30A-014 AA i VISA ,Wk j
Q V E N N E V I L L E www.iaoonewroof.net
ROOFING IV SIDING W 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
Proposal Submitted To: Date f Phone#'s C: GDYd
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Street � Email:
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City,State,Zip Code Special Requirements:
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❑ Recover S Strip [�] Layers 7 f
Complete Roof System / y��.Y r -ti <h-f� U• - /`'`S
We shall acquire all appropriate permits for all work
fj Home exterior and landscaping to be protected /
l Strip existing roofing to existing decking and dispose of. Do not Do. S rvt
�❑ Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
Install(151b.felt Synthe I underlayment over remaining decking area
[2 Install Metal drip edge at eaves and rakes/5" (white brown/copper)
Install manufacturer's starter shingle on all eaves an rake edges BBB
Install new pipe boot flashing standaC copper)/vents �-
Instal 3 laun ry r Cobra rolled vent ridge vent Winner
2oiof the
❑ Install proper soffit ventilation TORCH AWARD
Shingles: (6 nails per shingle) /
Shingles ❑ 25 year �30 year ❑ 50 year Color C` I/T
Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ C / )
ACCEPTANCE OF PROPOSAL: Tire above prices,specifications and conditions are I Down Payment($F',ro-,<_c I )
satisfactory and are hereby accepted You are authorized to do work as specified.
Payment will be 1/3 down at start of to arV balance due ur. completion. Balance Due Upon Completion($
Date:w; Signature.
Date. Estimator:(Print)Nam --t�`
/ ___(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 Coutlnonweauk of Massachusetts
Depar mmi of Indusosal Accidents
Office of Investigations
600 Washington.Stywr
&rs(on, MA 02111
Workers' Compensatim Insurance Affidavit: Btlrilders/Con&acturs/Ekctrician&Tlumbers
Applicant Information Please Print Legibly
Name(BUsmeasA)FpU=bDwindivkdual). Adam Quenneville Roofing & Siding Inc.
Address:
160 Old Lyman Road
ci /Statr/Zt : South hiadley MA 01075 phonc k 413-536-5955
Are you an employer?Check the appropriate box: Type of project(required):
1.V I am a employer with 15 4. ❑ I am a general co ubactrx and 1 6. ❑New construction
employees(full and/or pwt-hme).` have hired the sub-contractors
2.❑ I am a sole proprietor or Partner-
listed on the attached sleet. 7 ❑Remodeling
strip and have no employees These sub-caotracttxs have g- ❑Demolition
working for me m any capacity. employees and have wotionts' 9. ❑Building addition
[No workers' comp. insurance COwp.insurance-,
requard.] 5. ❑ We ask a corporation and its 10.F]Electrical repairs or additions
3.❑ I am a homeowner doing all work office's have exercised their 11.❑Plumbing repairs or additions
myself [No workers'comp. right of exemption per MOL 12 Roof repairs
insurance required.]r c. 152, §1(4),and we have no
employees.(No wortaers' t 3.❑Other
comp-insurance required]
•Any sppikaws*&I CkKkf boa#t mast aloe till ode rice UKdm below skowing to&workws'Campeaaaeioa policy fedormatiaa.
T Howeowaers who sub's ift dhkt atddava limCad"dwy are d kg alt west(sad dm a ktre Outside coat I On a=ft sabarit a felt'alsdrea umlauting sock.
-Conawon(let dock Ws boa coact otuKhM as sddkdoaall strut dwwtikg the arses of dle ab--comnKfors and fie wkeber or not Hose entities ks"
osp4ryea%. It rice sub-camascson Mist a Wkyl err,they neat provide(hek workers'c-*-policy nwobm
I awl an*MPI"Vr that is provfliV wertrsrs'CV Vq eesat(ser fn"reAce for wry employers. Below is tha policy and job site
information.
Insurance Company Name: AIM Mutual Insurance
Policy X or Self-ins.Lic.#: AWC40070128612014A Expaatrum Date: 4/29/15 r��
Job Site Address: 3 5 3 k J-t—n f.-e- a_ ',_ City/statelZip:F l ye r c.a �v A o 10 b
Attach a copy of the workers'compensation policy declaration par(showing the policy a=mber and expiration date).
Failure to secure coverage as required under Section 25A of MGL c I52 can laid to die imposition of criminal penakies of a
fine tip to$I,500.00 and/or one-year imprisonment,as west as civil penalties in the ftxm of a STOP WORK ORDER and a fuse
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 ctrY>�j,under the pains argil psaaltler of p nfxry that the igferwsation prvii4 ld abow is tries and correct
S g{yture: Date:
ekg"]t- 413-536-5955
O,()Ickl use only. Do not emits in this area,sv be completed by d4 or town officiaL
City or Town: Pcrudtdf kensr Al
Luang Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Lnspector
b.Other
Contact Person: Phone 0:
6
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 Road South Hadley MA 01075 8/21/2015
Address Expiration Date
413-536-5955
c.
Signature Telephone
9.
keallitered Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing 120982
Company Name Registration Number
160 Old Lyman Road South Hadley MA 01075 3/25/2016
Address Expiration Date
413-536-5955
Telephone
b
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....... I� No...... ❑
11. - Home Owner Exe= ion
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 buildine 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 6-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[O]
Brief Description of Proposed
Work: Strip existing rwfand install new asphalt shingle system.Install new gutter system.
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 and or addition to existina housing, complete the 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. 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
Maryann Lyman as Owner of the subject
property
hereby authorize Adam Quenneville
to act on my behalf, in all matters relative to work authorized by this building permit application.
see contract ,
Signature of Owner Date
Adam Quenneville Roofing & Siding 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 penalties of perjury.
Adam Quenneville
Print Name
a-<-- (, [,, H
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:. R: - L: _. R:
Rear
Building Height
Bldg. Square Footage _ % -i
i
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 Q DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES
IF YES: enter Book Pager and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO G) DON'T KNOW 0 YES 0
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 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 NO e
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 NO U
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
F ICity of Northampton Status of Permit;
Building Department Curb Cut/Driveway Permit
l 212 Main Street Sewer/Septic Availability
J'
JUN 1 32014 i,1'.J Room 100 WaterNVell Availability
N rthampton, MA 01060 Two Sets of Structural Plans
Electric,Plumbing&Gapf> ti$q -587-1240 Fax 413-587-1272 PlottSite Plans
Northampton,MFG 0,10 -Other Specify
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
353 Florence Road Map Lot Unit
Florence MA 01062 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Maryann Lyman 353 Florence Road Florence MA 01062
Name(Print) Current Mailing Address: 413-586-5194
see contract
Telephone
Signature
2.2 Authorized Agent.
Adam Quenneville 160 Old Lyman Road South Hadley MA 01075
Name(Print) Current Mailing Address:
413-536-5955
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 13,464.00 (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=0 +2+3+4+5) 13,464 1 Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
353 FLORENCE RD BP-2014-1341
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-014 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-2014-1341
Project# JS-2014-002245
Est. Cost: $13464.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 15115.32 Owner: LYMAN DENNIS C&MARYANN S
Zoning: URA(100)/WSP(100) Applicant: ADAM QUENNEVILLE
AT: 353 FLORENCE RD
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:611312014 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 6/13/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner