32A-084 AZZ DDZZut—AY\ WEI Master• • DISCOVER
i Q U E N N E V 1 L L E www.1800newroof.net
ROOFING ■ 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 @l800newroof.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:
H: W:
Street Email: .
City, State, Zip Code Special Requirements:
❑ Recover ❑ Strip ❑ Layers
Complete Roof System
• We shall acquire all appropriate permits for all work
❑ Home exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose of. Do not Do.
❑ Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
❑ Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
❑°
Install (151b. felt 7 Synthetic) underlayment over remaining decking area
❑ Install Metal drip edge at eaves and rakes (8" / 5') (`white /brown /copper)
❑ Install manufacturer's starter shingle on all eaves and rake edges BBB
Install new pipe boot flashing (standard /copper) / vents _r
❑ Install Snow Country or Cobra rolled vent ridge vent ; Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color
Ridge cap shingles
Warranty Options:
• We guarantee our workmanship for 10 full years (see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
El Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ , )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are 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: Signature:
Date: Estimator: (Pent Name) (Sign 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 Quenneville Roofing will not be
responsible for debris or dust in the attic or storage areas.
" The Commonwealth ofMassachusetts
,--' Department Department of Industrial Accidents
Office o Investigations '
x � »`r f.1 t f
-r ` 600 Washington Street
-
- -. '
Boston, MA 02111
=-'�° www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information .11 & a Inc,
lease Print Legibly
Name (Business /Organization/Individual): Adam Qaennev�le Roofing & Siding,
Address: / (' 0 0 1J 1,j ryian k clad
City /State /Zip: S614,t h J f7L4 '' f � 01O'5 Phone #: in 3 656 6 CC
Are you an employer? Check the a ro Yiate � box:
pp p Type of project (required):
1.1g I am a employer with
4. 0 I am a general contractor and I 6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7: ❑ Remodeling
ship and have no employees These sub- contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. El Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing airs or additions
re
3. El I am a homeowner doing all work h � P
myself. [No workers' comp. right of exemption per MGL 12.00f repairs
insurance required.] t • c. 152, §1(4), and we have no li.[❑ Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box R1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached 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.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. n'
Insurance Company Name: A T !' t /' 1 U it 1 1-11 S Lt (Q. ✓) a
Policy # or Self -ins. Lic. #: lad 6 '7 01 'a U ip / 1) l Expiration Date: 4 ` 3 q 0 2 c
Job Site Address:, .19 Craii , f S t` t Orillarripki City /State /Zip: mfr 6 10 I
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 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature:
j Date: do-Iii-19
Phone #: 9 - ' l ti' 6 V 19 5
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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: - Phone #:
J
SECTION 8 CONSTRUCTION - SERVICES
8.1 Licensed Construction Supervisor: / Not Appl ❑
Name of License Holder: {�(� � la /7 K V ` Le lo
License Number
110 Old t 'marl Pd. auA -Ii 14-64(L L), I 0073 3- aI - (aI 3 r
Address - ' Expiration Date
3- 53 - 51ss
Sig re Telephone
:`9 R i is� Yer` i kfome:Impiover ient-C "7V ' � R I - 7 Not Applicable ❑
Adam Quenneville Roofing & Siding, Inc. 0-0 q k
Company Name 168 Old Lyman Road Registration Number
South.Hadiey MA 91075
Address . Expiration Date
Telephone y 03 - 5 yti
ECTIONA0= WDRKEFty COMPENSATION INSURANCEAFFIDAVIT (M G L - c- 152, § 259(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. =Haling Owner4EXenptiou
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
•
•
.,
1
std :_3.+- t N _ _ -1
° SECTIONS- =DESCRIPTION OFPROPOSED•WORK (checkalt applicable .
ltew House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Si
Or Doors 0
Accessory Bldg. El Demolition ❑ New Signs [0] Decks [a Siding [D] Other [D)
i
Brief Descriptign of Proposed
Work: .a. A 'P . e a—, r l .... ! ( -I 4, 4 c • '- f / v L�.
"_ a . / , 4 , /-- .# A ' .-
1 " • + i rep te,e_ii -- jo 1 are - t - cmigl A- --e , 4 1 lie -
Alteration of e sting bedroom ' Y No Addin g new bedroom Yes No /,
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa e i h uo se iaika- i idktorrto. klstinq'housi i fo bitiiiii :
. 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
1. 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 , OWNER:AUTHORI igiON 'TQ BESAMPLETE:D' llkHEi+C� }
Ol11NEl2S IagE itioftg.LdTRAC ORAAPFLIES O,K151. DING ERMIT 5
I, ' \. J- f/ , as Owner of the subject
property
hereby authorize Adam Quenneville Roofing & Siding, Inc.
t� act on my behalf, in all matters relative to work authorized by this building permit application.
' g r ed� o wn C rli t�ll � � or- /4-7
Si ature of er Date
Adam Qaenneville oofing &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.
/qd Civil. (Yu a 17 /tie j!,` ILe
Print Name
i
Signat Owner /Agent Date
•
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
t
Existing Proposed Required by coning
This column to be filled in by
Building Department
Lot Size I I 1 1 I 1
Frontage i '!
Setbacks Front ( 1 i i
Side L:' ' R:! L :� R:`• 1 1
Rear I 1 1 i 1 i
Building Height 1 1 i i i i i
Bldg. Square Footage ,I 4 ' ! 1 l
Open Space Footage ' % �- -,
(Lot area minus bldg & paved I 1 L._._ __I i
parking) -
I 1 1 t
# of Parking Spaces
Fill:
(volume & Location) t I I H i
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0 ii
IF YES: enter Book 1 Page) 1 and /or Document #;
B. Does the site contain a brook, body of Water or wetlands? NO Q 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 r , Date Issued: I I
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and Location: E
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location: 1 I
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 ® r NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. i
Department use manly
_ City of Northampton us ` o fPe mlit
Stat
Building department Curb Cut/Dnveway P "° `
6 2U�2 : 4 212 Main Street Sewer /SepticAvallabilty
! Room 100 W at e riWe ll Availability'
t_ Northampton, MA 01060 Two S ets o-f Structural .......-..i-
lans
,� r� o�rH��J; ._.__ hAn 413- 587 -1240 Fax 413 - 587 -1272 PIot/SltePlan
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Zi 1 S I _ __
1.1 Property Address: }
Th see t r on to be completed by office
C'
j q 6 ) f � (e-e f Map Lo t Unit
= t
' (� odne " �� ; Overl Dis#nct
a0 ttrnptMr1 MA 0 J
u:Elm�St;D -, - CB Distnct ..°
SECTION 2 PROPERTY OWNERSHIPJAUTHORIZED
■
2.1 Owner of Record:
6-e.rl �Zi. r1- E 3 t--e l P G BOX i vi (51; �? 01064
Name (Print) Current Mailing Add:
•
I Address:
< Q16'6lf
Telephone
Ignature -
22 Authorized Agent:
Adam Quennev Roofing & Siding, In //g 0 Old i d s »t. u L1 /0d - :Svc / 6
Current Mailing Ad ss:
2Itt—
f i
Si nature / – 5 ' h � SS / ` D / /76
Name (Print)
9 Telephone
TION.3-= ESTIM ATED COS -_COSTS
3EC
Item ) to != cial U
completed Estimated byo Cost pemrit (Dollars applicant be <_ ... .. . _ _ - - _ - - : - se _ _
1i. Building (/ ert 00 � (a) Building Permit Fee Offi Onty - _ _
2. Electrical (b) Estimated Total Cost of =
Cns.tnfrm{5
i Plumbing BuildingP . Fee ) _ -
z
4r Mechanical (HVAC) _
5' Fire Protection ▪ r ,
6. Total (1 + 2 + 3 + 4 + 5) L'1 . 00 Check-Number
= - - - -- - =_ _ � _�__ _ - -u_ - _._ � This_ Setio Eor_ Offcia[; . U • s e Onlv._ -"=- - - - - - - --
u�lding Perm�tN _ i _ = D at e , r _ .
I
3
Signature, c • f � "' r h . - -
Budding eommE.ss�onerAnspector of Buildings Date
i
i
39 GRAVES AVE BP- 2013 -0173
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 084 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 -0173
Project # JS- 2013- 000284
Est. Cost: $8000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 5880.60 Owner: HART JOAN M
Zoning: URC(100)/ Applicant: ADAM QUENNEVILLE
AT: 39 GRAVES AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:8/17/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & 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 8/17/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner