29-264 AZZ D� VISA DISCOVER
, Q U E N N E V I L L E www.1800newroof.net
ROOFING ■ SIDING ■ WINDOWS We Are Licensed
160 Old Lyman Road • South Hadley, MA 01075
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 Association of Westem Mass. CT Registration #575920
Member of the Building & Trade Association P.P.C. 38710
Proposal Submitted To: Date Phone #'s C: (ft)) 6 -/ 713
2 6,4, „sal H:6 03) 3Y / 3016' W:
Street Email:
City, State, Zip Code Special Requirements:
F4 A1ncr /OA tLe LArt/t(p1 C pn rc'S JJ��
"CO 4 C /c.(, /
❑ Recover ® Strip RI Layers
TA 54. t ^ Pv
Complete Roof System s ` r ` ^ "`" I ' ` `� ° °�
We shall acquire all appropriate permits for all work
j Home exterior and landscaping to be protected
Strip existing roofing to extsttng- desking-and dispose of. Do not Do. -e
EA Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
• Install (151b. felt Syntheticyunderlayment over remaining decking area
® Install Metal drip edge at eaves and rakes 6/ 5" (white brown /copper) 6
I5 Install manufacturer's starter shingle on all eaves and rake edges BBB
® Install new pipe boot flashing (standar) copper) / vents _r
ER Insta Snow COUOw Cour Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) /�
GA-p Shingles ❑ 25 year ® 30 year ❑ 50 year Color -) t -
G'¢ Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years (see our warranty coverage)
0- GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options: ,✓U
❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ /0 4""
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ 35C )
satisfactory and are hereby accepted. You are authorized to do work as specified.
Payment will be 1/3 down at start of job, and balance due upon completion. Balance Due Upon Completion ($ 7 / 3 1
Date: SMA Signature[i/ �� 1 / /
Date: ,C Estimator: (Print Name) Ae„ 1 (2. - Eeti t (Sign Name) / 1-• �l
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.
The Commonwealth of Massachuset ts
Department of Industrial Accidents
it !=-47,- r " Office of Investigations
s : ".,3* 600 Washington Street
.2 ", -7
" Boston, MA 02111
rs. www.massgov/dia
Workers' Compensation Insurance Affidavit Builders/ Contractor - s/Elecfricians/PIambers
Applicant Information PIease Print Legibly
Name (B : A CI It 144. Duerr nxll ; ILL 04 (!) t S I / i ni 1 374 L
Address: /LeOe OlJ G -� � ari 4d .
city istate/p: i "a.d CA A- 0 /07SPlione #: -1 3 - C34 - 5 S �
Are you an employer? Check the approp fe bo= Type of project
I. PA I am a employer with 15'7 4. ❑ I am a general eua?raetor and I �e p J ect (r egnrre�d):
employees (lull and/or part time). a have hired the sub -coot ac ors
6_ ❑ New construction.
2. ❑ I am a sole proprietor or partner
listed on the attached shed. '- ❑ Remodeling
ship and have no employees Thew sub have g- ❑ Demolition
working for me in any capacity_ employees and have workers'
[No worku ura
s' comp_ insurance comp_ -X 9. ❑ BSS addition.
ed-) S_ 0 We; are a corporation and its 1 -0 Electrical repairs or additions
requir
3. ❑ I am a homeowner doing all worst officers have their 11_0 Plumbing repairs or additions
myself [No workers' of Per MCsL R,,,, repairs
insurance required.] t c. 152, §1(4), and we have no
e 13 ° OtbCr _
employ- (No ~orders' .
camp_ c required]
'Any appliaaat that checks box # 1 mat also fill oat the section below showing their wori¢rs' aourpcs atioe polky information_
I Homeowners who submit this affidavit they are doing all wort and than hire outside contractors recant submit a new affidavit indicating such
tf ontractoa that ch.ac this bore most attached an additional sheet showing the name of the wb•contractoia and slit Whether or not those entities have
employe*. lithe sub-contractors have employees. tbgr mast provide their workers' soap. policy mixaber.
I am an employer that isprvviling workers' compensation insurance for my employee~ Bdow is the policy and job site
infor7nsrtion_
Insurance Company Name: R T M m u to a( 1 n SGt ra n e
Pole # or Self -ins. Lie. #: P WC riot 2f i It) I won Pate: - a 9 - 6 1,3
Job Site Address: _r _# / 'to Pr. o " I __ , f1 D" d 6 ty1Stavi Z p: _
Attach a copy of the workers' .. peusation policy declaration page (showing the policy number and expiration date).
Failure to sxare coverage as required under Section 25A of MGL G 152 can Lead to the impositatm of criminal penalties of a
fine up to $ 1,500.00 and one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of statement may be forwarded to the Of35e 2 of
Investigations of the DIA for insurance coverage verification_
I do hereby citify undsr the pains and penalties of perjury that the informal °. provided above its hue and correct
Sienature: Date: .5 y 0
Phone #: _ I! l 5- 6 -6q
afQ na u.sc only_ Do not Write in his mxq to be completed by city er sown o i4 d
City or Town: Permit/License #
Issaiag Authority (circle one)_
L Board of Health 2. Building Department 3. City/Town Clerk 4. Etectrieal Inspector 5_ Plumbing Inspector
6. Other
Contact Person: Phone #_
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: I _ Not Applicable ❑
Name of License Holder : / t (1 b'l 0...12 G 1 vt.� t, 1 G( 7U 6 a-6
License Number
Lao 6 1cl al Y, pa • oii i )rd LLL , 'TM ()! 1s e- a (- ao 13
Address Expiration Date
G Z-t _ l s36 — S -C-
Sign Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam QoennevilleRoofmg& Siding, Int Ia a
Company Name 160 Old Lyman Road Registration Number
Address South Hadley MA 01075 3 a 5- ae I +
Expiration Date
Telephone V/ 3 S1.5 3
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 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Q Roofing `}4
Or Doors D "C
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0]
Brief Description of Proposed
Work: 51 4/Ad XP /GOp � I C .c
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 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, .5a - • • ,; , as Owner of the subject
property
hereby authorize Adam Quenneville Roofing & Siding, Inc,
to act on my behalf, in-ell matters relative to work authorized by this building permit application.
ignature o Date
t R i l k
Owne
I, Adam Quenneville Roofing & Siding, nt 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.
/4 0111 1 Vr
Print Name
Signatu r /Agent Date
Department use only
C ity of Northampton Status of Permit:
1 u 2012 Building Department Curb Cut/Driveway Permit
MAY 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
OF BUILDING
DE No N01�NS rthampton, MA 01060 Two Sets of Structural Plans
p one 413 -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
1 7 (0 L v , eik) pr , Map Lot Unit
kI(}f efICC "411 6 /O(' Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
ii(krhe I ' CCU n talkCLe ' 7(9 L o n q vl'P 7DeAfe. i/o renc t �'JR 6 /v 6 A
Name (Print) Current Mailing Address:
¢, /,Kb, LP l /1L 1 hW 11/ 3 3 3 0 8 (>z
Telephone
gnature
2.2 Authorized / Agent:
r( ii (�''
Jc4I� vn £ t ri t�t,Q ✓ i [ l,e, ((n v ijct �t-( YYu. ✓1 'c �e • 50.. d 4La i 7 frta
Name (Print) Current Mailing Add s:
ttf?, S36
Signatx( Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building / /02 96 9 G ca ( 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) 47/6 v Check Number 023 93 Y 03,5"
This Section For Official Use Only
Budding Permit Number.
Date
g Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
76 LONGVIEW DR BP- 2012 -0977
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 264 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- 2012 -0977
Project # JS- 2012 - 001695
Est. Cost: $10969.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 19994.04 Owner: LAUDER IAN K & RACHEL K
Zoning: Applicant: ADAM QUENNEVILLE
AT: 76 LONGVIEW DR
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:5/10/2012 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: Date Paid: Amount:
Building 5/10/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner