11A-010 (6) ■ M D Master c_
, , DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING ■ 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
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Proposal Submitted To: Date Phone#'s C: A'/j s ' 6'-/3/r.
Z.1/ 17-<7 -7-c /
Street Er `C �„�k �.e_,
,.-4,,, S o -Z s 6-7 rs-2.
City,State,Zip Code �("�� Special Requirements:
./..4.13— (V ,.> i T Ir ', r`, 1, .,.4e r r,,r. r' ,)-
1
❑ Recover ❑ Strip LI Layers ,..)r't.,? ''£^',1'..':k,4 r., .J �' C \
Complete Roof System PJ U-r, c<H I,�� •.,�� 'ti `, °'�""' J
,2K] We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected
I .. '•• • '- - • • • •• •• • Do not Do. Noy --
[} E3eterioratettexistir g-deekifig will be replaced at$33:47-perstrk aftel'-ful inspectirm.
21 Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
--} -I etalf-f151b.folt ent over
X Install Metal drip edge at eaves and rakes'(0/5")Jwhite rown/copper)
] Install manufacturer's starter shingle on all eaves and rake edges BBB
install--new-pipe toot fragh • :. : _e. M
14 Install Snow Country qt Cobra rolled vent ridge vent Winner of the
2010
❑- -- : e es: -- '• _ TORCH AWARD
//
Shingles: ( 6 nails per shingle) - i rt, 'G`--c f
C. e 7;�; /e-c,'� Shingles ❑ 25 year 30 year ❑ 50 year Color S/� 7
�', ', 0 �r "� Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
❑I Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
r
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($--' )J f )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are [ ''j 'r` ?,
p p r-- Down Payment($�,�-� )
satisfactory and are hereby accepted.You are authorize' do work as specified. `J '± A
Payment will be 1/3 down at start of job,and b lance,r-,...on completion. Balance Due Upon Completion($ 7C'1 )
`� (V-- lit',
Date: j CO i 2°1 Sgnature: J
Date: Estimator:(Print ame) ak",, ;T e" '.^.t. (Sign Name):/4,_
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.
k
c,ommonweaun
Department of Industrial Accidents
rte
Office of Investigations •
600 Washington Street
Boston,MA 02111
X may-
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Lesfibly
Name(Business/Organization/Individual): Adam £� lhf t o Rp I--�B�'� -a--'ti '� ► �'
Address: no 0 Cl of n C Ce o-
City/State/Zip: S„ Jj- r oic7r Phone#: q13—S3b
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ID New construction
employees(full and/or part-time).* have hired the sub-contractors
2._❑ I am a sole proprietor or partner listed on the attached sheet. 7: ❑Remodeling
These sub-contractors have 8. Demolition
ship and have no employees ❑
working for me in any capacity. employees and have workers'
9. ❑Btrildir>a addition
[No workers'comp.insurance comp.insurance.$
required.] 5. ❑ 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 12.®Roof repairs
insurance required.]t c. 152, §1(4),and we have no li.❑ Other
employees. [No workers'
comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the natre 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':zin (� -
urrt ''
Policy#or Self-ins.Lic.#: (k)C.L10 6`1OI ' L.D iDO 13 A Expiration Date:
�" +� #•.
Job Site Address:
3d Le.(rn( I d S+1_2,Q City/State/Zip: L L4L ; M} 0/OS
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 u er the pains and penalties of perjury that the information provided above is true and correct.
Sienature: Date: c ')b 113
Phone#: 4I3-S36'" S`iCS-
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#:
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780.CMR 11011) :... - __ - •
k. T
• --
Independent Structural Engineering Structural Peer Review Required • Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-..TO BE COMPLETEDII/HEN'- - -
OWNERS AGENT OR CONTRACTOR APPLIES FOR BOILDIN-G.,.pERIVIIT
. as Owner of the subject property
i am uold—riFirtrn e oo mg&Sidmg,Inc,
act on my behalf, in all matters relative to work authorized by this building permit application.
--St-Z C131\-ka(J. PI i(6 Tr3 ;
Signature of Owner Date
Adam Quennevilie Rook&&dm%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 penaltie .,.... _________ ___________ __,
A_-.44.1\,_ • 1 cit_
_ _____
Print Name —
M 7)k ____ F.11(4' 1).3
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder Quenneville WigkSidinglit - _____---- — —J.._ i'._. _ —HAP OY (40
-------160-01d-Lynralload—_____ License Number
1 '----------,Pla"--4-13------—- '-
____
*
Address blintrA11075 Expiration Date
cc
Signature Telephone
SECTION 13-WORKERS!COMPENSATION:INSURANCE AFFIDAVRINLG.L..c.152i§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.
i44
Signed Affidavit Attached Yes a. No 0
---- -
Version1.7 Commercial Building Permit May 15,2000
a
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL.:PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF'EI!i, LOSED:SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant): i -.____.__...__.
_---- _.___.... --------- _.- __.___..,.__.,....___.....,._.._.. Registration Number
Address __ __ _LL.._....,._.,_„ ......_._...-
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name _. _Area of Responsibility ____
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
•
i
�
Address Ristration Number �
I t !
a
Signature Telephone Expiration Date
i
Name ___._. - 4 �______.__W. _.____ _ _ Area of Responsibility.
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
s _ Registration Number _
Address
Signature Telephone Expiration Date
9.3 General Contractor
_.o _
.._ Not Applicable ❑
Company Name: _ ..___ din ( ueninv: pgorm„ p Cidh jam„ ._...
c=vam�11Ftli16tt l4ktlF/IIUF�"ps��1111Q�IDC.
Responsible In Charge of Construction �-Ly®x®Road — __.._ _ ____._
Actiarr a juits.A4�.�(AT.._.____._u South C T ,0Y ti _ -_
_Address )
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTONNZONING J ,
Existing Proposed Required by Zoning ,
This column to re filled in by
Building Department
Lot Size _____, .. _ _ _, __
Frontage ..w_._. _ _ .. ____. �.._ _ _..._ ._.. _.�__ ._._. __.w_._.__
Setbacks Front i i i
Side L:. w R:L---i L:1 . R:' i .....
Rear
Building Height ___
Bldg.Square Footage --___ ,----_ % _._._ __..
Open Space Footage _ % . --.
(Lot area minus bldg&paved i ; ;,,,,:,� -i ( ____
parking)
#of Parking Spaces
Fill: �_._____d.__ _.__._ __._
g
(volume&Location) — -. -- ---- ------
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
lF.YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ` ' Page' = and/or Document ft'
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 , Date Issued: 7—
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 e
m
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 a
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May D,2001)
^
.
SECTION 4-CONSTRUCTION SERVICEg FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE- .....
Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 53 Change of Use 0 Other 0
Brief Description 'Enier a brief description here.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
Ci
M Mercantile 0 4 0
U Utility
0 Specify:
COMPLETETHIS SECTION IF EXISTING BUILDING-UNDERGOING RENOVATIONS;ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: ' Proposed Use Group: ' 1
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): _
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION -,-; - . . -
Floor Area per Floor(sf)
v
1st
[
3m
__
m --- � 4w ^ -
4 _
. �
--
Total ��(Anaa Total PmposodNew�onoboc8on
'
Total Height(ft) � --
. _--_--___-__-___. _'_-
Total Heigh #
� .
7.Water Supply §54) 7.1 7.3
Sewage
pu�� c3 P,�ot [] / Zono Ou��oF�odZono�] D On site disposal isposal system
'
Version1.7 Commercial Building Permit May 15,2000
--------- e rtmeit Ilse only
.---- -''''.- Department
N City of Northampton
i t.ktY.i:Oif?,etr-rlit: ;.--''.''''.'''',,.--r.';:'f',-:':::''!' ';i-i,'--",':,,r':,y':Q''','A:,-'',:.::-''Y':'-
--'''.1
1 Building Department . GatlyCutiOnvpway Perm
20v3 \ 212 Main Street
Room 100 IseriticAvaltabitity
-WiterWell'AVailability
...T......-
____.2- 2::„,, .,,L.,76-izl, Nerthamptoon, MA 01060 tiva-sets-ofstry.cturaillq
\F )1,1.
1,10B-Cr‘ \' Ptie 2- 4 -587-1240 Fax 413-587-1272 Plot/Site Plans
OtherSpecrfv,,, ,- 7-., ...,,,,,. _. . -
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
_____ OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
L, ot s.ir -
. 3g c-nctr : Zone
Overlay District
- ._ _ ____. EiM-St Diefriot CB District
SECTION 2-PROPERTY OVVNERSHIP/AUTHORIZEDAGENT
2.1 Owner of Record: .- iv___......--T -7--6id
Name(Print) -v./ Current Mailing Address:
Signature ,Sp CANII 4A C43C- Telephone
2.2 A t horizedawt:,_ i -lai
v,-7i-li--i--9_19__1--.
act..m. we-flak-4_10i- • --/—
Name P Current Mailin9
(* rint)
)(.. _
Signature Telephone
SECTION 3-ESTIMATED-CONSTRUCTION COSTS ,
Item Estimated Cost(Dollars)to be . Official Use Only
completed by permit applicant
1. Building i.1c-00 : (a)Building Permit Fee
: 3 :
,...._— ........_____........_..
2. Electrical I --:---4-2------ 7 (b)Estimated Total Cost of
; Construction from(6) .
3. Plumbing * * 1 Building.Permit Fee
_ .......... ..„_______......,
4. Mechanical(HVAC) : – ---,
5.Fire Protection , ____. _______.____.
_
6. Total=(1 +2+3+4+5) V 3,3s)-C-.00 Check.Number 614 f-Og 36-
This Section.For Official Use Onil
Building Permit Number 8 P,, - ty-a_ L) Ltv . Date
issued
Signature:
Building Commissioner/Inspector of Buildings Date
38 LEONARD ST BP-2014-0246
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11A-010 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-2014-0246
Project# JS-2014-000380
Est. Cost: $3325.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 29010.96 Owner: WHITE GREGORY W&PATRICIA J REIDY
Zoning: URA(100)/ Applicant: ADAM QUENNEVILLE
AT: 38 LEONARD ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:9/6/2013 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 9/6/2013 0:00:00 $35.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner