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Q V EN NEVI L L E www.1800newroof.net
ROOFING 1r SIDING 1r 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
Proposal Submitted To: Date Phone #'s C:
5 �nA t<�� t re\ e { o c (8 / ✓t H:( y,3) -5 Y- 3coZ 7 W:
Street Email:
City, State, Zip Code Sp ecial Requirements:
!✓w ; F�s.r��i✓ M� ((ie' 6 • t(:f .,<e S
.. -
❑ Recover N Strip
Complete Roof System
LS We shall acquire all appropriate permits for all work
a Home exterior and landscaping to be protected
• Strip existing roofing to existing decking and dispose of. Do not Do. 6`' 'L ' _ f n<<<N{ 5
[ Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
• Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
Install (151b. felt / (5mthetic,) underlayment over remaining decking area
E'S Install Metal drip edge at eaves and rake .8'''/ 5" hite /brown /copper)
6
• Install manufacturer's starter shingle on all eaves and rake edges BBB
• Install new pipe boot flashing (standard/copper) / vents —'—
J Instalt`Snow Country Qr Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
`i ._ —. - Shingles ❑ 25 year LJ 30 year 50 year Color
CA C Ridge cap shingles
Warranty Options:
• We guarantee our workmanship for 10 full years (see our warranty coverage)
• GAF System Plus warranty
r___; GAF Golden Pledge warranty
Chimney Options:
LI Lead Counter Flashing ❑ Water Seal & Tuckpoint LI Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 9'0 Ct
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ 3 000
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 ($ G 0 6 0
Date: /// _ Signature��_
Date: /r / e b" /l( - - Esti .-:: (Print Na Le., � �� � �� (Sign Name) _!�_ '��� Z ✓
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 Canunorcweatth ofblassachresetfr
Departtnent of lndustria'Accidents
,• I ' - •: Office oflnvestiga tnrrs
_-7 600 Washington Street
'� Boston, MA 02111
:_ i f:. J� ` mar gm I&a
Workers' Compensation Insurance Affidavit Builders /Coat racburslEleettici uusfPIumbers
Applicant XUforrnra€ion - PIease Print Le i bhr
Name pusiacssiorgaaizalionfincrviduito: A l t on. ORM n.x -11: I t2 OYi el t Sr v j Y►. . E - yi C
Addiess: 1 (jO 01J G vna an 4I.
cit , 5 1'A- O1074hone #: I 3 - C VE -61 S �
Are you an employe? Cheek the apjn op i = box Type of psojeet (mired):
1. tr,g lam a employer with j gr 4. 0 I am a geauaal contractor and I
have hired the sub-contract= 5 ❑ Nt ar °ons6nr an
emPIDY ((fall and/or part -imu). s listed on the attached sheet 7 ❑ Remodeling'
2. ❑ lam a sole proprietor or part cr
ship arid have no onployees . These sub- contractors have B. o Demolition
working far me in employees and have workers'
ot�ag any Y- 9 - Q Building i t
comp- insurance.*
No workers' comp_ imam=
5. Q We arc a corporation and its MD Blediiea1 repairs or additions
3. Q 1 ama a homeowner doing all wore of eaa�tioazper 101131. 1 LQ additions
3.
r workers' camp- 1S 11(41) = no l3 n f rapai>S
employees_ WO austere
amp insurance required]
'Any applicant that desitc Until mist ako fill act t action below showing theirs compel:cation policy iodornotion,
t Hammon moett who sabaltthis efedrol info:d ig they are doing aJI coat and du Tae °abide come e= mast submit anew aads&R Indi:din
= Contracma that chock this ba c nest armed an additiosei slroetslowing the acme oftbe sab-coonaelocs and stac 'abed= oraottb°se eadd s bane
em bra& Vibe sabcordnottas lave emepl yeas, day oast ramble their *vibes* comp. pore member
f any an employer that &providing worlds' compensation l asuraacefor ray a ployee & Below is thepofirey and job site
n jo„rrario.L
mecca e c Company Name: R T M m /.41 - 1 r1 SEA ra M LL
Policy# orSepias.Lic.#: Pr1V C qt.] 2kL lo E - 1 f Q)A
Job Site Address: l g 8 E a r `e r /` '
Attach a copy of the workers' compensation panty declaration on page (showing the porcy comber and eapitac ion date).
Failure to secure coverage as leepired under Section 2SA of M431. s~ 152 can lead to of 1 peaabies of a
E up to S 1.SOO.00 and/or one -yew imprisonment, as wan as civil penalties in the flume *fa STOP WORK ORDER and a fee
of up to $250.00 a day agamstthe viobmor. Be advised that a copy of this statement maybe forwarded to the Offie a of
Inver ofthe DIA for insmance covciage verification_
I do hereby certify Corder the painr and pertaltin' ofpe jroy Otolthe information provided above is true and corm
f
Signa ua: 14-'1' Dar 11- 30 ii
?hone #: q 13- 5
comace rccc oRl Do ..or ...a. iii :hi. @.. to ba wmpicerret by city or Iowa official
City or Town: Permit/License #
Issuing Authority (rirde one),
1.. Board of Health 2. Building Department 3. City/Town Clerk 4. ElcctricsI Inspector 5. plumbing f tspector
6.Other
Contact Person: Phone ik
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: J Not Applicable ❑
n
Name of License Holder : ark LYI OW ti j tl.Q 70 t`
License Number
PAO 1 d yy ik 2 cX �j ou.fM ) id ,wit& O! 1 c (- d o 1
Address Expiration Date
-- 536 — S9C 5
Sign i Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofmg & Siding, Inc, Igo
Company Name 160 Old Lyman Road Registration Number
Address
South Hadley MA 01075 Expiration ate 5 _ a 1
Telephone `f/ 3" 5 .Y.a - S - 15 - 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 108.3.5.1.
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
p
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing f
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0]
Brief Description of Propose d ) _
Work: „ f7'_ l p ' X 15 h 4t ? d7 l Le (4f f 6 ,' tit ✓f �fi %� S f � 11A, /Lt✓ �l) sJ A
J LYE .
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, �_/6{} //Icol r3t L asOwnerofthesubject
property
hereby authorize Ado Quenneville Roofing & Siding, Inc,
to act on my behalf, in all matters relative to work authorized by this building permit application.
S _ Co) 11ac -f 1/ 11
Signature of Owner Date
Ads Quenelle Roofing & Siding,InG 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.
A Cia-14/1 t 1 i;7bLeV r 1Le
Print Name
Signatu er /Agent Date
4 N
L
., ., • � Department use only
L RECEIVED , City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
_ 2011 212 Main Street Sewer /Septic Availability
DEC VG Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
QF 8 N oRTZAFrok tDING 41,3-587-1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
eei Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
J vZaM art t _ a uI ivte, 9UU, A 1 " Qr ie t - No H1t1krr)fVl MA oIO6G
1
Name (Print) Current Mailing Ad ress:
Set Ca i /-r c * `E A C' to J-P e( Telephone
Signature
2.2 Authorized Agent:
Acid- vn Cia v u All uennevi 1e Roofing & Siding, Inc. t 6 o Oict b, ,,,,„L, f . So. t w(.ttt , -3,14(_
Name (Print) Current Mailing Address:
f� Li z___ t ire - C36 -51S5 .""
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS `
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1 q 1 0 6 ) 0 G (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) $ (1 0U Check Number 0 7, 2 7_9 $3,5
This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
,
188 EARLE ST BP-2012-0539
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A - 065 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 -0539
Project # JS- 2012 - 000899
Est. Cost: $9060.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 10802.88 Owner: YOURGA JONATHAN & PAULINE PARKER
Zoning: SI(97)/URC(3)/ Applicant: ADAM QUENNEVILLE
AT: 188 EARLE ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:12/1/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: STRI P & 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 12/1/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner