18C-105 > : D :M /
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QU le IM N EVI LLE V � MasterElite
ROOFING & SIDING, INC. GAFMC Residential Roofing Contractor
P.O. Box 612, South Hadley, MA 01075 We Are Licensed
1- 800 - NEW -ROOF • 1- 800 -4- SIDING Insured
Email: agrnewroof@wmconnect.com Website: www.1800newroof.net Factory Trained
MA Construction Supervisors Lic. #070626 MA Registration #120982 Factory Certified Installers
Member of the Home Builder's Association of Western Mass.
403at.
Proposal Submitted To: Date Phone # ss / _
KAmt 1 tC.15— cAuss 4U/�/6 H: 57sb 0S l �y V W: I G
Street ri ! Job Name 1 .\ s,
S1 (T ,1eatso RCA I �` a . . •
City, State, Zip Code • . = -.
k)o c,. v in p -bn MI\ 61 D c
Proposal to furnish 5 inst II a following
❑ Re -Roof XTear -Off ❑ Gutter ❑ Repair ,u, wA�� �
Complete Roof Preparation
dome exterior to be protected by tarps and plywood
,,*Shrubs, landscaping, trees to be protected from damage
X Entire existing roofing material to be removed to existing decking, including flashing, etc.
{1 Site to be cleaned everyday with roll magnet debris remov t • o con let'o /
A Deteriorated existing decking replaced at '-1& (T6" per sq. linear foot
X ' Metal drip edge installed at eaves ikr Metal drip edge installed at rake edges
A New metal step flashing will be installed where necessary
.1X New plumbing vent flashing will be installed and flashed Ask us about
2J Shingle valleys will be installed affordable
A New metal flashing will be installed around all chimneys financing
f We shall acquire all appropriate permits etc. for all roofing work options
Complete Roofing System
GAF Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north)
GAF Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas
ISKGAF Shingle -Mate® reinforced underlayment installed over entire decking (the best underlayment available)
❑ Other shingle underlayment will be used
/ GAF Ridge Vent will be i�� =_\ cA ,e p � I
Sh / \ J �J .�: Ti
P � /G r
0 � 1
r AF Timberline® Se s 30 year I 40 year :,� 4 ifetime Color x kLir
P: AF Hip and Ridge t atche i� a warranty will be installed
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❑ Other Shingle Name Color
Warranty Options: 61 40/� ; rA
❑ We guarantee our workmanship for 5 full years ''�, `1.
•GAF Smart Choice"' Systems Plus Ltd. Warranty (doubles your up ont ver e) i.35O , CO
❑ GAF Golden PledgeTM Ltd. Warranty: America's strongest warranty - G ' sacks our workmanship.
We Propose, ereby to fu ish materials and labor - complete 'n accordance with above specifications for the sum of: ` ' 1 1 . ?4 .
1, Alfac '/i e . - I - r dollars ($ '' ..9 O � cu
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereb accepted.
You are authorized to do work as spec' ied. P' ent will be 1/3 down at start of job, and balance due upon c. .. ,r.:.:
Date: Signature: _ iii . J L - ' Phone # ? ,,, i4 E_�r
Date:_ ` d/ 9 o 3 Salesperson' ig :ture: NR/ /�� ..�. i . i
Estimate e i ored . ixty .0) days from ab• a date i
f 11. h �! In co W �'c r� - � - 1 -n ('A A�nl t /API-, i l t 011.1, J no 'R
..0,: satimp, 01,itp of Norillampton ) 7 -- -= --7-,' ,----_,- . - -. .- -- i
ver3,%,,,,, .........._..*=_.„___. .._..._
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r �� � `! i � ` ASSACI�IiSttt6 ." = • —
DEPARTMENT OF BUILDITG INSPECTIONS �, = = f
212 Main Street • Municipal Building
INSPECTOR '� =" ,
Northampton, MA 01060 '
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction super ,-sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he /she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
,.., 1.
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.
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let
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(!:di jif Ni.Irtliaillpion ...*-=. .. —
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DEPARTMEN NG INSPECT-IONS T OF BUILDI
zcc> , Mi E —='-- -•
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WO B.I(ER' S COMPEN SA TIO N INS UIZAN CE AFFEDAVIT
.._
(lioonstdr..ortniticc)
with a principal place of business /residence at
(jphone) (--/ 4-041c
(stre:.-uci-tyt;tatc.iiiip)
do hereby certify, under the pains and penalties of perjury, :hat:
.__
(4 I am an employer providing the follov.iillQ Y. compensation covera for my
employees working on this job:
A wc:70 I aS WO t 1 ()2 1 - S
kr() \lb:A -1 2NSvzsa\nc c 4Z#LtAtti.: L i 1)- e lloH
- (Lasurancz G3E1p3J3y) (PoLicy Number) (Expiration Date)
( ) I am a sole proprietor, general coou cic or hotneowner (circle one) and have hired
the cont listed below - ;to have the follo worker's cohrpensalion pohoits:
(Name of Contractor) (insurancc Company/Policy Nurabcr) (Exn:rntion Date)
(Name of Contrncior) (1n_surancc C=anyiPohcy N urn bfe r) (Explration Date)
— ________ ..________ • ....._..___.
(Name of Contractor) (Ins Cota3panyiPolicy Numixtr) (Exr:ranon Date)
(Name of Contractor) (Insurance Cou=y,(Potic-y Numbs) (Extarauon Date)
(mtaci zcklition.1 sh..7ct if r......7.:,...:-- ....0 ir,:-.h..,.', :::: 7---•• ' - - . -
( ) 1 aln a sole propriet atiti have no (. v111 for me.
(‘ ) 1 am a hone owner performing all :1 -,.vo,:. myself
-;(=Y1T1 plc.. 1.- ,,,,,,, thy. wt.. ,...1c, b.C.:1 w cr.np I cry -,),..----:-..-- ta c'.) n-an ciar:rsx cr 1:-. LI-
n.cr IICV thrue, units i w b i d, L s, 1-,,,,,,,,,., ,..-..,;,,,,, 0 ,- Cc 11,4! F;;' Z.:"Varttr.2-rli 1.11c C:C) ...:C r),:< Cine.:nil y c.:‹::::::::::::'
czTplo unckr thc wocke:. mrp-_:-:.,ticK, Ac (GL,152,:n1(5.1), ar try a hotncowrker for a Lc= C.: pf-rml: :-.1,.:..1.......:r....-x ;L.:
legal statue of un ecaployer %Int:Ler Tian Vicsrkcer Cornpor.rtion Aci_
1 und.c.ratJuld that . copy of this rtatcy.an nany be fora.,arde.e! to r1:, Depart:Ile-tar of Inelautrial Arcie.',.. 011.1c., of :In.rar, for the ,
covtragt vL and th-tt ail-1m to .1 COVc.r.....g..: un.d.::: sc. 25A of MOt. 152 can lcud to the impolitical of cr-miJ per....thirs
co1cd o f , f,,,, o f up t si_500.0.9 .r..!..:r .v. ipri of up to Cr :: y P.:-1 civil peru/tica in '..t4 loan of a Stc, Work_ Ord.•--: a: a
fir or S100.00 a thy ig:Lii).-.1 tn..
For 6.-4:..t.a=r3..iti,e only
-,.
Permit Numl_nr
S I gllA ill re of I .icc ittcr.-, Tit'.-,-,
•=i7:1.--.?,:::.t.;_..
SECT10N 3 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:: Not Applicable ❑
Name of License Holder : 7 `1t.11f V t�V i Q C S /
()GM(
License Number
gla I /COs
Address /\ Expiration Date
Signature Telephone
�-- L)j3 � a4aC
eie. "'Ohi m :rm .erneri `.Contras o. ;._ - ; I*- . ,. Not Applicable ❑
AC c1 M Q■c.nre,vt li e « 1 ao e i
Company Name � Registration Number
Po (), 31a5/ot-(
Address '' (( pp c c.> I /� n Expiration Date
sax.- [Lel 1- ' A Telephone ` /& 1(r 7
SECTI0141.0 4WORKERS' 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 J No ❑
r"" a
»ML€� 1 0°2 t .._ l i l3 r " `l
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
' illit ti : ,, °" k s S j i - ' r u - a F te a " '
;SECTfO S:41DES R A,1T OR/RR VYOR (chec all ia ' e l . i
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing X
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: 3 i IQ Qc Qra ke, hofge..
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
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fad= e.. dff d or diliti.on° torexistin ho s°i fa arrm:ple. a ie tIowing_
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
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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. Mascheck 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
'SECt 0 NER AU1.4 ATJON TO BE'C OMPLETED WHEN
OWNERS,. ENT� FOR BUILDING PERMIT-
I, , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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I, 3�.ti Qrtr� C u.� 1- cf�}} , as Owner /Authorized Agent
hereby declare that the statements a1id 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.
SR\ir CRoA el
Print Name �J
• TZ: —..:,. -. �- / 1 - /� - U 3
Date
Signature of Owner /Agent
Section 4.
- ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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:
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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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
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 ?YES
No
IF - YES, desbribe size, type and location:
City of Northampton _`
Building Department
212 Main Street
Room 100
Northampton, MA 01060 TO'
��
phone 413-587-1240 Fax 413- 587 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR "DEMOLISH A ONE OR TWO FAMILY DWELLING
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SECTION 1 - SITE INFORMATION
1.1 Property Address: x i hiss l a ®b , omp etecf by office z
r te ' ('�f1 { `() ()a k 4M ' • ' .,,A"� � E^
K �
I Zone. ��0, O` rla ® lstrict :
EImSt District _,g m_.,CB Dis rict
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED
2.1 Owner of Record: t I n
1ta rr y , iJ 1 C1Gl SeAZ.-_ ,5 G foo n- RCX
Name (Print) Current Mailing Address: ,
5 S ( 0 7S'
Telephone
Signature
2.2 Authorized Agent:
()rn 0Q-ejr,,N..0vi Rc !�.� ��,� ( b oY: (0 I 'i; 1-111 o►G -
Name (Print) \ Current Mailing Address:
Signature Telephone
SECTIO•-3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use 'Only
completed b _permit applicant
1. Building gr5-6 (a) Building Permit Fee
2. Electrical (b) E- stimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Build Number: Date Issued:
'Signature:
Building Commissioner /Inspector of Buildings Date
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51 GLEASON RD BP- 2004 -0614
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C - 105 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2004 -0614
Project # JS- 2004 -0865
Est. Cost: $5850.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Adam Quenneville 120982
Lot Size(sq. ft): 7143.84 Owner: FOX LUDMILLA & ALEXANDER HAUSS
Zoning: URB Applicant: Adam Quenneville
AT: 51 GLEASON RD
Applicant Address: Phone: Insurance:
P O BOX 612 (800) 639 -7663 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:11/19/03 0:00:00
TO PERFORM THE FOLLOWING WORK: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 Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 11/19/03 0:00:00 2994 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Conunissioner - Anthony Patillo