32A-035 ll` 1 f L1 it -U n. UV `" -, vv.
Street Job Name
City, State, Zip Code Job Location
06(7WI7 A!I ti A(4 sS a�
Proposal to furnish an inystall the following
-1 Re-Roof Tear-Oit' K'' Gutter ❑ Repair
Complete Roof Preparation
<Home exterior to be protected by tarps and plywood
hr QJV �C�
��r4,� �
?S ubs, landscaping, trees to be protected from damage 4� houg o t V_i
Entire existing roofing material to be removed to existing deckin including flashing, etc.
� 9 9 g J' g g, t S`E
Site to be cleaned everyday with roll magnet debris removed at project completion (le '�
v
Deteriorated existing decking replaced at DP �er ❑ sq. ft. ❑ linear foot
.K Metal drip edge installed at eaves Kmetal drip edge installed at rake edges
KNew metal step flashing will be installed where necessary
New plumbing vent flashing will be installed and flashed Ask us about
Shingle valleys will be installed affordable
New metal flashing will be installed around all chimneys financing
�<We shall acquire all appropriate permits etc. for all roofing work options
Complete Roofing System
GAF Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north)
GAF Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas
GAF Shingle-Mate° reinforced underlayment installed over entire decking (the best underlayment available)
Other shingle underlayment will be used
GAF Ridge Vent will be installed A; e galled Shingles:CGAF Timberline®Series ❑ 30 year ❑ 40 ye Color GAF Hip and Ridge that matches shingle warran
-1 Other Shingle Name Color
Warranty Options: q-o
❑ We guarantee our workmanship for 5 full years
<GAF Smart ChoiceTM Systems Plus Ltd. Warranty (doubles your up front coverage)
7 GAF Golden PledgeTm Ltd. Warranty: America's strongest warranty - GAF backs our-wDrkmnship.
Ne P=seherebLyto furn'sh materials and abor-com lete i ac=olla e (annce ons for the sum of:
-/( ).
%WCEP ANCE OF PROPOSAL: The above prices,specifications and conditions are ory and are hereby acce d.
You are authorized to do work as speci 'ed. Payment wi 3 down at start of job, due upon^c on.
late: 9 3� C� Signature: Phone# . -O 4 31 51S
late: ,=J V Salesperson' ign ure:
Estimat are ho red for sixty(60)days fror Aove date
s
o���pro
Gzfy of Nort4ainpton
$ � �iLlassacltnsrtfs '=
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right.under 780CMR 108.3.4 to
act as has/her construction sups:,, sor. The state defines"Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to iltspect work at various stages,`which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing&gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
.ttv.xrT
Gl-ifli o �Iitz �lJ�tltt}tf��lt
� 6 fxtasaacflnsrlls '
m f DEPAJ'TM ENT Ot' BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORTCER'S COMTENSA Oil` INSURANCE AFFUMVI.T
I
% pith a principal place, of busiressJrn dencc
CIO 11CIVoy CcrLi )-, 111]f'tr di" pa171S i?iii I)Cil i 1C. (7i 7CrJl1rV iI1F±i
I am an employer providing the `ollowir.s .:orr_cr`s compensation covcra c for Ins+
C111plovees working on this job:
j==c-Z Comp-'.) (Pclic.Number) (E3:i;irtioa Datc)
( ) I z>1z a sole prop Teter, general homeolxner ;cirCl? one) and 't;a.,c lured
the contractors listed beiov-, ,to iii the Oil ' o -�i �;-5
.r: ;tjor kt_ s co neon
CNIa Ae of CoriLmctor) (InS t1C Curl r.)?;i'Til GllCr T>rllS71�i) iT'• GG Dale,)
(bl(Lme of Contractor] -- (711surnce Co ?: ..`vPe!ie; \'trek r) (I :pi^tina Dzie)
-------— ---- -
(Name of Contractor)
Datc)
- (Name of Contnctor) —- (Insumlic:, Com„!3)?�Polie; Numb-_r) (F;:ni-riior Da(e)
^IL1G1-`.G�'�I:7 CY:11 z:.-r{......... .....r_.....- ....'K:.:t:..n. ,-_._.... eii.�-(._..--,..•.�
( I iiIl'1 it L;olu proprl(°,of i'_:ltl havc. no 7I1c .: J!�.ii!� for 111C_
I i1iI1 i? 110111C C�'.'IlC" i)CriC`I111n pi1 .. .."
?iO-I-Ei:please t>e aware flea:•.��ile 1'rcrc:r.��r-s+�'.,o c-ply;•;>:—�::;n:'.�;_�;_aanc�ex;:--n:��m cr:;:air•+^;;c,<:: .,et!ir.g::
not ux>ce tf_:n tlu-co uni+,s in ut et he l; i >.v r_ re, oc a;'`u w:::_i x.••sr cn s1 Lhcr a c n
cn'.ploy'ur-:L r t}r.tvc:;c _re,x- icn,-r (G7,1 L2_::s!(5)1, by a hn;:t o«ncs`cr z G �x oc fa:i
— p
legal rtaiut of an amployat um!r tlso Wcvjccle ocy;wrilion Act
I u-derrtn d thi a emy of thu, crate,. eLy bo f x>v rtrcia l to t!»C-jn to,,—e.of l,,L I,iel Aa,i&=&Cfr,o of i::a+r—for tlx
°oven se vcrifictioa and that f-ihuc to t-:rtrc crotim,_ut 3: c�,ion 25A of MOL 152 can lc--d to 6--impoSajon o c•'ir_l petal/:ts
C—i.lti g of a fux of up to S 1,S00.0�0 ftn:V r i:::�rvr.z:c:^of up to rn. evil peruttio in do Ic-,nn cf
firm of S1o0.00 a d-y i aina m..
Foe,ciq vuiisYal 11
1�CSI7111 N11IIllY.:S �
5lrna turf t i,l .1.';C;J ('ZIt11r;
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SECT AN 8 C®NSTRUCT[ON SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :_ Aj
Lice se Numb/err
W o e
Address Expiratio D to
w_ ew, a
Signature Telephone
.;e..KU on#rac Not Applicable ❑
v CU n
Company Name Registration Number
vY/It
Address I Expiration ate
Telephone
S GT O�IaJ O IIIORKERS'£COMPEN,SA,.:ION 1NSUf3ANCE 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 fb—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 t
i
SECT10 O PROPOSED ffORK4 fig Q1l a 6 d IJ'
7-07W7 7701���P-
Itom:;, ." ._:.�z: -�. ....�u-t ...�k.,;.! �k..A.:� .a��`-�Z,�:m�'�i-.:r, ...:.�;�°'.., �;'�-u:i�..•..;z
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing .
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 1 'P
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative D Renovating unfinished basement Yes No
Plans Attached Roll ❑. Sheet 0
s o. ; = o a .tl=ition toe ,X sting oi2s,ng coats ..e:; -rd fA;IffiWL n
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
t
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 Nc
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
E N AU4Wip lZATION T' BE COMPLETED WHEN
E S E ONTRACTOR APPLIES FOR BUILDING PERMIT
.,. , .. �.
l as Owner of the subject property
hereby authorize to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Q)GAXA, as Owner/.Authorized Agent
hereby declare that he 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 Merl ur
rd -
y. �f
n �eJ rb
Print Name
()/A �Aj
Signature of Owner/Agent Date
✓1 �
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:
ity of Northampton
Building Department
212 Main Street
Room 100
4` 'Nyo h,,ampton, MA 01060
;pho? 413 57 1240 Fax 413-587-1272
_a
APP1ATIYlf 7Q O6NST�CT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1'- SITEINFORMATION
�ry
,�
1.1 Property Address:x
� ��
P a L
",
SECTION 2- PROPERTY=OWNERSHIP/AUTHQRIZED.AAOENT
2.1 Owner of Record:
p;�CA Elv\e,�y
Name(Print) Current Mailing Address:
C0 Telephone
Signature
2.2 Authorized Agent: �rte^
A�„, -2r "j- 57W-c-- s7
Name(Print) Current Mailing Address:
,mow d1 a 13
Signature Telephone
5ECTION3 ESTIMATED'CONSTRUCTION COSTS �J(,�
Item Estimated Cost (Dollars) to be Official Use Only
completed hermit a plicant
1. Building (a) Building Permit Fee
2. Electrical (b) =:stimated 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
Woo g:!Pe.rmit Number: Date Issued:
Signature!`. -
Building Commissioner/Inspector of Buildings Date
BP-2004-0468
G1S#: COMMONWEALTH OF MASSACHUSETTS
x%66 i� , CITY OF NORTHAMPTON
,.A
Lot: -001
Permit: BUildim
Category: BUILDING PERMIT
Permit# BP-2004-0468
Project# JS-2004-0670
Est. Cost: $4800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Adam Quenneville 120982
Lot Size(sq. ft.): 4660.92 Owner: EMERY TARA K
Zoning.URC Applicant: Adam Quenneville
AT. 71 CHERRY ST
Applicant Address: Phone: Insurance:
P 0 BOX 612 (800) 639-7663 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:10121103 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• Receipt No: Date Paid: Check No: Amount:
Building 10/21/03 0:00:00 2884 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo