17A-047 /\l D)
PISA master � 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
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 Horne Builder's Association of Western Mass. CT Registration #575920
Member of the Building & Trade Association P.P.C. 38710
Proposal Submitted To: Date Ptione #'s C:
(9/ 5,
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Street Email:
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City, State, Zip Code Special Requirements: (11.(
(CIA1 t MA- 6 (C -- � - 7 , Z?- i 71.i}7C /j _/
CG' � LA` !- Z
2 e 6A41 e
❑ Recover .Strip .Layers 1 4 ' / - A" - "F Ac " --12-- ( „ ='G
( ,. .
Complete Roof System
)2 We shall acquire all appropriate permits for all work No i SQL " / Cvr-- 64 WM.
t g, Home exterior and landscaping to be protected
191 Strip existing roofing to existing decking and dispose of. Do not Do.
Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. V ,
f% Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and is -- rr, ' FULL. CC -
Install (151b. fe Synthetic) nderlayment over remaining decking area 1 r IA) . /?tV 2 --
le Install Metal drip ed ` eaves and rake (8” 5 ") white brown /copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
Install new • i • e boot flashing st nda pper) / vents .......T._
___.
fyllbstal . ow Country • r Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper • - it ventilation A.Z% TORCH AWARD
Shingles: ( 6 nails per shingle) ` f
'171 ' ` ..1- -fr Shingles ❑ 25 year ar [l] 50 year Color F� C� JLL&
i c `4( ?C Ridge cap shingles 1 r - f 4 - - C=' t wf
Warranty Options:
❑ We guarantee our workmanship for 10 full years (see our warranty coverage)
17 GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
ead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 1 - 7 (F? Li )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ Li 2_S S --- )
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 u n completion. Balance Due Upon Completion ($ `� Y/ )
Date : /`f 1 Signature. • • , � - ° ~ --�' • " r •
Date: j l0 /7 - Estimat r: Print Name)
��. ( ) i L�'� (S ign Name) ti.-
Estimate ar 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 oflidassachusear
Department of Industrial Accidents
1 c, , ,-_ O ffice of Investigations
b �l�'= 600 Washington Street .
`• t ° `' Boston, MA 02111
' : .U� wwn mass.govldia
Workers' Compensation Insurance Affidavit Builders/ CoafarartforslElecfriciaus /PIumbers
Applicant Information PIease Print Legibly
Name (B : A del Wl atm m...)! : 1 44 An t Si j el L -�- vie,
•
Address: I Le O ( 2 J tij M A P1 4/
cityistairiLIp: 5aM4 kh /A /AA oio 6phnne #:_ f l 3 _ C V -515
Are
you an emploryer? Check the appro to boX Type of project (required):
I. rg I am a employer veith (5-7 4. Q I rut a general contraebr and I 6_ ❑ New construction
employees (bull and/or part-time).* have hired the S coatracnors
listed on the attached shed 7. Q Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees
These sub-contractors have g- Q Dcmolibon
working fix me in any capacity. employees and have workers' 9_ [1 Building addition
[No workers' comp_ insurance- t
ker
required-) 5. 0 We are a amporation and its 10.0 Electrical rtes or additions
officers have =excised their
3. Q I am a homeowner doing all works 1 I- Phrmbing repairs or additions
myscLt No wows' comp. right of exemption par Mg.
insurance l'med-J 1 c. 152, §1(4), and we have no 12 Roof repairs
employees [No weaken' 13.0 Other
_ gyp- -]
Any applicant that checks boot ii 1 mast also Sl1 out the section below showing their workers' compensation policy information_
t Homeowners who submit this affidavit i addieaing they arc doing all work and tarn bite outside co*traeo Cie mast submit a new affidavit indicating such.
rcontractors that check this bat mast attached an addi0onal sheet showing dm rime of the w and ate what= or nor those ratites have
employees. If the sub.contractehs have employees. they most provide their wed era' comp, policy number.
I am an employer that isprvvidurg workers' compensation insurancefor my unployeex Below is the policy =JIM, site
inforroonO n.
Insurance Company Name: AIM m m toad - In Su ra n e...L
Polic # or Self-ins. Lis #: ft we, 17 t 1 l k ( 101 Expiration Dom: i l l - N9 6 13
Job Site Address: ♦ ! l j t _ lal- ' 1 � ( `D--- V I C.Q- � iylSiEtle/7 -rP: rm.- 0 10 ‘, 9--
Attach a copy of the workers' , -, -- time policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 2SA of MGL c.. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be ibrwardcd to the Offer of
Investigations of the DIA for insurance coverage verification_
I do hereby comfy under the parrs undpenafies ofperjury that the information provided above is true and correct
sjgnatlue: : 6 q --) ;
Phone #: `I 1 3 6 -6 S
-
Official use only- Do not rusk zn ikis ram, to be wmplded bP ty c or toms ofe hrf
City or Town: Permit/License #
Issuing Authority (circle one):
L Board of Health 2 - Building Department 1 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 ❑
Name of License Holder : a (4 i l (.4.,2 6'1 VI.P L/ I � 7" e
License Number
Pilo MC - ,c2rt ozl. )I d U I Lk0! 1S e -a t- ao
Address Expiration Date
� ��lit%
Sign , Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Qnennevile Roofing& Siding, Inc. /d-o
Company Name 160 Old Lyman Road Registration Number
South Badly NIA 01075 3 -- a s- �a 1 44
Address Expiration Date
Telephone if /3 5 -5
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 1 1 Roofing Eg
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[D Siding [0] Other [CA
Brief Description of Proposed 511AP . X I t`16,5 3 6"....,:r` rS ° 'Ii-' 145 l ° S 6r1"`-.1) d t i- 5 f a ) 0A- -L ( : -- q Q,t.4
Work: ± Olt Lf ,(.t pit t1 0-?/uhf f1 1-n 54a_ t I )u,c �r G� - (f 4- ' 5y S ,Qyx. ,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa. 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 stones?
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, ,�'f' u_ -e (-en 1 rn r as Owner of the subject
property
hereby authorize Adam Qnenneville Roofing & Siding, Inc,
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Adam Qaenneviae 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.
f cltL t-yi 4 / Le V f /tie
Print Name
Signs /Agent Date
Department use only
R E C r 4VE D C' of Northampton Status of Permit
Bu ding Department Curb Cut/Driveway Permit
1 4 a! 12 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
► • rt mpton, MA 01060 Two Sets of Structural Plans
DEPT. OF BUILDIAMTos3 -5 -1240 Fax 413 - 587 -1272 Plot/Site Plans
NORTHAMPT
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
Map Lot Unit
F (01( 1,1 Ce M O 1 Q 6 �` �] Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
aiza v FI-e en ri ( n\ F[ar -nc
Name (Print) Current Maili d h t O / r,
)-0 -4-g_ Telephone
Signature
2.2 Authorized Agent: f J t� �' C
Acid. v n n i War) tl i i L C Ca o t) /ct bi rncult 2. • JD.
Name (Print) Current Mailing Add s:
t i(?) - S36
Sign Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /I / � ri 6 (a) Building Permit Fee
2. Electrical r 0 c o l! r . 0 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Budding Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 1 61, r 1 tC 6.0 0 Check Number (Y
This Section For Official Use Only r �
Permit Number. Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
ap
168 BRIDGE RD B P- 2012 -0993
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A - 047 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 -0993
Project # JS- 2012- 001717
Est. Cost: $12766.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 11107.80 Owner: FLEGENHEIMER JEAN
Zoning: RI(100)/URA(100)/ Applicant: ADAM QUENNEVILLE
AT: 168 BRIDGE RD
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:5/14/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE HOUSE & 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 5/14/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner