18D-013 LJU1 DD5-L—AY\ 15E1 Mauer L DISCOVER
Q U E N N E V 1 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: Date !Phone #'s C:
,M
H: W:
Street Email:
City, State, Zip Code Special Requirements:
❑ Recover ❑ Strip Z l a yw5
Complete Roof System JJ ,
We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected
❑ Strip existing roofing to existing decking and dispose of. Do not Do.
t Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
❑ Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
® Install (151b, felt / Synthetic) underlayment over remaining decking area
011 Install Metal drip edge at eaves and rakes (8" / 5 ") (white /brown /copper)
Install manufacturer's starter shingle on all eaves and rake edges
BBB
• Install new pipe boot flashing (standard /copper) / vents T
❑ Install Snow Country or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
f r . ' -,, r Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color r ; '
Ridge cap shingles
Warranty Options:
1r We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ -, )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are J Down Payment ($ r )
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 ($ )
Date: A ` Signature: .
Date: , , r Estimator: (Print Name) , ` 1 (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
responsible for debris or dust in the attic or storage areas.
•
The Commonwealth of Massachusetts
---- Department of Industrial Accidents
j1 O, ce of Investigations
6 ° ',i�'- = = 3 600 Washington Street
"... -;- Boston, MA 1)2111
`as , , www mass g'ovfdin
Workers' Compensation Insurance Affidavit Builders /ContracforsiEleetricians/Plumbers
Applicant Information Please Print Legibly
Name musalcssiorgathzatiorifindividua.0: A (kW. 01,41.Arve.f AZ Ot) t Sl d , ...1 a
Address: (Le 0 (V L -.1i i n A i A Y1 0 .
C ri y / S t a . : J , - �fi k f s i t 1 1 4 A - 0 1074hone #: t - 6' -69 5 "
Are you an employer? Check the approp , to box Type of project (required):
1. VI I am a employer with 15.- 4. 0 I am a general contractor and I 6. 0 New aoostruman
employees (full and/or part-time).* have hired the sub -contractors
2.0 I am a sole proprietor or partner- listed on the armed 7 ' 0 Rmn elin
ship and have no employees . These sub - contractors have 8. ❑ Demolition
working for me in any may. employees and have workers' 9- 0 Building addition
[No workers' comp_ insurance comp- antce.Y
required] 5. El We are a corporation and its 1 Electrical repairs or additions
h
d i
have ave exercse their 11.
3.0 I am a homeowner doing all work[ Plumbing repass as additions
right of exemption per MGL repaeis
myself, [No workers' comp. insurance requirecL] f c. 152, §1(4), and we have no 12 Roof
employees. (No ' 13.0 Other
_ care_ insanosca required
.) _
'Any applicant that cheeks box d 1 must also fill out the section below showing heir woricere compensarine policy information.
t Homoovvoers who subosit this affidavit indierdiag they are doing all wort and then trite onside mettactoss mot submit anew a$idevit indicating such.
1 Coatraetors that cheek this boot ems atlarbed an addition l shut showing the name of the and state win:that a not those sties lame
canployc $. If the sash-contractors have employees. they mast provide their woken' comp. policy number.
I can an employer that is provcdrng workers' compensation insurance for n9' employees Below is the policy and job site
infor mation.
nation.
Insurance Company Name: ii M m L tU L t 'T AS/ATOM `�
Policy # or Self -ins. Lie. #: T w e 1 1 !) I a,' �a 101 Expiration pate: - - 9 61 0 '
Job Site Address: 6 c Pi n ee 4ItY �'u .r� v - °-lt ianify rp► p: )711} io i 6
Attach a copy of t workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as =pared under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year Wit, as well as civil penalties in the form of a STOP WORK ORDER and a fete:
o f up to 5250.00 a day against the vioatoar. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA far insurance coverage verifications.
1 do hereby cc typ under ihe pains and penalties of pedury that the information provided above is true mrsf correct
S' , ate: Date: . -. G tf
Phone #: _'j 1 3 - � G - ti S .
r.
ofural scsc ossly Do not smite vie this arm Jo be ro arp(dad by eit p or towns Qfried -
t 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 it:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed
, C Supervisor (CSL)
_ll i �u y C X 6 1 fW V d /L_ License Number Expiration Date
Na e of CS H r j ��
_
Id List CSL Type (see below) __
i tk ki I
2 u vt PGA
f � / / Address Type Description
15_ ' .ta & Gt-L I 7 ,t. & (1 107') U Unrestricted (up to 35,000 Cu. Ft.)
R Restricted 1 &2 Family Dwelling
Signa 7/7 / M Masonry Only
7 2 RC Residential Roofing Covering
Cephone WS Residential Window and Siding
L //, 1;-5‘ — c, S -C SF Residential Solid Fuel Burning Appliance Installation
_ D Residential Demolition
5.2 Registered Home Improvement Contractor (HIC) 70 & t
IBC Company Name ��p �� py�_� Registration Number Address — — tltll " ° ,`.."" - ; , f - d / ✓ t3
c,,�� +`
(� Expiration Date
Signature (% // /,L Sftth"1E1 Y, ee.p Q , fsj
SECTION 6: 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 ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, �7 O < 14 K.. e _ , as Owner of the subject property hereby
authorize _ , 1 II ii ' a ' ! 1,1 I 1 , , to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
__ Adam.Quenneville Roofing & Skiing, Inc. , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Add k 1. 4 b vue V /Ze — —
Print Nam ' A.L.
j 1 � / /
a
Signa of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor (H1C) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5, respectively.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) (including garage, finished basement /attics, decks or porch)
Gross living area (Sq. Ft.) Habitable room count _
Number of fireplaces _ __ Number of bedrooms
Number of bathrooms ___ Number of half /baths _,
Type of heating system Number of decks/ porches
Type of cooling system _ Enclosed , Open
3. "Total Project Square Footage" may be substituted for "Total Project Cost" C ,e,,) 6, 0 d
New Construction Data: for Addition, Deck, Accessory bldg.
If there is a on site sewage disposal system and /or a private water supply a signature sign -off must be obtained from the
Board of Health 978 - 249 -7934 before application is submitted to the Building Department.
BOH Agent Signature: Date:_
•` Th: Commonwealth of Massachusetts
to • rd • Building Regulations and Standards
g 7
4 s State Building " : w • Code, 780 CMR 7 edition
• • ermit Application To Construct, Repair, Renovate Or Demolish a Revised January
One- or Two - Family Dwelling I, 2008
This Section For Official Use Only
Building Permit Number: Date Applied:
Signature: ,_ --
Building Commissioner/ Inspector of Buildings Date
I certify that the owner of record below is not delinquent in payments to the Town of Athol under any circumstances.
Tax Collector_ _ Date
SECTION 1: SITE INFORMATION
1.1 Property Address: � 1.2 Assessors Map & Parcel Numbers Init.
t - �2. I rt ".. -L
1.1a Is this an accepted street? yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area (sq 11) Frontage (ft)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Public ❑ Private ❑ Zone: __ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if y es❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' of Record: ff �
broo
Name (Print) Address for Service:
Signature Telephone i rp & (}
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner - Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:_
Brief Description of Proposed Work':
5 d ``i,e _. t it'. / (rlWI — V � 15
SECTION 4: ESTIMATE CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 6 o 0 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City /Town Application Fee
❑ Total Project Cost (Item 6) x multiplier _ _ x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:_
5. Mechanical (Fire
suppression) Total All Fees: $
6. Total Project Cost: $ b 6 6. 00 Check Noi ) 5 e ck Amount: _
52 PINE BROOK CURVE BP- 2012 -0461
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D - 013 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 -0461
Project # JS- 2012- 000753
Est. Cost: $4805.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 10018.80 Owner: THIBAULT LAURA L & MARK MONSKA C/O MATTHEW L LENKE
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 52 PINE BROOK CURVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:11/8/2011 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 11/8/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner