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23A-240 Vim. Proposal Submitted To Date ALLID/JD —kV —L\ QLP E N NI EN/ILLO street l ROOFING & SIDING, INC. S? /9/4‘...7"/ T,t, ∎C(4 olrcwtrs 160 Old Lyman Road, South Hadley, MA 01075 City,State,Zip Code 1-800-NEW-ROOF • 413-536.5955 Phone#'s "4 O/O 6.2 ' Email:info@l800newroof.net Website:www.1800newroof.net f MA Construction Supervisors Lic.#070626 MA Registration#120982 H.`V 5. 'f-'?(41 W: 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 t DH EV CV TW DHP Double Hung 3-Lite End Vent 3-Lite Center Vent Twin Double Hung Picture w/2 Double Hung Flankers 1+ � 1 f Y III III III a hl Woodgrain Interiors Vinyl Color Product Code Grid Styles NAT =Natural Oak WH =White BS I =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 t/16" RFE =Regal Florentine Elongated WW =White Woodgrain W =Williamsburg 1t/16" RF4 =Regal Prairie(2 passes) l TB =Thin Brass BAY BOW 4 BOW 5 BOW 6 GARDEN ii Ili hIll hiiiii 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 at ae Wm- O Rough Opening f O Rough Opening W Location Style Metal Style Series G W Location Style Metal Style Series (Room/Floor) "Cod/e" Y/N "Code" "Code" O Width Height UI F (Room/Floor) "Code" Y/N "Code" °Code" Li V Width Height UI 1 D('r 7/ 13 D//'fy �J( µ/ z 1)1 // .I _____ 14 0(1 /! T) f a 1) 4.r Y �� _ �t6 �g y r �� — � e ..1__ - ; - -- 8-- OH !X— r )( -_ 12 Y (� 24 Color of Color of / Window/Door Wrap (A,`_"4 PV C Window/Door Wrap / �i---At/'1'10 / I/ 4_( i✓..tphws exc"'r✓"n5 4-J4,4 C.n A4,� ?-'1 de" C.c Vrtt a„. We Propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: Total Sale Price$ 9,,A,rt Down Payment$ t to t..c'pr/f Upon Completion$ • 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:q //3- Signature: (9J Phone# Date: i !./ Salesperson's Signature: -^ Z1!�� Estimates are honored 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. The Commonwealth of Massachusetts Department of Industrial Accidents �' Office of Investigations _ . 1 Congress Street, Suite 100 `°n C 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 Quennevile Roofing& Inc,Siding, Address: /to 0 01 r.Q bama.11. dad- - City/State/Zip: • , ' � !'__.' / : _/095 Phone#: 13-53(0- 595-5 ------ ----- - -------------------- - Are you an employer? Check the appropriate box: Type of project(required): I.al am a employer with 4. ❑ I am a general contractor and I 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. p Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' g Y P h 9. ❑Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[�Other �n�OttS 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. :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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: A m m �"ila i-17soranC.+2. Policy#or Self-ins. Lic. #: alAk-8009 O r a h'(o i a©I.3 A Expiration Date: ti `f Job Site Address:Sr/ Mann ,Qf1cL(`.A._ City/State/Zip: 1ltr u4Lc- , iK-14 0�(o .. 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: /0101-11,5 Phone#: 4/3"53 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: ��pp��� j� Not Applicable £ Name of License Holder: Ado �Rook& lac. -06D-10 160 Old Lyon Road License Number South Hadley,MA 01075 91al �)S Address Expiration Date Signature Telephone 9 :Registered Home Imp vement Contractor 4 ._ Not Applicable E a0 6Pi - Compa " ':''� ' •" Registration Number 166 Old Lyman Rood a)?s-J)�I Address South Hadley,MA 01075 'f Expiration Date Telephone 'S-3 S%c 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 the4uilding 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 ❑ Replacem tt ws•.4 .Alteration(s);,Q . Roofing ❑ Or Doors'' L. '' , 'c t' Accessory Bldg. ❑ Demolition ❑ New Signs [a] `Decks i[E] Siding[0] Other[01 Brief Des9ription of Proposed �t, Work: KOat°VLe- `y drCA— W i* (l to tOmkikts Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa;;if Newhouse and•or addition.to exisfinq:houslnq .coixiplete he followmq: 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 ,as Owner of the subject property hereby authorize 'idL VY\ GvCl1Il.W I(IL(PC>✓`t't ' S-0:42Rc to act on my behalf,in all matters relative to work authorized by this-building permit`application. §neirLP C - /Oft 113 Signature of Date I, itikka Y1 O+�2I[itaffI i� t`oo �- S' ?C- ,as Owner/Authorized Ag nt 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. 14jam 6ken l (Lv._ Print Name ,©p_1, Signature of Owner/Agent Date Section 4. ZONING All 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 I 1 ! 1 l J 1 Frontage _ _ ____ __. ,___..______ 1 Setbacks Front E---] 1 i 1 1 Side L: R:s_.._...J L:L. I R: ` t ' 1 Rear C= t i Building Height _____ 1_ i Bldg.Square Footage 1-- 1 l --.--i % r---1 , � - - Open Space Footage % �--`--� (Lot area minus bldg&paved_ �Y _._ l.�__.�__i parking) #of Parking Spaces [- ;i Fill: l.a !e _ (volume&Location) I i lW L._- , A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:_ �j IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book __� _ Page and/or Document# _ a B. Does the site contain a brook, body of water or wetlands? NO er DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO e IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property? YES a NO 0 IF YES, describe size, type and location: w E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I. . L.. Y te , 0 � 1$1134 etrh e fiy xM in - • , � > 4 � � .� � � s-I = tY of Northam ton Sta s oP rm !ILJi Building Department r Uwive- ay errrtt #1 k A , x L Ob! — 7 2013 212 Main Street �JP r�e'W.' £ 4ai r�,� � �., . �1� u . Fa Gg prS 15110p b llty �a ld *a Y �Vti tik f d Room 100 i � , °�hS it ,Wa d$ , fey# F�}'S q f 8 er e,[A.ei a I,�ty',4t t 2,,.., ,, , }", ����.r "1 S g1 Electric, Plumbing � Yr its µr' u,'; r� rrr A , x� r� , 1, �kJ g&Gas Inspection lorthampton, MA 01060 twoRkets� `wv,,blot 0 94 ° `i' �t a ilw' ; 4 -` M°,4; Northampton, MA() � 2 " ` ♦+�4yµ��u'�1 ..I' yew ��y� ��� a 1F '�.-k 4 ..C'�q 4 "'; S .*121�.7� &ift,j ieiv. y ,Ty t-'21�J'@ I�'.v�( �3-587-1240 Fax 413-587-1272 PIo Site-Piatis ii,iaMti_imok r�, �� ,�'a N� XX%EEE��. 7 h,dfr y,. P o APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ON 0- TWO FAMILY DWELLING .' ._ s~ SECTION 1-SITE,INFORMATION ' fiez i This seik a be corrtp te ii bt offic .7 , '1.1 Property Address: , , . .µ f, �S .��4t6%y 5. k100. 1' = r " � ' i ap i � k -.T ; Lot f % g rPaUctit � ° il X- atiZ- g4i; . ri tgtr , "T l rmA go rr% 12 E`` 1 ?,Zone b r , '' "Overlay Distric �t , ' , r , .r { <',Elm St District qi. CB'District u SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record: Name(Print) �0 59 / 'l n i-2rfa 1 L, f(?-P Ajj , 004 Oiobt3- ( ? Curren�tailing Address: 'e.e. !- _ _ L `►i 3 Ste/'3��' 1.�0Y�LI,e.T Telephone Signature 2.2 Authorized Agent: alh a ,vi 16._q ''3 -Sie) 3, ...D1C, j b 0 old (?4, -S6_ i M, ! 0/17S Name(Print} Current Maili Address: `f 13"—C3tp°5 ASS Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building w (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) _ 7`©pp 6'0 Check Number 2a 2 G/ This Section For OfficialUse Only Date Building Permit Number:, • • . Issued: Signature: 1. Building Commissioner/Inspector of Buildings. . . .. . Date 57 MANN TER BP-2014-0424 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-240 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2014-0424 Project# JS-2014-000734 Est. Cost: $9000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 8973.36 Owner: ROGERS LEROY A&DANIEL ROGERS Zoning:URB(100)/ Applicant: ADAM QUENNEVILLE AT: 57 MANN TER 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: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 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner