24A-012 Z:Zi DD5LAZ . VISA eaCarCii lird.A DISCOVER
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 • 41 3.536.5955 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 fit Trade Association P.P.C.38710
Proposal Submitted To: Dates 1 Flo Phone#'s C: Lt 13--' \L)_g4..gt
/\IC 44t 4 (1 krverrtt H: due, wiGPAi; 3x439--Id51
Street Email:
_ $4 Ta h Sa f t *c,
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I10 'a,s f;- ' A ci 5heive 9-6,94rii-i nk, 11- -
City, State,Zip Code Special Requirements:
N,A-t- a;of il. ' 6) 060
❑ Recover Strip ❑ Layers
Complete Roof System
EXWe shall acquire all appropriate permits for all work I
Home exterior and landscaping to be protected 11 r,
'Strip existing roofing to existing decking and dispose of. Do not Do. �C�3 )(CUT-
,
�teriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
anstall Ice&Water Barrier at I eaves,valleys,chimneys,pipes and skylights
stall (151b.felt SyntIietic)underlayment over remaining decking area
❑ Install Metal drip edge at eaves and rakes(8"/5")(white/brown/copper)
stall manufacturer's starter shingle on all eaves and rake edges BBB
(_ice Install new pipe boot flashing(standard/copper)/vents •-
❑ Install Snow Country or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) 4-."\A e
& ." Shingles ❑ 25 year30 year ❑ 50 year Color
A Ridge cap shingles
Warranty Options:
e guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty `
❑ GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ /‘O CC )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Down Payment($ �9 )
satisfactory and are hereby accepted.Yo = e authorized to do ,,. as specified.
Payment will be.113 d wn at start of job,an•ba•,ce.. •on corn 4-. Balance Due Upon Completion($ / 0 7 )
05(6'3�r
Date: Signature: '/ —
Date: /0 �Estimator:(Print Name) C r rn It CI' Or( Name) ilf_
AB—
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
t1 , Department of industrial Accidents
Office of Investigations
` 600 Washington Street
4
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 Quenneville Roofing&Siding,Inc.
Address:_ 1 IPL0 0 1 (1 iYIC(rl I _LLB — — — ---
City/State/Zip: 11 I 'Y 1 J-� ZI Gin i-e'L. `� Phone#: 413 - v) :6 11. '3 c16'5
Are you an employer?Check the appropriate box: , Type of project(required):
I.X I am an employer with 1 7 _ 4. _ I am a general contractor and I 6. _! New construction
employees(full and/or part time).* have hired the sub-contractors { 2 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'
9. Building addition
[No workers' comp. insurance comp. insurance.+
required] S.i We are a corporation and its 10. Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 1 I. 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 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 em o ees,the must t rovide their workers'coon r. t olio number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. M
Insurance Company Name:--Art't ivl i4ttI.1 ..±115 1A,r 61tiee 1
Policy ft or Self-ins, Lie, #:_ r �7 rid I r�6 10 1 Expiration Date: '? `)x CI–a20
Job Site Address: Q5 t%-e _ city!State/zip:11G1r 0/0 .0
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 MGt_ 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 coves 'e verification.
1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: -,-4 Date: 511011-3
Print Name: LtW( 6())11.1 di lit Vi l i Phone fr. '-b 3=L)3 -`'- l l7?— -
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):
!.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
r•
8.1 Li g,Inc Not Applicable ❑
Name of License '. 'Y�, i 7O4'e(s
License Number
South Hadley,MA 01075
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor " Not Applicable ❑
Adam Qdenneville Roofing&Siding,Inc. 1 ZQQN
Company Nam1 old Lyman Road Registration Number
South Hadley MA 01075 3/a
Address Expiration ation Datt e
Telephone /3_.53&-.)S
_
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 /11 No ❑
11 - home Owne is bon
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 Ct
J
SECTION 5-DESCRIPTION.OF PROPOSED WORK(check all applicable) f-
n ,
New House n Addition [ Replacement Windows Alteration(s) rtislh 9.314 trig' 5��
Or Doors 0
Accessory Bldg. Zr Demolition El New Signs [D] Decks [Q Siding[C7) Other[GI
Brief Description of Proposed `' ! itco as
Work:--{ i1't(jt]� + .5 �(¢S , t1L fvt)F In 1
•
Alteration of existing bedroom �J Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet 11
GS'fr Ire . yi 9d•4
6a.if New house and or addition to existing housing,:complete.the followir :t4 ,µ,!! s Ib.r1.
I a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Dathrooms
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 1rh 11Irre , as Owner of the subject
property
hereby authorize Adam Quennevjlle goofing&Siding Inc.
to act on my behalf, 'n all matters relative to work authorized is building permit application.
_ /0))-3
Signature of Owner Date
1, Adam Quenneville Roofing 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.
Ado (Imo
Print Name
c/,° I13
Signature of Owner/Aoent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
r
Existing Proposed Required by'i'oning
This column to be filled in by
Building Department
Lot Size --
Frontage --
Setbacks Front
- __-__
Side L:---= R: — L: _._:a R:
Rear "'-__
Building Height - ._.:
Bldg.Square Footage % ___.
_ —
- Open Space Footage __� ___
(Lot area minus bldg&paved .__---
parking)
i
#of Parking Spaces
Fill:
(volume&Location) —' —
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW s YES Q
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW l YES 0
IF YES: enter Book - Page: i and/or Document#;�
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW is- YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
•
D. Are there any proposed changes to or additions of signs intended for the property? YES i0 NO 3
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 G
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
3S "'
Department use only
ity of Northampton Status of Permit:`
auilding Department Curb Cut/Driveway Permit e.
L frAi i 3 2013 212 Main Street Sewer/Septic Availability
Room 100 Water/Weil Availability
OFBUI DGINSPECTIONII Ni rthampton, MA 01060 Two Sets of S
W Structural Plans
`. --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
P/t.a5lacc4-
41nc1?--- Map Lot Unit
Zone Overlay District
Elm-St District CB District
SECTION 2:-`PROPERTY-OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
11r'e,-F 1 0 1,�,►• . ■ u-C / /► ..a AMY/ A : 0/b60
Name(Print) Current Mail ing As dress: //n 3 RoG^ 7k Y
Obte.--1,0_„(_J- Telephone Signature
2.2 AUAh�au�'uen�eevdle Roofing&Siding,Inc. /6,0 old 4mtarac>0 . d Lts, fhw 6ic9 s
Name(Print) � Current Mailing ddress:
_.)
-536--s--- 'S-C.
Signature Telephone
SECTION 3--ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use,Only
completed by permit applicant
1. Building - L` (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) 600 Check Number
This-Section For Official Use Only
- Date
Building Permit Number. Issued:
Signafui e: -
Building Commissioner/inspector of Buildings Date
110 PROSPECT AVE BP-2013-1093
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-012 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-2013-1093
Project# JS-2013-001804
Est. Cost: $1600.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 46173.60 Owner: BARRETT SARAH C
Zoning:URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 110 PROSPECT AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:5/14/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:ST RI P & 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 5/14/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner