38B-229 L\ DD • c.d DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING Ir SIDING 'V WINDOWS We Are Licensed
160 Old Lyman Road • South Hadley, MA 01075 Fully Insured
1.800.NEW ROOF • 413.536.5955
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 Western Mass. CT Registration #575920
Member of the Building & Trade Association P.P.C. 38710
I Proposal Submitted To: Date Phone #'s C: 1..p7 pi- 1- I ' 9 7
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SO h,i4. Tog Sf (i5 b pi H: W:
Email:
St eet 1
(j_ t`rvttti1 r1
City, State, Zip Code /� Special Requirements: ��l
hiorKanke•FIN'11 MA O10(90 1(9,_ K 1rjaV ¢
On � 4t - 2
❑ Recover 0:41 Strip Itl Layers 504 ti /
Complete Roof System ` 2 t2-if b veh
We shall acquire all appropriate permits for all work Q
Home exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose . Do not Do. _,M.Ae x —��� c or '-
Deteriorated existing decking will be replaced at $9pe
: � sq.ft. after full inspection.
Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
N Install (151b. felt 4 4 nderlayment over remaining decking area
A Install Metal drip edge at eaves and rakes @/ 5 ") (brown /copper)
.=install manufacturer's starter shingle on all eaves and rake edges BBB
e, Install new pipe boot flashing (standard /copper) / vents _i
❑ Install Snow Country or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) fip Lf"
Cr4E • F,k ,'n Shingles ❑ 25 year ❑ 30 year 50 year Color 1-fl- k or
Ridge cap shingles
Warranty Options:
4 . We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 2 t00 )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ ‘.; 66 )
satisfactory and are hereby accepted. You are authorized to do work as spe 'ed.
Payment will be 1/3 down at start of job, and balance duet :., - etio Balance Due Upon Completion ($ 1 33 7 )
Date :3/ (3 Signature:
Date: 3/I It 3 Estimator: (Print Name) G Co i - fir) Ye- (Sign Name 4- ',` gale
Estimates are honored for sixty (60) days from aboe 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 Massachusetts
Ari I k tatwor.
+ Department of Industrial Accidents
It
Office of Investigations
600 Washington Street
Boston; Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information n & (� Please Print Legibly
Name (Business/Organization/Individual) : Adam 9uenneville Roofing & Siding, Inc.
Address: I (P 0 D t G' 1.1. i"YlC{ rl Oa d
City/State /Z � fI I-4 (-e / IAA � Phone #: L+ 13 k 3 l,- 6 S S
J 01
Are you an employer? Check the appropriate box: Type of project (required):
1.)( 1 am an employer with 15 4. I am a general contractor and 1 6. Li New construction
employees (full and /or part time).* have hired the sub - contractors
7. _I Remodeling
2. , I 1 am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub - contractors have 8. ' ! Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp. insurance.
required] 5.1_l We are a corporation and its 10. i 1 Electrical repairs or additions •
3.11 I am a homeowner doing all work officers have exercised their II. i' plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] t c. 152, § 1(4), and we have no 12. I Roof repairs
employees. [no workers' 13. i_+ Other
comp. insurance required.]
'Any applicant that checks box NI must also fill out the section below showing their workers' compensation policy information.
'rtlomeowners who submit this of idavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that check this box must attach 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.
1 um an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. . -,`
Insurance Company Name: 1 M tt l , � iij..1 . L I15 tt rail i1 Cr e ,, t /I
Policy # or Self -ins. Lic. #:± �, '101 Akl /1) 1 Expiration Date: ''— . -,Ao /3
Job Site Address: € 5 iCuYV t /1 City / State /Zip: /I CgiiarYi f 11/1
ND
1
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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for covera:e verification.
1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Si _nature: Date: .3 - 1) 3
Print Name: MAW) IJYI 0 1. J A fl vi ' Le Phone #: � 1 - 6 j 3 6- LS c / .7 5
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license #:
Issuing Authority (circle one):
(.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Canstruction ,S}t� ROG1•lDg & Siding, Inc.
Applicable 0
}��aa
Name of License Holder : (� �
160 Road `� •
160 Old Lyman Road License Number
South Hadley, MA 01075 Jai o
Address Expiration Date
Signature Telephone
9.: Registered Horne improvement Contractor. Not Applicable ❑
CompAbak
lennevilic Roofing & Siding, INC. Registra /o n u cfd
160 Old Lyman Road (3 ate �)ao 1''
Address South Hadley, MA 01075 Expiration
Telephone t �
1 - 55TC
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 ❑
111 . Owner Exem tjo
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 Si ct J .
9
SECTION 5- 'DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition Ell Replacement Windows Alterations) Roofing 0
Or Doors E
Accessory Bldg. n Demolition El New Signs [D] Decks [Q Siding ID] Other [D]
Brief Da§cription of Propos ,d I /
Work e MO 6 1 D S �U+s 1( (DS 1 e pla ry W14 I1a ) 61 - r } hae+ 3U36-8
Alteration of existing bedroom Yes No Adding new bedroom Yes No c �
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the follovvi'ng ' ' +
a. Use of building : One Family Two Family Other
b. Number of roorns in each family unit: slumber 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 AUTHORIZ ATION - TO BE-COMPLETED WHEN
OWNERS AGENT-OR CONTRACTOR :APPLIES:FOR BUILDING PERMIT
1 l_ :(Ut °X SaPki d � , as Owner of the subject
property (�
hereby authorize I m ‘,4)i1 fJ, ) 162_ nc C 1''l , .7.717C. •
to act cn my behalf, in all matters relative to work authorized by t . building pemtt application,
(.7a - /0A+ .3/al )i3
Signature of Owner Date
'
9 tli I �- tj in !i a - ( 1)42C_ , as Owner /Authorized
Agent hereby decla hat the statements and inforation on the f'isregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
4-Aftm 6ie.nna. -U+ IL-
Print Name
3)at 113
Signature of Owner / Agent Date
•
Section 4. ZONING Att 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 ,_ _....___.....µ.. _.
s
Frontage —..________._____ — . .. .
Setbacks Front
--:; R :^M.. —. L: R:______. _ ,__
Side L:
Rear _ _ _
Building Height
Bldg. Square Footage i 7 % - -__ _.^
Open Space Footage ____ % :------.
(Lct area minus bldg & paved __.__._..: �.___ -
parking)
i
# of Parking Spaces -- `
Fill:
(volume & Location) _____ ' —,
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book • Page- and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES t NO 0
IF YES, describe size, type and Location: ;'
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
ECEIVE® Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit In
5 2013 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
QF BUILDING INSPECTIONS N •rthampton MA 01060 Two Sets of Structural Plans
- -587 -1240 Fax 413 - 587 -1272 Piot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: qq
(!� 62trtli e o 0 0 - e-
Map Lot Unit
Zone Overlay District
1
_Earn St, District CB District
SECTION 2 - PROPERTY -OWNERSHIP /AUTHORIZED AGENT_
2.1 Owner of Record:
11 , ltoc rCetrui Aio 1 n
46 av9?rn , Au at 01(40
Name (Print) Current Mailing Address:__
SiZS C' �n-1a,r ,h 3 j7
Telephone
Signature
2.2 Authorized Agent:
6\-dnm 0 ti1►i l Ot,g.r154 -SAY c 160 old / eoct c _ d 1 , krt- 01 biS
Name (Print) Current Maill -vl Address:
Signature Telephone 1142)-6-310'.69S-5-
4 2 1^ 69 5
,SECTION 3 - ESTIMATED CONSTRUCTION COSTS -
Item Estimated Cost (Dollars) to be _- Official Use Only
completed by permit applicant
1. Building D 00 (a) Building Permit Fee _ -
2. Electrical (b) Estimated Total Cost of
Construction from -(6) -
3. Plumbing Building Perrnit Fee
4. Mechanica( (HVAC) -
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 4 a D CO, L16 Ch eck Number 7 1/4
- This Section For Official - Use Only_ - -
• _ Date
Building Permit Number. ` Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
65 FAIRVIEW AVE BP- 2013 -0865
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 229 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- 2013 -0865
Project # JS- 2013- 001443
Est. Cost: $2000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 20952.36 Owner: TODD BENJAMIN & SOPHEE
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 65 FAIRVIEW AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:3/26/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE PORCH 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 3/26/2013 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner