23B-074 ZiI � M �
Q U E N N E V I L L E
www.1800newroof.net
ROOFING W SIDING 'V WINDOWS We Are Licensed
160 Old Lyman Road South Hadley,MA 01075
1.800.NEW ROOF 41 3.536.5955 Fully Insured'
Email:info@1800newroot.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
'V
Proposal Submitted To: Date Phone#'s C:
teet Email:
n J 7 !2 1.a r. _ __
City, State,Zip Code Special Requirements:
Recover k Strip `]Layers t�Ai , vPl'r
Complete Roof System
We shall acquire all appropriate permits for all work
K Home exterior and landscaping to be protected
0 Strip existing roofing to existing decking and dispose of. Do not Do.
F)0 Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
E Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
Install(151b.feltSynthetl underlayment over remaining decking area
Install Metal drip edge at eaves and rakes(8,')/5")((white)brown/copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
] Install new pipe boot flashing(standard/copper)/vents �'—
Install Country r Cobra rolled vent ridge vent Winner of the
_.. 2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
{� _Shin les 'fc
g ❑ 25 year 30 year ❑ 50 year Color
-_.___. Ridge cap shingles
Warranty Options:
; We guarantee our workmanship for 10 full years(see our warranty coverage)
GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ � X )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Down Payment($ S
satisfactory and are hereby accepted.You are authorized to do work as specified.
Payment will be tl3 down at start of job,and b ante due upon completion. Balance Due Upon Completion($
Date.-,Z Signature:
_ rint NamDate: S 9 "u _Estimator: e)_ ,
(Sign Name _7
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.
sate
Department of Industrial Accidents
Of ke of Investigations
600 Washington Street
wi Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Adam Quenneville Roofing & Siding Inc.
Address' 160 Old Lyman Rd
City/State/Zip: South Hadley MA 01075 Phone.#: 413-536-5955
Are you an employer?Check the appropriate box: Type of project(required):
1.® lam a employer with 15 4. ❑ I am a general contractor and I 6 El 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. Q Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. employees and have workers 9. Building addition
[No workers'comp.insurance comp.insuraace.t ❑
nqj 5.❑ We an a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ lambing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.[JRoof repairs
insurance required.]t c.152,§1(4),and we have no
employees.[No workers' 13.[]Other
comp.insurance required.]
*Any applicant that checks box 01 must also till out the section below stewing their workers'compensation policy information.
t Homek►wners who submit this affidavit indicating they am doing all work and then hire outside eonbwAa s must submit a new affidavit indicating such.
ZCantmators that check this box must attached an additional sheet showing the name of the sub-eontradozs and state whether or no those entities have
employees. 1f the sub•eontmetors 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.- AIM Mutual Insurance
Policy#or Self-ins.I.ic.#: AWC40070128612013A Expiration Date: 4/29/2014
Job Site Address: H SOM, tPCU,--) City/Statcop: ��y.?,,o_T /yl 0/(�
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
time 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 o/pedury that the information provided above is true and correct.
Simature: J1_ Date:
Phone • 413-536-5955
Offic al use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Ir6-suing Authority(circle one):
Board ofRealth 2.Building Department 3.City/Toivn Clerk 4.Electrical Inspector 5.Plumbing Inspector
Other
ontact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Adam Quenneville CS-070626
License Number
160 Old Lyman Rd South Hadley MA 01075 8/21/2015
Address Expiration Date
4135365955
Signature Telephone
9.Registered Home improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing 120982
Company Name Registration Number
160 Old Lyman Rd South Hadley MA 01075 3/25/2016
Address Expiration Date
Telephone 413-536-5995
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....... b No...... ❑
11. - Home 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 __
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑✓
Or Doors ED
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (Q Siding[O] Other[0]
Brief Description of Proposed 10
Work. Strip existing roof and install new asphalt shingles
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 artld or eddition to existing;housing, complete the following:
a. Use of building : One Family X Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? no
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? 2
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 X 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
Steve Dostal as Owner of the subject
property
hereby authorize Adam Quenneville Roofing Siding Windows
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Coi6- ct 3IX4
Signature of Owner Date
as Owner/Authorized
A ent hereby declare that the statements and inform on on the foreg ing application are true and accurate,to the best of my knowledge
and belief.
S1 Q7ned under the,pains and penalties of perjury.
Print Name
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 Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L. _._m R:. _ L: .,_ R:I.....
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 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW C) YES Q
IF YES: enter Book i Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q 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 0 NO
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_ IJ
ep rtmgr*use ofiJ r
- City of Northampton Stetus of Permit;
Building Department C�iCtlbrtyaayPrtxii
6 212 Main Street eerapticAaG
Room 100 f.t rll fiItAvaIabII
iectr � _ Northampton, MA 01060 Two.$ f 8tr�44tuural tat��i�
:.
--- — phone 413-587-1240 Fax 413-587-1272 P(6ttS-0 f*l its
others S� Ify
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
Ek 504k mGU" -4u-c- Map Lot Unit
iZone Overlay District_
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Steve Dostal 88 South Main St Florence MA 01062
Name(Print) l Current Mailing Address: 4135866289
See Codnzct Telephone
Signature
2.2 Authorized Agent:
-'41h (Iriii/r pc1�t v�id�% I CaC n�� �t�ri�i/►�c+c�� � I� 1 /K1� U!(77S
Name(Print) Curren— t Mailing)Address: °r
e -
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (�, / Cv (a)Building Permit Fee
2. Electrical t� t� (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+ 3+4+ 5) 8,688 Check Number 5
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
88 SOUTH MAIN ST BP-2014-0986
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-074 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-2014-0986
Project# JS-2014-001708
Est.Cost: $8688.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 18643.68 Owner: DOSTAL STEPHEN C&DIANE O
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT. 88 SOUTH MAIN ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:312712014 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 3/27/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner