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L\ I D)E6V �/i �$A (uttf cw 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: 4 ,3 Z, t4 5 0`7 ASIAN �Prt15 v.) 26-- H: 4 t3 S Z--;75c1 W: Street Email: '' 1 o ? t 1-T y ni.. r►1 City, State, Zip Code Special Requirements: F l u r e.A7-4. /ILA 0106 L Z 1 rJc: F ©R &. c k Pot 9 ❑ Recover [1St Strip 1 L "I S Complete Roof System [X] We shall acquire all appropriate permits for all work _ C Home exterior and landscaping to be protected [y] Strip existing roofing to existing decking and dispose of. Do not Do. Silo- © Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. 41 Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights © Install (151b. felt / s underlayment over remaining decking area • Install Metal drip edge at eaves and rakes / 5 ") (white /brown /copper) Install manufacturer's starter shingle on all eaves and rake edges BBB © Install new pipe boot flashing (standard /copper) / vents • Install Snow Country or Cobra rolled vent ridge vent Winner of the /// 2010 HA S4-� 1 � ( /'� TORCH AWARD Shingles: ( 6 nails per shingle) GPT Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color Pe-w" ? Y L- L f t Ridge cap shingles Warranty Options: lk We guarantee our workmanship for 10 full years (see our warranty coverage) X 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 i.. ordance with above specifications for the sum of: Total Due ($ 3 0 t ) ACCEPTANCE OF PROPOSAL: The above prices, specif atio' and condition . re Down Payment ($ 3 i 00 ) ■ satisfactory and are hereby accepted. Yo - - au o ized t' do work as spe. tied. Payment will be 1/3 down at start of job, • e e /p, n pietion. Balance Due Upon Completion ($ \ \ \ ) Date: ' Signature: 4 Date: / © Z 6. / / Estimator: (Print Name) SA-r,-) (/(/ - > r I (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. ____ ,,,....111.11.11111....1•111.M.III■maimialM■elmi■Mallmmir r■•■•••••■••or.vmw m ., ■Imm . r . morm The Commonwealth of Massackusear --- Depa tnferit of Irzdrertr ,, ::-..,=„7, ' :.. `` Office of Investigations *-_— 600 Pirashgiorr Street If _ _ Boston, MA 02111 : ,,P- www_rnass.govIda Warkers' Compeusatlon Tnsuran a A$idavit Bra ders/Cout racfor /Eleciriciaus/PM mbers Applicant Information tt Please 'ti[at Levity Name : AokYyl l ttifit'Vt -1/; !Le t�lJoIt�t t' S i r 1i . 1i'tC • Address: i ti U ( t J t-1 ynl An 0. c m ` / S __AT. kfra ' Mif 010 - A ) hone r 3 - C - S5 Are you an employee? Cheek the ap .. s . = bow TYPe of Irolt (requited): I. VI I a@ a employer with i 67 4. [] l am a general contactor and I s have hind the sub-cou acmes 6 - Q Near c shvction. cmpltsyees (full and/or pa time). listed on the attached sheet. 7_ ❑ Rezne?deling 2. ❑ tam a sole proprietor or partner- ship and have no employers . These sub-contractors have S. ❑ DrunoliIion working for me in any capacity_ employees and have workers' camp.. # 4_ ❑ Big addition. LNG workers' comp insurance 5- ❑ We are a corporation and its 14.0 EEleddcal repairs or additions 3_ 0 1 am a homeowner doing all work have c�oetaisod 1 LIJ Pha�mg repairs or actions - myself. NO humaaux napixed-1 1 12 Roofru pairs f G 1 52. §I(4� said we have no 13 -0 Other empbyees- workers' comp- insurance winked.] `Airy applicant that checks basil matt also iiU out tbcsa$on Wow showipg thartvorbas comp to psiky inisnuatice. t Eions who submit Iltik et5dev c they ate drag ail work sad thee him outside conirectom mast xa i mitnnew affidavit O r avcb. rCostrastu toad &sac this but must siIss'sed as sddisiaasd shoot t show - rg the NUM oftha and siaacIdaciher armada= des have anployec. If are stibmemactras bare eoatuloyoes they nastptovide their wockmi comp. pore, aemabcc Ian an employer that ispravha&ng medics' compensation iirsurtnwefor ray =ploy= Blow is the parley amijob site nsfarnatiorc instraact Company Name: A 1'Yl u h /Li - i n Si t rat n es._ polic it or selims. Lir ti A tU e r1 b t lit, ll) 1 Expiudion Patm LI - a q JO 1 a Job Site Address: /V / 1il u t ( roe - rO(Le 1 I t y : 6. lo (o 9_ Alta ch a copy of the workers' compensation policy declaration page (showing the pel y utu4anber and expiration date). Failure to Beane coverage as grad under Sir li= ofMGL c. 152 can lead to the imposition of l paiahics of a fee up to 51,500 .00 =War one-year iminisonment, as well as cif penaltirs is the &an *fa STOP WORK ORDER. and a fine ofvp to $250.00 a. day against the violator Be advised that a copy of this statement maybe forwarded to the Office of Inv aaos ofthe DIA for insurance image verification. 1 do hereby G rtij' ander the p� and penalties afperjray that the infonno ion provided above is flue arsd correct_ D a m k - - 1 11 Pbone#: t 3-cb6-69SS . , a .„- - 'N only_ Do t dva archer its ams r Obis c i• '" ba "" j j cif), or tt, Q4o�$[ City or Town_ PermitiLicr ase # Issuing Authority (circle ore): L Board of Health L Sanding Department 3. City/Towa Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other . Contact Person: ?bone ____ SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 1� i, y1 Acapii4 i) i PLe License Number (A, n 1d C j m 0 , A. Po( �O'u i )Ird£LL e -off(- do Address Expiration Date Lit Sign V y� Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Qnenneviile Roofing& Siding, Inc, 1,3e ? Company Name 160 ad Lyman Road Registration Number Address South Hadley, MA 01075 3 S - ae Expiration Date Telephone 4 5 x - 9/55 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 j< 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 -vear 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..iiiimMIINIMMili=1.0.11MilliMINMINIIIIMIONNINIMMIlnii SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [] Addition ❑ Replacement Windows Alteration(s) [J Roofing ta Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [CI] Other [0J Brief De r'i►,pPtion of Proposeq n n Work: ` j`t 1! I % 7 v x ! S i t n e Q l (12-4u a?�Q4 ' 1 y f C �U? G� Q£. # �� 'ma "Ir J 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 1, / 4 I (Q 4] L LL `� 7 n , as Owner of the subject property (� Roofing hereby authorize Adam *nude Roofing & Siding, In to act on my behalf, in all matters relative to work authorized by this building permit application. e 004-racfjvu:.los4'd II_- If- '1 Signature of Owner Date Adam Queue* Roofing & SIding,1I 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(tL l,Yi. 1.C2 G112/21/ i /Le Print Name / / -(g_ ► Signatu r /Agent Date • ECEIVED Ci of Northampton Status of Permit Department use only B 'Wing Department Curb Cut/Driveway Permit NOV 9 20L1 12 Main Street Sewer /Septic Availability Room 100 Water/Well Availability ort ampton, MA 01060 Two Sets of Structural Plans - 7 -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 i h a L Map Lot Unit F.( D r Y1 U AAA o 10 6 9-- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: /I n Ct s ti'v1 ( � C� n �(G't rc - 4- ta-e vi co yt,'A Name (Print) Current Mailing Address: 1) �((3 680- g55`( Ocril tra ( t -e y1 C t 0 S d Telephone Signature 2.2 Authorized Agent: � vn C u.ito ink Vi t L,e._ con 61ct bIrna✓t 2 . 50. f dLt i 7itc Name (Print) Current Mailing Add s: Lam_ LIP7- S36- Sign Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 1 Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 13 CJ o (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) /3 G f , G 0 Check Number dr � ' 1 . 4- This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date _____ .,,mmilleourrurrrommummormannuir marrimirmr..ft immierrismum• ... ,.. 76 PLATINUM CIR BP- 2012 -0522 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 240 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 -0522 Project # JS -2012- 000872 Est. Cost: $13015.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 36546.84 Owner: BAUSTIN ALLAN P & BARBARA E THOMPSON Zoning: SR(100) //WSP Applicant: ADAM QUENNEVILLE AT: 76 PLATINUM CIR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:11/29/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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 11/29/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner