36-224 (3) VISA Mas(edf , 4 DI /C•VER
Q U E N N EV I L.1.. E www.1800newroof.net
ROOFING & SIDING, INC.
160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed
1 -800- NEW -ROOF • 413. 536 -5955 Fully Insured
Email: info@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 Member of the Better Business Bureau P.P.C. 38710
Proposal Submitted To: /� Date 6 6/20,2, Phone #'s Work:
64/ la- YCE�S�I A Well ( /�rijoz H: /3s 1/ y672 Cell:
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Street Email: f pc c,rS k e y c.c& e' i.-e
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City, State, Zip Code Special Requirements
Qrec1 Ce r_ ' A O f 1s 2 6 f t'ce d4 Gex(-4
o O Op, Pe,'
Complete Roof System 3
We shall acquire all appropriate permits for all work Dpi /LD 9Cti.r C. & P S f I C_
Home exterior and landscaping to be protected
A Entire existing roofing materials to be removed to existing decking
Xj Deteriorated existing decking will be replaced at $3.47 per sq.ft.
j gc Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes, skylights and A (15 Ib. felt / •M nderlayment over remaining decking area
X1 Install Metal drip edge at eaves and rake (8' 5 ") (white brow, / copper)
X Install manufacturers starter shingle on all eaves and rake edges
0 Install new pipe boot flashing ar / copper)
'Install new step flashing where necessary (standard / copper)
' Install Hand nailed rigid baffled continuous ridge vent S'k C0V h'r
Li Install proper soffit ventilation j
� D �-�r
Shingles: (6 nails per shingle)
(1r r ri4,,d f.e N� LT Shingles ❑ 25 year E] 30 year( Color M; SS r'l S rot R
(wit F Ridge cap shingles
Warranty Options:
❑ We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF ELK System Plus warranty
AF ELK Golden Pledge warranty
Chimney Options:
l ead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of:
Z, t
Total Sale Price $ I ' 5 Down Payment $ WCo Upon Completion $ 16 1.9
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted.
You are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion.
Unpaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reason-
able attorney's fees incurred by Adam Quenneville Roofing and Siding, Inc. to recover any sums due under this contract.
Date: r /Zc/ 2-- Signature: �ti`'tl"�_ `� - AY Phone # I n /6 c;
Date:6 / Z�{ / Z E stimator's Signature: , ! �i" _ (W yCCt f Ct70* it .
ATTENTION HOMEOWNERS: Please cov r 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 and Sidings
will not be responsible for debris or dust in the attic or storage areas.
I/09
Z\ V), VISA Master DISCOVER
QUENNEVILLE
ROOFING ■ SIDING Mr WINDOWS
160 Old Lyman Road • South Hadley, MA 01075 BBB
1.800.NEW ROOF • 413.536.5955
Email: info@ 1800newroof.net Website: www.1800newroof.net Winner of the
2010
MA Construction Supervisors Lic. #070626 MA Registration #120982 TORCH AWARD
Member of the Home Builder's Association of Westem Mass. CT Registration #575920
Member of the Building & Trade Association
Proposal Submitted To: Date Phone #'s C:
•
H: . W:
Street Email:
City, State, Zip Code Job Name /Location:
Proposal to furnish and install the following
Ask us about
affordable bank
financing
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ )
satisfactory and are hereby accepted. You are authorized to do wdrk as specified.
Payment will be 1/3 down at start of job, and balance due upon completion. Balance Due Upon Completion ($ •� )
Date: " Signature:
• Date: ' a + - Estimator (Pant Name) (Sign Name) 1 ; r d
Estimat6s al 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
• rr Department of Industrial Accidents �` u Office of Investigations
600 Washington Street
Boston, Mass. 02111
www.mass./;ov /dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information a Roofing Q Please Print Legibly
Name (Business /Oreanir.atinn /Individual) : Adam Quennev+ilIe Roofing & Siding, Inc' - -' — -- -- - —
Address: 1 L 0 V 1 L- �� 131(, VT Oa cli
City/State/Zip: c � �nc( .��.1 1-1-a c ! i , t V O Phone
ti:
___ _ _� I _ -
#: i I 6 ''
.) `M `- -
L? r t _ __ _ _._
Are you an employer? Check the appropriate box: Type of project (required):
I .)(1 AM an employer with ._)1 4.. ' 1 am a general contractor and I 6. New construction
employees (ruf and /or part time).* have hired the sub - contractors 7. Remodeling
2. • 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. employers and have workers' q 13uiltlinu addition
INo workers' comp. insurance comp. insurance.
required] 5.i We are a corporation and its 10. Electrical repairs or additions
3. ; I am a homeowner doing all work officers have exercised their
I 1. Plumbing repairs or additions
myselr [No workers' comp. right of exemption perm tv1Gl,
insurance required) t c. 152, § 1(4), and we have no I2.X.Roofrepairs
employees. [no workers' 13.ICC)tlaer
comp. insurance required. ] �t _ . _ .. -..
`Any applieunt that rht•rka bus lit mast also lilt out th' section below showing their' %slithers' compensation policy formation. l/ —
'II n. i,war,rs who strlmntl t irrr !bey tree. doing 011 work and than trim outside contractors most submit a new affidavit iodicatint such.
t`mrtsclorr that check Ibis tMos most allrlch an rµlditinnrrl shed showing the lame nl the ]nlr- ernllractrrr, and state whether or not H entities have employees. If
the soh- cnnlraellifs have ear 11u ees, they must nrtvide their workers' coin r, alley number.
1 oil an employer that i.'. providing workers' compensation in.cnrance fur my employees. Below is the policy audio') site
inliormatirt, ( �
Insurance Company Name: / / 1 m t / ,et 1 1 e,,2_tt rc,i 0 e e /
Policy Ii or Self -ins. Lic, it: //t '701 d9, 6'`` ID ! Expiration fate: L i � ( I — c;ZO //
lob Site Address: 64 ii 4 P r ` ki' City /St / /ip:�l'"' / 0 (ef_2 f / {�/( r,
Attach a copy of the workers' ra►tttpelrsatiun policy declaration page (showing the policy number and expiration (date).
Failure to secure coverage as required under Section 25a of MG,L 152 can lead to the imposition of criminal penalties of a tine
up to $ 1,500.00 and /or one year imprisonment as well as civil penalties in the firm of a STOP WORK ORDER and a tine of
$250.00 a day against violator. 13e advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA fbr coverage verification,
—
/ do lterlap certi/'y under the pains and penalties of perjury that the information provided above is true and correct.
: SI' ruture.' ; Lr'`. Date: t / / - it,
— - -- — — —
t'rira Munn': dal i'yi Le't i j n 0 I/ i / Lk -- Plume 11: — t/ / 3-• 4)36-- 6 r l _
- --
Official use only Do not write in this area to be completed bp city or town official
City or i'uwn: _,_ _�. _ __ Permit/license #:
Issuing Authority (circle vas:):
1.13oard of Beath 2. Building Depart Mott 3. City /town Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Other
Contact person: A ___ -- — — — -- - -- Phone #: — — — --
9
SECTION 8 - CONSTRUCTION
8.1 Licensed Construction Supervisor: Not Applicable ❑
Ada Name of License Holder: -da cUJ i 3 �U' `� `e 6
License Number
/£o Old L and ed. S oct ' i d( 1. i t oiciS ?- l- /
Address Expiration Date
5145
Sig Sig a re Telephone
- -. te _ r° Not Applicable ❑
.9.jRegisteied {:Hoi•n� mprovemen = Contractor ...-m . Y. �;t x _0 4 � �,��:,,��.,� }: _.�. PP
Adam Quenneville Roofing & Siding, Inc. / o qi
Company Name 160 OW Lyman Road ` Registration Number
South Hadley MA 01075 — ��- r
Address , Expiration Date
Telephone y/3 6 j�yS
1
SECTION A.0 WORKERS' COMPENSATION 114811RANC AFFIDAVLT (M G L 12, § 25C(6j)
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 ❑
fi . _..Home OwnetlEXe iiptii i
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
•
', I
J
SECTIONS -T DESCRIPTION` OF- PROPOSED WORK {checkall applicable) -_ 4 ,
.
c
i
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing .
Or Doors E
Accessory Bldg. El Demolition ❑ New Signs [O] Decks [0 Siding [0] Other [pal 5&ah f
Brief Description of Proposed `x-L4 tic - � i-- C
Work: -- / - 747V ' - >L -& Al C. a - y=- !, . _. , , , :" Gf- yft, D �/ ,
Alteration of existing bedroom Yes No Adding new bedroom Y es No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
Vf riVi aTiril ii aViel ition ia:extstinq.hoan aiii let i e ell'owrng:
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
SECTIO 7 O F OWNERAUTHpRI ZATION "r0 BECOMPLETEQ WHE
WNERS AGENT OR l RACTptwpLI FOo Bi71LDINGTE t.
• I, PI- Q 1 -5 k 't' f N Q Fr Kra ko S I C i , as OwneDof the subject
property
h authorize Adam Quenneville Roofing & Siding, Inc.
to act on my behalf, in all matters relative to work authorized by this building permit application.
s Ae , e— / 60)(1 74(.G6a -.l4 ' / 1 - / ` --
ignature of Owner Date
pb g
Agent hereby declare that the statements and information on the foregoing application I am uennevdleltoa Siding, Inc as Owner /Authorized
A
9 y cation are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
/7dtit7 ( ta {'7 /L j/1 /i e
Print Name
Signatue�Owner /Agent Date
i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by'Loning
This column to be filled in by
Building Departef ,
Lot Size 1 i 1 1 I 1
Frontage 1 I I +. i-
Setbacks Front i I j i i[[
Side L:'- 1 R:' L: R:' � S { f
Rear = 1 I 1
Building Height 7 j i j
Bldg. Square Footage 1 i 7 % i"--1 I 1
Open Space Footage
(Lot area minus bldg & paved i f I
parking) .
I
# of Parking Spaces ' I
Fill: , - - --- l
(volume & Location) t I i
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ! 0 YES 0
IF YES: enter Book 1 I Pagel - and /or Document # I
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions - - - -- y p p g of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location: 1 1
E. Will the construction activity disturb
(clearing, grading NO excavation, or filling) over 1 acre or is it part of a common plan
ve
that will disturb over 1 acre? YES ® 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Departmeirt use o nly
city of Northampton Sta
r = - - -- Building Department c �b Cut/Dnveeway Pe>mi a � 3 k
I 212 Main Street • i seweNSepticAvailability` '-
`` JUL 2 12 9 Room 100 WaterIWell Availab Iitjr �- u � ' }
__ North mpton, MA 01060 Two Se st ` o f S P lan s z-
DE " ' L phon 413- 587 -124 Fax 413- 587 -1272 r lo t/S t o Plans -` ` � ` z m � - 1 77 ' `
,W . , N I , R T HA', .
Oaer Speci3�r =
� , . .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO F DWELLING
.SECTION 1 SITE INFORMATION
1.1 Property Address: _ i Thi se ction to be completed by office
// hJ [,�
10 q W , /i ter Ne(( 111 . Map Lot Unifi
C1 r 2 t/L U t M 0 / e C rc Zone i O ve rl ay Distr
4 ^ 'k
L .,. f .'G'... } t . ..
.:Etm�Sf: l7 sfnct -=�:. CB -5 -- ., �
SECTION 2 - ;PROPERTY OWNERSHIP /AUTHORIZED AGENT -
4 2. Owner of Record:
ry f a a r5 64 ail ; rt-�e r i c 1-a bl..Q., - P to c-e P U
Name (Print) y Cu nt Mailirx.Ad ess
r P- 0106, o
,``''//rry�ee l ri
4 / �1 ' TelA Y (� 1 '" phone
ignature
2.2 Authorized Agent:
Adam Quenneville Roofing &Siding, Inc, jbo ��/ G� 1h a r� ed. Svu 4/Ad(e
Name (Print) Current Mailing Ad
/,7 4(— �{l 3 S - 5 5 f o /� X75
Signature v Telephone
SECTION 3 -=ESTIMATED°CONSTRUCTION=CO STS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant = _ _
11. Building 1 I S�"i', e o ( a ) Building P ermit Fee -
2. Electrical : :: 1 (b) Estimated Total Cost of -
_ °Construction.from.(6). _,
3. Plumbing Building - Permit Fee
4, Mechanical (HVAC)
5' Fire Protection x s , _ F _
6 Total (1 + 2 + 3 + 4 + 5) r] 1 8&'I a� Chec Number /c 3'
T _ . _ <_ -.This Section For Qfficial Use - -
Date t
B u ilding Permit Number = i ssued
$ - I
S ^rte j k : ? S pY
ignature ', _. - »: j ..i.':', --- -
Building Commissioner /Inspector of Buildings a Date
i
•
64 WINTERBERRY LN BP- 2013 -0058
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 224 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- 2013 -0058
Project # JS- 2013 - 000086
Est. Cost: $27188.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 57934.80 Owner: PARSKY PAULA F
Zoning: Applicant: ADAM QUENNEVILLE
AT: 64 WINTERBERRY LN
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:7/16/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE HOUSE & GARAGE ROOF &
REPLACE SKYLIGHTS
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 7/16/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner