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09-006 AZ \I D ' V/SA Mastery ® G DISC•VER 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 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 f Phone#'s C: I'..),+/n L.s,1-c.w le( r ,:� 69 /''f�447 s/343 H:(s-- gCS '�1 3 W: -Street.-- ------- - --- -- � Email: i V0r^.__It07a_ 1 City,State,Zip Code Special Requirements: L Ler!j ./414 0/C > .__—_ G i r(,n .( d l %. .✓ o.) S�'''�S 4.4 onr4dt.' ti Recover (`k{ Strip ` Layers + /I I -� , w� f Complete Roof System 4 f ��,� 1a� X We shall acquire all appropriate permits for all work �:,< G✓ti ` t�s1F//` �°' `"�` 4 - Home exterior and landscaping to be protected • Strip existing roofing to existing decking and dispose of. Do not Do. stops r1_`a Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection. _ FA Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights ] Install(15Ib.felt yno-etjc underlayment over remaining decking area Install Metal drip edge at eaves and rakes®/5")(whiteQtTPaWrcopper) N Install manufacturer's starter shingle on all eaves and rake edges BBB Install new pipe boot flashing(standar copper)/vents Install now Gour r Cobra rolled vent ridge vent Winner of the 2010 [_] Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) 6 A- F Shingles Li 25 year k 30 year ❑ 50 year Color F Ridge cap shingles Warranty Options: N We guarantee our workmanship for 10 full years(see our warranty coverage) ] GAF System Plus warranty • GAF Golden Pledge warranty Chimney Options: Sj Lead Counter Flashing [] Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ s- ) 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 balancddue upon completion. Balance Due Upon Completion($ ) Date / Estimator(Print Name �{fitT.c��` } ( )—_. �� C,,T 4,..‘ (Sign Name)_ ,! 7G'r���!���� 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 of Massachusetts *I . Department of Industrial Accidents It 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/Indivicluai) Adam Quenneville Roofing&Siding,Inc, Address: 11�0 D ICI L r YI Ct r l C 0 A cl_— -----__--------____-- City/State/Zip: )OcL-1-11 f-1-zto 14),:j, t i Phone#: 1 ? r-) L 6-'7'35 C)I0 'S I Are you an employer?Check the appropriate box: Type of project(required): I.)( I am an employer with 15 4. . I am a general contractor and I 6. _.! New construction f employees(full and/or part time).* have hired the sub-contractors Remodeling I 2. lam 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' 9. Building addition [No workers' comp. insurance comp. insurance.+ required] .i We are a corporation and its 10. ' Electrical repairs or additions 3. lam a homeowner doing all work officers have exercised their J 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.,Roof repairs employees. [no workers' 13. __ Other —__ comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 'homeowners who submit this affidavit indicating they are doing sill 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 ens levees,the must ruvide their workers'corn . olic number. --,- I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infOrnlatiOft. a 1 -- Insurance Company Name:_I_LL Pl_ iv I u a.I .1.n5 IX(CA f1('E _______ _---.--- ----- '/ ----- r '7V rd I(� Expiration Date: � , Ui Policy #or Self-ins. Lic. ti: A C..,, —,� _' Job Site Address:___— -_- . r-P-taa Cit /State/Zi 4,11 PAPt. OA) '53 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 tine 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 covera,e verification. -, 6,,T_. --a — I do herby certify unde e pains and penalties of perjury that the information provided above is true and correct. Date: I l tart) (Tint Name: tet,Y1 )1 r] I V t Phone T 1 ,,—L: (,. �j c Official use only Do not write in this area to be completed by city or town official City or Town: — __Permit/license#:— i Issuing Authority(circle one): (.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 ti 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville Roofing&Siding,Inc, 7a&A 160 Old Lyman Road License Number j,....\____ Sou&Hidley,MA 01075 kia 1 Address Expiration Date q13-53 —CciSS— Signature Telephone 9.`Registered Home Improvement Contractor.' Not Applicable ❑ Adam Quenneville Roofing&Siding,Inc. f a 09g,t=1- Company Name 160 Old Lyman Road Registration Number South Hadley,MA 11075 2401 V Address Expiration,Date Telephone q13 X36-5 rs 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 Ar No ❑ 11. Home Owner xellistzon The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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-vearperiod 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 SECTION 5-DESCRIPTION.OF PROPOSED WORK(check all applicable) New House n Addition Replacement Windos;, AlteftttiRn(s) 1 I Roofing Or Doors El w+r,a Accessory Bldg. n Demolition El New Signs [D]' 4111 beClekii Siding[©l Other[Dl Brief D- notion of Proposed n' Work: %► -4-13 of s O )&I :!. r I /. r A e so _ S�lr 9a 1~ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Oa,if New house and or addition to existing housing, complete the_following: I a. Use of building: One Family Two Family Other t•ri b. Number of rooms in each family unit hN�umber 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 . 1. 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, Toh n Ltd"C‘3,51 e L 4 Gtzt -ost Mande , as Owner of the subject property hereby authorize Adam Quenneville Roofing&Sidinng,ink% to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date - — — Adam Quenneville Roofing&Siding,Inc, i , 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 Ck,ni ( eat Rib) (--5L- Print Name S- /6 ji3 Signature of Owner/Agent Date Section 4. ZONING Ali Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information r Existing Proposed Required by'�'oning This column to be filled in by Building Department Lot Size ? ----- L Frontage --- Setbacks Front ____ R:__ — L:___.__ R:�___.._- Side L: ..- J. Rear -- Building Height Bldg.Square Footage % T ._ Open Space Footage ____ % ___ -- (Lot area minus bldg&paved _,__.___ __._._.,._.. v_ ---- parking) i #of Parking Spaces ---- Fill: (volume&Location) --- —, ----- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES Q IF YES, date issued:- IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: enter Book Page; 1 and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: : C. Do any signs exist on the property? YES Q NO 13 IF YES, describe size, type and location: • D. Are there any proposed changes to or additions of signs intended for the property? YES iQ NO e IF YES, describe size, type and location: z 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 RECEIVED City of Northampton status of Permit iBuilding Department Curb Cut/Driveway Permit k , NAY r 2�{ 212 Main Street Sewer%Septic Availability NAY Room 100 Water/Weil Availability { orthampton, MA 01060 Two Sets of Structural l Plans DsPL OF NORTHAMPTO BuLDWG N,INSf MA 01 E U1�18 4 3-587-1240 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 This section to be completed by office 1.1 Property Address: � quo J IIIIAP 1 ood Map Lot Unit. , nom" c i C c-2 Zone Overlay District ,I Elm St.District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: john LA- 'c=—4- rrAcLOJ VY12n qCo)4n QC C �� f 3 )/° Name(Print) Current Mailing A dre . �s-nod 9693 . X- Telephone Signature 2.2 Authorized Agent: am Quenneville Roofing&Siding,Inc, )60 ©Id 14„,,c,,, , ,, . t, li Hod ,1f r 0 X 67 s Name(Print) Current Mailin ddress: 'L.� L-/L&-53b-5 iS Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4 U 10 00 (a)Building Permit Fee 1 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) 11 e_5i bC p 136 Check Number a Pg 7 .3 This Section For Officiaitlie:Only =-_ . Date Building Permit Number Issued: Signature:. Building Commissioner/inspector of Buildings Date 400 KENNEDY RD BP-2013-1058 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 09-006 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-2013-1058 Project# JS-2013-001750 Est.Cost: $25000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): Owner: MANDEL GERALD&JOHN LATAWIEC Zoning:RR(100)/WSP(100)/ Applicant: ADAM QUENNEVILLE AT: 400 KENNEDY RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:5/7/2013 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 5/7/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner