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17A-041 VISA J Q U E N N E V I L L E www.1800newroof.net ROOFING W 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 ^s Proposal Submitted To: Date L Phone N's C: Emai Street �:� 1 i City, State,Zip Code Special Requirements: 7 Recover Strip [ Layers Complete Roof System " We shall acquire all appropriate permits for all work Home 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$3.47 per sq.ft.after full inspection.'7Pr►M Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights Install (151b.felC�yntlle c);underlayment over remaining decking area Install Metal drip edge at eaves and rake0 5" �whitelbrown/copper) Install manufacturer's starter shin le on all eaves and rake edges BBB Install new pipe boot flashing tandard copper)/vents �- w I Install Snow Country(r Cobra rd ed vent ridge vent Winner of the 2010 TORCH AWARD Shingles: ( 6 nails per shingle) ci - --Shingles ❑ 25 year �] 30 year ❑ 50 year Color 10V,ITP 1jr- ____ ''�'_J Ridge cap shingles Warranty Options: ]l We guarantee our workmanship for 10 full years(see our warranty coverage) I GAF System Plus warranty ji� GAF Golden Pledge warranty Chimney Options: I, Lead Counter Flashing [1 Water Seal&Tuckpoint ❑ Rubberized Crown Metal Chimney Cap We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ 12 5 7 j ) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I (jC. 11"+7s/Down Payment($ 7 500 ) satisfactory and are hereby accepted.You are authorized to do work as specified. —T Payment will be 1/3 down at start of job,and ance due upo�mpletion. I Balance Due Upon Completion($--5q7 q7 -5 ) Date:_ !% /( / Signature:__ ___ ______ I�r Date:___ !71 (L � Estimator:(P nt Name)__ 'Ile . _(Sign Name) 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 -- i Department o Industrial Accidents Office of Investigations -- 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information pp Please Print Legibly Name (Business/Organization/Individual): Adam aennede Roofing&Siding,Inc. Address: 16--,G C1 c tart -9,0n.J City/State/Zip: u�,� '°J©9SS Phone#: q1353(,- S9 S5" Are you an employer? Check the appropriate box: Type of project(required): 1.[�1 am a employer with S 4. ❑ I am a general contractor and 1 p -� -+ have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working or me in an capacity. employees and have workers' g Y p tY� 9. E]Building addition [No workers' comp. insurance comp. insurance.'+ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their l l.�lumbin repairs or additions 3.❑ I am a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other _ comp. insurance required.] *Any applicant that checks box 41 must also fill 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 stib-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: n; at ZaSor'a n u_. Policy#or Self-ins. Lic. #:+k0c,gQ,09 ova Slo)o101:2 A Expiration Date: Y J c)-c1 1 )`f Job Site Address: ��to de, -�_OCt.CA City/State/Zip::::�(51.Q/h,@,e, nAou.-�- Attach a copy of the workers' compensation polyicy declaration page(:ihowing 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 N ider the pains and penalties of perjury that the information provided above is true and correct. Signature: /� -' Date: Phone#: 413'53 to- 515-6— 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: I oto b License Number 10 OM Lynn Road Address South Hadki'>tt,t 81075 Expiration Date ,'�L 1 South i171t[16731 'S3lb-SST SS Signature Telephone i9.RedsteredHome;lmprovement Contractor: . � _. _ _ _ Not Applicable £ Adam QaesaeviDe Roofing&Sng,k Company Nam Lyman Road Registration Number Song ad 1 M—A BIOS 3 � x ly Address rr/I�2 Expiration Date Telephone 7 `S3tr�t/ST 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...... £ Y� o-�y�ame O-wner�`��e1n�i� o>a 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 SECTION 5-DESCRIPTION OF PROPOSED WORK{check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors �7_ Accessory Bldg. ❑ Demolition ❑ New Signs [raj Decks [)_] Siding[p] Other[01 Brief Des 'ption of Proposed Work: O� ki �¢ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet P .-•• �.-��"-•.,x' sa;1UNewr.hous:e.and=o�.actdltlan fa:exls tmg FrOUSina complete"�tie'fQ�lovumc : , . a. Use of building:One Family Two Family Other 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, bLita' ��t�tJ� as Owner of the subject property hereby authorize C(Cti^ C to act on my behalf,' in all matters relative to work authorized by this buildin ermit application. 1�e-t- Cu" c ]a-I Signature of Owner Date I, A&m (.�P.RillLilf !'_ Imo. _' rI�' �� t 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. Prin Name f p ib 1)3 Signature of Owner/Agent Dat Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning 11iis column to be filled in by r--- 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) #of Parking S aces �-� l� Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO � DONT KNOW 0 YES 0 IF 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# B. Does the site contain a brook, body of water or wetlands? NO & DONT KNOW 0 YES 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 e� NO Q IF YES, describe size, type and location: I _ D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excayation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton 1` 1 � Building Department CO DEC �. ._` Er 212 Main Street JJ 44 Room 100 Wate-V. PAN l�5 ""N rtham ton MA 01060 � r4 g r. � P � ��st Elecinc � s R y 13-587-1240 Fax 413-587-1272 Pfol1PEa s 4 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONOOR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 7 71 1.1 Property Address: � Tfiis se�ct�on tbecoEnple edbibff ce F, ;;r ��r��h't�s•.: ��'��.1.�`„�j°'��ft`�.,.'°''X14="�t #, p 1 � � xL � ., �•��.' �,11-tilt• ->. 1 Elm St District. ' tF C8 D�stncti : a SECTION 2.7 PROPERTY OWNERSHIP/AUTHORIZED AGENT: : . 2.1 Owner of Record: ��C`�c9 Name(Print) 1 Current�M fling Ad �ess: ' rl Telephone� Signature 2.2 Authorized Accent: >�7 ar e(Print) Current Mailing dress: x/13- �3 4-5- S—S" Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use Only completed by ermit a licant 1. Building (a)Building Permit Fee S 5. vv 2. Electrical (b)Estimated Total Cost of Construction'from 6 `' 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S. Fire Protection 6. Total=(1 +2+3+4+5) L10 Check Number This Section For Official'Use Onl ' .. . .. Building Permit Nu Date-mber: Issued: Signature: - Building Commissiarterllnspector.o€Buildings Date 196 BRIDGE RD BP-2014-0755 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-041 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-2014-0755 Project# JS-2014-001298 Est. Cost: $12525.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 19994.04 Owner: MATHERS JOSEPH&LAURIE Zoning: RI(100)/URA(100)/ Applicant: ADAM Q U E N N EV I LL E AT: 196 BRIDGE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:1213012013 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 12/30/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner EW