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24D-211
A D ZI-AVi, VISA ea M " { e..e DISCOVER 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 Fully Insured 1.800.NEW ROOF • 41 3.536.5955 u 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: i ;, < i r Street !Email: 0 - a 4 ' City, State, Zip Code Special Requirements: / , C ,. tl / }' } .- 7 i f, f - i'\ : e ,`'. t •,'., t f 3, 't .,(:.„;74.1 !a "V. L j Recover X Strip C Complete Roof System J - /� We shall acquire all appropriate permits for all work ` t, i rI 1 S 6 ,1 Home exterior and landscaping to be protected Strip existing roofing to existing decking and dispose of. Do not Do. Poc f, i - , r <ek_ r =; s � r ,[ Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and slots X, Install (151b. felt (Synth nderlayment over remaining decking area Install Metal drip edge at eaves and rake (8)/ 5 ") (whitk/brown'copper) 6 i N Install manufacturer's starter shingle on all eaves and rake edges BBB x , Install new, pipe boot flashin standar copper) / vents —T— X Inst Snow Cou r Cobra rolled vent ridge vent Winner of the 2010 Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) :0 -' Shingles LJ 25 year 30 year E. 5 0 year Color _I - t , . � � ' "f. �_,_ -- Ridge cap shingles / Warranty Options: We guarantee our workmanship for 10 full years (see our warranty coverage) GAF System Plus warranty [J GAF Golden Pledge warranty Chimney Options: Lead Counter Flashing ) (1 Water Seal & Tuckpoint ❑ Rubberized CrownMetal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ °' 'O . (t!' ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are r ' x - t .., Down Payment ($ _ '`"' ) 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 ($ ' . "`'" '' ° ) Date: E� Signature `/- � .., �.. Date: ` i Estimator: Prltat me t -. -- � ) TT — – i " _ (Sign Name)4 _ Petirnnfec nom hnnnrew-4 i.,r r,vh. IGn\ ,l,,.,.. F........t-.,..... -+- - - - - - -- • •The Commonwealth of Massachusetts Department of Industrial Accidents l hr� : ,r. i ; Office of Investigations 1/41/ 4b,., off:.. h 600 Washington Street =' `vi� Boston, MA 02111 r"'t. www.tnass.gov/dia Workers' Compensation insurance Affidavit Builders/ Contractors /Electricians/Plumbers Applicant Information — _ j Please Print Legibly Name ( Business1Organizaionandividtul): A 36 k OW/ t ' '1/ ; 1 ' del 10 S ( I� .J I e' YW -- i L O 0/C t imam Address: � Cit /State/Zip, S kPati ' (r, A 0107—Phone #: '(r ' - S ` Are you an employer? Check the approp .. to boz Type of project (required): 1.VIIama employer with t 4. ❑ 1 am a general contractor and I 6. ❑ New construction employers (full and/or part time).* have hired the sub-contractors 2. ti I am a sole proprietor or partner- listed on the attached sheet, 7_ [] Remodeling ship and have no employees These sub-contractors have g_ ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp_ insurance comp_ insurance_$ 9 111 Building addition j 5_ [] we are a corporation and its 1 -❑ Electrical repairs or additions 3. [II I am ahomeowner doing all work officers have exercised their Ill] Plumbing repairs or additions myself [No workers' comp_ right of exemption per MGL 12.14 repairs c.. 152, 1 4 and we have no insurance required.] t employees. [No workers' 13_[1 Other comp_ insurance required] *Any applicant that cheeks box erg 1 must also fill out the soon below showing their workers' compensation policy information - t Homeowners who submit this a$davit indicating they are doing all wok and then hire outside contractors trust submit a new affidavit indicating such_ IContractors that check this box most attached an additional sheet showing the name of the sub- contradms and skate whether or not those entities have employees. If the sub - contractors have enrpkoyoa, they must provide their works' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site info rnrafiott. Insrz-ance Company Name: A W I I ` M C / ! t t tll(J nSLt Ya it C Policy # ! i or Self -ins. Lic. #: t '1v1 . - (p IL) I Expiration Date: - 'a q -') 6 f 'o� Job Site Address: d - 0 S i CCt t - JA t` ' * Ctfy/Stnte/Zip:i Ck 014 O ( 0 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required ruder Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fine up to $1,500-00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Bc advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un der the pairzs and penaftie-s of perjury that the information provided above is true and correct. Signature: Y7A-'[.- - - - -- Date: [ 2 ' lo- i [ Phone #: `t 1 3� r) .-- 4 ,, -. 5Se Official use only_ Do not write in this area, w be comptded by city or town official � � City or Town: _ Permit/License # Issuing Authority (circle one): 1_ Board of Health 2_ Building Department 3_ City/Towu Clerk 4. Electrical Inspector 5_ Plumbing inspector 6. Other Contact Person: Phone #_ ._.- _.... -.._ 'OMR A/ it loos toi rousti Bosc yqgti Amr,. tor,. Pq, 01112 If0 rwiu i i;(01,lier. SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Not Applicable ❑ �" Name of License Holder : Ma e dk " a p"""b & Inc. 140 Old Lya* Road License Number Address r 111!1 WS Expiration Date +t3 S�t� -SgSS Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ A `�' "'b� ennevile Roofing & Siding, INC. /0 Company Name Registration Number 164 Old Lyman Reed 3/ d s /,90/.9 Address Sontk Hadky, MA 01075 Expiration Date Telephone 1 4i 345 cA 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 Ortg0C.?yf KOOTI '47; SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing 2g Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [E] Decks [0 Siding [0] Other [0] Brief Description of Proposed Work: Ai) \cl� Nt i) T■r '■vnitt 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, `_J C)i I}'1 k 1 /J k $ k l , as Owner of the subject property '" ° hereby authorize Alum 0i Sidin Inc. to act on my behalf, in all ma�fers r elative to wo auth ized by s building permit application. ` ;.t=L ' ;r', _R_ /ALIO ( - /0 - 1 Signature of Owner Date Ads Qum& Rig & 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 e l C_} ) Z 0 1 1 Signature o n dr /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved - parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® ,Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1- [ I] Department use only RE,CEIV D City of Northampton Status of Permit: �"�� Building Department Curb Cut/Driveway Permit a 2011 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability, Northampton, MA 01060 Two Sets of Structural Plans - ; - cr - i ': ", ne . 13 - 1240 Fax 413 587 - 1272 Plot/Site Plans „� iil ALN y '1 Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: q This section to be completed by office p 350 SAC>,-�e SkctQi Map Lot Unit Mori hcmMpt-cn '(mac: 0 \C L Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: h Ci vkOr c'Cx a50 Sictte S -4rek Name (Print) Current Mailing Address: c . _/ L1 t3 ��) — 121 o-� Crfi4 (C f -e n U ose d Telephone Signature 2.2 Authorized Agent: Adam Qlienneville Roofing & Siding, Inc, N), -),6 uy(Y\c, t\ c.∎ ..(.`\.Q mc, \t 1 Name (Print) Current Mailing Address. /i/)L..2.- LA \3 — -)3� — �Ss Signatufe Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Q+ C\ , ')C.-,-- (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) 'SCA ) �C Check Number r2) t 7 035 This Section For Official Use Only Building Permit Number: I s g Issued: Signature: Building Commissioner /Inspector of Buildings Date 250 STATE ST BP- 2011 -1057 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D - 211 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit # BP- 2011 -1057 Project # JS- 2011- 001701 Est. Cost: $9000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 7666.56 Owner: SKIBISKI JOHN F REALTY PARTNERSHIP Zoning: URC(100)/ Applicant: ADAM QUENNEVILLE AT: 250 STATE ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON: 6/16/2011 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 6/16/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner