39A-011 (2) Li DDLYR\,. [ VISA Master 111.1 DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING V' SIDING ' WINDOWS We Are Licensed
160 Old Lyman Road • South Hadley, MA 01075 F ull 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 7 \ \ \ \1' Phone #'s C: SQL
e\ s C \ DY H: Y37 S5 I. W:
Street Email:
JQ cz as v.) c∎3\ Pi*...
City, State, Zip Code Special Requirements:
NeRc , .(Y1C\ 0 f66 _' 1Y bOWVi c,,_,(< 5c`c.se
G'(\c ()(\l' ?C )C- -
El] Recover /Strip I Layers
Complete Roof System
Nt We shall acquire all appropriate permits for all work
V j Home exterior and landscaping to be protected (�
Strip existing roofing to existing decking and dispose of. Do not Do.2jG�.Y) ?(y t CV\
Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
V'Install((151b. felt Synthetic) underlayment over remaining decking area
Install Metal drip edge at eaves and rakes (8"0 (white /brown /copper) a
Install manufacturer's starter shingle on all eaves and rake edges
BBB
❑ Install new pipe boot flashing (standard /copper) / vents —117--
El Install Snow Country or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) ��
AF Shingles LI 25 year [1] 30 year El 50 year Color S 1''�� .
_ 1 Ridge cap shingles
W ranty Options:
V We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty .
❑ GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ S. S 7 ' )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ �, . O 0 6 )
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 ($ \$71. )
Date: 7 L Signature: L.
7 \N1
I� ( oft -� e
dSfl C( (Sign Name J4 ' —
Date: Estimator: Print 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 Ouenneville Roofing will not be
responsible for debris or dust in the attic or storage areas.
' The Commonwealth of Massachusetts
■ irI Deportment of Industrial Accidents
i` Office of Inrvestigations
600 Washington Street
4
Boston, Mass. 02111
www.mass.goo/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly__
Name (Business /Organiialion /Individual) : Adam QuenneVlille Roofing & Siding, loci - - - -^ —' _ —
Address: I L2 L) 0 I C! L- i Yi Ci K1 1 N 0 e' d
L /
City/Skate /`Lip: )( L �L l /fad � �tfi l Phone #:_c� ! 6 '')
cli 01 `a_
Are you an employer? Check the appropriate box: r 'Type of project (required):
1.)( 1 ant an employer with .. 1 . 157___, 4.. - I am a general contractor and 1 6. New construction
employees (full 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 halve no employees These sub - contractors have 8. Demolition
working for me in any capacity. employees and have workers' q Building addition
[No workers' comp. insurance comp. insurance. j:
required] 5.1 We are a corporation and its 10. Electrical repairs or additions
3. , I ant 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 I2.X repairs
employees. [no workers' 13. Other
comp. insurance required,
'A ny applicant that cheeks box 111 most also fill out the section below slowing their workers' compensation policy information.
*1lnmeownrrs who submit this a ffidavit indicating; they are. doing ali work and then hire outside contractors most submit a new affidavit indicating; such.
:;t :nntaetors that cheek this hov most attach an additional sheet showing, the name of the sole- conlracurrs and .state whether or not those entities have employees. If
the sub enntt'artnrs (hive rnh thrvces, they most rrrnvitic their workers' comp. policv Humber. ____ _ — - —_
1 um an employer than is providing workers' compensation insurance, fur my employees. !Mow is the policy and job site
information. q ,
Insurance Company Name: A . M � 0 /4,a - !. _ . ry.7 Lt nil e f _
Policy 11 or Self-ins. Eic. /I: A. Iv t,-,., i1 0 / A ls'( 10 l Expiration Date: q )■ Ct - 6) J3
Job Site Address: /0 ' 1,9 . 0.-)r 1 I ht Av-e - IUw f iI 6 rn Pi']city /Stitt /Lip: , YIA - 0 . /0 6 0
Attach a copy ()I' the workers' compensation 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
tip to $1,500.00 and/or one year imprisonment as well as civil penalties in the fbrm of a STOP WORK ORDER and a tine 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 fbrcoverageveritieation.
/ do herby certify under the pains and penalties of perjury then the information provided above is true and correct.
Sit rrunu'c: � �t -- Mule: J l a -- — - --
Print Nome: _ /f d.(vi i ( 11 t'1 ✓ i i IX - - - - -- Phone it q 1 3 C; 3 6 Li 5 — — —
1 Official use only u Do not write in this area to be completed by city or town official —
1 city or Town: _ __ ..._ _ Permit/license #:
Issuing Authority (circle toe);
1.Board of heath 2. Building Department 3. City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: ___ _ ______ _ -- Phone #: - - --
,op t-;1111; (0;71
Ift
Ufa rill
Ycrial ',vac ' 011110 me
Version1.7 Commercial Building, Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No a
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
h h C� (h
j� I (? as Owner of the subject property
•
hereby authorize Adam Quenneville Roofing & Siding, Inc, to
ac on my behalf, in all matters relative to work authorized by this building permit application.
Signa re of Own r Date
I
ACS /I d 2Z (C LO Gj;'u' ✓/ / (_ Adam Quenneville Roofing & Siding, Inc. as Owner/ uthorized
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 perj perjury. LT( W t)1CP 1/410 _
Print Name
GZ / /
Signatu owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Naive of license Holder : � � R,��.,1 ad 0
160 L
OR Lyon License Number
S ky,MA 01075 .3 - ` as l
Address Expiration Date
1 # 5— 6 59 -5
Signature V 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 0 No 0
Version1.7 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)
9.4 Registered Architect: A,//j4
Not Applicable 0
Name (Registrant):
•
Registration Number
•
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s): 401- 4
•
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Sighature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Narhe 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
i
1
I
Version 1.7 Commercial Building Permit May 15, 2000
S 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building Ca-
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ RoofingChange of Use ❑ Other ❑
Brief Description Enter a brief description here. 4-t ....e,xt S!-1,t 1t - d 1 4--
Of Pro osed Work: 2` rb' L�-- r y.-1-4-1- - , k J4
hi-Go '
1 11. .Q. -#L/ 1 . z. i
SECTION 5 - USE GROUP AND CONSTRUCTION the
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑
A-4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B 1 ❑
F Factory 0 F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1-2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage 0 S -1 ❑ S -2 ❑ 5B 1 ❑
U Utility ❑ Specify:
.
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
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
1
2nd 2nd
3rd 3 rd
4 th
4 th I .
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❑ Municipal ❑ On site disposal system❑
,
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 fille Wry
Building Department %
Lot Size 1 1 1 t i t
Frontage 1 1
Setbacks Front 1 1 I j
Side L: R:i L:� R:' ! ( I 1
Rear = 1_____1 1
Building Height I i
Bldg. Square Footage 1 I l % 1---1 I I `s
- --- Open Space Footage ' % i _ -
(Lot area minus bldg & paved I ! I =
parking)
# of Parking Spaces ! 1 -
Fill: _r — 1
1 ----
(volume & Location) i 1 '
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:1 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 1 0 YES �t��+'
IF YES: enter Book Page �^►�,
and /or Document #
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:
1
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location: 1
1
D. Are there any proposed changes to or additions p p g dditions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location:
1
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.
m.__
, Department use only
�'&LL , 4, A
1 _ - -: -2= A_ City of Northampton I Status-ofPe q .. 1 --.
R _ y 4-4 i k. vX. F -, M A 4 F fit` -mil ;T
. Building Department Curl; Cut/DnvewayPermif. 1 .f a
JUL 19 ail2 212 Main Street ,sewer /SepticAvaila
Room 100 W UVeli a ; x
REr of s u N��z, : Northampton, MA 01060 Two Refs of St Plans4N° st '
NORTHAMF .. MA 010Rn atkA..,m,
pnione 413- 587 -1240 Fax 413- 587 -1272 li rt r 4 t''. ' � - � tr,, *,y 7
s o Sl a Pians 3
~ * 4.> 1
Q ther: S pecifr
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO Fi4MILY DWELLING
S ECTION 1 "SITE INFORMATION -
1.1 Property Address: p �_
r This section to be completed by-ofFice
10 1 c W r i3)1 t / 7 V yl GC, --- Map t Lot 4 Unufi
N c r *I1 a vn I " n r M v ` k Zone Overla Dr
_ Duct - • - CB District
S ECTION.2 PROPERTY OWNERSHIP /AUTHORIZED. AGENT
2.1 Owner of Record:
Uhri 3 Co/b _ a�S 06bar�� 1006 d ( ( M,- -
Name (Print) r� Current Mailing Address:
!�, . �• .. . / . ✓/ / Telephone ' S' C'
ignature �' � 7 J 1
•
2.2 Authorized Agent:
Adam Quenneville Roofing & Siding, Inc. /ia o Old Ge -u i4 `241.ciw f-A. / '6
Name (Print) Current Mailing Addcass:
Signature i•• C�� 1 //3 - 6 ' 9 5 5 d / '7S"
•
g Telephone
SECTION 3-==ESTIMATED CONSTRUCTIONCOSTS :, a_
Item Estimated Cost (Dollars) to be Official Use Only . _
completed by permit applicant . , _ . -.
11. Building (a) Building mit Fee
5 o - Per - -
2. Electrical (b) Estimated Total Cost of
._J_Construct3on.from {B) - :: -_, .- -_ . _: - .:'...]:-...1...:
3. Plumbing Building Permit Fee
4 Mechanical (HVAC) = =
5'. Fire Protection
6 Total = (1 + 2 + 3 + 4 + 5) g'7 G7 0 Check Number +r /gi 3 _
gi- _.ThtsS For_:Official=Ule Only_- _
st udding Permit Number s Issued. ='
Slgnaf x _
Buildin Commission din of Buildin Date •
•
10 WRIGHT AVE BP- 2013 -0080
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A - 011 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 -0080
Project # JS- 2013- 000124
Est. Cost: $5874.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 6011.28 Owner: COLBY CHRISTOPHER & BEVERLY
Zoning: URC(100)/ Applicant: ADAM QUENNEVILLE
AT: 10 WRIGHT AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON ::7/19/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE GARAGE & PORCH 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 7/19/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner