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16A-020 BUILDING 1, 2, 3 & 4 FAIRWAY VILLAGE-BLDGS 1-4 BP-2016-1150 GIS#: COMMOWEALTH OF MASSACHUSETTS Map:Block: 16A-020 ITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1150 Project# JS-2016-001979 Est. Cost: $307950.00 Fee: $2156.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): Owner: BARKOWSKI j4DELE J Zoninc: URA(102)/WP(17)/WSP(15)/ Applicant: ADAM QENNEVILLE AT: FAIRWAY VILLAGE - BLDGS 1-4 Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:4/5/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ( BLDGS 1,2,3 & 4) 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 4/5/2016 0:00:00 $2156.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1150 APPLICANT/CONTACT PERSON ADAM QUENNEVILLE, ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY01075 (413)536-5955 Q PROPERTY LOCATION FAIRWAY VILLAGE-BLDGS 1-4 MAP 16A PARCEL 020 000 ZONE URAO02)/WP(17)/W$P(15)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: STRIP& SHINGLE ROOF(BLDGS 1,2,3 &4) New Construction Non Structural interior renovations Addition to Existin Accesso Structure Buildine Plans Included: Owner/Statement or License 070626 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON T141S APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: §' Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit May 1.5,2000 Department use only `.- ity of Northampton Status of Permit: JC' ullding Department Curb Cut/Driveway Permit - 3 212 Main Street Sewer/Septic Availability ^y _ Room 100 Water/Well Availability ortham ton MA 01060 Two Sets of Structural Plans DE NpFtll n ki ' p phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR 0 FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 504 Fairway Village Road 4 Buildings Units 101-115 Map Lot Unit Leeds, MA 01053 2 Buildings Units 205-213 3 Buildings Units 301-315 Zone Overlay District 1 Building Units 405-408 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Fairway Village Condominium Trust 504 Fairway Village Road Leeds, MA 01053 Name(Print) Current Mailing Address: 413-650-6018 Signature See Contract Telephone 2.2 Authorized Agent: Adam Quenneville Roofing & Siding Inc. 160 Old Lyman Rd South Hadley MA 01075 Name(Print) ,Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 307,950.00 (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) $ 307,950.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Versionl_7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ (Roofing❑ Change of Use❑ Other❑ Brief Description (Remove existing roof material and instAll new asphalt shingles on buildings 101-115, 205-213, Of Proposed Work: 1301-315,405-408(10 total) j L_ SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A A-4 ❑ A-5 ❑ JB ❑ B Business ❑ 2A ❑ E Educational ❑ 211 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 313 M Mercantile © 4 ❑ R Residential R-1 ❑ R-2 ❑ R-3 ❑ 5A [j S Storage ❑ S-1 ❑ S-2 ❑ 58 ❑ U Utility ❑ Specify; M Mixed Use ❑ Specify: ; S Special Use ❑ Specify, COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: I � Propased Use Group: Existing Hazard Index 780 CMR 34):I —i Proposed Hazard Index 780 CMR 34)- SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st Znd 2ntl 3rd 4t" f 4 t --------------- Total Area(si Total Proposed New C=onstruction(sf)�r Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone� Outside Flood Zone[] Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning 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) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW ® YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , Date Issued: C. Do any signs exist on the property? YESQ NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Adam Quenneville Roofing &Siding Inc. Not Applicable ❑ Company Name: Adam Quenneville Responsible In Charge of Construction 160 Old Lyman Rd South Hadley MA 01075 Address 413-536-5955 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Fairway Village Condominium Trust 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 3)ayJ/, Signature of Owner Date Adam Quenneville 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 3lakIr� Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville CS 070626 License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/2017 Address Expiration Date _ 413-536-5955 Signature Telephone SECTION 13-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 0 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 504 Fairway Village Road Leeds, MA 01053 The debris will be transported by: USA Recycling The debris will be received by: USA Recycling Building permit number: Name of Permit Applicant Adam Quenneville Roofing & Siding Inc. .3)A b(0 - -- A/�— — Date Signature of Permit Applicant The Commonwealth of Massachusetts kipDepartment of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgovldia Workers' Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Adam Quenneville Roofing & Siding Inc. Address: 160 Old Lyman Rd City/State/Zip: _ South Hadley. MA 01 OZS Phone#: 413-536-595 Are you an employer?Check the appropriate box: Business Type(required): 1.® I am a employer with 15 employees(full and/ 5. ❑Retail or part-time).* 6. nRestaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any capacity, [No workers' comp.insurance required] $• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have I0.n Manufacturing no employees. [No workers' comp.insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.t4 Other Roof repairs *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: AIM Mutual Insurance Insurer's Address:_ 330 Whitney Ave. Suite 730 City/State/Zip: Holyoke, MA 01040 Policy#or Self-ins.Lic. # AWC4007012861-2015A Expiration Date: 4/29/16 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 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: /JA� Date: Phone#: 413-536-5955 Official use only. Do not write in this area,to be completed by city or town o,ficial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 6 IYA A I I i U E NN EVI L L E Winner of Me TORCH A.WA'AD � A00FINO V SIDIN4 '►WINI)O uS 160 Old Lyman Road+South Hadley•MA 01075 We are Licensed 1,800.NEW.ROOF , 413,536.5955 FullyInsured Emaii;inial t Sbpnewra Website:wow.1800newroof net FactoryTralned MA Construction Supervisors Lie,#070626 MA Registration#124982 FactoryCer0ed Installers Mumbernrthe Home sumac,Asses orwastem Mass. CT Registration 4575920 MemlAar of the Building*A 7r»db Assazlsk»rt t'.P Wto Proposal Submitted To; bate: Phone Vs C: VJ kl cTA4r3/41/1 is H: z� i1 L? W; Street: Email° M01c3 041 City,State,Zip Code Special Requirements: iJ r rpt A�w 0 f 0 t _ F0 1 1 ),Ui s k-t Aa JV V CIO t'6 y 6-r Wit. R fl L jfl Gid;ty�tior5 d.A int ctztm VSTM GARAGE OTHER RECOVER EW 13UTTElts Layers. 2 3 4 Plywood Included: Yes r rho Tear oifSLATE;91SHA0S Sk2l e+) CQNiPLMR09F-PROTL( IQN SYSTEM 14 We shall acquire appropriate;permits for all work Z Home exterior and landscaping to be protected fe Strip existing roofing to existing decking with full Inspection DO NOT DO 0 Ali project waste shall be removed by dumpster(dumpsterfor contractor use only) .;i Deteriorated existing decking will be replaced at$3,77 per sq,ft,after full inspection Customer initial s: kX Install Ice&Water Barrier at all eaves 3'J 61,valleys,chimneys,pipes and skylights 91 f Ar- k. Install(151b,felt AgaDunderlayment over remaining decking area xg. Install Metal drip edge at eaves and rakes8` S")(white 1<3gD) Instail manufacturer's starter shingle on alt eaves and rake edges ord Install new pipe boot flashing J vent accessories fc Install ridge ventµ taw Countrobm rolled 4'8:affl /Roll AP Shingles;(standard 6 nails per shingle) , t l Shingles „ 25 year _i $o Year f- So Year Color. Ridge cap shingles Warranty Options: w We guarantee our workmanship for 10 full years(see our warranty coverage page) GAF System Plus Warranty: { GAF Golden Pledge Warranty AQRS Recommendations: read Counter Flashing Water Seat&Tuckpoint ;::;:: Rubberized Crown Z,Metal Chimney Cap Replacing old skylight {or waiver Atrnzt be atgned') Mason work for valuer muss be signed) Heated panel roof system insulation Ventilation Opted out of AQRS,recommendations Customer Initials. 4Wg nropasu h+lr9bY[o furntsh+natensis and tabrar-i'ortpia a,n wcordantowitb above�Potlfltat ons for the&MM of., Tot4t ou m is ! ACCEPTANCE OF PROPOSAU rhe above prkes,specifications and tundKlona are � Down Payment;{$30179$'01 satisfactory and are her W accepted,You 00 authorized to d4weltk as specirrsd. Balance Dun Upon Completion:f$Se V f PaymentwlNtiet/s.dawnatstanoE(nb,Am"du upon nrpl van, v,��a�( phf'r-m-t Date: Z I Signature: V 5 AA pate: Esdmatar:(Print Nance) t5ign Name) Estimates are Donated for sixty(60)days from above da e, ATTENTION}i{ M80WNERS:Please coverall personal belongings in the attic,garage or storage areas due to the possibility of rooting debris or dust corning In through tracks of the wood.Allam Quennevllle Roofing will not be responsible for debris or dust in the attic or stotage areas. Customer Initials: 1 -= Roadway&Sidawalk Improvements Farrway lriAaye ...Ilf� ^ryye' _ -Mc •`�"il..�y.•-`�,yc=i. Pam J ��R� 14 Al i)epih f aveU."A '? \ Wck Purer Pn1aa move,S?Rcprace Asphalt /a �1•hdl Deplh.Lsphcrl Cbnsfrucffon - ~ �_ I S �....-y s IN If E7LTIh lFolk+r,�p Rceunsirucrt°n •( Cape Cad Berm LEGEND ,nttaale H.,a,..�®.�.am, {Ruadway�SidesyaBYs and Brddl'PalwPgggo); Fv Lk--p h Paveme l ReaWaabbn:t80 740 SF anvavrays-Pav-aentrs=vad and nmzfaced.337,d4C -Fug Vap 0SA*-*Rscvsfach(on:tr5960SF FLd Depth New ParJlkg CORSf7MUOn:*TW SF L- - -..._----- ---- -BnrkPataas::tBBOSF m[on Crndroi barrier - - CtUENNSVILLEM R00FING,r SIDING V WINDOWS 1.60 Old Lyman Road South Hadley, MA 03075 (0}413-536-5955 (F) 413-536-1448 FAX Corer Shut Date. �)I s t, Attn: l r*, Fax: . ,3-7- 1 Q,�a From: Pages includirig cover,* J