30C-051 (3) Q►U E N N E V 1 L L.E www.1800newroof.net
ROOFING 'W SIDING ♦ WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075
1.800.NEW ROOF 473.536.5955 Fully Insured
Factory Trained
Email:info@ 1800newroof.net Website www.1800newroof.net
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 one#'s C: 7`
H: '�Y.3 9/ W:
W:
Street Email:
City, State,Zip Code Special Requirements:
Recover Strip [ ] Layers
Complete Roof System
We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected f
Strip existing roofing to existing decking and dispose of. Do not Do.
l Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
[ ] Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
[ 1 Install(151b.felt CWRc underlayment over remaining decking area
Install Metal drip edge at eaves and rake '5") bite brown/copper)
Install manufacturer's starter shingle on all eaves and rake edges 13133B
( ] Install new pipe boot flashinQstZandar copper)/vents �—
II Snow Count or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soff it ventilation TORCH AWARD
Shingle , A ( 6 nails per shingle) /
Shingles ❑ 25 year ❑ 30 year X 50 year Color
A F Ridge cap shingles
Warranty Options:
Z,We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
(� Lead Counter Flashing [ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ ( .rJ, V,41 0 )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I Down Payment($ 'i} )
satisfactory and are hereby accepted.You are authorized to do work'as specified.
Payment will be 113 down at start of lob,and balance due upon completion. Balance Due Upon Completion($ 0 0 t _)
Date:. 3-12 � Signature:
Date: / Estimator:. Print Name �+-�..j! ' N � (Sign Name
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 Ouenneville Roofing will not be
responsible for debris or dust in the attic or storage areas.
T71c Cpmmwwwm&A of Mamer./tt tam
oJ1xdatsl1sw1 Acc-idertts
Office a1arvestilat(6an-1
_ 640 Wattskiaron Stmer
_, �1 itostoa, MA #2111
Workers' C.ompens]lmn Insurance Affirixvlt: Boikie(-S/C,on tr-acturs/Electncuna/PMuaabers
Aip"Al (AfOMU6013 Please Print l iblj
Name Adam QUtlIrIIryvIIIC H00(111y ' -Stcnny Inc
llddtcss
C.II�JG1UC/11�. Jug � r1111fey'JA 011)/.,
Are You as em*Wyetl C1eck tit appropriate b*x: Trpe o!project (rrgwired)
4. 1 on■Boomm al caoR ac fr and I I 6.
Ncw con auctxxI ~ l am a tmFlO yea With eploya(1W AO&CM pui-I-) have bwvd ibe sb-canttacxs
L_) 1 am a sole propraetor a pelt," bated on be attarcAed aifaeat i ' (_) RtanodeUttg
ahrp and have no eanployeea Tberr nab-conwactors ha— � � R L-J Deinoboota
wortmg for we w airy c ur wiployete and ha ve worte f%
aW�Y r 9 i � Budgh" D"bcri
)No workers' comp, autaaacc coanp. iwusranct-'
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tled ) ) Ll We are a corpa+ratam and rta f 10 -, F1exCc}aMn: a adttaoona
a home� &NAA All work ofSoas halve eserci>Ax! tha+r I I �I fluwrbaax�re{aenra cx rada1211011A
oryadf (No workaa' conq, ngltt of esaaafaaoa per MOL I 1 LPL Rnof rerpans
fnsurrance reytaueC.) ' c 152, §1(4), and we harm rx?
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ttach a copy of tht workers' -t—paasaatiea pawky 4,darsda.pW (ai*wiarg tlae Paley naawber aawt expiimtiee date).
salve to seems coverage as rtagtsirtd uodm S.etieta 23A of MUL e 132 can load b dw mopwriam of cxvnaaal petaakc. of a
roc up to$1,500.00 and/or aaat-year iaaapa iaoamaot, AM WIND Al civil paaai tbCS is am titan of a STOP W KK OICDER am a rme
up to$250.00 a day aga=t the vwlakw. Be advised that a copy of Chu statement may be forwarded sfa the Office of
vevagatKbu of the DLA for ="mace coverage veri5putwn.
da fh�ayp.ri«r AMd pr^*&J#a .f prrfiary t*Af J*,J,,.&rm+ttfin prVVJA0d"ik"',it"o and cwrr r-f.
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O(Jfrifr!agar rw{y. Dr"of write in tkia arm, or ►,r[+eayp O"d h C*Y or torn ecial
LINT or Iowa: PtrrwWl. kenae r
lumla{Aati*rity (circle Matt):
1. Board of Health 2. Baikka* Dcpartaoewt I City/rvwaa 0eri t. f_Jectrxal Inapectar 5. rtombing Inspr<i r
6. other
Coa.tact tors..: rhMaee M:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Adam Quenneville CS070626
Name of License Holder:
License Number
160 Old Lyman Rd South Hadley MA 01075 8/21/15
Address f Expiration Date
413-536-5955
Signature Telephone
9!Realstered Fiume Imbrovement Contractor: Not Applicable ❑
Adam Quenneville Roofing 120982
Company Name Registration Number
160 Old Lyman Rd South Hadley MA 01075 3125/16
Address Expiration Date
/11 Telephone413-536-5955
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.......41 No...... ❑
11. Home weer 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) 7
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ID
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[0] Other[0]
Brief Description of Proposed
Work: Strip existing roofing and install new asphalt shingles
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 k Ouse and &additlon to existinti 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Michele Atkinson as Owner of the subject
property
hereby authorize Adam Quenneville Roofing&Siding Inc
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Contract
Signature of Owner Date
0 (
l Adam Quenneville GZA� �. a,&,,v-,f, ,I�nf
as Owner/Authorized
Agent 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.
Adam Quenneville
Print Name
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
rr. e
Lot Size ... . . _ .
Frontage ......
Setbacks Front
Side L.°. R F L l __. R.r..._.. '
Rear
Building Height �
Bldg. Square Footage % T
Open Space Footage %
(Lot area minus bldg&paved ,
parking)
#of Parking Spaces ""
Fill:
3 I CC
volume&Location ..... . ............. a
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES Q
IF YES: enter Book Page. and/or Document#I
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
_ n
IF YES, describe size, type and location:I
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
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 U
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
prt0e anCR� iik
h E ;
City of Northampton
status aferi# H4 t m
M Building Department Curb CU#t�rl���ry P�m�tt °NM;�i`
Wit
Sw
.. 2015 212 Main Street uwr rlB ptl A �tlabilill � u' 7 NO
„PR 2
I .
Room 100 V1Vdter/StUi1 , ± ilbilt#y �� ro
Northampton, MA 01060 o
Two # i�ftru %r �P��r� .
lectric,Plumbing&Gas inspections �i
Northampton,MA o,4�o0ne 13-587-1240 Fax 413-587-1272 PJot/8ite'P� 9 ��
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
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Michele Xz�SCr 36 Platinum Circle Florence MA 01062
Name(Print) Current Mailing Address: 413-584-8190
See contract
Telephone
Signature
2. Authorized Agent:
t't1 �� i}�t ��ar��1'� l�� �1 C� '1 �'�� ��H c'ecj t 0 I07-5
Name(Print) Current Mailing Ad ess:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 18,020.00 (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=0 +2+3+4+5) 18,020 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
36 PLATINUM CIR BP-2015-0925
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma:Block: 30C-051 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-2015-0925
Project# JS-2015-001786
Est.Cost: $18020.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 40641.48 Owner: ATKINSON THOMAS H&MICHELE N
Zoning: SR(100)/WSP(85)/ Applicant: ADAM QUENNEVILLE
AT. 36 PLATINUM CIR
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:41212015 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:
FeeTvpe• Date Paid: Amount:
Building 4/2/2015 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner