29-130 (2) D Name 1 Date
QU E N N E V I L L E o Street Ad ess
ROOFING'► -Street
SIDING ■WINDOWS BBB Cs,,,'c'' C0�t--
1.800.NEW ROOF -T. City State� zip
ci �� rot o(Cs(03
413.536.5955 Winner of the Home Phone# Work#
1800NEWROOF.NET TORCH AWARD (4( Ski-7-16'i:6 i.z '
RESIDENTIAL ■ COMMERCIAL Cell •Email
`-F ,,y S -en• 1
160 Old Lyman Road•South Hadley,MA 01075 `t >
C c:i
StraightForward Pricing® . °
✓1 Story 2 Story 3 Story -
7 Remove&Replace 3 SQ of Shingles,Stepflash/Counterflash 41'to 50'of Wall or Chimney,
Remove&Replace 41'to 50'of Valley,Install 121'to 160'of Drip Edge,Install 71'to 100'
of Ridge Vent&Ridge Cap Shingles(Baffled or Rolled),Lead Flash Chimney 24'to 28'
perimeter,CLEANING Roof or Siding 2,001 sq ft-3,000 sq ft,Construct Cricket and Flash '
3'to 6'wide Chimney,Cover 51'-65'of Fascia or Rake with Aluminum,Remove&
Replace 1 SQ of Dormer Siding Qty,x$1787 ea=$
6 Remove&Replace 2 SQ of Shingles,Stepflash/Counterflash 31'to 40'of Wall or Chimney,
Remove&Replace 31'to 40'of Valley,Install 91'to 120'of Drip Edge,Install 51'to 70'
of Ridge Vent&Ridge Cap Shingles(Baffled or Rolled),Lead Flash Chimney 19'to 23'
perimeter,CLEANING Roof or Siding:,501 sq ft to 2,000 sq ft,Cover 41'to 50'of Fascia
or Rake with Aluminum,Remove and Replace I SQ of Wall Siding Qty x$1392 ea=$
5 Remove&Replace 1 SQ of Shingles,Stepflash/Counterflash 21'to 30'of Wall or Chimney,
Remove&F-Replace 21'to 30'of Valley,Install 71'to 90'of Drip Edge,Install 31'to 50'
of Ridge Vent&Ridge Cap Shingles(Baffled or Rolled),Lead Flash Chimney 14'to 18'
. perimeter,CLEANING Roof or Siding 1,001 sq ft to 1,500 sq ft,Cover 31'to 40'of Fascia or
Rake with Aluminum,Minor Tuckpointing and Watersealing of Chimney 5'to 9'in height Qty_x $922 ea=$
4 0Rc love&Replace 2 Bundles of ShinglesjStepflash/Counterflash 11'to 20'of Wall or
Chimney,Remove&Replace 11'to 20'of Valley,Install 51'to 70'of Drip Edge,Install 21'
to 30'of Ridge Vent&Ridge Cap Shingles(Baffled or Rolled),Lead Flash Chimney 9'to 13'
perimeter,CLEANING Roof or Siding 501 sq ft to 1,000 sq ft,Cover 21'to 30'of Fascia or
Rake with Aluminum.Clean 251'to 350'of Gutter,Minor Tuckpointing and Watersealing of / �� 3
Chimney less than 5'in height.Strip-off and Re-Shingle 2nd Story Bay Window Qty l x $763 ea=$
3 Remove&Replace up to 1 Bundle of Shingles,Stepflash/Counterflash 6'to 10'of Wall or
Chimney,Remove&Replace up to 10'of Valley,Install 31'to 50'of Drip Edge,Install up to 20'
of Ridge Vent&Ridge Cap Shingles(Baffled or Rolled)(Rolled) tastrettflo 8'perunete 0 5P Capf 5't-
CLEANING Roof or Siding up to 500 sq ft,Cover 11'to 20'of Fascia or Rake with Aluminum,
Install Dryer Hose Connection&Flash through Roof,Strip-off and Re-Shingle 1st story Bay
Window,Clean 101'to 250'of Gutter,Install 51'to 100'of Ice&Water Barrier Qty X $612 ea=$ (`')—
2 Remove&Replace up to 1 bundle of Shingles,Stepflash/Counterflash<5'of Wall or Chimney,
Install up to 30'of Drip Edge,10'or less of Gutter or Fascia Replacement,Clean 31'to 100'
of Gutter,Cover 10'or less of Fascia or Rake with Aluminum,Install Rubberized Crown on
Chimney Cap,Install Stainless Steel Cover on Chimney Flue,Install 21'to 50'of Ice&Water
Barrier,Remove&Reinstall 1 Soil Boot Qty x $427 ea=$
1 Roof Certifications,Gutter Cleaning up to 30',Install up to 20'of Ice&Water Bather Qty_x $179 ea=$
Replace Rotted/Damaged Decking,as needed,at$3.47/sq ft Qty x$3.47 =$
Shingle-CLOSEST MATCH: Roof Pitches greater than 6/12 Add 30%=$
Brand: Sc lzc"'S 3 7AA Excess Build-Up of Moss&Mold Add 30%=$
Color: AAJ.•.", &—A/ (intl) 3rd Story Roofs Add 20%=$
Other Services: 2�/tit,. cx- �i<,, $ ' oo
P/l e F/-/ �a $ 3.5--60
$
i),/,/„,/ f Q 5 Di SC, _�
Notes: �<,� - 54 t:�.,�.<c� /_I y — y
Sub-Total$ 60 7-c
Diagnostic Fee$ —99190—
Total Due$ 3 '757
Down Payment Due Today$ 46+0
Balance Due Upon Completion of Job$ ?, 7 s
I hereby'irfiT•. i o, •• eed with the above StraightForward Price®
Specialist Print Name: 4,< r,-/-t,
Thank You!
The Common wealth of Massachusetts
•
rtl Department of Industrial Accidents
Office qf Investigations
6011 Washington Street
Boston, Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber.
Applicant Information Freese Print [.eKibv
Name tfl,rsmess/Orgarri atinn/!ne!is idual) Adam Quenaeville Roofing&.Siding, Inc.
Address: ( C G' C l
1" - L r yin Yt d
City/State/Zip: )(:, ( */1 1- Cj 4 I_ �,%f Phonet/ c� 1 '3 1 `I')
C1� )riYr�
Are you an employer?Check the appropriate box: 1 Tvpe of project (required):
I.X I am an employer with )j 4 I am a general contractor and I I 6 veus construction
employees(fall 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' y tiuilJin�addition
)No workers' comp. insurance comp. insurance. +
required] s We are a corporation and its 1ti F-Icc ni:f! repiairs or a ldurs+n
: I am a homeowner doing all work officers have exercised their
! ! Plumbing repairs or adition,
myself [No workers' comp. right of exemption perm Mist
insurance required) + c. 152,S l(4). and we have no 12 'f_Roof repairs
employees. )no workers'
Other
comp. insurance required.
L.— -
%ny applicant that checks hos at must also fill out the section below showing their workers'compensation policy information.
•homeowners who submit this affidavit indicating they ore doing ill work And then hire outside(untrscturs must submits new Atfrdu-it iraicattne such.
:Contactors that check this box must attach in additional sheet.showing the Mime of the sub-rnntrArrnr.And two-whether or nor nm.c coterie.h3•r rnq,lo vrr
the sub-contractors have employees,the:must provide their workers'cons, policLnumbcr. __ . .
I am an employer that is providing workers'compensation insurance for ml•envtovres. Hero.,is the poticr and joh.sitf•
information.
t
Insurance Company Name: �! �t�u tt �/1 ri5 t f �1 n ee
+ 41 1Li 14P, /G) ' I ■nir•alion hate r - � 1- �L `�
!nlicti it or Sell ins. l_rc. - � �� �-- _ -- r/ ,�� �/� ( / y,
Coo 11�O)rI ,1 A n r Ll /V O 1 o fOC�!oh Site .AJdress. � ' Q,+�Q �_--__ _--. _ ( tty�Statc?/il• T Vc-K��til.�t "" �
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration (daft)
i'ailure to secure coverage as required under Section 25a of Mtil 15.2 can lead to the imposition oicrtntinal pen.,!ttrs Of .t
up to Sr i,500.00 and/or one year imprisonment as well as civil penalties in the titrin of a STOP WORK ORDER and a floc r,!
$'75(f-00 a day against violator. Re advised that a cops o} this statement tiw he !;+nvardcsl to the Office or vesti ations of phi
DIA for coverage verification
I tin herby certify under the pains and penalties of perjury that the infarmution provided above is true and correct.
/lint C J d i 3
7 '
Maw ( 'IIJ j1 r] LF_
Print Nome. V t l'hur,� re t t , t
Official use only Do not write in this area to he completed by cite or town official
City or Town: Permit/license f:
Issuing Authority (circle one):
I.Board of heath 2. Building Deportment 3. City/i'own Clerk 4. Electrical Inspector 5. Plumbing Inspector
O. Other
Phone a' _
( unty(t person:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Adi nue itril�n DMA...D_0.J. r- . —1 0 lc
License Number
160014 Lymu Road )a, ) 1.3
Address !bulky MA 01075 Expiration Date
({13 -53 6--C9SS
Signature Telephone
9.:Regrstered Home Improvement Contractor " Not Applicable ❑
• ea
Company a e " Registration Number
160 Old Lyman Road 3 j ci
Address South Hadley,MA 01075 Expiration Date
Telephone
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 ❑
11 -"Mime 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,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 Naru
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition I ReplacemeiggillifttkWt Aheration(s)f r1 Roofing >CI
Or Doors El !xci ip.m 3f
Accessory Bldg. ❑ Demolition ❑ New Signs [D] i"'I ij[DeOlcs, - 4,1a0r' Siding[D) Other[L ]
Brief Description of Proo ed
Work: pi(t e� c).DL+nata.& LC-S nstr s, [ S k 145 k F nab- 200
Alteration of existing bedroom Yes No Adding new bedroom Yes No •
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa..lf New.house and or:addifion tc ezistinq ho using,_compiete
a. Use of building : One Family Two Family Other
` jl
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 J c r (\ .6 I x_ Srn o I en S' , as Owner of the subject
property
hereby authorize A /
n QtJpr f/; I Le Rot/ nS CIO ru , C'
to act on my behalf, in all matters relative to work authorized by this building permit applic on.
a. Plrb3
Signature of Owner Date
I CWh 11- J��tl 'Lk_ 1200 /31t , as Owner/Authorized
Agent hereby declare that the statements and informatio n on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
P nt Name
p
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
r
Existing Proposed Required by'Zoning
This column to be filled in by
Building Department
Lot Size _ _
Frontage
Setbacks Front i
1
Side L: ' R:---' L: R:
r
Rear : -"`
Building Height
Bldg.Square Footage i
Open Space Footage — % — --.
(Lot area minus bldg&paved ______ ,.. i
parking)
i
#of Parking Spaces
Fill: .i
(volume&Location) `
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
(.J
NO DONT KNOW Q YES Q
IF YES: enter Book Page t and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO C5
IF YES, describe size, type and location: a
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO a
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 Gy-
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
143C-C(3
Department use only
C E V t City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
AUG _ 9 2013 212 Main Street • Sewer/Septic Availability
Hv Room 100 Water/Well Availability
B OF BUILDING INSPECTIONS
Northampton, MA 01060 Two Sets of Structural Plan`
NORTHAMPTON,MA 0106y I..- 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
1.1 Property Address:
This section to be completed by office
Map Lot Unit
L41 R1arno Ce)0 1+
Zone - Overlay District
Elm St District -- CB District
SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED:AGENT
2.1 Owner of Record:
-- C)\()n lo- So-)o I-e nS L4 Li t Q111_O ex
vr- frJ 02e,kez. i 61010)-
Name(Print) Curr t Mailin Ad ess:
Telephone
Signature
2.2 Authorized Agent:
Actctri a.e.nita.011kTocrfir-34irct,6 . . '-. 110o old IrQ h , . 4ad�, Aug- D 07C
Name(Print) Current Mailing ddress:())\____ q 13-- 53 b-ScS-S
Signature Telephone
SECTION 3--ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 5 r 00 (a) Building Permit Fee __
2. Electrical 7 (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) S to 7C ov Check Number
This Section For Official Use Only ` '
Date ,
Building Permit Number:` Issued:
Signature: _
Building Commissioner/Inspector of Buildings Date
41 ALAMO CT BP-2014-0154
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29- 130 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-2014-0154
Project# JS-2014-000286
Est. Cost: $5675.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 12283.92 Owner: SMOLENSKI JOHN A&ELLA L
Zoning: Applicant: ADAM QUENNEVILLE
AT: 41 ALAMO CT
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:8/9/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 2 BUNDLES ROOF,SKYLIGHT & FLAT
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 8/9/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner