38D-042 LAS! D) r--
VISA Master.) r DISCOVER
Q U E N N E V 1 L L E www.1800newroof.net
ROOFING V SIDING 'V WINDOWS We Are Licensed
160 Old Lyman Road • South Hadley, MA 01075 F Insured
1.800.NEW ROOF • 413.536.5955 y
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:
eccc,. je ilaslii H: 05 - 0511, W:
Street Email:
3S 110..\tw Ave
City, State, Zip Code Special Requirements:
{ I
il}0<lketmlikOrr (Y )4 - 010LO (3(.6,::,c,\ U( Ne.13116cj csm Cen • ; !
❑ Recover X.,qtrip 1 L ), (
Complete Roof System
)We shall acquire all appropriate permits for all work —
a Home exterior and landscaping to be protected
1 Strip existing roofing to existing decking and dispose of. Do not Do.
Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
Install (Water Barrier at all eaves, valleys, chimneys, pipes and skylights
gf Instalk(151b. felt Synthetic) underlayment over remaining decking area
Install Me a rip edge at eaves and rakes (8" / 5) (white brown /copper) o
Install manufacturer's starter shingle on all eaves and rake edges BBB
❑ • _ _ , • • 1 • _ - _ . . -; - . - - - t Winner of the
2010
• I • es- _ _ - - - TORCH AWARD
Shingles: ( 6 nails per shingle) r
(-=4 r Shingles 111 25 year 30 year ❑ 50 year Color 149C;(...) f cr 6 r
GA t 4w - ( ',,, Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
'Ilk Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifi io for the sum of: Total Due ($ p .00 )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ O 50 .00 )
satisfactory and are hereby accepted. You are authorized to do work as specified. 1 �-� i
Payment will be 1/3 down at start of job, and balance due on completion. Balance Due Upon Completion ($ 1 (a S .Oa )
Date: 11 )8f I I Signature:- `--
Date: 1 /JBj 11 Estimator: (Print Name) _ 5 Se d let (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
.1 :� Office of Investigations
=3,iikS 600 Washington Street
�:'(.'� Boston, MA 02111
'= ry,...: www ttwss_govfdia
Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Ad Qu:erine_v� I!. +1�OSl t S(Vin) 1 1�a
Name (B '
Address: 1 (.e O (2l J l - v ►? et n 4 • '
City/Siate/Z ip: Scik-141 t_tL � A- O /O74hone #k: L 1 3 - - 5 3 i CC
Are you an employer? Check the approp to box Type of project (required):
1. DI [am a employer with rj 4. 0 1 am a general contractor and I
employees (Silt and/or part-time).* have hired the sub - contractors 6_ ❑ New construction
listed on the attached sheet 7- ❑ Ramodcling
2. Q Lam a sole proprietor or partner-
ship and have no employees . sub - contractors have S. 0 Demolition
w for me employees and have workers'
orking any rapacity. 9. 0 Building addition
[No workers' comp_ insurance camp_ insu ante t
5_ 0 We are a corporation and its 10 -0 Electrical repairs or additions
officers have axe cised their 11.
3. ❑ L am a hDiriWwncr doing all work ❑ Pltmibirug repairs or additions
myself. [No workers' comp_ right of exemption per MGL 12-ja Roof repairs
insurance required-I t c. 152, §1(4), and we have no j Q Others
employ- [No workers
comp- insurance required.]
*Any applicant that cheek box NI mud also fill out the section below showing their workers' conmensation policy lobo nathn_
f Homeowocrs who submit this affidavit indica ing they ale doing all work and then hire outside matadors mud submit anew af5davt indicating such_
IContradots that drear this box mast attsched an additional sheet sliming the name of the sub- contractors and stale whet= or not those atities have
employees. If the subcontradors have employees, they must provide their workers' comp. policy number.
I anz an employer that is providing workers' con penwfion insurance for my employees. Bellow is the policy curd job site
information
I n s u r a n c e C o m p a n y Name: ATM M u tual i n Su. Y'(X ii el_
Policy # or Self -ins. Lie. #: Pr W C O 1 I ( /01 Expiration pate: - VI' ' a 01 at
Job Site Address: 2) t (t O kJ n/ of f htirela. o i city/state/4: MA solo 6 o
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to seam coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year inTrisomnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be tbrwarded to the Office of
Investigations of the DIA for insurance coverage verification_
I do hereby ceay7f' under thepains and penatties of perjury that the informatiari proved above is lure and correct
Signature: / �L Date: '1 " q t I
Phone #: q i 3 - 6 -Sq 5'S'
Official use only. Do not write in this area, to be completed by city or town 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 1t
F>fi li; Wit AI
Ctlf
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Adapt, i/) t unne l /v 6
License Number
(Cta 0 (d rna v>_ f6(1 . ( Oct M e al- aid/3
Address 1 , 97 ( Expiration Date
(3- 6 5 CS
Signat Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing & Siding, Inc. / pa q e .-
Company Name 168 (Rd Lyman Road
Registration Number
South Hadley, MA 01075 3-.35 a o / 0--
Address Expiration Date
Telephone L P 3 G 5955
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 X No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 buildine 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
611 ptifitt 'MO:* ipt
0 11 IF MO Pr
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) EJ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [C] Siding [ID] Other [CI]
Brief Description of Proposed,
Work: gxieA -I t5 bnt (ear n-4 3a rCtl T rbQ - Q _Curti i f ShInS1f'
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
R e ) 2 CL o Glt-o t. N , as Owner of the subject
property �� jr.
hereby authorize Ads Quaint ` Q �� ag& lit
to act on my behalf, in all matters relative to work authorized by this building permit application.
She ConTh'- C f eae(o s -e
Signatur Owner Date
I, Adam & , as Owner /Authorized
Agent hereby declare that the s atements 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.
Adam A (1,(eu evclle
Print Name
Signat f Owner /Agent Date
RECEN Department use only
City of Northampton Status of Pe
Q 20`ti Building Department Permit:
Curb C o Pe veway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
0�r oc suuDiNO o o�sooNS 1, • rthampton, MA 01060 Two Sets of Structural Plans
"" p one 413 - 587 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH c'fl 6R MAN A DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
38 1-4Zt-r I ow Map Lot Unit
N 0 (I h a v►y lo n i M A" o i o ID Q Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: ZS
-eb -e000 4- S4 S ckoer (,5o 4(.v_41i3-{bri eve . ?o5-1-6 1 M A..
Name (Print) Current Mailing
..tee coy/ ir'act encl os'eck. one (046 Address:
(a5 I (.
Telephone
Signature
2.2 Authorized Agent:
M A% A, Q t e.nA49 ./ ;1 t e, Ades Q enneville Rig & SidOc " t I; o 0 (,1 L y m a ft 2d
Name (Print) Current Mailing Address
57,6-5 ss So l-iad( , MA otoos
Signa ure Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
•
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ¢I Ac 38, b0 (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) ?6?)e. 6 Check Number (21/ g1
This Section For Official Use Only
Building Permit Number: I sssuu
ed:
Signature:
Building Commissioner /Inspector of Buildings Date
38 HARLOW AVE BP- 2012 -0143
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38D - 042 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 -0143
Project # JS- 2012 - 000209
Est. Cost: $2538.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 5706.36 Owner: SCHOEN STEPHANIE COOPER
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 38 HARLOW AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON: 8/4/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE GARAGE 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 8/4/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner