30B-049 Lam, ./\ VISA el Carti: , CArd DISC•VER
Q U 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 • 413.536.5955 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
rProposal Submitted To: Date Phone #'s C: 413-775- d5q•
L fin" ''tnt&q �
( o1'a.tl H: `i t3 -41is- aL15(� W: I
Street Email:
City, State, Zip Code Special Requirements:
C �Oi^^ie. Mc, SIGC� am-e aa-e O C- It Oil!
Recover F4ip I. toltif ` S1/4.0Ae.. G uw, FS' ex- Oc.A,C- ` ..An 1 in
hick yid
C9mplete Roof System
shall acquire all appropriate permits for all work
We
Home exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose of. Do not Do.
��"�D'' eteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
II stall Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
Cr Install (151b. fe / S nt etic underlayment over remaining decking area
LJ Install Metal drip edge at eaves and rake/ 5" (e- `•rown /copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
stall new pipe boot flashing.iandar copper) / vents —T—
Instal now Country r Cobra rolled vent ridge vent Winner of the
2010
LI Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
= 'Q' \*r ye.-1 Shingles ❑ 25 year 30 year ❑ 50 year Color re,tJ''O' J�
— _b_� a c-\d, .. - Ridge cap shingles J
Wa my Options:
[_.(We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chjrnney Options:
Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 4:1)3 �13.0 0 )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ 5 l i b\.00 )
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 ($ 1c>, yap. )
Date:_ I6)41 r� Signature: - , 4' int900
Date: ' O I3.� 1 I, t Estimator: (Print Name) M- ` __ (Sign Name) V
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
- - ice Jr: 0,07ce of lnvesstigations
s' Yli: ; , 600 Washington Street '• w '''� Boston, MA 02111 w ww mass govhlia
Workers' Compensation Insurance Affidavit Borders /ContractorsiBlectriciansf1'Iumbers
Applicant Information Please Print Legibly
e
Nam (B A � i tin Ott.M n.L I i t 2 [�Q � 0 fi S � � t n � , 1 �c
Address: (( O 01J i v A n d.
City/Sca rap __ t 'real dl I R A- OIb74P]�ne #:L t 3 - 6 % - 6q SS
' Are you an employer? Check the appropriate bor Type of project (required):
I. Cg I am a esoploycr with 15- 4. 0 1 am a general contractor and I 6. 0 New construction
employees (WI and/or part-time).* have hired the sub- 000tarsots
2. ❑ I am a sole proprietor or partner
listed. on the star-bed sheet. 7 - ❑ Remtto delin
ship and have no employees These sub- contractors have S. 0 Demolition
working fear me in any capacity. employes and have workers' 9. [] Building addition
[No workers' comp. insmaoce "0i'. ms x,t
ed) 5. 0 We are a corporation and its IMO Electrical repairs or additions
requir
3. ❑ 1 mu a h anecraner doing all wcdc officers have exercised their ILO Phrmbmg s or additions
right of exemption per MGL repairs
myself [No viorkers' comp. insurance 1 t c. 152, §1(4), and we have no
i f
op [No ' IAA Other
comp. insmaoce required.) .
'Airy applinat that checks box dI mud also fill out the section Wow showing their woricrs' compensation paw Venation_
t Homeowners who submit this affidavit intro: 1 they aen doing all nook and dice hire outside motzacmsts smut sabeoit anew affidavit indicating such
CContsastois that check this box use alt udied m additheal shoat showing the name of the mb•aordndans and stab whether or not those whin lave
cmployoa. If the sub-contractors hence maployers, thtq rant provide their wackcie comp- policy se obea.
F eem an employer that is proviemg workrrs' compensation $ uvrence for my employees` Below is the policy acrd Job site
isgrorntaliotc
rnscnance Company Name: AIM m tttLt J "I n set ra n cu . p
Policy # TI or Self -ins. Lic. #: C r i !) t a,k 2,k6 /U 1 Expiration Ate: - 9 l j o i a
Job Site Address: iqq 1 J. I
( i d. l - iv-0, l o r-e n e (ty/St/d /Ztp: /144 o l l) 6 --
Attach a copy of the workers' compensation policy declaration pogo (showing the policy camber and expiration ation date).
Failure to secure coverage as required trade' Section 25A of MGL c. 152 can lead to ihes imposithe of criminal penalties of a
fine up to $ 1,500.00 and/or one -year imprisonment, as well as civil penalties in t1Ze form of a STOP WORK ORDER and a far.
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.
1 do herby cer 5' prw:,s antI penalties ofpe]wy that the informeron provided above is true and correct
Sjgnerist e: r Date: / / - q - / i
Phone #: L I 1 ' �- G -S el S.c
L fri,.l rest only- Do not write or this are% to be completed b cii p or taws official
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 #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
jj��
Name of License Holder : MA& uYI IL2 t I VLF' 7o i
License Number
/ (o n 1d " J yn ty. � � � j o u f � i ) d Ce v I V i m . o! s - a r -
Address Expiration Date
-- 536 - 5955
Sign , Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Quennevife Roofing& Siding, Inc, lc2le Fe
Company Name 160 Old Lyman Road Registration Number
Address South Hadley MA 01075 Expiration Date 5 �O 1
Telephone o f / 3 y 34 - c`i.c
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 108.33.1.
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
M M
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing El
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EJ Siding [0] Other [01
Brief Description of Proposed
Work: 1 ) *: kit) CR.& I(J4 r 6 fs/a + n5 ra i 3 t )ha 1f 4-4Fi ct rato .1
Alteration of existing bedroom Yes 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
I
i---1 al a V) 2 ktL , 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.
Sk
Cot fut c-t ..e vt C 105-4 II q —
Signature of Owner Date
I, Adam Quenelle Roofing & Siding, Inc, 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.
Print Name
Signatu er /Agent Date
4
�±. �� � k
i
,,
v v.- ``''FD
Department use only
\ TO City of Northampton Status of Permit
y , 5 : uilding Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
�014G "t oA°6o Room 100 Water/Well Availability
•o �°" 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
) C, ej k) V -e r S id - e � t l la- Map Lot Unit
F (0 { . � G2 o i U lc Z Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
1.-(1 n i 111 a ri c /16. 14 i v-t rs i L _ fir. - rya (-e vi , rvl4-
Name.Print) Current Mailin Address:
y
t1-6 i6_61 di0Pd
5 C 6)1 C Cl .e /t 0 S Telephone
Signature
2.2 Authorized Agent:
,4c1le vn r tlin vtn. d (t.e.. (Go blci bi matn a 50. d(ut 1 7140
Name (Print) Current Mailing Add
LIP? C36 -sas
Sign Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /6/58.3.0 (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) 11 3 , 6C) Check Number 6a3S I 5 �
This Section For Official Use Only l
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
199 RIVERSIDE DR ' BP- 2012 -0488
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30B - 049 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-2012-0488
Project # JS- 2012 - 000819
Est. Cost: $16383.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft): 4791.60 Owner: MANCHA LYNN
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 199 RIVERSIDE DR
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:11/17/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP SLATE & SHIINGLE 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 11/17/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner