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17D-060 (2)
LJ 1)) VISA ! 1117 DISCOVER Q U E N N EV I LLE 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@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 Building4 Trade Association P.P.C. 38710 Proposal Submitted To: Date Phone #'s C: �/ /'rwt ars 13./9((. 0 - /16 W: Street / Email: a0 (" "t 11.e City, State, Zip Code Special Requirements: / 1 " /Uf A4 0 (-1 t.�r. .. FI�LT s,��< t � s.ur"✓ L.� 'SC ❑ Recover © Strip ❑ Layers Complete Roof System g1 We shall acquire all appropriate permits for all work [$ Home exterior and landscaping to be protected ///� NI Strip existing roofing to existing decking and dispose of. Do not Do. le) � � /r-s [�]c Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. ® Install Ice & Water Barrier at all eaves, valleys, chimneys,• pipes and skylights ® Install 51b. e Synthetic) underlayment over remaining decking area © Install Metal drip edge at eaves and rakes/ 5" ( ,•rown /copper) l ® Install manufacturer's starter shingle on all eaves and rake edges BBB ❑ Install new pipe boot flashing (standard /copper) / vents —''— Lk Install Snow Country o obra roe ven ridge vent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) F Shingles IN 25 year ❑ 30 year ❑ 50 year Color X'/ 6 6A Ridge cap shingles Warranty Options: L We guarantee our workmanship for 10 full years (see our warranty coverage) J ❑ GAF System Plus warranty / `r e ❑ GAF Golden Pledge warranty Chimney Options: (2, ) ❑ Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ �ZC� ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ ) satisfactory and are hereby accepted. You are augtorized 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: I (1 Signaturef.. ! h (0 Q Date: !r? /7/, Estimator: (Print Name) k:SrA. t fir. (Sign Name) Estimates are honored for sixty (60) dalys 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. Ili : The Cornmorzwealth of lblassaclzusetts - Departprent of Industrial Accidents - iz --; Office of Inv 6atzolzs - . Mme' :M-- . • fn . - • - - • 600 YTYaslzzn�aton Street : -- ... -1 5- - - . Boston; MA 02111 _ - - - �er te'' - fvtvw_nzassgov /di• - - • Worke s' Compensation Insurance Affidavit: Builders /ContractorslEIectricians !Plumbers Applicant i nformation . - - PIease Print Legibly Name ( Business /Otganization/Individual): ' Adam Quenn Ruofmg & Siding. Inc, Address: ( (e 0 - Q id bi r ' t a. n . e Dad - .- . it Cit /State /Zip: JITIc li L& d�01 Phone _ , b • Are you an employer-? Check the•approp late box:. Type of project (required): i 4. 0 I aea a. general - contractor d I 1 _ I am a. employer with. 1 �� 6_ El New construction emuioyees (full and/or part time).* have hired ilte sub- contractors an • -- _ 2_n, I am . a. solejproprietor or.parmer- - meted on the atrached slieet 7: 0 Remodeling - ship and. h no e - - - - The e have 8_ ❑ Demolition working fair me in any capacity. - employees and have Workers' 9 0 Bnildins addition 1N aomp. itsurance - - - comp: Tnsu ance$ - -_- - - - - required.] _ 5. 0 We are a corporation and its I0_❑ EIecuicaI repairs or additions re q ] 3_ 0 I am a homeowner doing all wort officers have exercised their ILO Plumbing repairs or additions myself [N 'workers' comp_ right of exemption per MGL 12.0 Roof repairs - insurance re uirect . - - - c._ I52, § 1(4),_and we have no ] - -- -- - employees_ [No workers'. 13.0 Other comp. insurance required.] • any applicant that box Ail nest also fill out the section below showing their workers' compensation policy information. T Homeowners who subnfrit this affidavit indicating they are doing-all work then hip: outside contractors roust submit a new affidavit indicatin_s such rContractors that checktbis box must attached an additional sheet showing the name ofthe sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they mustprovide their workers' comp- policy number. - - I anz an employer that isprovidiizg workers' compensation insurance for my employees Below is the policy and job site information. . - . - q� 1 _ • - - Insurance Company Name: A L M - I " i /A tt I i-41 S iGL (1 ri a - Policy ;r or Self -ins_ tic. - 4: k W C.- 0I A 6' lb I Expiration Dare: 4 / — a q r2 O f . ) Job Site Address: (raked - Ave. City /State /Zip: ! / O gip. / Jia4 df06 >Z Attach a copy of the; workers' compensation policy declaration page (showing thejpolicy number and expiration date). Failure to secure cove age as required under_Section 25A of MGL c. 152 can lead •to the impc$sition of criminal penalties of a - fine up to $1,500.00 and/or one-year imprisonment; as well as civil penalties in the fonn of a STOP WORK ORDER and a fine of up to $250_00 a day aga inmt the violator. _ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the ILA-for insurance coverage verification. - - - I do hereby certify u r the pains and penalties ofperjury that the information provided above is true and correct Si - Date: `01/ 9 h a- - Phone - -T /31 s36_,.....,3 ?33 - - - Official use onlu Dp not write in this area, to be completed by city or town official! - - -- try or Town: -- - -- -- -- - -- .... - - -- - Permit/License Y - -- - j Issui gg Authority (circle one): I_ Board of Health 2. Building Department 3. City/Town Clerk 4_ EIectrical Inspector 5_ Plumbing Inspector b. Other • 1 - _ - Contact Person: Phone: i SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Adam am/tit/die- 7 O4' ( License Number Itco old _, a_, . udLt, - 0/025 �a� ) ao1_3 Address ( Expiration Date X13 -536 S/SS Signature Telephone 9.:Registered Home Improvement Contractor $' .: Not Applicable ❑ � -✓ cur. OUr./1 /. °i kg_ ` ©cetr ' S f eti3 , c • /c3. 9.1 Company Name Registration Number /to old 4 mcc) (2t-- Jas I ► Addre ,�1 ``` /// Q Expiration Date .� '1 ruiti t y 1 1►"i r .0 �D Telephone ( Sj ��rs SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL: 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. - 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 faun 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 9 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) w New House n Addition ❑ Replacement Windows Alteration(s) I ( Roofing ig Or Doors 0 Accessory Bldg. ❑ Demolition n New Signs [D] Decks [0 Siding [D] Other [0] Brief Des9r.iption of Proposed Work: Kern c -. — rep 14h.A. ?✓nQ n� (4 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. tf New ; hou s e and.oc addition to existinq' housing, coniplete 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 a , ry / )f1 S to 1/ , as Owner of the subject Prope , r i r , hereby authorize % A • i / ' .e 4 ri I 0 II - - ' to act on my behal in all matters r- ative to work authorized by this bull ing permit applicy on. Signature of Owner Date I, k-/r v na i 1 (12 —" POO - S ;' nj , .a)'I (_ • , as Owner /Authorized Agent hereby declare that the statements and i?Tormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ains and penalties of perjury. AArn e,?11 Print Name ii' Signature of e Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information e Existing Proposed Required by 'Zoning This column to be filled in by Building Department Lot Size • - I ' Frontage Setbacks Front Side L R: ---- L: R: • Rear �....._ Building Height Bldg. Square Footage �1 i , % Open Space Footage Anew z % - (Lot arcs minus bldg & paved parking) I ! E i # of Parking Spaces Fill: (volume & Location) i ; [ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW ® YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book I 1 Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ON DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained IQ Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 - IF YES, describe size, type and location: 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 Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton DEC 2 6 2012 Building Department Curb Cut/Driveway Permit 212 Main Street • Sewer/SePtic Availability Room 100 VVaterNVeII Availability Northantlpton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: )0 & A-ve- Map Lot Unit 0/ H.0 Zone Overlay D str ct EIM St. District 1 11111111 CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: MarLi br :3C0 i I 0 ?0 (Tett 4C% Ploz124‘e-t- n(14- 0/ Name (Priap Current Mailing Address: 116 9 a Le_ Telephone Signature 2.2 Authorized Agent: tlAttin Goealtir/i Ite_lopCr5- -5).‘otirt.j/ )k-,,c) Old t ide-titan i e e i, 40,0(4, Ail- Om Name (Print) Current Mailing dress: %f33&' Signature Telephone SECTION -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (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) -it 00 Check Number op " - This Section For Official Use Only_ _ - - - _ _ _ Building Permit Number: - - Signature Building Commissioner/Inspector of Buildings Date • 20 GARFIELD AVE BP -2013 -0670 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 060 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 -0670 Project # JS- 2013- 001110 Est. Cost: $2500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 28880.28 Owner: DRISCOLL EDWARD A JR & MARY F Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 20 GARFIELD AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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 12/27/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 20 GARFIELD AVE BP- 2013 -0670 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D - 060 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 -0670 Project # JS- 2013- 001110 Est. Cost: $2500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 28880.28 Owner: DRISCOLL EDWARD A JR & MARY F Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT: 20 GARFIELD AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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 12/27/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner