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35-248 (2) /I D)/1 y111111111MI*aid) DISC•VER Q U E N N E V I L L E www.1800newroof.net ROOFING V' SIDING Iv 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 Buildings&Trade Association P.P.C.38710 Proposal Submitted To: Date Phone#'s C: �Lo C Chen I�� i3 H: 1-1,3-5sq- 5-O30 W: Street Email: l� Lai SliPtocr City,State,Zip Code Special Requirements: TIa(('nt mA ), ❑ Recover Strip EU Layers Complete Roof System We shall acquire all appropriate permits for all work XHome 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$3.47 per sq.ft.after full inspection. rti Install Ice&Water Barrier at all eaves,valleys,chimneys;pipes and skylights • Install(151b.felt/SyntheticOnderlayment over remaining decking area • Install Metal drip edge at eaves and rake 0 5") (white brown/copper) a Install manufacturer's starter shingle on all eaves an rake edges BBB • Install new pipe boot flashin (standar copper)/vents Instalf...Snow Countrv)or Cobra rolled vent ridge vent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: , ( 6 nails per shingle) L��cM _ Shingles ❑ 25 year X 30 year ❑ 50 year Color:A) /,,1r_ (''{ Ridge cap shingles Warranty Options: ❑ We guarantee our workmanship for 10 full years(see our warranty coverage) ❑ GAF System Plus warranty GAF Golden Pledge warranty Chimney Options: Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum ot:Total Due($ 13, )a3 t1C ) r Y. F ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are f Down Payment($ s 5 n ;') ) satisfactory and are hereby accepted.You are authorized to do work as specified. �(y , '2 Payment will be 1/3 down at start of job,and balance due upon completion. Balance Due Upon Completion($ '`1 } ) Date: 7/4,,//) _Signature: rr Date: —lib�1�� Estimator:(Print Name) `-.rePP(b L (Sign Name v^ i. 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 ,t i . Department of Industrial Accidents tOffice of In vestigatiorzs t 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumhers Applicant Information �� __ Please Print Leeibly Name 1 BUN/nesvOrganization/Indieidual) • Adam Quenneville Roofing&Siding, Inc Address: I I�^Q (�' !CI r?- `4 IY(li l f�Ca ci C r City/State/Zip: )()G( fi 1 t-:-2 Ci 1-c'c j t K� it Phone#: L/ -), :j )j L `) cl`' 5 Are you an employer?Check the appropriate box: Type of project(required): X I. I am an employer with 15— _ 4. I am a general contractor and I ' 6. 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. i)ernolition working for me in any capacity. employees and have workers' q Building addition [No workers' comp. insurance comp. insurance. required] S We are a corporation arid its i 11). Flectrtcal repairs or additions 3. I am a homeowner doing all work officers have exercised their H. myself (No workers' comp, right of exemption perm MGL . Plumbing repairs or addition., insurance required) t- c. 152. § 1(4),and we have no i 12°,goof repairs employees. [no workers' IS. Other comp. insurance required-1 i •1nv applicant that rherka bo al must also fill out the section below showing their workers'compensation policy information. 'Ilomeowners 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-ew,trartors and state whether or not those entities have employe.. 1 the sub-contractors have employees,they niut provide their workers'romp.policy number. ___,_„y,--_._._-._-.._....__..... /am an employer that is providing workers'compensation insurance for ml'empluve ea. Below is the policy and job site information. /� ! insurance Company Name: .A f�l__ P1 _u n L/(.�.1-__1,,I15 Gl l' '4 i1 e e f Policy tt or Self-ins. Lie. ti: rn `fit'i r�6 t: 10I.. Tspiration [)ate Y ',.A(I-,L;'Li - city/state/zip r e(( � l r { t or6� Job Site Address:�� LCIe.� t� ��_,Lc�r1s�__ __ _. I�`'1`�-� Attach a copy of the worker ' compensation policy declaration page(showing the policy number and expiration (bate). Failure to secure coverage as required under Section 25a of M(i1. 1 51' can lead to the imposition of criminal penalties ut ., his up to $1.500.00 and/or one year imprisonment as well as civil penalties in the tc,nn ofa STOP WORK ORDER and a tine of $250.00 a day against violator. Be advised that a cops of this statement ntac he t;'irwarded to the Office of Investigation. 01 the DIA for covers a verification _____ __ /do herby certify under e pains and penalties of perjury that the information provided above is true and correct. _____LL Stnuturc: aria•• '11 1 1 I !'rim Name: A0/1 11.2 i1 iLe V I Phan, fit: '-i i `: L'• _ `. _ Official use only Do not write in this area to he completed by city or town official `___ city or !'owns Permit/license tt: Issuing Authority(circle one): I.Board of Death 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector- 6.Other (Ontact person: Phone tt: _ __-.. . .. SECTION 8--CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 10 jp ) to Adam Quenneville Roofing&Siding,lne, License Number 160 0Id Lyman Road tat J 13 Address South Hadley MA O1h5 Expiration Date 3 .53 �/aS� Signature Telephone Registered Home Imnrovemerit Contractor: Not Applicable ❑ . , 1 . . . 1,Aa96tc• Com•an a'' " ' i' �� Registration Number 160 Old Lyman Road 3 asf i I Address South Hadley,MA 01075 Expiration bate Telephone l i. '33 OJT 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 ❑ 1 1. — 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,von 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 £ ' 4i .t SECTION 5-'DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Re laceme t Wi ci Alteration(s) Roofing n _ � I p � �: Alteration I � Raofin Or Doors Accessory Bldg. IT Demolition I I New Signs [D] Flecks ID Siding[DI Other[D] .Il!, et, ',, ../ . ,. Work:: cripfion of Proposed 4 ,Ir.fM) 1 p h 5h-460 Work: DV-e- I D�SIUn (oS� D 11arc !Ji '`l V �J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a..lf New house and-.,or addition to existing housing, complete the_folloyvir a;r. W.~, : ;` a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Ni miler 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 FOR , OWNERS.AGEIdT:OR CONTRACTOR APPLIEE S FOR B UILDING PERMIT 1, f i 1 A l b e U r3 ,as Owner of the subject property hereby authorize l'19 ro Neitheville Roofing&Siding,Inc. to act on my behalf, in all mattert relative to work aUthorized tidy this building permit application. SAL e,tik-kia,04 -71 [711?) Signature of Owner Date _ z , , ,X001. ` $ , i, Adam Quenevilieloofing&Siding,In , as Owner/Authorized Agent hereby declare that the stateThents and'information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the (154 ains and penalties of perjury. A-dim\ de.pital),IL-c Print Name )(\........._ Signature of Owner/Agent Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by ioning 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) 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 IT YES 0 IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (3 YES 0 . ; IF YES: enter Book - Page, and/or Document it' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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 0 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 0 NO (5D IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r Department use only F3ECEPir' i� City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit. ;�i. A 2013 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEPT OF BUILDING INSPECTIO Northampton, MA 01060 Two Sets of Structural Plans HAMPTON nAo1os0" on 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 !5 Lct'3\,\P Map Lot Unit Zone Overiay District I Em St.DistrIct CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: n o4 cL C LU n o� 15 LS Lana 116iPw, flu4 6)064 Name(Prh , (/l o�_ �J Currg+�t�M 5644- 030 .QQ. ��Ul\Tit Telephone Signature (� Signature 2.2 Authorized Agent: 1.01 0 L A % 'v ■ -G , - ! My )too old ctn rc, So. L, �-Dios Name(Print) Current Mailing dress: )c..„. yi3-S3 -c cc Signature Telephone _ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building (a)Building Permit Fee I13aa3. ®v 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 13, 3 DU Check Number o09 (� This.Section For Official-Use_Only. - Date Building Permit Number Issued: Signature: Building Commissioner/Inspector of Buildings Date 15 LADYSLIPPER LN BP-2014-0079 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -248 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-2014-0079 Project# JS-2014-000160 Est. Cost: $13223.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 59677.20 Owner: CHEUNG FLOYD&SHERI Zoning: Applicant: ADAM QUENNEVILLE AT: 15 LADYSLIPPER LN Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:7/23/2013 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 7/23/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner