29-599 a g r rf orm A ] Proposal Submitted To Date - vic liv ' A =
D F
Il QUENNEVI Street
ROOFING & SIDING INC. Ft'i ` i ' E '
ouc.vre 160 Old Lyman Road, South Hadley, MA 01075 City, State, Zip Code
1. 800 - NEW -ROOF • 413. 536 -5955 Phone # s r (-- v o ' 6,6 ,r..
Email: info @1800newroof.net Website: www.1800newroof.net
MA Construction Supervisors Lic. #070626 MA Registration #120982 H:4) - ' T 1
3 /*JM'
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
OH EV CV TW DHP
Double Hung 3 -Lite End Vent 3 -Lite Center Vent Twin Double Hung Picture w/2 Double Hung Flankers
IIII 1 � � i %i� ": mu 111111
III
/11 4 0 IMO 1111.1111 Elm L
WoodgrainJnteriors Vinyl Color - Product Code Grid Styles
_t9AT �� ..,+Natural Oak WH = White BS = Bayshore ST = Standard 5/B" 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 1/16" RFE = Regal Florentine Elongated
WW - White Woodgrain W = Williamsburg 11/16" RF4 = Regal Prairie (2 passes)
TB = Thin Brass
BAY BOW 4 BOW 5 BOW 6 GARDEN
, l
1 1 1
1 i t ��. f 4 ' 4 I 1 e n I I L� !1' 11
Woodgrain Interiors Wood Options Vinyl Color ' Product Code Grid Styles Glass Options
NAT = Natural Oak BIRCH WH = White A - Aurora ST = Standard 5/B" 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
( 7-,-__:-,:. Casement Casement
�l
-- Triple Casement Triple
I
= -il y !
Existing Window New Window Existing Window New Window
Measurements
Measurements
4s ss L
O Rough Opening 2 Rough Opening
Location Style Metal Style Series Location Style Metal Style Series 8
._11.1 (Room /Floor) "Code" Y/N "Code" "Code" ,,,-6 W F C Width Height Ul — (Room/Floor) "Code" Y/N "Code" "Code" Width Height Ui
—
1 /e A f / /'J u IA) 36 I 5 ,5(
2 /1 Y/ A/ ff fA�� , .:1 �
a ' 1 4
3 R, D N A/ Aft kf34. - ' c ' � y % . � t . 4 15
4
/Z, D it A ry- -I III % . ` 4.7 16
5 7 17
6 1e - _
7 19
8 20 —
9 . .
10 22 .
11 23
12 24
Color of Color of
Window / Door Wrap I Window / Door Wrap a
tl ii ite.%oi t41u' w 'Zt Gave- X,A 5r - G" F7 Vt
\ C3`11'1 .e, C .. (AA, 9 9.
We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of:
Total Sale Price $ c , j 5'"6r Down Payment $ 9 a? 5 Upon Completion $ I 7 7
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 Que nevilie Roofing and Siding, Inc. to recover any sums due under this contract.
1 . i /
Date: I ``" / Signature: - . "C - Phone #
Date: ' d. / < Salesperson's Signature:: -»--'' " k' WI 'V i t� et Jta � '` f � ' }
Estimates are honored for sifcty (60) days from above date -,
Please remove all breakables from interior wall surfaces during installation. AQR &S I not be responsible for damage.
;.;
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ` ( Not Applicable ❑
Name of License Holder : J) "�' t d i • 0(/ l ? /Le v i ( `
License Number
Address y ( Expiration Date
/ t 57,x-_5 -`i s d 11. v to 7
Signs Telephone
9. Registered Home Improvement Contractor. Not Applicable ❑
Adam QaenneviHe Roofing & Siding, Inc. /ao
Company Name R egistration Number
160 Old Lyman Road _
South Hadk , MA 81075 3
Address Y Expiration Date
Telephone 6 5// S S
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 X 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
Amemeeimemorminonmemememe
The Commonwealth of Massachusetts
---- -- Department of Industrial Accidents
X31:.. a Office of Ittvestigafl'onz
=^�;, ~ = 600 Washington Street
�• �'�'�" n � Boston, MA 02111
-.-w. r`
-,. :� >' www.nwss_govfd&
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information �y Please Print Legibly
Name 18 A Otatin�v; lie ko4l t Si vjhj e it
Address: Rio O I J 11 Yri A h 4/.
city/s.te/Z a - ... -1 k ltd AO 0/07Plone # _ I .3 6 -51 CC
Are you an employer? Check the aPPropr'te box: Type of project (required):
1. rA I am a employer with 1 �j . 4. 0 I am a general contractor and I 6. ❑ Now construction
employees (fall andJor part-time).* have hired the sub -coca ac tors
2. Q I am a sole proprietor or partntx listed on the attached sheet. 7- ❑ Remodeling ship and have no employees These sut�-contractors have $. ❑ Demafition
working for me in any capacity- employees and have workers' 9. ❑Building addition
[No workers' comp_ insurance Um'rauc` -#
5. 1 We are a corporation and its 10 0 Electrical repairs or additions
ed) h
ffi
ocers have exercised their I1. Plumb'
3. ❑ I am a homeowner doing all work ❑ Plumbing repairs or additions
right of eaceraption per MGL
myself [No workers comp. 12[} Roo/repairs
insurance required.] t e 152, §I(4X and we have no f
employees_ [No mss' I3_ (, Otinrar x(11 Gd �i ll�
_ comp_ required.]
*Any applirsnt that cheers box NI must also fill out the section below showing the waiters' compensation policy iafumatioo_
t hiomcowner% who submit this affidavit inderdods they are: doing all work and then here outside contactors must submit a new off davit inducting such.
!Contact= dun cheek this box mast armed an additional sheet showing the nanie of the sob-contractors and sari vier oe not thane entities Laves
employees. If the subcontractors have =players. they must provide their workers' comp. policy number.
I am an employer that is providnrg workers' compensation insurance for my etrrployees .edow is the policy and job site
in ontartiore.
Insurance Company Name: /4I M t ! y� t ti to LC.t - in S(il ra f1 c ..
Policy # or Self -ins. Lic. #: /'1 A W C '701 U (v 101 Expiration Pate: 1 4 - a 9 - d a 1 a
Job Site Address: Cltyi tari/Tp:
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 a 152 can lead to the imposition of criminal penalties of a
five up to $1,500.00 and/or one -year Wit, as well as civil penalties in the form of a STOP WORK ORIDER 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 Offirr of
Investigations of the D1A for insurance coverage verification_
I do hereby certify under the pains and penalties of pedury that the information provided above is true mid correct
Iiipa o: / /1 Date:
phone #: 1 3 i 'tJ 6 `6
O, fjtri..l use only. Do not write in this area, to be completed by cry or town official
City or Town: Permit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
1 Contact Person: Phone it:
iqiii oilt44€44 Nwisa rit;!wit'' Pei:
i (,i'jl t)Iti SiiiieiSi; '•,t). i',--,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemerj flndows Alteration(s) El Roofing ID
Or Doors
Accessory Bldg. ❑ Demolition El New Signs [oj Decks [Q Siding [0] Other [C7]
Brief
Work Description of Proposed_ n 5 t v l j 'i! 0 f 1 6 _r `* d o ( re p t a& 0'624, f ( d( GF u7 .5
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
ea. 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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, r l `(? 1,01- I r1 f I S 1 , as Owner of the subject
property
hereby authorize im I Iv���R i &jn IMF,
to act on my behalf, in all m at ers reljbye to ed by thi building permit application.
Cp 7i, `1 u c f -eat o --e
Sig . - Owner Date /t _ ( I
I, '" & I �� , 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.
A{14 m 61/Q ifLe l` ILe.
Print Name
Signature oE rlAgent Date
C.
s
S # ,1 �4R�
e
1 Department use only
RECEIVED City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
LSEP 2 0 2011 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
orthampton, MA 01060 Two Sets of Structural Plans
or: "MO INSaEC a 1135871240 Fax 413 - 587 -1272 Plot/Site Plans
roN,
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
4 ,c"2 x Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
e 7) / r l r? I is/ ,/ 5 t n-e 6;4 �''o (-e 'i e / f144
Name (Print) /�_" Current Mailing Address:
Signature
Telephone '7 ' r i , q 3 / 5'
2.2 Authorized Agent: 61,,
Name (Print) Current Mailing Add s:
L /(y 63o- 155 fM o io'7
Signs a Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 6-6. 0 0 (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) ,9' g s'6, Check Number 62/001 4
This Section For Official Use Only
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
42 STONE RIDGE DR • BP- 2012 -0279
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 599 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- 2012 -0279
Project # JS- 2012- 000445
Est. Cost: $2956.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 81021.60 Owner: DIBRINDISI ERIC P & SUSAN M
Zoning: URA(100) //WSP Applicant: ADAM QUENNEVILLE
AT: 42 STONE RIDGE DR
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON :9/20/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL 4 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 9/20/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner