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23A-093 LJA � /�' DISCOVER QV 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 • 41 3.536.5955 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: f Date Phone Ws C:(Cl7)K5;1 • c2/3"C Sete. Ca #rte 4 CI /E./ // H :0 i y - U/i �` W: Street Email: 17 R,/'// .4 4 c City, State, Zip Code Special Requirements: f ga.4 c /h. 0 / UE _ tJ i't'!re- 67 F' f p c 4u0 an y � l rw Pe '1 I.q cl�cc 61 ❑ Recover M Strip Complete Roof System We shall acquire all appropriate permits for all work [VE Home exterior and landscaping to be protected Strip existing roofing to existing decking and dispose of. Do not Do./c63 i s' l A ..e (sgh /1 Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. N] Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights • Insta11k51b. felt ynthetic) underlayment over remaining decking area Install Metal drip edge at eaves and rake v 5" (white l.rown /copper) R 6 Install manufacturer's starter shingle on all eaves and rake edges BBB ❑ Install new pipe boot flashing (standard /copper) / vents • Install Snow Country o( o c4vent ridge vent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) 6.4 F Shingles ❑ 25 year ® 30 year ❑ 50 year Color � ��► r Ridge cap shingles Warranty Options: g We guarantee our workmanship for 10 full years (see our warranty coverage) ❑ GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: ❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 67/0 ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ / 700 satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down at start of job, and balance due upon completion. Balance Due Upon Completion ($ 3V1() Date: /b // Signature: _ Date: G / ( /Ca/ Estimator: (Print Name) (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 Quenneville Roofing will not be resnnnsible for debris or dust in the attic or storaae areas. ..- .. -.-::- Massachusetts - Department if Public Safer V Board of Buildin2 Re 2ulations and Standards License: CS 70626 ADAM A QUENNEVILLE 160 OLD LYMAN RD S HADLEY, MA 01075 . - . ........ - -..e....— _-....- ........„. Expiration: 8/21/2013 ( .milliis,h, Tr: 21002 . . . . .... . ... . ,.:ic,...\ 0 ' 0 0 r 4 • / i Office of Consumer Affairs and usiness Regulation 1 0 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C Registration Renistration: 120982 IF, . =a -1::.=:=Z.."..-'-a -- -,,, Type: OBA : -....1 --.:7.:.: - - -:- -7-----1; Expiration: 3/25/2012 Tr# 293069 ...,....*: ADAM QUENNEVILLE ROOFING' .-: ADAM QUENNEVILLE !.::: ,-... .f: 160 OLD LYMAN RD - --:",- SO. HADLEY, MA 01075 : : _ .._ _....... ,.., _ ._—___. Update Address and return card. Mark reason for change. . : ..:. Address n Renewal 1 Employment Lost Card :.:7;tr;:; - 4 - ‘7Mi7.3 - 74,.. , Miv — Alr — I;P:-./1 7 -7.7.7 i lk ' . ; '114 k: ilP■ .'' ''':::'‘'',•' ' ,' . 42 ' : ; `, :4 :': . ..! ... : t ^ ' i 1' ' ' . I ., :!...':'' ,f - : ''.■:''''' - ''' .if... ; --,y-ii,,,I: . :: , .,i, ....,..,, .,,,,. , k;,. ;,: ik '. - 0 . ,,:. . , :: , 1 ,.,„, 0 4 117 , i 1 14. 4 :11 . .. , .: 0, .1 .r....41 .,6, 5 ,g1 : , ..;41 :, - ' '', .,:, . .4 4, ' . -.v . , :-.,.. •. fr ir .; : H i l fil N i, STATE OF CONNECTICUT -:-,,- DEPARTMENT OF C'E:q° PROTECTION Be it known that 4 ';''S . ....... :. ADAM QUENNEVILLE r 160 OLD LYMAN ROAD ikt SOUTH HADLEY, MA 01075-2632 is certified by the Department of Consumer P rotec t ion as a registered k-' HOME IMPROVEMENT CONTRACTOR .- PI Registration # HIC.0575920 A All ADAM QUENNEVILLE ROOFING .. , ' •'' „.: Effective: 12/01/2010 I ---. V4 „i i.fiej r —.) Expiration: 11/30/2011 ' -- k.,...-.7.-q Jerry Farrell, Jr., Commissioner iiln:I.;0; .-1 . 4 v* , 4' t, 1 '', -:' '' A; -: (:, ,i 4 ' ■ ;.,,,it? ".', tl ii ;:''..4pi - ''', 7. ' ,,.% — ,:n ..' .'-, ;1;; . k■ ',:N. '''' , 1 !'-' -4, T -.. -,.,.: A ' ...: ,:'.. :^..., , 2 ' .., . r , ::.:,,, .. k'.. ''In': ,.4•1.. ' .,;"' 474 41 : . j1,. 1 y . ^ ' ..:,. '., ' '': - 1% ?r' ." ,.:".*. A ACORD ® CERTIFICATE OF LIABILITY INSURANCE f DATE / 23 / rUDDIYYYYI k.......--- 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N AME ACT L ynne Methot, Ext. 102 Foley Insurance Group Inc. PHONE Fah. (413)214 -7474 � (413)214 - 7447 37 Elm Street E � A l t ss; lmethot @foleyinsurancegroup.com INSURERS) AFFORDING COVERAGE NAIC k West Springfield MA 01089 -2703 INsumNA:Peerless Insurance INSURED INSURER B : Adam Quenneville Roofing & Siding Inc. INSURERC: 160 Old Lyman Road INSURER D : INSURER E : South Hadley MA 01075 -2632 INSURER F: COVERAGES CERTIFICATE NUMBER:CL116230 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WU AODL'SUBR )<MMDWYEFF PO``1��Y E P LTR TYPE OF INSURANCE AMR WND POLICY NUMBER t YYY) )t/Mlt?WY1xYY) . LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE 10 RENTtU PREMISES Me occurrence) $ 100,000 A 1 CLAIMS -MADE X OCCUR 4006912267 6/23/2011 6/23/2012 MED EXP (Any one person) S 5 , 000 PERSONAL R ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP /OP A $ 2,000,000 7 POUCY X , a j LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ' $ - ANY AUTO BODILY INJURY (Per person) I S AU. OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS nt ) PROPERTY DAMAGE — H S HIRED AUTOS AUTOS (PSr eaddent) S UMBRELLA UAB OCCUR EACH OCCURRENCE S — EXCESS UAB CLAIMS.MADE AGGREGATE ; DEO 1 RETENTIONS $ WORKERS COMPENSATION ' WC STATU• - 01H - AND EMPLOYERS' LIABILITY Y / N _TORY LIMITS FR , ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED/ N / A E.L. EACH ACCIDENT S (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, descr u nd er DESCRIPTION OF OPERATIONS below E.L. DISEASE - POUCY OMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE I Brian Foley /LYNNE �^ � ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. Jun•23.2011 09:43 AM Remillard Insurance 1- 413 - 538 -bulu �....,� OP ID: LL ACC?RL?' DA's ''''n �.- CERTIFICATE OF LIABILITY INSURANCE 08/23/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS IRON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE mum BELOW. THIS CERTIFICATE OF INSURANCE. DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I ISURER(8 ), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If th6 certificate holder Is an ADDITIONAL INSURED, the policy(tea) must be endorsed. If SUBROGATION IS WAIVED, subject to the temps and conditions of the policy, certain policies may require an endorsement. A aM6ernent on this oerttficate does not confer rights to the certtflca to holder M lieu of such mss). PRODUCER 413-538-7882 Remillard Insurance Agcy, Inc 4134384179 .: .. . 79 Lyman Street South Hadley, MA 01075 01811116 ADAMQ -1 Stephen E. Radon a Clem a AFFORDING cos varuy NAIL r mow Adam Quenneville'RoOlIng & L mm,RNa a A I AIM Mutual Insurance Company Siding Inc a : Travelers ins. Co. 100 Old Lyman Road ueutmc South Hadley, MA 01075 4NSURIIR D oeet*RaR a : _ OWIRIRF: .• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i TtaS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQENREt1ENT, TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES OESORBED FAIN 1S SUBJECT TO ALL THE TERMS, ILT EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. WITS SHOWN MAY HAYS BEEN REDUCED BY PAID mom nye Of assumnice • RAM POLICY NURSER rn ! 0251 m n worm MESrJU UASSrLITT aAC►tocarfaente commilectmestanAL UMn.ITY 1, ti e CLAaee•MADe ❑ OCCUR teEC EXP (Paton. an00$ N MEOW. a A N INJURY $ (-� GENERAL AIRGGATE $ I LOC PRODUCTS - COM POLICY 1 t I PIDP A06 j AARONOe02 imam BOGt.E LENS 1.000,00C 8 ANY AUTO BA7450L948 11/01/10 11/01/11 eooELY INJURY (Par perm) i AU. ONINEC AUTOS BODILY INJURY Eaw swamp $ X SCHEDULED AUTOS PROPERTY ADE X ma AUTos pow i isseng N X NON -OWNED AUTOS 1 W IIRILLA UM ..._• OCCUR EACH OCCURRe CE ^ MOSS UAS ct esMAOe AOOREGATE 6 DEDUCIBLE s RETORTION WOreEeRe COMPINSAT10N M O aNl I.0YMtt+' 1.660/41Y X [, 1 X ! A . ANY PROPRIEToRPARTNeRomanws ' AWC101288101 04/29/11 04/28112 EL SAM ACCIDENT $ 1,000,000 OFFORESSEASER°T LJ N!A ij EL =AM - CA tA1P1 OYFf N 1 y900,000 OF OPEPATION$ b. w EL. SWAP - POIICT LINT _ 6 1,000,000 aeaaePnow OF OPERATIONS i LOCATIONS r VEHICLE, (Mae ACORD 1$1. MOWN Rrpwria aahodds, R Sao yam to r•yuN.,) CR1IFI2ATE HOLDER CANCELLATION sumo ANY of THE ABOVE Ve3CRNI50 MUMS DE CANCELLED BERM Tae EXPIRATION DATE THEREOF, t oTICE WILL BE DEUVERED IN Acconoasica wme Tree Pouc r pitovesarss. AUThOSreao REPe $.NTATIVV!! t ®1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/08) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents . f is= Office o Investigations ii. 600 Washington. Street _.. • I Boston, MA 02111 v a www.rnass govldia Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumbers Applicant Information nn PIease Print Legibly � dd W. (Q r Lv i Le. geo,ri t'!� t .S i d i re C Name p ..+..:r. ;..;.+ Address: I ci o 01J i im a vi Ad. City /State/Zi • : __,. • +i If MA 0 io7SPbone #: _ I 3 Are you an employer? Check the apptop , to bo= Type of project (required): 4. 0 1 am a general contractor: and I 6. ❑ N ew cons l . 1 am a employer with have hired the sub-contractors employees (full and/or part-time).* listed on the attached shoot. 7.. ❑ Remodeling 2. ❑ 1 am a sole proprietor or partner- These sub - contractors have S. 0 Demolition ship and have no employees - employees and have workers' working for me in any capacity. employees 9. [] Buildin additni e. [No workers' comp insurance comp_ tnsuranc 5- 0 We am a corporation and its 10.0 Electrical repass or additions requirtell 3. ❑ lam a honneowcxx doing all woslC of ram have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 120Roof repairs insurance requic -] t Y [No workers' 13_❑ Other comp. insurance roquire dj ' ; AMY applicant that checks box. 0 1 most also 511 out the section below showing their woritcre compensation' information. t Homeowners who submit this affidavit indiading they are doing all work and thew hire outside contractors land =basil a. new affidavit indicating such. 1 CantnrstDes that cheek this box mast attacked all additional shad showing the name of the sob -aau *dvea rod state vnhcahrr or not those entities have employees. lido nub - contactors loon aaployos, they oast provide their workers' cony, policy number. I cum an employer that is pravidnng workers' compensation insurance for nzy employers. Below is the policy and job site infOrroatiar+- Insurance Company Name: hl- ! , M m U Q t t I.( rl SL& it a i'1 � W - Policy # or Self -ins. Lim #: FT C r i i) / a 4 t'v 101 Exp on Der: 14 - a q - )6 to Job Site Address: City/S p- Attach a copy of the worktrs' compensation: policy declaration page (showing the policy cumber 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 foam 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 stattmerit may be fawardcd to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certib under the pains and penaltks of perjury that the inforrrtmion provided above is II— and correct S 'atom: / Dote: /d ' / ' / Phone #: _____ 1 ___ 4 1 1 3` 6 6 " Official use only. Do not write ire this area, to be completed by city or town officio' City or Town: Permit/License # . Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. E ectr cal Inspector 5. Plumbing Inspector 6. Other Contact Person: __ Phone #__ ,4 !aq 1 ' ithl9A ii011 nolo (ow !tit 1 .7fc , '"Out (!'441!or SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �l Not Applicaa ble ❑ Name of License Holder : AC11 IA /4 . lX 1. %1 /U (11 / `� License Number 16,0 /d Lyme GA M . � L , croK y.- ar-goy Address J J Expiration Date 1 //3 5 C - 6 S Sign re Telephone 9. Registered Home Imp � rov � ement � Ce� ��r � � ,. ir- Not Applicable ❑ Company Name A Contractor; �� u1» 160 Old Lyn' Road Registration Number South Hadley, MA 01075 3 - ,9C / (9- Address / G Expiration Date '�`// Telephone 7(� - � /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 )( 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 1 toe% t 011%. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Er Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks [[] Siding [C) Other [ Jj Brief Description of Proposed r Work: - rt i / �,D��" I �� l f fa L� � s ( / ,P r /Ji7 � 1 c uG r �S lGt 1 , , ot- Alteration of existing bedroom Yes No Adding new bedroom Yes No .n sr r Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. 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 5 i°4/ 1 CD // e b , as Owner of the subject property �f f 1 _ hereby authorize Pelt (`n ('te u- e n fu ' t(.e 6 '� (t j , h C to act on.p w behalf, in all matters relative to work authorized by this build ] permit applicatioK c C t -E' / ( Sigig6riof Owner Date / — ! ' ( Ad s Qua & 1st , as Owner /AMA hnriz d 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. , Print Name e /7 '7 L lU -� f/ Signature Owner /Agent Date _ " Department use only City of Northampton Status of Permit: J O` � Building Department Curb Cut/Driveway Permit 5 . 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability • rthampton, MA 01060 Two Sets of Structural Plans of t• one 413 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify • APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Pro ert Address: (( J� This section to be completed by office ;r f e (Ci �1 i - (.�� Map Lot Unit F/0414 14 el, (14A 0(06 Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: '1 _ 4-, �- -a1-11 ie _ I'7 t r�t, �� Al . Fl6r t Name (Print) / Current Mailing Address: lU �O < . _5-et Con (f 4 G {� I/i C-10 st"G( Telephone t r /; Signature i 1 --6 1 � — 0 7 e 3 9 2.2 Authorized Agent: A vA rev; GLe 16,061 rd . Name (Print) Current Mailing Ad s: �C W 63� 0 107 "3 Signat Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 67/0, 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) S f /d (00 Check Number 7/ y €/ O 3' 5 • This Section For Official Use Only Permit Number: Date Building Issued: Signature: _ Building Commissioner /Inspector of Buildings Date • s Y 17 FAIRFIELD AVE BP- 2012 -0343 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A - 093 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- 2012 -0343 Project # JS- 2012- 000556 Est. Cost: $5110.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 13242.24 Owner: GOTTLIEB SETH G & JENNIFER N Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 17 FAIRFIELD AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:10/6/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP,PLY & 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: FeeType: Date Paid: Amount: Building 10/6/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner