42-141 i
VISA , D Proposal Submitted To Date
OAvlpS vA0 8uE Y12f3/p
QUENNEVILLE Street T1- PIT,N P
ROOFING & SIDING, INC.
MOWER City,State,Zip Code
160 Old Lyman Road, South Hadley, MA 01075 Fta 4 boa Z
i-800-NEW-ROOF • 413.536-5955 Phone#'s `
Email:info@l800newroof.net Website:www.1800newroof.net H. �� 5� YZ2, W:
MA Construction Supervisors Lic.#070626 MA Registration#120982
Member of the Home Builder's Association of Western Mass. CT Registration#575920 Dumpster Location
Member of the Building&Trade Association Member of the Better Business Bureau D�,i/11"ew-4
Y
DH EV CV TV/ DHP
Double Hung 3-Lite End Vent 3-Lite Center Vent Twin Double Hung Picture w/2 Double Hung Flanker-s
• . 14_ $ i
Woodgrain Interiors Vinyl Color Product Code Grid Styles
NAT =Natural Oak WH =White BS =Bayshore ST =Standard 5/8" RP =Regal Perimeter
GO =Golden Oak CA =Camel SB =Seabrook RC =Regal Colonial RFL =Regal Florentine
CC =Colonial Cherry ET =Earthtone NE =Northeast G =Gregorian 1 1/t6" RFE =Regal Florentine Elongated
WW =White Woodgrain W =Williamsburg 11!1 6" RF4 =Regal Prairie(2 passes)
TB =Thin Brass
BAY BOW 4 BOW 5 i3OW 6 GARDEN! 1111
I`' �- I Z d i, 5 13 11 ;,
' .11,i ' .L____..J
_
Woodgrain Interiors Wood Options Vinyl Color Product Code Grid Styles Glass Options
NAT =Natural Oak BIRCH WH =White A =Aurora ST =Standard 5/8" G =Gregorian Stay-Clean Glass
GO =Golden Oak OAK CA =Camel RC =Regal Grids W =Williamsburg Regal Glass
CO TR 1/3-1/3-1/3 TR 1/4-1/2-1/4 QUAD
Operating Casement Single-Frame Equal-Lite Single-Frame 1/4-1/2-1/4 Single-Frame 4-Lite
` Triple Casement Triple Casement Casement
Existing Window New Window Existing Window New Window
Measurements Measurements
yF at
2 - O Rough Opening 2 O Rough Opening
W Location Style Metal Style Series C W Location Style Metal Style Series G
= (Room/Floor) "Code" Y/N "Code" "Code" U Width I Heights UI H (Room/Floor) "Code" Y/N "Code" "Code" �V Width Height UI
D14 W ( 13 Pf V•
2 14
3 5
q 16
•
5 7
7 9 1 Y
20
g 21
'10 ( 22
1 23
11 12 r 24
Color of t I Color of VJ t I4( {t
W,
Window/Door Wrap 14 Window/Door Wrap L
We Propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:
Total Sale Price$ III 5(5 Down Payment$ i � Upon Completion$ 75/5
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do work as specified.Payment will be 1/3 down upon signing,and balance due upon completion.
Unpaid balances shall accrue with interest at 18%per annum. Purchaser(s)will pay for all costs,expenses and reason-
able attorney's fees incurred by Adam Quenneville Roofing and Siding,Inc..to recover any sums due under this)contract.
Date: 'l !,/5 Signature: ��� ""t x" Phone# Y/3-514 12
Date:_?/ //3 Salesperson'\s Signature:
Estimates are ored for sixty(60)days from above date
Please remove all breakables from interior wall surfaces during installation. AQR&S will not be responsible for damage.
/ J D.), igyg21 Master era DISCOVER
�
e
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 Western Mass. CT Registration#575920
Member of the Building&Trade Association P.P.C.38710
Proposal Submitted To: Date Phone#'s C: `1/3_51'-107Z
04 v i D BU$5 Tao( gu iz 9/28/43 H: /�-5 6 Y-?Zr1/ W:
Street Email
7 63 (Ai 9( 14 of+ ro rJ 2b
City,State,Zip Code Special Requirements:
f oR fNG'-� MA 6 I G 62 —G 1 Tee+a 2
2 pr&cg5 P-Yuk D N R-
❑ Recover kr Strip Layers
Complete Roof System
LK We shall acquire all appropriate permits for all work
X Home exterior and landscaping to be protected
.517,
Strip existing roofing to existing decking and dispose of. Do not Do.
I Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
IX Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights
Install(151b.fel /Synthetic nderlayment over remaining decking area
k Install Metal drip edge at eaves and rake/ 41157-/brown/copper) a
Install manufacturer's starter shingle on all eaves and rake edges
BBB
Install new pipe boot flashing tandar. copper)/vents
[R Install Snow Country Corr rolled vent ridge vent Winner of the
2010
n TORCH AWARD
Shingles: Otlt��lf -
r ( 6 nails per shingle) n �,�/
6 • • Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color ftW -46.^f /
a Ridge cap shingles
Warranty Options:
❑ We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
XI GAF Golden Pledge warranty
Chimney Options:
X Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ ds )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are G K't(-,B I C Down Payment($ Y )•
satisfactory and are hereby accepted.You are authorized to do work as specified. -
Payment will be 1/3 down at start of job,and ce due uncompletion. Balance Due Upon Completion($ 764'5 _ )
Date: ?)/Z'J� Signature: ( ! a "
Date: (/ � Estimator:(Print Name) �f�t�V C'� - (Sign Name) A w,
��
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
;,1 �— Department of Industrial Accidents
" _7.
Office of Investigations
l Congress Street, Suite 100
Boston, MA 02114-2017
'� www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Adam I uennevllke Roofin 1 &Siding,Inc.
Address: /Cp 0 Old J mcc..r'1 T,QCe a
City/State/Zi•: .,A', • ,4_4 ■ A, I ic7S Phone#: gI3-S-3(0- 59x5
Are you an employer? Check the appropriate box:
general contractor and I Type of project(required):
I (" l am a employer with _ J S 4. ❑ I am a g
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑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 Y # 9. ❑Building addition
[No workers' comp. insurance comp, insurance.
re
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
q , officers have exercised their 11. Plumbing repairs or additions
3.❑ I am a homeowner doing all work ❑ g P
[No workers
myself. ' com right of exemption per MGL
y [ comp. 12 [A Roof repairs
insurance required.] t c. 152, §1(4),and we have no nn--
employees. [No workers' 13.[Other trt D���'
comp. insurance required.]
*Any applicant that checks box#'1 must also till 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.
*Contractors 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: 111 \-ucI l _J-.)-)5 L�ra.nG2. _
Policy#or Self-ins. Lic. #: ►/41.t)G LIOD'i Ola h,l oa.013 A Expiration Date: t1)49-9 1 1`+
Job Site Address:-114,— Gti '> 1a \ZA • City/State/Zip: 61t�k C Q -
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 perjuiy that the information provided above is true and correct.
Signature: P\....-- Date: 3 ( 1 3
Phone#: 4/3--53(o-Sa5-S
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 yuennevllle Rooflg& Inc. Not Applicable a
Name of License Holder: A9 (��j 160 Old Lysol Road License Number
South Hadley,MA 11g75 g c
Address Date
413-S3 4:3•-c9cs
Signature Telephone
9:Reaistered Home-improverrient Contractor Not Applicable £
Adam Queuueville Roofing&Sidi,lac. 1
Company Name Ly®�®RA�u . Registration Number
I
Address ' ' f r ' Expiration Date
Telephone � )2? Tcc
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 kluiiding 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 fo 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 [j Addition Replacement VgIndoWs. ,Nteration(s) ® i: . Roofing Ell
Or Doors [� ,
;ti?r i�,to+
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks it Siding 101 Other[01
Brief D cription of Proposed
Work: NC.9Iat, Asp ha 0 At-SL t -4- IS U(),AQ 4405 /0140 w5
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sar If. New.house and'or-addition to existlnq-h'ousinc,.complete the.followlnc:
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
I, ^ U i cL- °F mew` 1 t z C- ,as Owner of the subject
property
hereby authorize A-Ckh•- (a-e-n/ t TOQ
to act on my behalf,in all matters relative to work authorized by this building permit application.
ate, etnSha•C.,f /613/i
Signature of Owner Date
I, Cf&A K.Q,tdl its& 66-6-vii ..tcLn l7-C' ,as Owner/Authorized
Age t hereby declare that the statements and inforfriation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the painand penalties of perjury.
Pri Name
I0'343
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 Zoning
This column to be filled in by
Building Department
Lot Size = _..._..____.1 I •
Frontage _. ;__ __ _ _ _ ___I L________ _
Setbacks Fronj [_ J } 1 I i
Side L:' 1 R:1 1 L:{ : R . a
Rear — t ^t
Building Height 1-1 L
Bldg.Square Footage --— l 1--------[ % F - r--•i
-
Open Space Footage
(Lot area minus bldg&paved ,. _EI T]
parking)
#of Parking Spaces = ,i
Fill: e . is . .w� _.. _. �.v.€
(volume&Location) . J I t
�� i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW e YES 0
IF YES, date issued:] I
IF YES: Was the permit recorded at the Reg'stry of Deeds?
NO Q DONT KNOW YES 0
IF YES: enter Book 1 Page � 1 and/or Document# —�"'-1
B. Does the site contain a brook, body of water or wetlands? NO d DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued: I ---1
C. Do any signs exist on the property? YES 0 NO e
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO cy
IF YES, describe size, type and location: jj
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 I acre? YES fl NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
•
� OS M *� epa finehil rise i 0 x �r W;
. — City of Northampton a a *PM �t 1 �i
§, 'u$txFterarttt �, r.•i ,,
f . Budding Department ,i rii e itito, 4. 0 ;� �' l '� � °
r I — ? 2013 212 Main Street t °u�r�[.� „�r Avai ��h; h
ir1�}' �,4.�` 'C51s fr iy �. �ib -To i.`Tr,k i Q 1
u�1+Jeter/tRkfeIG t milt illt} ,,it`� -_d ie ' '4 r ray ,o,ti
Room 100
IeC?rIC, PiUmbtn i ' rimig x x+,+,v„.,.,( k rd :,,, , r e1"p ry a
Northampton,9&Gas Inspections orthamp#on, MA 01060 Two e sf tC uY�i PlSa +�i x 4 �� N � i S r {r
MA 01 . s,' r � a a rl
••- .a 3-587-1240 Fax 413-587-1272 'Pl f�/Slt'e�Pia s 4:ei' ;°i.� W� x "� " � u F " }
i- $N55+ ..�'}`i S`t �,`,+f HY '�u,�,a"T,' m.rte'# - , -y,k*f` �, �P",' ,�y ��?c
Qtfler Speci tfO �PK" � i~*� -�t, i x k
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONF1O�TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
E fd t a r oice
L This sect ton#Q be complee i
+r 1.1 Property Address: ; 5 r 4 t
lL� UL uj rt" Uit, a0 l o Lo4�Y iMap . .. r - , L + r 1 w TC:gt-A. i kJ r .9.4 n i .. M s ,Zone . ti wv erla Dls fctr „,..
St Elm StFDistricta �4 ,yF..I,t:'.m, .;� ^r,,CBi,Distrl'ct . §, ..ya r,
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT .
2.1 Owner of Record:
d A ,s ,1-�cid e6 u�--e-Q— ''11403/04-1-112: . ed, p a2eAtfi,ow biorfo
Name(Print) Current Mailin ress,:
-) eat 4 Telephone `mss�u
Signature
2.2 Authorized Agent: n
A-a_cun �r nAp v��ZA/ i--&-cl hs ,. tic_. 160 old ted 1 .fie •1 L!, N4 0117s
Name{Print) Current Mailing ddress:
/----..- `fi 3— 510°SS.sC
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS .
Item . Estimated Cost(Dollars)to be Official Use.Only
completed by permit applicant -
1. Building Ii ` )ao as (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) 8 3! J O. D Check Number d 7€99Y Z�
. •• This Section For Official Use Only
•
Date
Building Permit Number: Issued:
•
Signature: .
Building Commissionerllnspector'of Buildings .Date
•
•
•
763 WESTHAMPTON RD BP-2014-0423
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:42- 141 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/REPLACE WINDOWS BUILDING PERMIT
Permit# BP-2014-0423
Project# JS-2014-000733
Est. Cost: $23120.00
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 17946.72 Owner: BLISS DAVID K&TODD H BUZZEE
Zoning: Applicant: ADAM QUENNEVILLE
AT: 763 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:10/8/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & INSTALL
REPLACEMENT WINDOWS
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 10/8/2013 0:00:00 $70.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner