32C-239 Roy S. Brown Architects
85 Chilson Road - Wilbraham, Massachusetts 01095
Phone 413.596.2360 Fax 413.596.2360
Email: rsba85 @yahoo.com
•
JUN h, 1
DE F sui
6/8/2012 N� �rHar ✓ � �n���
01060
City of Northampton
Department of Building Inspections
212 Main Street, Municipal Building
Northampton, MA 01060
Re: Controlled Construction
Dear Inspector:
I request that you grant a modification to waive the requirement for controlled
construction for the replacement roofing project at #1 to #23 Eastern Avenue, because
the work is so minor in nature, will not affect health, accessibility, life, fire safety or
structural capacity. It is impractical in that the cost of the control would be considerable
when compared to the cost of the proposed work. Thank you in advance for
considering this waiver.
//74sL—
Roy S. Brown
The Commonwealth of Massachusetts
09 Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass. 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information & Please Print Legibly
Name (Business /Organization /Individual) : Adam Quenneville Roofing & Siding, Inc.
Address: 1 IP 0 0 l c L j rvi v R o a c�
City /State /Z tl Zt G l -Q Phone #: 4 l 3 ' - ` 5 S
J
61
Are you an employer? Check the appropriate box: Type of project (required):
I . X I am an employer with 15 4. I am a general contractor and I 6. New construction
employees (full and /or part time).* have hired the sub- contractors Remodeling
7. 2. i_J I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub - contractors have 8. Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers comp. insurance comp. insurance..
required] 5.1 We are a corporation and its 10. Electrical repairs or additions
3. i I am a homeowner doing all work officers have exercised their 11. ': Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] t c. 152, § 1(4), and we have no 12. )(Roof repairs
employees. [no workers'
13. Other
comp. insurance required.]
'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
+Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that check this box must attach an additional sheet showing the name of the sub- contractors and state whether or not those entities have employees. If
the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. A { /
Insurance Company Name: II"( I pi,(L I M u .L 115 t r Ci h e e /
Policy # or Self -ins. Lic. #: A Iv C 'w 1 k a /1� I Expiration Date: `t -el- o2O /3
Job Site Address: 1 c et.5 1'r1 - f V r 1 am pIi1 City /State /Zip: i' y4- O /0 to Q
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration (date).
Failure to secure coverage as required under Section 25a of MGL 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for covera_e verification.
I do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: / Date: 5 "94--„10/
Print Name: d ` '/ a i / .e V ` t Phone #: 1 -- 43 6 n C/ )
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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: Phone #:
• Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes ® No ►�1
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, ' Ud f1 /h rt , as Owner of the subject property
hereby authorize Adam Quenneville Roofing & Siding, Inc, to
act on my behalf, in all matters relative to work authorized by this budding permit application.
P-e
/l ,e4- rl -4a_ 6 ; 4 --- 1 , .9—
gnature of Owner Date
1, Adam Quenneville Roofing & 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.
A1di'n Qal h vi e tilde.
Print Name
Signatur oL� f Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: / Not Applicable E] Name of License Holder : d a 4Y1 a bu ri e J ; / 1 ` ' 9- 4
License Number
/ 62 o 10 ld I j May, km 1- 5c tt i-A // d(y, (1J4 010 75 g- i ) 7 ,90/
Address Expiration Date
-� 4(3 6 �
Sig Telephone
SECTION 13 - 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 01": No
t
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable At
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
5L\
D
Quenneville Roofing & Siding, Inc.
160 Old Lyman Road
South Hadley, MA 01075
Attn: Joan Hart
E. & J. Real Estate
P. O. Box 2188
Amherst, MA 01004
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 st �5t
2nd 2 nd
3rd 3d
4 th
4 th
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone El Municipal ❑ On site disposal system❑
•
Versionl .7 Commercial Bui!din& Permit May 15, 2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
NAY 2 5 201 212 Main Street Sewer /Septic Availability
�1! Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
NORTHAMPTON, MA 01099 "One 413 587 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans
___.. Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: /� y� This section to be completed by office
L"C �j 7L �n MA � u Map Lot Unit
r a n (n /
p � / " , 0 ('9 6 Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 1 �, f 4' ,A- Name (Print) - o t m1 f' U- d — tL ` ht Current Mailing Address: 0, Box (I+ / k 61 lea
Signature ,jiLL ..j , -it -o Telephone L/(3- ( -9S 3 --• 7 V 3 l
2.2 Authorized Agent: I /
Name (Print) M Cl /J /14 l L f 7 L �/ /Le Current Mailing Address: % 1 O Id I � ` man /*la
Sent / Hzd1 I fet Old`/5-
Signature � !,( Telephone J/ 3 - -6
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building L/4// ,- 1 (a) Building Permit Fee
2. Electrical rr (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection tic j 1 , („, f Ur?
6. Total = (1 +2 +3 +4 +5) Check Number 4/tee 5414 X 90 —
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
I request that you grant a modification to waive the requirement for control construction for the
project at xxxx in Northampton because the work is of a minor nature, will not affect health,
accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control
construction is considerable when compared to the cost of the proposed work. ((I have provided a
stamped letter from XXX in support of this request.)) Thank you for your consideration.
Respectfully,
Your Name
Your Company
Your Address
, o4 �(H ,
AMpi exwx, �� f , * Cr i - of rf IIaotp fon � � =*
rte, +•k
DEPARTMENT OF BUILDING INSPECTIONS
4
._._m_ ,
�� = �=-�=
INSPECTOR 212 Main Street 0 Municipal Building 7 c, a = •,?
Northampton, MA 01060
FAX TRANSMITTAL
61/ / / g_
DATE
.•••••• ti e
FAX TO TELEPHONE NUMBER 53 "' l q
TO iCalatlek-- ,,te,00,64 4_
FROM
2
RE: ( A --
PAG4S INCLUDING THIS SHEET Cq
o:
y
p Linda LaPointe �' °`��
I Secretary
City Building Department f
212 Main Street, Rm 100 587 -1240
I ,,
Northampton, MA 01060 -3189 Fax 587 -1272
■
/\ master.- . f 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 • 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 Westem Mass. CT Registration #575920
Member of the Building & Trade Association P.P.C. 38710
Proposal Submitted To: Date Phone #'s C:
Street � t3 -Fian fk rf
rr
f S Ia: / //nS Actress PD ,,,leg i 9r.Arfs.1 i1 hl ety
City, SState, Code Special Requirements: e/ri,rQ 6 u /yd , '
y �
®VD(7�j rir�,C�7or) 7 Q /nc ,C75 the iF fco-tS a nlL
❑ Recover ® Strip 9 Layers
0 C-� /'e C. vc,TrIS on 'fhe
Complete Roof System F/4 -I goofs W // be_ fe, /4 -C/ co
T eo err) 6 i & :nsf., /e j 4� F•,�+��eis
® We shall acquire all appropriate permits for all work Seec s cu i ts+ won w ( 64, , c .e y ✓ s.rl s .
[x] Home exterior and landscaping to be protected
X1 Strip existing roofing to existing decking and dispose of. Do not Do.
® Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
® Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
�] Install 5lb2el Synthetic) underlayment over remaining decking area
f] Install Metal drip edge at eaves and rakes 5 ") hit brown /copper)
(i Install manufacturer's starter shingle on all eaves and rake edges BBB
1 Install new pipe boot flashing CM/copper) / vents _''_
IA Install Snow Country or Ora rolled vent ridge vent, Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
/9F Shingles ❑ 25 year 30 year ❑ 50 year Color 4 1: 11 _r ^--•_ • �(
..L7F Ridge cap shingles LAI t A1/ `'` "" t ,
Warranty Options:
N We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
® Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 7 67_5 )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ /V 8-/ )
satisfactory and are hereby accepted. You are authorized to do work as specified.
Payment will be 1/3 down at start of job, and nce due upon completion. Balance Due Upon Completion ($(7 7 o 7 )
Signature: _ �.c •ate
Date: -5 ' 7 / . Estimato rint Name)} reply Sc. cJ,e/ (Sign Nam:
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.
i
.mil - 6 2012
DEPT. OF BUI�uiF aSPECTlOfv3
NORTHAMPTON MA 01060
QUENNEVILLE
June 1, 2012
City of Northampton
Department of Building Inspections
212 Main St. — Municipal Building
Northampton, MA 01060
RE: Control Construction
Dear Sir/Madame:
I request that you grant a modification to waive the requirement for control
construction for the project at 23 Eastern Avenue in Northampton because the
work is of a minor nature, will not affect health, accessibility, life and fire safety,
or structural requirements and is impractical in that the cost of control construction
is considerable when compared to the cost of the proposed work. Thank you for
your consideration.
Respectfully,
%ma dam A. Quenneville
Adam Quenneville Roofing & Siding, Inc.
160 Old Lyman Road
South Hadley, MA 01075
File # BP- 2012 -1049
APPLICANT /CONTACT PERSON ADAM QUENNEVILLE
ADDRESS /PHONE 160 OLD LYMAN RD SOUTH HADLEY (413) 536 -5955 O
PROPERTY LOCATION 23 EASTERN AVE
MAP 32C PARCEL 239 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Y,�y� /, /
Fee Paid a v5 y 9
Typeof Construction: STRIP & SHINGLE ROOF & REPLACE FLAT ROOFS
New Construction
Non Structural interior renovations
Addition to Existing,
Accessory Structure
Building Plans Included:
Owner/ Statement or License 070626
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO PRESENTED:
/ Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolitit De e,"
40 0 1- Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
2:1 EASTERN AVE BP-2012-1049
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 239 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 -1049
Project # JS- 2012- 001809
Est. Cost: $44675.00
Fee: $270.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 15812.28 Owner: HART JOAN M TRUSTEE
Zoning: URC(100)/ Applicant: ADAM QUENNEVILLE
AT: 23 EASTERN AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON :6/13/2012 0 :00 :00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF & REPLACE FLAT
ROOFS
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 6/13/2012 0:00:00 $270.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner