32C-155 v� ZZi---AD 'n
Proposal Submitted To Date
Street
IL...' QUENNEVILLE
ROOFING & SIDING, INC.
0110/AVER City, State, Zip Code
160 Old Lyman Road, South Hadley, MA 01075
1- 800 -NEW -ROOF • 413- 536 -5955 Phone #'s
Email: info @1800newroof.net Website: www.1800newroof.net
MA Construction Supervisors Lic. #070626 MA Registration #120982 H ' " W .
Member of the Horne Builder's Association of Western Mass. CT Registration #575920 Dumpster Location
Member of the Building & Trade Association Member of the Better Business Bureau
DH EV CV TW DHP
Double Hung 3 -Lite End Vent 3 -Lite Center Vent Twin Double Hung Picture w/2 Double Hung Flankers
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Woodgrain Interiors Vinyl Color Product Code Grid Styles
NAT I = Natural Oak WH ' = White BS = Bayshore ST = Standard 5/8" RP = Regal Perimeter
GO = Golden Oak CA = C amel SB = Seabrook RC = Regal Colonial RFL -- Regal Florentine
CC = Colonial Cherry ET = Earthtone NE = Northeast G = Gregorian 1 1116" RFE = Regal Florentine Elongated
WW = White Woodgrain W = Williamsburg 11;16' RF4 = Regal Prairie (2 passes)
TB =Thin Brass
BAY BOW 4 BOW 5 BOW 6 GARDEN
Ili ' . , I 2 3 a 5 1 ' 1 ' 4 5 i 7-1
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'IlLY •
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Woodgrain Interiors Wood Options Vinyl Color Product Code Grid Styles Glass Options
NAT = Natural Oak BIRCH WH = White A = Aurora ST = Standard 5/8" G = Gregorian Stay -Clean Glass
GO = Golden Oak OAK CA = Camel RC = Regal Grids W = Williamsburg Regal Glass
CO TR 1/3- 1/3 -1/3 TR 1/4- 1/2 -1/4 QUAD
Operating Casement Single -Frame Equal -Lite Single -Frame 1/4- 1/2 -1/4 Single -Frame 4 -Lite
rr- Trip __ Triple C_
le Casement Tri le Casement Casement
I ll I I ,'
iii II ii I I 10 Ili
II
Existing Window New Window Existing Window New Window
Measurements _ Measurements _
51
O Rough Opening
O Rough Opening
W Location Style Metal Style Series
p W Location Style Metal Style Series O
_ _ F. U Height ~ (Room /Floor) "Code Y/N "Code" "Code" V Width Height UI — (Room /Floor) "Code" Y/N "Code" "Code" Width ight UI – -
13
14 I
3
4 16
5 17
8 18
7 19
8 20
9 21
22
11 23
Color of Color of
Window / Door Wrap Window / Door Wrap
We Propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of:
Total Sale Price $ Down Payment $ Upon Completion $ ,
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: - Signature: Phone #__
Date:___ -
Salesperson's Signature:
Estimates are honbfed tor sixty `(60) days from above date
Please remove all breakables from Interior wall surfaces during installation. AQR &S will not be responsible for damage.
L The Commonwealth ofMassae*usttr
Department of Industrial
k ott ,,',,�� hr-'' 600 Washington Street
Boston, MA 02111
y .p www mmss.gov/ha
Workers' Co ®peasstion Insurance Affidavit: Builders/Contractor's/Electricians/numbers
Q (� Please Print Lebl�
Name ( Business /Organization/l �1 _ t. R't° Y t ` I k ' 1 t 67 1 , n3 "s 1 \ /uL_._L 0 C
Address: 1 la I) n (d L J —
City/StateJL• : _;\ 114 _! - -' !... _ 1.1 Phone #: 1 -
Are yaw w employer? Cheek the appropriate tor: Type of project (required):
1.I4 I am a employer with 15 4. 0 I am a general contractor and I 6. ❑ New co nstruct i on►
employees (full and/or part - me).• have hired the sub - contractors
ti
2. El am a sole proprietor or partner- listed on the attached shoot 7. ❑ Remodeling
slop and have no employees
These sub -contractors have 8. 0 Demolition
working for me an any capacity. y have wor k e rs ' 4. ❑ Building addition
[No workers' comp. insurance
mquiredi 5. 0 We are a corporation and its 10.E3 Electrical repairs or additions
officers have exercised their
3. ❑ I am a homeowner doing all work ri >i of pc 1
MGL 11. Plumbing repairs or additions
myself. [No viorkers' com. insurance u t c. 152, §1(4), and we have no 12. hoof
fees. workers' I3. [] Od ra ______
comp. insurance requited.] ,
•Airy applicant that tacks box 11 mat also HI out the action below mowing rhea waken' oosipeaaa6aa policy information.
t Hon toamata aio shit die admit latitude& shay as doing ail word; ad dice bim at►sida matactot anent aimitaacw affidavit atdioting>o .
rConemo sieve deck di tonneau a stud edaa oddball *ea showing *a nacre albasalscat ra ita adieu wkildernrnot the mails an
eapioyeee. !file seb-aoaetacias talc a pioyme, day asst provide their adore eaatp. policy Camber.
1 site s t a ployer Oat Is providing workers' compensafien bummer for my employees, Below is tilre policy gad jab site
Insurance Company Name: -i"\ /' u 4--u t) Ylc--,u y n t P___
Policy # or Self -ins. Lic. #: A IOC, 7 O 1 ,49,1c l 01 Expiration Date: Va q /ab 1 +
Job Site Address: 3ck Klnet Av 1 vac.µ..* N.
p4en r A City/SWWZIp: 0106
Attach a copy of the waiters' coanptasaliew policy deekratiaar page (s hawing the poly .weber and tag,Matiee date).
Failure to sedge coverage as requited tinder Section 25A of MGL c. 152 can lead to the imposibioo of criminal penalties of a
fine up to 51, 500.00 and/or one-year impcbaornenl, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advisor' that a copy of this shat may be forwarded to the Office of
Inv ions of the DIA for insurance coverage verification.
I eb hereby etre hinder the andpersoliks ofperf irry that the beforsaattos pnwriteitabore Is true and
Sign: Date: 1- a (o- I I
Phone _ 1 113-5310 - ,5 - 9 55
we Dirty. Do not write he Ibis area, to be completed by city or gown official
City or Town: Perauit/Lieease #
baling Authority (circle one): —`^
1. Board of Health 2. Bathing beparteest 3. City/Town Ckr1t 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #7.
44,1; dri!-
- PIMP (U$ft j 4. Ktytit.'
if
PIN"
101(41E141(, Kotitift 7
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
Adam Quanta le Reefing & Siding, Inc, ?v (a
160 Old Lyman Read License Number
Sena Hadley, MA 01075 g - a l - '
Address Expiration Date
L/I3.s3, css
Signat Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Qu iwiilk Roofing & Siding, Ins. I a.o a fra
Company Name Registration Number
160 Old Lyman Road 3,- a s- t
Address South Hadley, MA 01075 Expiration Date
G Telephone 4 413-536 -S4 SS
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
71pol 6nr Awl; soopk4 m1,
/IP 6Kno* 6 f '411.ift
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors Cti
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [El Siding [O] Other [0]
Brief Description of Proposed
Work: eeunr9vL 3 w 4 4.rnu S ctv Ga sl■t-e
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 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
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, i\ Om o ■ ,S h cr-E we%1 , as Owner of the subject
property
hereby authorize Qom*
to act on my behalf, in all matters relative to work authorized by this building permit application.
-ac-
Signature of Owner Date
Ada *milk Rook/ Sidi!, hit , 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.
A a..,w, Q Lim ,,,4-», l Le-
Print Name
14-1G-ti
Signature of Owner /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fi11:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 4 ,4 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, e cavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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, ,
- 31�4 Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
WA 2 B Ott 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
orthampton, MA 01060 Two Sets of Structural Plans
�. - ". one 413 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans
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
3C1 IC∎ Este AVe. • Map Lot Unit
isa cl .rr o i a`'tA O 1000 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
DO rrr 5kokwtt1 39 Ki nsie pc. Noc- 0�.o.,�.p3o ,, i a4 P 0l 04o
Name (Print) Current Mailing Address:
413-S3i: -S`tsS
Telephone
Signature
2.2 Authorized Agent: / �1
Ain Q� Rig & Siding Inc. 'co 0 is L yr .„.„ Ra , S 6 044 F(c f/
Name (Print) /"� t Current Mailing Addl�ss:
l A tin -5 3G -S9SS
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building la Oo (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 1 000,00 Check Number , � 9 '? 10 S
This Section For Official Use Only
Building ermit Number: I s
g Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
39 KINGSLEY AVE BP-2011-0878
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 155 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP- 2011 -0878
Protect # JS- 2011- 001436
Est. Cost: $1200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 6011.28 Owner: SHOTWELL DONNA M
Zoning: URC(100) //WP Applicant: ADAM QUENNEVILLE
AT: 39 KINGSLEY AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:4/29/2011 0:00: 00
TO PERFORM THE FOLLOWING WORK:INSTALL 3 REPLACEMENT WINDOWS
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 4/29/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner