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29-523 Z , D 1 VISA '+',) DISCOVER 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@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 Phone #'s C: S k t t x yV 3/ r6 13 H: yf5 Ye 6„ -- 1530 w: treet Email: City, State, ip C e Special Requirements: ' I - I D v t I NO of 0 6. 2 6' ct 4- lNQ. 4W ii Recover X Stripayers C J r i d5( �r!f�� 1-S1ai i ,/ 0 /,-L tect - ( " Sa tc)liO4 Complete Roof System s •)- -rw f t c't"e- O We shall acquire all appropriate permits for all work IT r �'.1e j 7t �pt; ''7` �� ��, y�i �� 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 per sq.ft. after full inspection. Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights Install (151b. felt i6 ;;U:0) underlayment over remaining decking area [Jnstall Metal drip edge at eaves and rakes V 5 ") dir •rown /copper) 6 Install manufacturer's starter shingle on all eaves and rake edges BBB Install new pipe boot flashing sfa dar copper) / vents — T — �Install Snow Country o obra rolled vent ridge ven Winner of the � 2010 ❑ Install proper soffit ventilation .rte TORCH AWARD ,,11,,�� Shingles: ( 6 nails per shingle) lit) L-/ C-A 1, ler 1 f Ar- Shingles ❑ 25 year LI 30 year �j 50 year ColorBrs C ice e 1 . `•..if- qd G_ Ridge cap shingles /v Warranty Options: ❑ We guarantee our workmanship for 10 full years (see our warranty coverage) ❑ GAF System Plus warranty X AF Golden Pledge warranty Chimney Options: K 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 ($ 7 g 0 0 ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ 2 3 3 ) 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 ($ S'Z 67 ) Dater 1 t i(' 13 Signature: t . 1 / I Date: Estimator: (Print Name) �yct17 Cat �t1YC. (Sign Name) - "L . c : i Estimat are onored 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 ei , . Department of Industrial Accidents cf , ) Office of Investigations 600 Washington Street Boston; Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization /Individual) : Adam Qnennevllle Roofing & Siding, Inc. Address: 1 !PD 0 16 1--- r lCtIll iR cl City /State /Zip: )OLC fI'1 I4 J 1- - � 1 1�'�} Phone #: i 3' 3 C - 6- q 65- J 01075 Are you an employer? Check the appropriate box: Type of project (required): 1. X 1 am an employer with lc 4. I am a general contractor and 1 6. LI New construction employees (full and/or part time).* have hired the sub - contractors 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. employees and have workers' q Building addition [No workers' comp. insurance comp. insurance. + required] 5.1 We are a corporation and its 10. ;1 Electrical repairs or additions 3. 1 1 am a homeowner doing all work officers have exercised their 11. El Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. fl Roof repairs employees. [no workers' 13_ _ Other comp. insurance required.] *Any applicant that checks box til must also fill out the section below showing their workers' compensation policy information. filomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 1171 M rt� M Insurance Company Name: ►'1 tri - MA I f. . L 115ttroo fl ce Policy # or Self -ins. Lic. #: A V1] C 101 �.kt 10 1 Expiration Date: � `dq alp 13 Job Site Address: 9 Gre 'rJ Lanz, City /State/Zip: ( /Lej , nket bib 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coveta_e verification. /do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Dale: 3 )o1 1 113 Print Name: / M O ILQ 6111-e V i II L Phone #: L t 1 3- E 3 6- .6 6 S 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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #: SECTION 8 - CONSTRUCTION SERVICES' 8.1 Licensed Construction $ft vi e l in eville Roofing & Sidling, Inc, • Not Applicable 0 Name of License Holder : y t�jUu 160 Old Lyman Road License Number 0 South Hadley ,MA 01075 ja013 Address Expiration Date L{t3 r - C Signature Telephone '9'Registered Horne Improvement' Contractor _ `' Not Applicable ❑ Adam Quenneville Roofing & Siding, Inc. o �dr� Company Name 160 Old Lyman Road Registration Number Address South Hadley, MA 01075 F;;pir2tio lac 1 te Telephone 'Y/3 3.6"S%S5 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 IX No ❑ 1 - Ro ne Owner Exe o 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, 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 assurnes 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 —See ebal SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) t New House n Addition n Replacement Windows Alteration(s) n Roofing I3 Or Doors D Accessory Bldg, [i Demolition n New Signs [0] Decks [[] Siding [O] Other [01 • Brief Description of Proposed j �1 r �" Work: r-v /11 ii O P 01 La ef5 Q4- 36S 4- reps P,c2. A Aim 64F F f aL4. JU� Q " Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a if Neill 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 COMPLETE[) . WHEN OWNERS AGENT-OR CONTRACTORAPPLIES FOR BUILDING PERMIT I, 5k , as Owner of the subject property (� hereby authorize f �FCtt UYl a- PM/10.0 / D. DD H-- ,S` ,, C. to act cn my behalf, in all matters relative to work authorized by this brliiding permitlication. C - . 3 / 011 /13 Signature of Owner Date x t r:i C ', x y At s �„.' . "i "5 ', E N, , f a i * �S M tekA: , I, Ad Q m ,niv,ul jt IC..et— ir -+k �l.Q i . C ° , as Owner /Authorized Agent hereby declare that the statements and inf ation on the - foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pal s and penalties of perjury. Pt dam � 0en i'1.e v,1to-- Print Name ,3)af //3 Signature of OwnerlAaent Qat Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information b Existing Proposed Required by 'Toning • , This column to be filled in by ( lV e 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) z # of Parking Spaces _ Fill: (volume & Location) -- _____ A. Has a Special. Permit/Variance/Finding ever been issued forion the site? NO 0 DONT KNOW 09 YES 0 IF YES, date issued:- IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW V YES Q 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 of signs intended for the property ? YES 0 NO 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required_ • p Department use only City of Northampton Status of Permit: 1613 Building Department Curb Cut/Driveway Permit • 212 Main Street Sewer /Septic Availability n " aut O Room 100 Water/Well Availability oryt OF _ Northampton, MA 01060 Two Sets of Structural Plans phone 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 9 r or U, -�1Z� Map Lot Unit Zone Overiav District ref 6101102_ Mm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Pri t) Current MAin dress: Telephone 5S /530 Signature 2.2 Authorized Agent: t ` J f _ d 11 1 . ) t t)/ ± .�� itJth A • 11 )o old s P , I4adLJ purl. bIo% Name (Print) Current MailWg Address: 3L Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be - Official Use Only completed by permit applicant 1. Building � 900 a o (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) 4 9) 90D ©° Check. Number "r� o This Section For Official Use Only - _ - Building Permit Number: i ssue d : Signature Building Commissioner /Inspector of Buildings Date 9 GREGORY LN BP- 2013 -0864 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 523 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 -0864 Project # JS- 2013 - 001481 Est. Cost: $7900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 5924.16 Owner: YU WEI SHING & WAN CHU YU Zoning: Applicant: ADAM QUENNEVILLE AT: 9 GREGORY LN Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:3/26/2013 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 3/26/2013 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner