improvement Ceentractor _y µ Not Applicable ❑
Adam Quennevilie Roofing&Siding Inc 191093
Company Name Registration Number
160 Old Lyman Rd South Hadley Ma 01075 3/22/2022
Expiration Date
Telephone 413-536-5955
_,. ._
SECTION 10 WORKERS'COMPENSATION 1.N .SURANCE AFFIDAVIT(M . §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 Xi ' No ❑
1
City of Northampton
a a. 5�,v� J'.
� „ ti°. Massachusetts ��4"' . ��{�
!PI y� ,n4 i ,s y '
(
DEPARTMENT OF BUILDING INSPECTIONS ..k 4212 Main Street •Municipal Building
oz
.e Northampton, MA 01060 Ss
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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:
26 Longfellow Dr Florence Ma 01062 ,
(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)
)‘-7 i S-4--Irr
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. ,
i
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
I
Proposal Submitted To: Date: Phone#'s: : 413-695-6624
Emily Wojcik 12/27/21 H: W:
Street: 26 Longfellow Dr Email: emwoj cik@aol.com ` '
City,State,Zip Code: Special Requirements: '
Florence, MA 01062
PROPOSAL FOR:
2 Velux Venting Skylights;
___!_ GARAGE OTHER NO INTERIOR WORK DONE BY AQRS
RECOVER
Layers: 1 2 3 4 Plywood Included: Yes o No
❑ ear off SLATE or SHAKES -
COMPLETE ROOF PROTECTION SYSTEM:
We shall acquire appropriate permits for all work
.4.---Home exterior and landscaping to be protected
-a" Strip existing roofing to existing decking;with full inspection DO NOT DO: BACK LOW SLOPE ROOF
All ro ect waste shall be removed b p ster or contractor use onl WITH SOLAR ON IT
P 1 Y dum erdum f( p Y)
Install Ice&Water Ba '-rat all eaves 3'/6' valleys,chimneys,pipes and skylights
Install(151b.felt/Lynthetic) , derlayment ver remaining decking area
)-'Install Metal drip edge at eaves and rake/5")(whited' w )>
7,9'• Install manufacturer's starter shingle on all eaves and rake edges
,8Y Install new pipe boot - :/vent accessories
(0" Install ridge ven I•w Co.• • Cobra rolled/4'Baffled/Roll
Shingles:
GAF Shingles I Color: Pewter Gray
GAF Ridge cap shingles
i
Warranty Options: - •
If We guarantee our workmanship for 11° full years
❑ •GAF System Plus Warranty - i
• ❑ GAF Golden Pledge Warranty 1
Chimney Options:
O Lead Counter Flashing O Water Seal&Tuckpoint p Rubberized Crown O Cricket
O Mason needed(customer provided)
Additional material and labor charges may apply.
IX Deteriorated existing decking will be replaced at ss. .ft.an dimensional lumber at $15 per linear ft.,
• after full inspection. Customer Initials:
i
• 20,299
We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ )
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 7.0 0 0 )
satisfactory and are hereby accepted.you are authorized to ork a pecified. Bal..-- :.e Up• Completion:($ 13,2 9 9 )
Payment will be 1/3 down at start of job,and balance upon co letion.
12/27/21 r
Date: Signature: I
Date: 12/27/21 Estimator:(PrintName) Joe S opek I (Sign ' e) --"'"
413-121-4329
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 QuerA41,kR ofing will not be
responsible for debris or dust in the attic or storage areas. Customer Initials:
NOTICE OF SCHEDULE CHANGES
The contractor agrees that when delays become known to the Contractor,the Contractor will advise the Owner as soon as reasonable.
DELAYS IN THE COMPLETION SURE TO HIDDEN CONDITIONS
The Owner hereby acknowledges and agrees that in certain remodeling work,the demolition of portions of the pre-existing structure may reveal additional
defects,conditions or the need for additional work,which must be repaired,altered or carried out in order to commence or complete the work described
under the contract.In such case(s),the Owner agrees that the duration of the work and the scheduled date of completion may differ from the date on the
front,and that such variation which is not avoidable by the Contractor shall not be considered to be a violation of the contract.
ADDITIONAL WARRANTY INFORMATION
All warranties for equipment supplied by the Contract under the Agreement shall be those given by the manufacturers of such equipment,which shall be
and are hereby passed through directly to the Owner.Under such manufacturer's warranties,the Owner may be required to register or mail In a warranty
card or other evidence of ownership and use of such equipment in order to activate such warranties.
The warranty give the Owner specific legal rights,and Owner may also have other rights which vary from state to state.Under Massachusetts law,sale of
goods carry an implied warranty of merchantability and fitness for a certain purpose.All material is guaranteed to be as specified.All work shall be
completed in a workmanlike manner,according to standard practices.Any alteration or deviation from above specifications involving extra costs will be
executed only upon written orders and will become an extra charge over estimate.All agreements are contingent upon strikes,accidents or delays beyond
control.
SUBCONTRACTING
Contractor agrees that,notwithstanding any agreement for materials and/or labor between Contractor and third party,Contractor is responsible to Owner
for completion of all work described in a timely and workmanlike manner.
. •
NO ACCELERATION OF PAYMENTS BUT ESCROWINGALLOWED c .
The Contractor may not require payments to be made in advance of the times specified in the Payment Section(front)for the reasons the he deems himself
or the payments to be insecure.If,however,he deems himself to be insecure,he may require,as a prerequisite to continuing the work described herein,
that the balance of the payments under this contract that are in control of the Owner,shall be placed in a joint escrow that requires the signature of both
the Contractor and the Owner for withdrawal.
You agree to pay cash according to the terms shown above or,if we approve your credit,to sign a note provided by us for payment of the amount due.You
also agree to sign a completion certificate upon completion of the work.If you fail to pay according to the above terms and have not signed our note,the
entire unpaid amount becomes Immediately due,and you must pay a collection cost equal to our actual collection costs up to 15%of the total amount you
owe,plus attorney's fees and court costs.In addition,you understand that by failing to pay according to the above terms,the Contractor may have a claim
against you which may be enforced against your property in accordance with the applicable lien-laws.
INSURANCE
Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself,his employees or his subcontractors
in the performance of,or as a result of,the work under this Agreement.Contractor agrees to carry insurance to cover such damage or injury.
The Contractor recognizes his obligation to maintain a workers'compensation insurance policy to cover his employees.Contractor further recognizes the
obligation of any and all subcontractor to maintain a workers'compensation policy to cover their employees.
Contractor maintains a liability insurance policy with minimum coverage limits of one million dollars($1,000,000.00)
CONSTRUCTION RELATED PERMIT ACQUISITION
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits.The Contractor
shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory permit granting or inspectional agencies,
authorities or individuals.
MODIFICATION
e
This Agreement including the provisions relating to price and payment schedule cannot be changed except by a written statement signed by both the
Contractor and the Owner.However,cancellation by Owner is allowed in accordance with the Notice of Cancellation.
COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void,deleted or not
applicable,and until all exhibits and related or referenced documents that are incorporated herein are attached hereto.
COPY OF AGREEMENT TO BE GIVEN TO OWNER
The Laws of Massachusetts shall govern this Agreement.It must be executed in duplicate,and an original,signed copy hereof shall be given to the Owner at
time'of execution.No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner a copy thereof.
ARBITRATION
In the event the Owner and Contractor have a dispute regarding any of the terms,conditions,provisions or performance of this contract,the parties agree
. to place the matter into arbitration before an independent arbitrator assigned by the American Arbitration Association to resolve their dispute.Owners
acknowledgement of arbitration clause .
CANCELLATION
Owner may cancel this contract within three business days of executing this document.Such cancellation must be in writing and delivered to the
Contractor.Contractor reserves the right to cancel this contract at any time within thirty days of the date of this contract.If we cancel you will be promptly
notified in writing by an authorized officer of Adam Quenneville Roofing&Siding Inc.If we cancel,we will promptly return any down payment(s)you have
made.
1
:',:-,: i'if'40
ACORD.►l m CERTIFICATE OF LIABILITY INSURANCE OATS{MMA101YYYY)
' THIS CERTIFICATE'IS ISSUED AS A MATTER;OP INFORMATION'ONLYAND CQNFERS NO�RIGHTS SPON;THE CERTIFICATTE HOL DER THIS. ' .
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY"iAMEN:I EXTEND,OR ALTER THE;COVERAGE AFFO 2DEO BY THE.P,OLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
.,REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT::II the'certificate hoider.Is.en ADDITIONAL INSURED the palicy(Ies)►tits tfbo endorsed If-SU9ROG71TIOti IS WAIVED.stbjectta .
the terms and conditions of the policy,certain poilctes may raqulre an endarsement.AA statement omthla certificate does not confer rights to the
.certificate holder In lieu of such ondarsomentte)._
PRODUCER, • NGT 88ix'ah..8.ti1i910 ..... •
Clayton Insurance Agency, Inc. PHONI ji'Ax
i.td ho.Ext4 (413)536 - . ,• .. .. -•(A/C,NO:.�ua13�a-isTa
1649 Northampton Street ;ti' AIL remok)alaytoninsuranca net
ACORP-0S::
H. O. BOX 969 INSURER �AFFRDINQ COVERAGE NAIC
Ko eloa.. MA 01041 0989 INsuRERAauti1us..Insurance.Company
' INEUAE0 • • INSURER a;Arbella Insurance CO.
Adam Quenneville Roofing 6 Siding Inc. iNBURER.c:ASM Mutual Insurance Company
160 Old Lyman Road ,
INSURER 0: '
South Hadiay, MA' 01075 INSURER E r
> :... :. .r ..,, :INSURER.:
COVERAGES CERTIFICATE NUMBER:2021MASTEIC .REVISION-NUMBER:
TEA575:70 CERTIFY THALTHE POLICIES OF INSURANCE LISTED UELOW;HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE 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 ALLTHE TERMS,
INSLT Yi20 • PoL10Y-NUMBER . IM►Alnolyyrif INIVI f�('r "• <.
`, _
EXCLUSIONS'AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,-6>eP
INOR` Ai7OT.'SUBH POLICYYYYI UMITg
LTA`= TYPE OF INSURANCE
X. COMMERCIAL GENERAL UAB,UTY
6FF: POLICY
EACH OCCURRENCE 3 1,000,000
A. _. CLAIMS•MADE Q OCCUR 0A44ADET+pRENTE0, $ 100,000
7-
FtiE>Iig. .• ..flip 4}
NNL.2933L3 I 6/23/202/ 6/23/2022 MED EXP(Any tine parem) $ _, . S,000
; j PERSONAL d AOV INJURY S 1,000,000
• .GE(+PLA(3OREBATEUM ITAW'US'SPER; I GENERALAGOREGATE S 2,000,000 '
X •
POLICY��. Jew n LOC • PRODUCTS-G9MPJOPAGG ,S 2,000,000
OTEIEn,:
S
• AUTOMOBILE Um:wilY .. .K, -. .. f: • ;C Ci46114 h`4444144 f',.... 1,000.,.000
ANYAUTO BODILY'INJURY Kiwi* .$ ..,
H ' • ALL OWNED X,SfHE0I1LED 102010709E 4/23/2021 6/23/2022 BODILY INJURY(ParaEddeni) S
AUTOS AUTOO
• X HREDAUTOS X NON O ED ;_PPAOPERTYiOEEMOE 1
^� . IJNINENNDERINSMOTORIOTS 8 100,000/300,000
X UMBRELLALIAO OCCUR EACH OCCURRENCE S 5,000,000
A ' EXCESSLIAO CLAIMS•MADE:;. AOOREOATE '.S 5,000...000.
0E0. I J RETENTION E " 'AN1342102 6/23/2021 ' 6/23/2022 S.
' ' WORKERS.COMPENSATION � PE•fi lt1•)H-
AND EMPLOYERS'UABRJTY x!STATUTE j ER
ANYPROPRIETOR(PARTNER/EXECUTIVE •YIN - EL EACH ACCIDENT . )G' 2.i000r000`
OFFICERIMEMBEREXCLUDED? N/A '
C (Mandatory in NH) AFIC4007012061 -4/29/2021 4/29/2422 E.L-DISEASE.EA EMPLOYEE
S 1,000.000
OESCPc0 a`OuOPRTON3w_ .. .
E -POUCYMIT • 'S 1,000.000
s r
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddWonal Ramaiks Schedule,rosy br'yitathad.If mon owe IC iqub ed) '
S'or Informational Durposae Only
,
CERTIFICATE HOLDER . ... - CANCELLATION .1
• , SHOULD ANY OR THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Adam Qu6lnnevill® Roofing Siding. Inc THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
160 Old Hyman Rd ACCORDANCE WITH THE POLICY PROVISIONS. 1
South Hadley, MA 01075 ..
AUTHORIlEri REPRESENTATiV
E
•
i4141hap1: R4gan/`c'(4 /7l*k, P `^
( I ODU 2014 ACORD:CORFO,Rf TION. :Alt.rights;rosarvad.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORO
INS025(201401)
The commonweattn of lvcassacnuserw ,
z Department of Industrial Accidents
1. —- '11111 Office of Investigations
w7-vi E
Q .t nrie� 600 Washington Street
Boston,CIA 02111
l' ,s www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print. Legibly
t
Name(Business/Organization/Individual): A e+r'1 'Gl UCs'r'4 a`.:.1�t. ` J.t 1 i'. ;,,-'n C. .
U
Address: (GO 01 A:. -.7 , ' -�-
City/State/Zi 50v t ktobta Ain 0101c Phone#. '1 13 -53C
Are you an employer?Check,the appropriate box:
''"Type of project(required):
`1.45 I am a employer with 15.... 4. Q I am;a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity:: employees and have workers' 9 Building addition
[No workers'comp.insurance comp.insurance.t
required.] 5. 0. We are:a corporation and its 10.❑ Electrical repairs or additions
3.0 lima homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.[No workers' .comP right of exemption per MGL
12.6 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.LJ Other
comp,insurance required.]
*Any applicant that checks box#1 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.
xContractors 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. lithe sub-conttactors 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: n I
Insurance Company Name: .�'1 1 t)i vG.' �/15 U le.t'"
'took'o I.. l a Policy#or Self-ins.Lie # A C �� I Expiration DateY:.
26 Longfellow Dr P Florence Ma 01062.
Job Site Address: Ci ,/statelzt
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 forwarded to the Office of
Investigations of the DIA for:insurance coverage verification.
I do hereby certify,;" thernins and penalties of perjury that the information provided above is true and correct.
$t g�ature /cladJ Quenne�(�e _ Date: 01/05/2022
8rt
Phone/i.,'13 " 53C 59 5
Official use only. Do not write in this area,to be completed by city or town official 1
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 i
Contact Person: ... Phone#
Commonwealth of Massachusetts I
Division of Professional Licensors
--.)" •Board of Building Regulations and Standards
ConsttlitttAdAtiOrVilor
CS-070626 0 1" r ‘„,x.pires:08/21/2023
„ 'A- •*7 re —7' —t;,-,'" -
ADAM A QUONEV ' St
160 OLD LYMAN RD $,-
SOUTH HAoutiy,MA
' 0-io f' <1,,,i , ;F!,.,1,,Z, •;.-, ,
isvi A
Commissioner d, i•.. K 1:11.0itor.- ,
o
C.., ... 1
sc," te-oe64
.it
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvemetit,Cohtractor Registration
Type: Corporation
,.. , , !,-, Regstration: 191093
ADAM QUENNEVILLE ROOFING AND SIDING;INC. <'•=', ! , “=",,t C Expiration: 03/22/2022
160 OLD LYMAN RD.
SO.HADLEY,MA 01075 ,, - •,,,,-;, •,,-,-,,,, . ,
Update Address and Return Card.
SGA 1 0 2010.05/17
„. • . , , . ,
..eie •',Ite,*..,4,P'I'll...I.'.,'W,I;3*•:"4". *. '34*.i'10. °VW>'....i ',`=4:40,,,0,,,,,ea.0 ,I.''..- ,;„,a4.2',:!'it4t.."4:4'4e -ir''' 40()K.'0:*4..C.'it'V'4'4,4
...:'42 ':: "1/4,".4.ith.I 44411:,: igil°Vik.,',A1'7*',A:4.A.-4444,7 -''..4 l''''''''''Sls'-';'°,'''.4''"..44"%1/1k..",''1;"I' -,:'',,f.rt 4;°? sf 5. , "•19''l''1 r k f'.?-, ,11/41°4;.?),:t,
Al,- STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION
,P-1-.'4°„ Be it known that
'ritro, •
• •
ADAM QUENNEVILLE
rANIri,,
XI
•
.,...'N.
160 OLD LYMAN ROAD ,
•
4ty,'SOUTH HADLEY MA 01075-2632
-' „....
•
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1-, • , ,.
• .,
= i.4
•
,4'
I`
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has satisfied the quail ricaticitis recrilited bylaend is hereby,registered as a
, 4, °".
•I
HOME IMPROVEMENT CONTRACTOR
. i
'4 1.
.,..
.11 1:11 Registration # HIC 0575920 I
,-,
, ..—,..
,
ADAM QUENNE VII J.1, ROOFING
r.;kt: I Effective: 12/01/2021 , ,
E,
xpiration 03/31/2023
Mchelle Seagull,Commissioner ,
‘
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1
26 Longfellow Dr
Subject: 26 Longfellow Dr
From: Kaylee Quenneville <kaylee.aqrs@gmail.com>
Date: 1/10/2022, 1:26 PM
To: bwillard@northamptonma.gov
Here is the speks of the skylights you already have the contract but i attached it as well. We are
just removing the two existing skylights and installing the new velux skylights in their place along with
a flashing kit.
—Attachments:
Wojcik_Skylight_OrderForm-1641214742190.pdf 22.9 KB
Wojcik_AQRS Roof Contract-1641214742166.pdf 973 KB
•
1 of 1 - ! 1/10/2022,1:37 PM
D
Ck% li l'ltlhgfEVl i 1.�s ticiewitaim sualt4s, iNC,
SKYLIGHT- Order Form
12/27/21
Date:
Customer Name: Emily Wojcik
Customer Address: 26 Longfellow Dr
Florence State: MA 010°62 Zip:
VELUX SKYLIGHT
- Blind Flashing
QTY Model Size Code Kit
(Factory installed) YESf NCI
2 VS _ MO4 YES
2 . ZCT 300 , Poles
Z
Seles Reba: , Joe Snopekc .
%
ly
IEIIIh IEN01li&ME,•• esaWard, VISA DISCOVER'i
s-c301,11,10..r iiiredlaG.••••�r�ar4raa3aut
Cl()WINNER ...._.
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: • 413-695-6624
Emily Wojcik _ 12/27/21 H: W: •
Street: 26 Longfellow Dr - Email: emwojcik@aol.com
City,State,Zip Code: Special Requirements:
Florence, MA 01062 •
PROPOSAL FOR: • 2, Velux Venting Skylights
t G RAGE OTHER NO INTERIOR WORK DONE BY AQRS
RECOVER •
Layers: 1 2 3 4 Plywood Included: Yes of)
I ear off SLATE or SHAKES ^
' COMPLETE ROOF PROTECTION SYSTEM:
- We shall acquire appropriate'permits for all work •
.I—Home exterior and landscaping to be protected .
—Strip existing roofing to existing decking with full inspection DO NOT DO: BACK LOW SLOPE ROOF
All project waste shall be removed bydumpsrer(dumpster for contractor use only) WITH SOLAR ON IT
Install Ice&Water Ba '-rat all eaves 3'/6U',valleys,chimneys,pipes and skylights
J/Install(151b.felt/ ynthetic) • derlayment ver remaining decking area
'Install Metal drip edge at eaves and rake /5")(white6ieco;)
Install manufacturer's starter shingle on all eaves and rake edges
,.H Install new pipe boot /vent accessories
r 'Install ridge ven Snow Coun Cobra rolled/4'Baffled/Roll
Shingles:
GAF Shingles Color: Pewter Gray
GAF Ridge cap shingles
•
• Warranty Options: '
L We guarantee our workmanship for 10 full years
I GAF System Plus Warranty •
C GAF Golden Pledge Warranty
Chimney Options:
• ❑ Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Cricket
i ❑ Mason needed(customer provided)
Additional material and labor charges may apply.
Deteriorated existing decking will be replaced at$5. .ft.an dimensional lumber at $15 per linear ft.,
after full inspection. Customer Initials:
• i
We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of: Total Due:($ 20,299 )
•
ACCEPTANCE OF-PROPOSAL:The above prices,specifications and conditions are Down Payment:($ 7,000 )
satisfactory and are hereby accepted.You are authorized to work pecified. Bal e Up Completion:($ 13,2 9 9 )
Payment will be 1/3 down at start of job,and balance upon co letion.
Date: 12/27/21 Signature: ,
Date: 12/27/21 Estimator:(Print Name) Joe S opek (Sign a e) i0 ��
413-221-4329
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 QueVIt R(aofing will not be
responsible for debris or dust in the attic or storage areas. Customer Initials:
NOTICE OF SCHEDULE CHANGES
The contractor agrees that when delays become known to the Contractor,the Contractor will advise the Owner as soon as reasonable. •
DELAYS IN THE COMPLETION SURE TO HIDDEN CONDITIONS
The Owner hereby acknowledges and agrees that in certain remodeling work,the demolition of portions of the pre-existing structure may reveal additional
defects,conditions or the need for additional work,which must be repaired,altered or carried out in order to commence or complete the work described
•
under the contract.In such case(s),the Owner agrees that the duration of the work and the scheduled date of completion may differ from the date on the
front,and that such variation which is not avoidable by the Contractor shall not be considered to be a violation of the contract.
ADDITIONAL WARRANTY INFORMATION -
All warranties for equipment supplied by the Contract under the Agreement shall be those given by the manufacturers of such equipment,which shall be
and are hereby passed through directly to the Owner.Under such manufacturer's warranties,the Owner may be required to register or mail in a warranty
card or other evidence of ownership and use of such equipment in order to activate such warranties.
The warranty give the Owner specific legal rights,and Owner may also have other rights which vary from state to state.Under Massachusetts law,sale of
• • goods carry an implied warranty of merchantability and fitness for a certain purpose.All material is guaranteed to be as specified.All work shall be
completed in a workmanlike manner,according to standard practices.Any alteration or deviation from above specifications involving extra costs will be
executed only upon written orders and will become an extra charge over estimate.All agreements are contingent upon strikes,accidents or delays beyond
control. •
SUBCONTRACTING
Contractor agrees that,notwithstanding any agreement for materials and/or labor between Contractor and third party,Contractor is responsible to Owner •
for completion of all work described in a timely and workmanlike manner.
NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED
•
The Contractor may not require payments to be made in advance of the times specified in the Payment Section(front)for the reasons the he deems himself
or the payments to be insecure.If,however,he deems himself to be insecure,he may require,as a prerequisite to continuing the work described herein,
that the balance"of the payments under this contract that are in control of the Owner,shall be placed in a joint escrow that requires the signature of both
the Contractor and the Owner for withdrawal.
You agree to pay cash according to the terms shown above or,if we approve your credit,to sign a note provided by us for payment of the amount due.You
also agree to sign a completion certificate upon completion of the work.If you fail to pay according to the above terms and have not signed our note,the
entire unpaid amount becomes immediately due,and you must pay a collection cost equal to our actual collection costs up to 15%of the total amount you
owe,plus attorney's fees and court costs.In addition,you understand that by failing to pay according to the above terms,the Contractor may have a claim
against you which may be enforced against your property in accordance with the applicable lien-laws.
INSURANCE
Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself,his employees or his subcontractors
in the performance of,or as a result of,the work under this Agreement.Contractor agrees to carry insurance to cover such damage or Injury.
• The Contractor recognizes his obligation to maintain a workers'compensation insurance policy to cover his employees.Contractor further recognizes the
obligation of any and all subcontractor to maintain a workers'compensation policy to cover their employees.
Contractor maintains a liability insurance policy with minimum coverage limits of one million dollars($1,000,000.00)
CONSTRUCTION RELATED PERMIT ACQUISITION
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits.The Contractor
shall'not be deemed responsible for delays in the work described in this Agreement caused by regulatory permit granting or inspectional agencies,
authorities or individuals. •
•
MODIFICATION
This Agreement including the provisions relating to price and payment schedule cannot be changed except by a written statement signed by both the
Contractor and the Owner.However,cancellation by Owner is allowed in accordance with the Notice of Cancellation. •
• COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void,deleted or not
applicable,and until all exhibits and related or referenced documents that are incorporated herein are attached hereto.
COPY OF AGREEMENT TO BE GIVEN TO OWNER •
The Laws of Massachusetts shall govern this Agreement.It must be executed in duplicate,and an original,signed copy hereof shall be given to the Owner at
time of execution.No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner a copy thereof.
ARBITRATION
In the event the Owner and Contractor have a dispute regarding any of the terms,conditions,provisions or performance of this contract,the parties agree
to place the matter into arbitration before an independent arbitrator assigned by the American Arbitration Association to resolve their dispute.Owners-
acknowledgement of arbitration clause .
CANCELLATION
Owner may cancel this contract within three business days of executing this document.Such cancellation must be in writing and delivered to the
Contractor.Contractor reserves the right to cancel this contract at any time within thirty days of the date of this contract.If we cancel you will be promptly
notified in writing by an authorized officer of Adam Quenneville Roofing&Siding Inc.If we cancel,we will promptly return any down payment(s)you have
made.