31A-272 _i _1I D),5,\Z Name
f�s�c t >htTrcAc Date
a(133`
Q U E N N E V I L L E 6
Street Address
ROOFING■ SIDING ■WINDOWS BBB 0 ) r :�l c�c e c r.
city State Zip
1,.800.NEW ROOF �— ,�„`E.c e�V., n.,,„ 31r,,t1
413.536.5955 Winner of the Home Phone# Work#
1 800N EWROOF.NET TORCH AWARD ,'-II'3-5`dU " b i�t-i
RESIDENTIAL •• COMMERCIAL Cell# Email
160 Old Lyman Road•South Hadley,MA 01075 (4 �, ;t
StraightForward Pricing® •
1 Story ?! 2 Story 3 Story
7 Remove.&Replace 3 SQ of Shingles .tepflash/Counterflash 41'to 50'of Wall or Chimney,
ove: • s o *alley,Install 121'to 160'of 0:• • o I i'
of Ride Vent&Ridge Cap Shingles(Baffled or Rolled) Lead Flash Chimney 24'to 28'
LEANING Roof or Siding 2,001 sq ft-3,000 sq , onstruct c et an.Flash
3 to 6'wi Chimney,Cover 51'-65'nF Fascia or Rake with Alu nu Remove&
e lace 1 S f Dormer Siding ap'iT� 1 f LI%•t L
P 8� � GQ��oc.«. �t�'in`' 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 1,501 sq ft to 2,000 sq ft,Cover 41'to 50'of Fascia r'q i�j.
or Rake with Aluminum,Remove and Replace 1 SQ of Wall Siding Qty x$1392 ea=$ �+�
Remove&Replace 1 SQ of Shin:l- tepflash/Counterflash 21'to 30'of Wall or Chimney,
'- .• •ep ace to 0'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 $922 ea=$ 9) •uJ
4 Remove&Replace 2 Bundles of Shingles,Stepflash/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
Chimney less than 5'in height,Strip-off and Re-Shingle 2nd Story Bay Window Qty 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),Lead Flash Chimney up to 8'perimeter,
• 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 to 30',Install u to 20'of Ice&Water Barrier
g P P Qty x $179 ea=$ {
InReplace Rotted/Damaged Decking,as needed,at$3.47/sq ft Qty x$3.47 =$ I �S .00
Shingle-CLOSEST MATCH: Roof Pitches greater than 6/12 Add 30%=$
Brand: T�^, n f Excess Build-Up of Moss&Mold Add 30%=$
Color: ''r.-,,. �,r-z .� (intl) f" 3rd Story Roofs Add 20%=$
Other Services: -1 n3 I c C 1c r $ tar-/(t,C'
$
$
Notes: Prr,,,ur/ eI]l _?c' Ur'r-c ,),na(,�
f,-,.A I r°' c, I rnv i C::ti c , - 2' ,
P- Sub-Total$ 751-1(15 00
511....,..-c..- r:rc.,-, ,ioo� 99-004, Cl� f �c >7�x
Lo.,..,,i0.0' , Pct C 3x Diagnostic Fee$
I r - �',t e(1r' -33 IC Total Due$ -1G'/C t'
C<''''',‘-'Jr- Cle.ek,;,cr? ;,ri,r, tip -tc ;rr-;Tr,I Down Payment Due Today$ 0 Soo.do
G Cc) L,,Jttitc r i
1 c ;,R,-c;CC ('Ce f ic,c. 3 Lt t;oc,r(-1 Balance Due Upon Completion of Job$ 514/( t'.
I hereby autthoorrri�ize you to proceed with the above StraightForward Price®
X_____1245141 --
_ 4
Specialist Print Name: -c. ;/ :r•c'I c,
Thank You!
The Commonwealth of Massachusetts
= Department of Industrial Accidents
y-=� t►=
Office of Investigations
1 Congress Stree4 Suite 100
Boston,MA 02114-2017
4;14- www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information A & Please Print Legibly
Name (Business/Organization/Individual): Adam Quennevile Roofing&Siding,Inc,
Address: /too Old L8mgfl cQ.
City/State/Zip: r u .��JJ�.! I 11075 Phone#: x{13`536-C9 SS
Are you an employer?Check the app '�priate box: Type of project(required):
1.IP
lain a employer with 1 c 4. 0 I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers'
g Y p n' $ 9. Building addition
[No workers' comp. insurance comp.insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
120 Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13.❑Other
employees. [No workers'
comp.insurance required.] _
'Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A _
: Iv\ (Y1u-i-ut 1 Soru.r)CQ-
Policy#or Self-ins. Lic.#:\14C '1CO7OI ipI )-O A Expiration Date: —xi—aO[y
Job Site Address! ?7 :"� ,s4' -'hC } . �, City/State/Zip: n OIDO
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 c. 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of peijury that the information provided above is true and correct.
Signature: " Date: 01013
Phone#: 41S
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 Health 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 Supervisor: Not Applicable ❑
Name of License Holder: Adam Quennev&Roofing&Siding,Inc. No D-6
License Number
160 Old Lyman Road tat 113
Address South Hadley,MA 01075 Expiration Date
A._ L/l3. s 10-sssc
Signature Telephone
9.Registered Home Improvement Contractor Not Applicable ❑
Adam Quenneville Roofing&Siding,Inc, /a 09,6-1-
Company Name 160 Old Lyman Road Registration Number
oath Hadley,MA 01075 IJla`r' ''
Address Expiration Date
Telephone L{ 3-536-5't1ss-
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 1- No ❑
11. --Home Owner-Exe>r��11�oll
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-AL
State of Massachusetts General Laws Annotated.
0641 Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition n Replacement Windows Alteration(s) n Roofing i")ci
Or Doors 0
Accessory Bldg. n Demolition I I New Signs [0] Decks [El Siding[p] Other to]
Brief De. nption of Proposed t
Work: 14-R, l t r em C1u Q i UMANp,d lik:S
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a; If New house and-or addition to existinq housinq, complete the following:
a. Use of building :One Family •/ Two Family Other 1
b. Number of rooms in each family unit Number of Pathrooms
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 1-2,12.(iB,tY'S
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 PtAef t/t)k1141 � ,as Owner of the subject
property ��__
hereby authorize '� %l Cat\ 0 .11ttevi t _ (Zoci,QQ�t-\5 `--SIgi"s 1 44 c "
to act on my behalf, in all matters relative to work authorized by this building permit application.
G E/i ti//3
Signature of Owner Date
', ,!°'<i','',-,i,=;. �
,41St ; ., . ,,4-.q, ,' . w r t a . `§ ,;"J ,1L:,;1,i "PO
i t1]p rn 0 �Ar201(k RO-C;n1R '-- 3:i0,0-ill -�- C . , as Owner/Authorized
Ag t hereby declare that the statements and information the foregoing a lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains nd penalties of perjury.
A. m t lenfizvi ICS
Print Name / Q)iti 115
Signature of Owner/Agent Date
Section 4. ZONING All information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by'toning
This column to be filled in b4" 'a 3
Building Department
Lot Size : --- ._______,__: .__. _.
Frontage -° — _ . _
Setbacks Front _ `
Side L:------- R:--- L:._...__.L. R:
Rear �W. _.
Building Height •
Bldg.Square Footage - • % uT __
Open Space Footage ___ ___ % _
(Lot arca 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 Cc DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
`J
NO 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 d DON'T 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 , 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 i NO ,,,-
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exc tion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
Department use only
City of Northampton Status of Permit:
[—AUG O au Building Department Curb Cut/Driveway Permit...
212 Main Street • Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT.OFEU, DING INSpECrONS Northampton, MA 01060 Two Sets of Structural Plans
NORTHAMPTON,MA 01060
• • - 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
Map Lot Unit
IQs Gut r...
Lone Overlay District
Elm St.District - CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
iae -e,r j,OI 4re(AS-e-- a.7 as 6i aaa, 0C i-t'l ao
Name(Print) Current Mail Address:
Se.:�.. C6,.--tttx. (3- sue- 0
Telephone
Signature
2.2 Authorized Aq t:
Ylt0,r1i jL o& rc t` ?S,.1 /be ea ,ed, se- , r O/875-'
ame� Current Mailing d
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS -
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 3( (a)Building Permit Fee .
r1,(oLfie-00
2. Electrical (b)Estimated Total Cost of
Construction froin.(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection :.
6. Total=(1 +2+3+4+5) 4i 1-1,404t=. -00 Check Number cgtf� '
`: This Section For Official Use_Only .,
Date
Building Permit Number: Issued:
Signature: _.
Building Commissioner/Inspector of Buildings Date
23 DRYADS GREEN ST BP-2014-0195
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-272 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-2014-0195
Project# JS-2014-000329
Est.Cost: $7646.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 33541.20 Owner: WHITTREDGE PETER
Zoning:URA(100)/ Applicant: ADAM QUENNEVILLE
AT: 23 DRYADS GREEN ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:8/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR ROOF,CHIMNEY & SIDING
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 8/19/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
23 DRYADS GREEN ST BP-2014-0195
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-272 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-2014-0195
Project# JS-2014-000329
Est.Cost: $7646.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 33541.20 Owner: WHITTREDGE PETER
Zoning: URA(100)/ Applicant: ADAM QUENNEVILLE
AT: 23 DRYADS GREEN ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:8/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR ROOF,CHIMNEY & SIDING
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 8/19/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner