35-248 (2) /I D)/1 y111111111MI*aid) DISC•VER
Q U E N N E V I L L E www.1800newroof.net
ROOFING V' SIDING Iv 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 Western Mass. CT Registration#575920
Member of the Buildings&Trade Association P.P.C.38710
Proposal Submitted To: Date Phone#'s C:
�Lo C Chen I�� i3 H: 1-1,3-5sq- 5-O30 W:
Street Email:
l� Lai SliPtocr
City,State,Zip Code Special Requirements:
TIa(('nt mA ),
❑ Recover Strip EU Layers
Complete Roof System
We shall acquire all appropriate permits for all work
XHome exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose,of. Do not Do.
Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection. rti
Install Ice&Water Barrier at all eaves,valleys,chimneys;pipes and skylights
• Install(151b.felt/SyntheticOnderlayment over remaining decking area
• Install Metal drip edge at eaves and rake 0 5") (white brown/copper) a
Install manufacturer's starter shingle on all eaves an rake edges BBB
• Install new pipe boot flashin (standar copper)/vents
Instalf...Snow Countrv)or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: , ( 6 nails per shingle) L��cM
_ Shingles ❑ 25 year X 30 year ❑ 50 year Color:A) /,,1r_
(''{ Ridge cap shingles
Warranty Options:
❑ We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum ot:Total Due($ 13, )a3 t1C )
r Y. F
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are f Down Payment($ s 5 n ;') )
satisfactory and are hereby accepted.You are authorized to do work as specified. �(y , '2
Payment will be 1/3 down at start of job,and balance due upon completion. Balance Due Upon Completion($ '`1 } )
Date: 7/4,,//) _Signature: rr
Date: —lib�1�� Estimator:(Print Name) `-.rePP(b L (Sign Name v^ i.
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 Massachusetts
,t i . Department of Industrial Accidents
tOffice of In vestigatiorzs
t 600 Washington Street
Boston, Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumhers
Applicant Information �� __ Please Print Leeibly
Name 1 BUN/nesvOrganization/Indieidual) • Adam Quenneville Roofing&Siding, Inc
Address: I I�^Q (�' !CI r?- `4 IY(li l f�Ca ci
C r
City/State/Zip: )()G( fi 1 t-:-2 Ci 1-c'c j t K� it Phone#: L/ -), :j )j L `) cl`' 5
Are you an employer?Check the appropriate box: Type of project(required):
X I. I am an employer with 15— _ 4. I am a general contractor and I ' 6. New construction
employees(full and/or part time).* have hired the sub-contractors Remodeling
2. I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees 'These sub-contractors have 8. i)ernolition
working for me in any capacity. employees and have workers' q Building addition
[No workers' comp. insurance comp. insurance.
required] S We are a corporation arid its i 11). Flectrtcal repairs or additions
3. I am a homeowner doing all work officers have exercised their
H.
myself (No workers' comp, right of exemption perm MGL
. Plumbing repairs or addition.,
insurance required) t- c. 152. § 1(4),and we have no i 12°,goof repairs
employees. [no workers'
IS. Other
comp. insurance required-1 i
•1nv applicant that rherka bo al must also fill out the section below showing their workers'compensation policy information.
'Ilomeowners who submit this affidavit 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-ew,trartors and state whether or not those entities have employe.. 1
the sub-contractors have employees,they niut provide their workers'romp.policy number. ___,_„y,--_._._-._-.._....__.....
/am an employer that is providing workers'compensation insurance for ml'empluve ea. Below is the policy and job site
information. /� !
insurance Company Name: .A f�l__ P1 _u n L/(.�.1-__1,,I15 Gl l' '4 i1 e e f
Policy tt or Self-ins. Lie. ti: rn `fit'i r�6 t: 10I.. Tspiration [)ate Y ',.A(I-,L;'Li
- city/state/zip
r e(( � l r { t or6�
Job Site Address:�� LCIe.� t� ��_,Lc�r1s�__ __ _. I�`'1`�-�
Attach a copy of the worker ' compensation policy declaration page(showing the policy number and expiration (bate).
Failure to secure coverage as required under Section 25a of M(i1. 1 51' can lead to the imposition of criminal penalties ut ., his
up to $1.500.00 and/or one year imprisonment as well as civil penalties in the tc,nn ofa STOP WORK ORDER and a tine of
$250.00 a day against violator. Be advised that a cops of this statement ntac he t;'irwarded to the Office of Investigation. 01 the
DIA for covers a verification _____ __
/do herby certify under e pains and penalties of perjury that the information provided above is true and correct.
_____LL
Stnuturc:
aria•• '11 1 1 I
!'rim Name: A0/1 11.2 i1 iLe V I Phan, fit: '-i i `: L'• _ `. _
Official use only Do not write in this area to he completed by city or town official `___
city or !'owns Permit/license tt:
Issuing Authority(circle one):
I.Board of Death 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector-
6.Other
(Ontact person: Phone tt: _ __-.. . ..
SECTION 8--CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 10 jp ) to
Adam Quenneville Roofing&Siding,lne, License Number
160 0Id Lyman Road tat J 13
Address South Hadley MA O1h5 Expiration Date
3 .53 �/aS�
Signature Telephone
Registered Home Imnrovemerit Contractor: Not Applicable ❑
. , 1 . . . 1,Aa96tc•
Com•an a'' " ' i' �� Registration Number
160 Old Lyman Road 3 asf i I
Address South Hadley,MA 01075 Expiration bate
Telephone l i. '33 OJT
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 ❑
1 1. — 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,von 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
£ ' 4i
.t
SECTION 5-'DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Re laceme t Wi ci Alteration(s) Roofing n _ � I p � �: Alteration I � Raofin
Or Doors
Accessory Bldg. IT Demolition I I New Signs [D] Flecks ID Siding[DI Other[D]
.Il!, et, ',, ../ . ,.
Work:: cripfion of Proposed 4 ,Ir.fM) 1 p h 5h-460
Work: DV-e- I D�SIUn (oS� D 11arc !Ji '`l
V �J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a..lf New house and-.,or addition to existing housing, complete the_folloyvir a;r. W.~, : ;`
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Ni miler 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
FOR ,
OWNERS.AGEIdT:OR CONTRACTOR APPLIEE S FOR B UILDING PERMIT
1, f i 1 A l b e U r3 ,as Owner of the subject
property
hereby authorize l'19 ro Neitheville Roofing&Siding,Inc.
to act on my behalf, in all mattert relative to work aUthorized tidy this building permit application.
SAL e,tik-kia,04 -71 [711?)
Signature of Owner Date
_ z , , ,X001. ` $ , i,
Adam Quenevilieloofing&Siding,In , as Owner/Authorized
Agent hereby declare that the stateThents and'information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the
(154
ains and penalties of perjury.
A-dim\ de.pital),IL-c
Print Name
)(\........._
Signature of Owner/Agent Date
Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by ioning
This column to be filled in by
Building Department
Lot Size ---- '------ __!..
„ .....
Frontage --- _
Setbacks Front ---:
Side L:— R:-- L:____, R:
Rear ---.
Building Height
Bldg.Square Footage --
Open Space Footage ______ ____ % ________ ____
(Lot 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 IT YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW (3 YES 0
. ;
IF YES: enter Book - Page, and/or Document it'
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 0 NO
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 (5D
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
r Department use only
F3ECEPir' i� City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit.
;�i. A 2013 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT OF BUILDING INSPECTIO Northampton, MA 01060 Two Sets of Structural Plans
HAMPTON nAo1os0" on 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
!5 Lct'3\,\P Map Lot Unit
Zone Overiay District I
Em St.DistrIct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
n o4 cL C LU n o� 15 LS Lana 116iPw, flu4 6)064
Name(Prh , (/l o�_ �J Currg+�t�M 5644- 030
.QQ. ��Ul\Tit Telephone
Signature
(�
Signature
2.2 Authorized Agent:
1.01 0 L A % 'v ■ -G , - ! My )too old ctn rc, So. L, �-Dios
Name(Print) Current Mailing dress:
)c..„. yi3-S3 -c cc
Signature Telephone
_
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Building (a)Building Permit Fee
I13aa3. ®v
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) 4 13, 3 DU Check Number o09 (�
This.Section For Official-Use_Only.
- Date
Building Permit Number Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
15 LADYSLIPPER LN BP-2014-0079
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -248 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-2014-0079
Project# JS-2014-000160
Est. Cost: $13223.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 59677.20 Owner: CHEUNG FLOYD&SHERI
Zoning: Applicant: ADAM QUENNEVILLE
AT: 15 LADYSLIPPER LN
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:7/23/2013 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 7/23/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner