35-191 �I D)ZZGlri�\\�� VISA ClitoralIf 11 111174 DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING 'V SIDING ■ WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075 Fully Insured
1.800.NEW ROOF • 413.536.5955 y
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 4Trade Association P.P.C.38710
Proposal Submitted To: Date Phone#'s C:19 3 J<°- 15 ra'
I (A L rx_ 6-1)01 H:''-/i 1 5 r t-t • Oc,"ro w:
Street Email:
City,State,Zip Code Special Requirements:
.� c>�• ��'t'V `�!'� ° F.'li iC t- �t".r. 1 r�, C °l'.< `% n'•,rr c r1'
❑ Recover 15Z Strip a] Layers
Complete Roof System . ,T I rithc v ,
We shall acquire all appropriate permits for all work i 4 h��z I^,o;;_ �. C1c,.�
JA Home exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose of. Do not Do.
2] Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
[ Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights
[1 Install(151b.felt/Synthetic)` nderlayment over remaining decking area
21 Install Metal drip edge at eaves and rakes:(-0/5" h9brown/copper) a
(
Install manufacturer's starter shingle on all eaves and rake edges BBB
0 Install new pipe boot flashing(standard/copper)/vents
Install(,Snow Count r Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) 1
1--)fy� Shingles ❑ 25 year 30 year El 50 year Color c ra
Ridge cap shingles
Warranty Options:
❑ We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
I GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ 'I ) ' ! )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are f' 0 0 C!
satisfactory and are hereby accepted.You are authorized to do work as specified. C ,c°` <4"1/'' Down Payment° ($ )
Payment will be 1/3 down at start of job,and balanced upon co pletion. Balance Due Upon Completion($ / I (.71 11 '°1 )
cDate: 1 Signature:I =
Date: Gj lu i -)- Estimator,(Print Name) 7.3c--°IT (Sign Name) u�
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 Department of Industrial Accidents
=''ice
--1 .-. Office of Investigations
=��1= 1 Congress Street, Suite 100
= = .
Boston,MA 02114-2017
.a,p_ www mass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Auulicant Information Roofing Inc.
Please Print Legibly
Name (Business/Organization/Individual): Adam Queunev�Ie Roofing&Siding,
Address: f(,p0 Old tea>7
City/State/Zip: r .,. 1100 r� htiA 1 IOW* Phone#: 11)3^5 3h-c9S-S
Are you an employer?Check the app priate box: Type of project(required):
1.111 I am a employer with I S 4. 0 I am a general contractor and I 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers'
g y p t3' $ 9. 0 Building addition
[No workers' comp. insurance comp.insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.I It Roof repairs
insurance required.] t c. 152,§1(4),and we have no 13.0 Other
employees. [No workers'
comp.insurance required.]
*.Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. y,� i - _ _
Insurance Company Name: A Z 1�\ ''Atr &l ..�St1CQn C¢-
Policy#or Self-ins. Lic. #:1tlA3e 400'701 a.INA X13 A Expiration Date: 4
Job Site Address: l aA4 ad City/State/Zip:()014 a.rn.j , r-01060
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 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 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 of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: tl I It 113
Phone#: Lit ` 53L:
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):
1.Board of Health 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 Construction Supervisor: r • Not Applicable ❑
Name of License Holder: Adam Quenneville Roofing&Skiing,Inc, rl 0 Gj, (A
160 Old Lyon Road License Number
South Hadley,MA 01075 1.1-L (3
Address Expiration Date
�-
413 --s36--SlSc
Signature Telephone
9.`Registered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing&Siding,Inc. J?09 k a_
Company Name 160 Old Lyman Road . Registration Number
South H9dley,MA 01075 3/ac fit/
Address t[ Expiration Date
Telephone I�3-53E,
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 Exelr tpo
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) a ,
New House 0 Addition I I Replacement Windows QIter tiort(s) pi Roofing X
Or Doors 0 • .t '
Accessory Bldg. n Demolition 1 1 New Signs [D] ' Decks [C] Siding[D] Other[D]
Brief D cription of Proposed ,
Work: Mohr< I D S (ls tr-00 1.0 i An Gtr AV{'ICt.2eE S{V115 L?S
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 Ta-OWNER AUTHORIZATION-TO BE-COMPLETED WHEN
OWNERS.AGENT:OR CONTRACTOR.APPLIES FOR BUILDING PERMIT
1 Uj'ne.k k ,as Owner of the subject
property
hereby authorize AaCt p..\ (.. k,k.ei-maiii I l jO
O ' -S d2 r , C
to act on my behalf, in all matters relative to work authorized by this building permit application.
'Pl14/13
Signature of
Owner Date
a �
x` •fir•, , ,e..,. ,; . ,X:'i ,,,, !., ,,yN; ,i...$
I rl� cQp OvI 0A ILQ --C-C6. , y—. 44). 11C- • as Owner/Authorized
Agent- ereby declare that the statements and information the foregoinapplication are true and accurate, to the best of my knowledge
and belief.
Sign d under the pains a d penalties of perjury.IL,
dap,Print Name
a L...., /4 13
> Signature of Owner/Agent Date ,
•
Section 4. ZONING Alt Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by ie
Building Department
.
Lot Size :..._ �,w—_�- _._._ _._.._. —':
Frontage --- — - _ --
Setbacks Front
Side L:----- R:_--_— L:___ L, R. .__..__-
Rear ------: . ___ '_
Building Height
Bldg.Square Footage - °!o ____
Open Space Footage _____ °!o _ ._ ----
(Lot area minus bldg&paved v_.__.___ ---- -
parking)
of Parking Spaces -
Fill: - .
(volume&Location) — ----. ----
"- A. Has a Sp ial Permit/Variance/Finding ever been issued for/on the site?
p_____ NO DONT KNOW 0 YES 0
IF YES, date issued:,
IF YES: Was th recorded at the Registry of Deeds?
_....0' 1. DONT KNOW a YES 0 I
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ei DON'T KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued: -v w.
C. Do any signs exist on the property? YES J NO ei
IF YES, describe size, type and location: #_
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
RECEIVED Departmeftt use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit t.
AUG I 6 2013 212 Main Street
•
Availability
1 Room 100 Water/Well Availability
DEFT OF EuLL, ACT u""Ns Northampton, MA 01060 Two Sets of Structural Plans
NORTH WFTON,MA O 1 0 _�... - .
—TM-he 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
Map Lot Unit
,'t Lone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
etIt.hx.4-h Lepc,k Tzd nw n r n Ditto
Name(Print) �c Current Maiii Addr
Telephone
Signature
2.2 Authorized tent:
A.�iw _ '7 1c l(e0 ctn i ds _SA. qPtaleid PER-0)6i<
Name(Print) Current Mailing M.dress:
13-534-S lr
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
T. Building (a);Building Permit Fee
/;?1 6,97,00
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)
1014 6C11,-0 0 Check Number . iIca? ''
This Section For Official-Use:Only
Date
Building Permit Number: Issued: .=
Signature:
Building Commissioner/Inspector of Buildings Date
1214 BURTS PIT RD BP-2014-0196
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35- 191 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-2014-0196
Project# JS-2014-000330
Est.Cost: $12697.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 12196.80 Owner: LYNCH ELIZABETH
Zoning: Applicant: ADAM QUENNEVILLE
AT: 1214 BURTS PIT RD
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:8/19/2013 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 8/19/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner