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38B-198
pi D Z\4/\ ..... Vijoffil MaSIW I DISCOVER QUENNEVILLE ROOFING 'V SIDING V' WINDOWS 160 Old Lyman Road • South Hadley, MA 01075 BBB 1.800.NEW ROOF • 413.536.5955 —1.--- • Email: info@l800newroof.net Website: www.1800newrootnet Winner of the 2010 MA Construction Supervisors Lic. #070626 MA Registration #120982 TORCH AWARD Member of the Home Builder's Association Westem Mass CT Registration #575920 Member of the Building & Trade ASE ociation Proposal Submitted To: Date Phone Ws C: .. . ,.. ,-- H: . / / :.• " . '' ' - - ' ', ';. VV: - Street / Email: , .. City, State, Zip Code Job Name/Locahon: /tP i ' 0 / ," r! / 7 ;. ? 1. ;, , i i / ::' il / I =r -," ' /, I :• r r ,, Proposal to furnish and install the following / r i i — ., i t ,.,:, 1 r ' 1 ' f ,., V _ ^ ', +7 A f / / , , / . 1 — I ' A 1 1 , - - 1 d' - / ..t ., t. - . 4/ , r; : . i ...--.) ._:. f if 1 ' it i _ 1 - 1 1 i ,.---7 ' ti. t i 1 , ‘-- 4 L..- ' ; ' :7 / ' : , '-'--- , , •-e : ,' f , "` A' . L''' ''''' '''' ...,- ^ , f I ,:' • l '` i ,, , 1 ' I .. 1 I ' i ...;;; 4/ -,‘ '''' • ,, Y ';;"1- -b< , , , - : , ii."-- - --- 1 .„.• ,..-^ f I 4 , / 1/ / /-/ j ' 7°° ". • 1 1.. _ „,..,, ...,,,, a 1 !-'.1."t . -t.„ - ,. r , ' - ---; ' , . ---- i Ask us about affordable bank financing We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 7it !'). ,,.. , ) ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are Down Payment ($ i. I satisfactory and are hereby accimted. You are authorized to do work as specified. -, -- - Payment will be 113 down at start of job, and balance)lue completion. Balance Due Upon Completion ($ Date: ' I ' . ' Signature: ,;-• , , 4 , , , „ Date: " ' .; . , Estimator: (Print Name) / " / ' ' F / ' r . -- (Sign Name) Estimates are honored for sixty (60) days from above date 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. • - ♦Iassachu.ctts - Department of Public Safco . Board of Building Regulations and Standards V Construction Supervisor License License: CS 70626 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 �"�- -�- Expiration: 8/21/2013 t "nnaii..i.mer Tr#: 21002 --- to -620470noiteiteeda , , 4 ' 1 4 = Office of Consumer Affairs Regulation —r e onsumer rs and usiness g ='fi =4. 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement _Contractor Registration - - - - - - . Registration: 120982 Type: DBA r ; .i Expiration: 3/25/2012 Tr# 293069 ADAM QUENNEVILLE ROOFING = ' ADAM QUENNEVILLE _ __ _ _ 160 OLD LYMAN RD SO. HADLEY, MA 01075 - -- - ~ Update Address and return card. Mark reason for change. t (i Address • Renewal Employment Lost Card '''''r-71114 t r ^}''• • t a ,-A,' + 4 -r• v` :.'' r.3r�ej " ,5$ h &'''.v- ;`t. - s.A•v- H .. t •. ., t F o -Yx� i '+..t !r!ft,;! 44:',11-:t"...0.::,: t ,i li , ? 1� { r ': k ". ' � . ri - T .i la d : *1 e <> , ',. ). ', . " ; z -4 " +C J,, "' � ' .. r ' , rD,� ., t a .-. R N - r � � �i / } lt. ( {� , JET. , ,. �y ! �. ,, t f n ,.1 k 1 t rDI 7 s is y 9 iF 1 J 1. 11 L ' f r ( '• ° fie. i 1f� r 1 % / ,y3. i ' Jk. j ., ,. .1..„ ?, _ "* ij+ l• , �J!1 "� �1 / !lk IY M 7 �I!�7 !\ X5 "_ A M y STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION x '° Be it known that c ADAM QUENNEVILT .F.0= 1 60 OLD LYMAN ROAD a rd. i SOUTH HADLEY, MA 01075 -2632 Pte' , , , ;: i pri is certified by the Department of Consumer Protection as a registered - A 1 HOME IMPROVEMENT CONTRACTOR . Registration # HIC.0575920 I ) �•: rim ADAM QUENNEVILLE ROOFING 1 . K Effective: 12/01/2010 g:!:, , 11/30/2011 O.,* Expiration, � - c. ^ Jerry Farrell, Jr., Commissioner : J Vi r�1y � ' /4 - r, F { r jAr ' r i, ,f ft ' ` r iV — h yt� ✓ `h} r , r r ,, i i 'fi , t Ivv1 , 'z' 'C v Y: ;k { { „,..0 1 , ^ , : d r ;: Y . ° 1`.• T i .‘,..1 .- ,T y -,1,.. 2 t i �. �,.111 , ,ti i ..:u ” i�p <,.,, r fi r . y lii .. � �. ' � «;rt, YS < s, ..t a ,, t x r : + ' wr �''' i '.:%!.'.*: ��- .. ' �h' � Z '� .. �. � .� t <r" .°' n {' � -L :0„....' �.� �, 7 . t k t. a z .6{?.Y ,,ITJ t ,� 1 tl .i , rt 4.,. The Commonwealth of Ilfassachusetts ter - Department of Industrial Accidents it, .7 °" Office of Investigations ti �;� i ,„ ,., a ,,,.,,, y 600 Washington Street R 11 r ` ( R _!f �,' :f'�" Boston, MA 02111 9 ''- y ev� www_riwss_gov /dia Workers' Compensation Insurance Affidavit: Builders /Contradors[El dricians/Plujmbers Applicant Information - __ -- - - - -__ Please Print Legibly P ; Name (Busiacss/Organi 'ideal): A C) � VYt 0/Akyi t'VQ- V � l , lb e 1 t ! I I v ) �- 0 e m • Address : J L G' V I J t� j/Yl Ali ____ - - - --- City /State/Zip: � Q,�,71' t a ) ! t A Olb7S #: Lt f 3 " C'6 ``��1 S Are you an employer? Cheek the a rote box y PP P Type of project (required). 1. Pi I am a employer with 1 j D 4- ❑ I a a general contractor and I 6_ Q New construction employers (full and/or part-time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑ Reeling ship and have no employees These sub -contractors have g_ [l Demolition for me in capacity_ employees and have workers' working any cap ty- 9. El Building addition [No workers' comp_ insurance comp_ rnc„ran� $ 0_ required.] 5. ❑ We arc a corporation and its ! ❑ Electrical repairs or additions officers have exercised their 11_ Plu nb' 3. Ill 1 am a homeowner doing all work � ripens or additions myself. [No workers' camp_ right of exemption per MGL 12,R oof repairs insurance required.] t c. 152, §1(4), and we have no 13_❑ Other employees. [No workers' comp_ insurance reg uired.J `Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information_ - - ` t Homeowners who submit this aeidavit indicating they *redoing all work and then hits outside contractors must submit a new affidavit indicating such. IContractors that deck this box most attached an additional shod showing the panic of the sub-contractors and stair whether or not those entities have employed. If the seh-eontradnrs have Employees, they must provide their worker' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: R T/ W M m u -r- ()l. [ i n Sara it C.f . W Policy # or Self -ins. Lic. #: IF C / 1 0 f f- L /01 Expiration Pale: 44 - 9q-A611 Job Site Address: 090f )1 - 3" 1 I ' _ _ 0(11401p to b Cityistatt'Z p:_ _ 0 /(J ) 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 prairies 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 oldie DIA for insurance coverage verification_ 4 I do hereby certify under the pains and pennfties of perjury that the information provided above is h t ue and correct. Signature: ` ` Date: / 6 Phone #: q t 6 - q 6" � Official use only_ Do not write in this area, to be cnmpfeied by city or town official City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2_ Building Depat anent 3. City/ Town Clerk 4_ Electrical Inspector 5_ Plumbing Inspector 6. Other Contact Person: Phone 14 ;,;A, SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction - Su /T ervisor: /,!`�) I Not Applicable ❑ Name of License Holder : a- G'n V� . 1 i V I lie 70 49 /IL License Number I ( C� v 1 1- ivta.p1 l SQ.tad &/ 6- (9, -d-c1'') Address J Expiration Date 4'6 yr3-- clp-- ss- m it- coq 5 Signature /„7" Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Qaeaaev'Iie Roofing & Sidiag, lac j, 0 9 e Company Name 160 Old Lyman ROSd Registration Number S oU� Hadky, MA 81015 Expiration Date s , Address rr�� Telephoneg - § 3L' g 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 ❑ 11. - Home Owner Exemption 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 ' ":" -Igt"tst;11.1f iTif', !ttiRt ftlf41ItC, #{1 /7;:;'n,t' SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ig Or Doors C] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [0] Brief D cription of Propoqseed Work: , 144.0a.l >(Q - l -e4 61 6 Bt rovf'Q rttt i. ( t o ( i t , t?f� j f f pto a_ r e ici; 0 5h�1 f (, U ,SG�tivtitc_S . Alteration of existing bedroom Yes f K No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: _ Number of Bathrooms _ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT O O ' R CONTRACTOR APPLIES FOR BUILDING PERMIT I, T r� c A a ��-LLD `i lc/ , as Owner of the subject property 1 A hereby authorize Amt Rte; & g, to act on my behalf, in all matters relative to work authorized by this building permit application. 2 C 0-4 f j 'Gc J S-ed — lr Signature of Owner Date Ads *nevi 11` _ g IE. , as Owner /AJhn 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. Add. do / . CQrce n tLe U� �( Print Name Signature o ner /Agent Date Department use only 1VED City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 2 2011 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans .oFBUI�NG ,ot r.7o - , , - 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify APPLICATION 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 "� q Map Lot Unit C"?(V °° Zone Overlay District Elm S`, District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Scide-wski r U Sot 1 5r-. oL 1 Name (Print) ( Current Mailing Address: © /06 O Telephone q( 5 L [ r j 6 r q Signature �T I lc� cT 2.2 Authorized Agent: Adam Qmnnea Roofing & Siding, Inc, J G l� C �' 6O. 4141.11 �( /vLQ 6'l ° 7 Name (Print) Current Mailing Address: J ,,V7:7 (:,t ----/_, yR 5 o/016 Signatur Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ti 3, 6 9.6', 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 = (1 + 2 + 3 + 4 + 5) ft ' 6 0 6 Check Number �/ V / ,3,-5— & / This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 208 SOUTH ST , BP- 2012 -0132 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 198 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit # BP- 2012 -0132 Project # JS- 2012- 000195 Est. Cost: $3525.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 11717.64 Owner: SADOWSKI JEFFREY A & LAURIE J Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 208 SOUTH ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON: 8/4/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE LEFT SIDE SLATE W /SHINGLES 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: Date Paid: Amount: Building 8/4/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner