31B-056 Name Date
QUENNEVILLE Street Address 'City State Zip
ROOFING ■ SIDING WINDOWS /
:7c _e_Ph l k h .� /1,4,4 0/0(0
1.800.NEW ROOF d
413.536.5955 / Home P ne # Work Phone Cell #
1800NEWROOF.NET C = __ ('(- > YYT 3'tC!? RESIDENTIAL ■ COMMERCIAL Email:
160 Old Lyman Road • South Hadley, MA 01075
StraightForward Pricing®
Story ` 2 Story 3 Story
Replace 4 SQ of Shingles, Stepflash /Counterflash 41' to 50' of Wall or Chimney,
7
Replace 51' to 65' of Valley, Lead 17' to 25' Chimney, Construct Cricket and Flash
3' to 6' wide Chimney, Roof or Siding Cleaning 2,001 sq ft - 3,000 sq ft, Cover
Fascia or Rake with Aluminum 51' - 65', Replace 21 -30 Slates, Remove and
Replace 1 SQ of Dormer Siding Quantity x $1787 ea = $
Replace 3 SQ of Shingles, Stepflash /Counterflash 31' to 40' of Wall or Chimney,
6
Replace 41' to 50' of Valley, Lead 16' to 20' Chimney, Install 71' to 110' of Ridge Vent.
Roof or Siding Cleaning 1,501 sq ft - 2,000 sq ft, Cover Fascia or Rake with Aluminum
41' - 50', Replace 16 -20 Slates, Remove and Replace 1 SQ of Wall Siding Quantity x $1392 ea = $
5 e lace_ - S�of Shingles Stepflash /Counterflash 21' to 30' of Wall or Chimney,
Install 51' to 70 o idge Vent, Replace 31' to 40' of Valley, Re -Flash or Replace
up to 2 Customer Supplied Skylights (no interior trim work), Install 250' to 350' of
Drip Edge, Lead 13' to 16' Chimney, Roof or Siding Cleaning 1,001 sq ft - 1,500 sq
ft, Cover Fascia or Rake with Aluminum 31'- 40', Replace 11 -15 Slates Quantity I x $922 ea = $ a
Replace I SQ of Shingles, Stepflash /Counterflash 11' to 20' of Wall or Chimney,
4
Install 3 to 50' of Rid e Vent, Install 21' to30' of Valley, Clean 251' to 350' of
Gutter ad 9' to 12' Chimney (perimeter) or Small Stone Chimne, Replacement
of Customer Supplied Skylight (no interior trim work), Strip -off and Re- Shingle 2nd
story Bay Window, Install 101' to 200' of Drip Edge, Roof or Siding Cleaning 501 sq
ft - 1,0(10 sq ft, Cover Fascia or Rake with Aluminum 21' -30', Replace 7 - 10 Slates Quantity / x $763 ea = $ ' 6 3
Lead up to 8' perimeter Chimney, Replace '1 to 2 bundles of Shingles, Stepflash/
0,3 Counterflash 6' to 10' of Wall or Chimney, Install 31' to 100' of Drip Edge, Install
4 to 8 Hat Vents, Instal Dryer Hose Connection, Replace 15' to 20' of Valley,
Strip -off and Re- Shingle 1st story Bay Window, Install up to 30' of Ridge Vent,
Minor Tuckpointing and Watersealing of Chimney ( <3' in height), Re- Stepping and
IceGuard 2'x 4' Skylight, Installation of Curbmount Skylight, Clean 150' to 250' of
Gutter, Install 51' to 100' of Drip Edge, Cover Fascia or Rake with Aluminum 11'-
20', Replace 4 -6 Slates, Roof or Siding Cleaning up to 500 sq ft Quantity x $612 ea = $
Replace 1 Soil Boot or 1 Box Vent, Replace up to 1 bundle of Shingles or up to 20
2 Shingle Tabs, Stepflashing /Counterflashing 5' or less of Wall, Installation of up to 50' of
Drip Edge, Installation of up to 3 Hat Vents, 10' or less of Gutter /Fascia Replacement,
Clean 31' to 150' of Gutter, Reflash Electric Pole /Heat Stack, Crop up to 30' of Valley.
Replace 1 -3 Slates, Cover Fascia or Rake with Aluminum 10' or less, Install Rubberized
Crown on Chimney Cap, Install Stainless Steel Cover on Chimney Flue Quantity x $427 ea = $
1 Roof Certifications, Gutter Cleaning (up to 30') Quantity x $179 ea = $
Replace Rotted /Damaged Decking, as needed, at $3.47/sq ft Quantity x $3.47 = $
Roof Pitches greater than 6/12 Add 30% = $
Shingle Color: Excess Build -Up of Moss & Mold Add 30% = $
3 TA-6 Nt . I 5 t� 3rd Story Roofs Add 20 % = $
Ice /Snow Removal (Minimum $400) $
Tarp (Minimum $500) $
Other Requests: . e t ,Q l c c e SL (CeS 7" P s c 'J,ce $ Q
Notes: J te4ei' /c,.,: Jw , r .'c c23>>
+Y31
((� Sub -Total $ a `l
BBB Diagnostic Fee $ - Sttgr
— 'T' — I he eby authorize yo to proceed with the above StraightForward Price of Total Due $ 2Y)
Winner of the X AVM
2010
TORCH AWARD Down Payment Due Today $ 700
, `` Balance Due Upon Completion ' pletion of Job $ /78J "
Specialist Print Name: /`a S t.+ ! - Thank You!
The Commonwealth of Massachusetts
... Department of Industria l Accidents
3r.=_ _ Office of Investigations
s', ' = _7
600 Washington Street
—_ Boston, MA 02111
• . -�� www trtass.govldia
Workers' Compensation. Insurance Affidavit Builders/ Contractors /Elecfxicians/Plumbers
Applicant Information n /� Please Print Legibly
Names ; A a�. W. Otc.erltve.v; 14 fSo041 t SI' i h5 , _LAC!
Address: 1� U U 1 ct 11 i m a n 41 . .
City/State/Zip: Sat 1,'I-it N d 1► i f[ 0174bone #: . t 3 -`a sC Are you an employee Check the app .. • to be= y Type of project (required):
1. VI I are a employer with i 5 4 . ❑ I am a general contactor and I 6. ❑ New construction.
employees (Bull and/or part-time).*
have hired the sub-contractors
2. ❑ I am a sole proprietor or partner listed on the at he d s 7- ❑ Remodeling
ship and have no employees
These sub- contrae ors have &. ❑ Demolition
working for axe in any capacity. employees and have workers' 9. ❑Building addition
[No venire s' comp. tnsm[ance comp_ co
5. 0 We are a corporation acid its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
riglttofpexMGL
myself [No workers' insurance � t comp. c. 152, 11(4), and we have no erumptice
12.111 Roof repairs
employees_ [No workers' 13_0 Other
'RI
Any appiicant that eiracke bent #1 rand also hi out the section below showing foci worn wmpaccioa policy indnruntion.
t Homeowners voila submit this affidavit they ut doing all work sad then hire outside matadors mat abaoit anew ■ilida k isalicatiog sack
CContactaa that cheek this boot mast attached an additiowl shaft showing the maw of the wb-cvntrarsoa nod sesta whether or ma those amides hoot
employees If the mbcantractoss hart; employees, they most provide the ' comp. polky maabeT
I am an employer that isproviduig workers' compensation insurance for trey employees. Below is the policy and job site
inforrsrat'on_
basin-awe Company Name: R T M m /At T n SUr a n CA..
Policy # o r S e l f - i n s . Lic. # : l - i v e . t 7 01 2 k l a l v ( E x p o o n D a t e : q - a q - a D) a
fob Site Address: I a III e - T1� r 1V iklbr key iP: nitol- 0 ID 6 G
Attach a copy of the workers . • expensatio policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as rcquioe4 trader Section 25A of IdGL c. 152 can lead to the imposition of criminal peaoakie s of a
free up to S1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this st dement may be forvrarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby comfy under the pants and penalties ofperjury that the information provided above is true and correct
5..7rabur: % Dalt: _ - — i 1
Mont #1 Lt 3 " 6 1S 1
a -1,d &Ise only. Do- :sot nor$ ler this arm, to be completed hp y or Iowa official {
City or Town_ Permit/License # (l(
Issuing Authority (circle one):
L Board of Health Z Banding Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
`irl. .a 1i r�
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ( Not Applicable ❑
Name of License Holder : /1(1 L'Yl tc.. tin. t' Li; ILE' 7a 6,
License Number
< n 1 d rn o v Po( S ou . ) d tt,tj , & o ra�1 s - a ( - �o /
Address U Expiration Date
0--s36-5,?c5
Sign Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing & Siding, Inc. / c) -- o ff'
Company Name 160 Old Lyman Road Registration Number
South Hadley MA 01075 3 s
Address Expiration Date
Telephone (//
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition [] Replacement Windows Alteration(s) [] Roofing O.
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [M] Other [0]
Brief Descpiption o Proposed
Work: EC.P j r<L ( 47 Q ( e U Gam. 0111/y1(
9 ��l l
Alteration of existing bedroom lr`es No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. 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
VYL
I, � u �7 � A (0 i , as Owner of the subject
property
hereby authorize Adam Qnennevive Roofing & Sidiing, Inc,
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Adam Quayle Roofing & Sing 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.
/ c iLGLt. 4 I,C.Q 1/7 v i /L a
Print Name /f
Signatu er/Agent Date
-0 I
•
cts,
4 .
•
ammo eir 11 I
Department use only
• 9 City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
= Room 100 Water/Well Availability
oEpt uao
Fr°N Northampton, MA 01060 Two Sets of Structural Plans
phone 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 Property Address: This section to be completed by office
b -Q /1� ilUl f l,t� �� Map Lot Unit
etic
, ✓1 {/ � Zone Overlay District
i
if 0 I 1( t in p I Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
-/
t J a-4)14 L p 1U �4 hit�� r ,�d /�ipred ,n�ah� ( 14,4-
Name (Print) Current M g Address:
L (1 f � rr / 2 4/a o
� (fJ se /LL' l6.S- �' Telephone ( ! 5 G6 _, 3 J 1 ii
Signature
2.2 Authorized Agent: / �n
/cki- vn 0(a-rink 1(i ( Ce 0 (� 1G� 1,-t-1 Yritr. ✓� Ic �p • � P . I GQ.
Name (Print) Current Mailing Add s: u
Sign Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (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 9 � /
6. Total = (1 + 2 + 3 + 4 + 5) '5 C O Check Number " 13s
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
■
•
20 LANGWORTHY RD BP- 2012 -0471
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 056 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 -0471
Project # JS- 2012- 000776
Est. Cost: $2485.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 10367.28 Owner: KAPLAN JAMES L & ROBARDS BROOK
Zoning: URA(100)/URB/ Applicant: ADAM QUENNEVILLE
AT: 20 LANGWORTHY RD
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:11/9/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE 2 SQ SHINGLES & RELEAD CHIMNEY
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 11/9/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner