29-131 (2) ADAM QUENNEVILLE ROOFING
P.O. BOX 612
SOUTH HADLEY,MA 01075
1-800AEW-ROOF
MA CONSTRUCTION SUPERVISORS#070626 MA REGISTRATION#120982
CUSTOMER ADDRESS:
Mr. Doug Smith
33 Alamo Court
Florence MA 01060
PROPOSED DUTIES:
1) Protect siding by hanging a tarp from gutter,where required
2) Strip off old layers of shingles down to sheathing on main house only
3) Clean roof and replace rotted sheathing($40 per sheet of plywood,extra if needed)
4) Install aluminum drip edge.018 drip edge on bottom and sides of all roofs
5) Install 3 feet of ice and water barrier along bottom of all heated areas and valleys
6) Install 15 pound felt underlayment on rest of uncovered roofs
7) Install new pipe flange flashing
8) Install new side wail flashing and chimney flashing,where required
9) Install shingles of choice in accordance with Tamko manufacturer's specifications
10) Install proper roof ventilation (ridge vent)
11) Thoroughly clean up roof and grounds,dispose of debris(removal fee included)
12) Roof is warranted not to leak under normal weather conditions for!25
years(depending on shingle selected). Labor is guaranteed for 5 years.
WE PROPOSE: to hereby furnish materials and labor in accordance with above
specifications for the sum of:
Tamko 25 year Three Tab $2,975.00
��yyr w.ko� 3aoc.00 YjY�
NOTE: This quote may be with a n by us if not accepted within 90 days.
Signature Date
ACCEPTED: The above prices,specifications and conditions are satisfactory and are
hereby accepted. You are authorized to do work as specified. Payment
will be 113 down at start of job and balance due upon completion.
Please sign one copy and return to above address. Thank you!
Date q'�'U _Signature �o«rPhone#
4�ItAI f p2
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m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WOM CER'S COMPENSATION INSURANCE AF MAVIT
• h I�e
with a principal place of business/residence at:
(streei/ci ty/stafrJri p)
do hereby certify, under the pains and penalties of perjury, that:
�- 1 am an employer providing the following workers compensation coverage for my
employees working on this job: '
(lam ance Company) (policy Number) (Expiration D )
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insurance Company/Poky Number) (Expiration Date)
.,
(Name of Contractor) (Insurance Company/Poki ,Number) (Expiration Date)
(Name of Contractor) (lnsu=ct� Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atlarlt addificcid sh'c- if nccc- u t4 incdudc information pc:ta.iuing to all oo¢tratton)
O I am a sole proprietor and have no one working for me.
( ) X am a home owner performing all the work myself.
NOTE:plcasc be aware that while homcowzxrs wbo crIlplay pawm to do Mxinlcnsncr'oorruruction or repair woti�on a dwelling of
not morn than throe units is w-trich the homoowncr raider or on the groun6 appurtenant thescto err nc<gctacnily oomidcrcd to be
employers under the worker's coatpcnsatioa Act(GL152,ss1(5)),application by a homcowacr for a 6ccnse a permit may cvidcnoe the
lcgil ctsrhrs of an employer under the W"kres Compomation Act.
I undcre-snd that a copy of this ctat=cnt may be forwnrded to tho Dep�of Indun ,l A.&—&Ofrroe of tmwanoa£or the
coverage vaificslioo and that failure to sean-e covecago undo scctioa 25A of MGL 152 can lead to the imposition of crimiazl pcn ks
ooasisting of a f nc of up to S 1,500.00 and/or impzis�of up to one year and civil pcnattics in tlx focm of a Stop Work Ordcr and a
fum of S 100.00 a day against m
For only
4/z�� Permit Number
tvfap<l Lot#
SiPAture of Liccnsedpermittee e
SECTION'8'-,,CONSTRUCTION SERVICES'
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
�Re �i r.,vemer r.n a r � 4 s "° . of Applicabte 4
uc.�plc�v a L)e)s�
Company Name r t Registration Number
D � y� � "1n7 y� a t
Address 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...... ❑
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 ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: r a r4 r
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 ho" and 'or. addition to ezist>Ing°Housing;Ca°rriplete-th64",following:
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. Mascheck 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 -OWNE RAUTHORIZATION'-TO BE COMPLETED WHEN
OWNERS AGENT QR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize _ —to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I,
�n` ''Lt �e�'l'1E ✓( ��, 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 perialties of per ury.
Print Name
Signature of Owner/ gent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
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)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
- City of Northampton S
Juilding Department G .
212 Main Street
,-Room 100 a.e.
ApR Northampton, MA 01060 a
phone 413-587.1 40 Fax 413.587.1272 Pao5�te �^R'
--� {1t er�SpectR
_.r
APPLICATfON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING `
SECTION 1- SITE INFORMATION
1.1 Property Address:
This section fo,beAcompleted by office
2
G Map lot Uft�
Zone M NOverlay Districts
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
K� Do 5 Ste, 4A 3 "o-iL
Name(Print) Current Mai ing Address:
Telephone
Signature
2.2 Authorized//A�\gent: // I
Name(Print) Current Mailing Address:
IVCc�j —A//
Signature Telephone O L 6
SECTION_3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
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) Check Number
This Section For Official Use Only
Building;Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
*-Vj-4
33;ALAMO CT BP-2002-0905
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map`131ock 29-+31 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0905
Project# JS-2002-1476
Est. Cost: $3200.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Adam Quenneville 120982
Lot Size(sa.ft.): 9365.40 Owner: SMITH DOUGLAS M
Zoning:URA Applicant: Adam Quenneville
AT. 33 ALAMO CT
Applicant Address: Phone: Insurance:
P O BOX 612 (800) 639-7663 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:4119102 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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/19/02 0:00:00 2219 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo