23A-090 A A
M- Am =2�)d
QUENNEVILLE
ROOFING ♦ SIDING 'V WINDOWS BBB
160 Old Lyman Road•South Hadley, MA 01075
1.800.NEW ROOF 413.536.5955
Winner of the
Email:info@ 1800newroof.net Website:www.1800newroof.net
2010
MA Construction Supervisors Lie.#070626 MA Registration#120982 TORCH AWARD
Member of the Home Builder's Association of Western Mass. CT Registration#575920
Member of the Building&Trade Association
Proposal Submitted To: Date Phone#'s C: '-"D,53-1- (,f 3 D
-b ILi H: K�c 1� yr3 3�f8 sC�9
Street Email
gal L KctU(a Kv�m�&VxG) ill S'DM, _
City, State, Zip Code Job Name/Location:
�1[.,—Cc r'r-,A Cq 106"
Proposal to furnish and install the following
Nr-W 0-,, -l�tc COOL
hJP c a
�i kJ
Ask us about
affordable bank
financing
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ H JD co )
ACCEPTANCE OF PROPOSAL: The above rices,specifications and conditions are P4 cr
P P (Q a Down Payment($ acs•�'`'� _)
satisfactory and are hereby accept ou ere authorized to d ork as specified.
Payment will be 11 down at start of job, n ante due upo Balance Due Upon Completion($ 0 3f1 )
Date:_ 2-�* Signature: —
Date:1, X11 1 Estimator:(Print Name) �« Sc °� (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.
Az&r PISA
QUENNEVILLE
www.1800newroof.net
ROOFING 'V SIDING W WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075
1.800.NEW ROOF • 41 3.536.5955 Fully Insured
Factory Trained
Email:info@ 1800newroof.net Website:www.1800newroof.net
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 Phone#'s C: 11`13-
H: Kr3rl,\ 3- 3`I1- ( �7
Street Email:
3a� Kar\o to ca
City, State,Zip Code Special Requirements:
A (D10(, ,.,era el7wo�a, eXC(T7 o�, n_(C,
�or��ncc m _�
IC.0 t vicArt
Recover Strip L] Layers Irk Zc -
7� 4?-1j�n w0.rTr'�7
Complete Roof System 3 �rc� ice + (.j_ker Goy
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.S ► r*
Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
Install Ice&Water at all eaves,valleys,chimneys,pipes and skylights
Install(151b.felt Synthetic) nderlayment over remaining decking area
Install Metal drip edge eaves and rake (8" 5") (whit brown opper)
C
Install manufacturer's starter shingle on all eaves and rake edges BBB
XInstall new pipe boot flashing standar opper)/vents
❑ Install Snow Country or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
5lotel,,r
GAT_Shingles ❑ 25 year [� 30 year ❑ 50 year Color
_
—Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years(see our warranty coverage)
5.5. ch��S�Z �o �t,i�r� 01,c+St -D(Q�
[ GAF Golden Pledge warranty
Chimney Options:
)] Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor•complete in accordance with above specifications for the sum of:Total Due($ 1_I 0(x3
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Down Payment($ 1-101'60 )
satisfactory and are hereby accepted.You are authorized to do work as specified.
Payment will be 1/3 down at start nd balance due unon cdTfoktion. Balance Due Upon Completion($ a r0
Date: `4-Signature: —
Date: l> �V Estimator:(Print Name) )corn ScA\o'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 ComxwxwMftA of MaijacAmiem
al Deparoxfmi of Indatsvial Accidents
Office of INVessicafions
Y
600 waskiftraft srreel
Boston, MA 02111
rIC12 S
Workers' Compensation Insurance Affidavit: Raikiers/Contracturs/Dect a /Phtwbe rs
Applicant Information Playse Print Lezibb.
Name Adam Quarmoville Roofing & 5ldlr)g InG
Address-
CltY/St&C&Zlp Su,,it4 tiauley!VIA01075 PbKxw 4 13-536-5955
Are you&A employer?Chock the &PPr*Pdkit b*:: Type of project(required),
10 1 am a ewpioycl with-15 4. am a SmaAl coultackilt And 1 6. ❑ New cmmuction
aniployeft(fUD ADWOC have hired the sub-cons actors 7. f-1 Rrusodehllg
❑ I am a look Proprwot of pan=- Broad on the attached sheet.
absp and have no employets Them sub-cocIlractorl have 9. L] Demolition
working fix me in say capacity. eaWloyees and have wofbm 1* 9. L-] Budding oddAtion
(No worlow'comp. witwwxe comp. insurance-4
required-) 5 wt am a corporation and Its 10❑ Bectncal r"as of adchtionx
I am a bomeewom doing all work officers have ex=cised tfieff Elrumbong rep—of addatom
rl&of C�cw per MOL :2,
myself [No workr"'conip Roof repairs
c. 15 2,§l(4)I,and we have no
insurance requited] 13.El ottut,
enqAorem,[No wodmrs'
coop. jimuracce toRLared, ---------------
A.Ay"k—an clod,em#I uno sim 1W ow ae adios below showing&W wallas'cwt mPosud0s Polky iatorsaetlaa
Howerwe"I who w4b"IM"IBA"Imacatigg that AN dsiq an Wed Md 6M him ow Aft ceatescsra mom unI , J new&Mdxo bi&EMMS MchL
-CD&gwmm am CbMCA ftig bm mom OW10d M&&ftjmAt 96M dwwiml the Muse of am yub-�racIwn zmA now W%~or awl OMM mm ties Line
Ravin, If the Mors b"V umpiwfem,airy manor pan*A* WOU"'C0111W.POWY I.
nip
I Amon exopl"wr the/is Pro,14AW wor*,rrs I coinpo"Andieft i&=MRc*for ofty MVYPIAYWW3. BelvW13 the poneyeAd fob rile
ipt form alieft
Lasuirance Company Name _ AIM MU(Lia; Insurance -- - ----
poiscy III of Sejf_ws U, # AWC400 70 1 286 1 20 1 4A EXPUMtKM Date- 4/29/15
Job Site AMmss.-3,-)[- Loc-V-s� S�rf,4 o locji,
.kn,ac►A copy of the workers'compow"don peNcy Anciaradom pop(Xbowiag the paiky number mad exp"lliOu date)-
Fulme to secum covenW as required lubdw Soction 15A of MGL c- 132 can ked to die imposition of CliMiRAJ PCOMItiell Of A
fine up to$1,500.00 mad/or ooe-yew imprisonment,as wuU as civil penakies to die forms of a STOP WORK ORDER and a fintir
of up io MOM a day against the violaux. Be advised dam a copy of Ibis sateuxat may be forwarded to the Office of
investigations of the DlA for umirance coves zp verificabon.
I do hereby,cerlo,xinder the privet and penahim q(porfury thel As iftforwgplwn proviAmd&bow ii&w4 and correct
-----------------------------
Mime 9- 413-536-5955
offlcw ww*n(r. DO not eerier in Kris area,tlr bor cow9gerod by chip sr/open official
City of Town;
Lasulal Authority(cirde one).
1. Board of Real6 2. Building Department 3. Ckyffwwm Uerk 4. Electrical Inspector S. ?%mJ)jftg Inspector
6.Other
Coatac(Person.- Most
SECTION 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor: Not Applicable ❑
Adam Quenneville CS-070626
Name of License Holder:
License Number
160 Old Lyman Road South Hadley MA 01075 8/21/2015
Address Expiration Date
413-536-5955
Signature Telephone
9.Registered 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
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.
x
Signed Affidavit Attached Yes....... ❑ 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 1:3
Accessory Bldg. ❑ Demolition ❑ New Signs [tom] Decks [M Siding[p] Other[p]
Brief Description of Proposed
Work: Strip existing roofing and install new asphalt shingles and EPDM rubber roofing on dormers and porch flat roofs
Alteration of existing bedroom Yes x No Adding new bedroom Yes x No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
sa. ]f New house and or addition to existing 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
David Drake
I, as Owner of the subject
property
Adam Quenneville Roofing&Siding Inc.
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
See Contract
Signature of Owner Date 1 �1
Adam Quenneville ��
I, `i't C , 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.
P. An
Pffnt Name
L%%�
I _
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
a
Lot Size
Frontage A _
Setbacks Front .T'
Side L. _ R. . _.. L:. . R:� _
Rear . _w
Building Height -
Bldg. Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
_.__... -
Fill:
volume&Location 3-- - - .m•- •--
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW Q YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Pages and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO G) DONT KNOW 0 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: k
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 0 NO Ikv
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department,t se only
City of Northampton Status PfPermt
Building Department Curb � i ri e ay ""ermlt
212 Main Street Seuirerlep cAVllilijr
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
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
321 Locust Street 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:
David Drake 321 Locust Street Florence MA 01062
Name(Print) Current Mailing Address: 413-537-6932
See Contract
Telephone
Signature
2.2 Authorized Agent:
Adam Quenneville Roofing&Siding Inc. 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 19,450.00 (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) 19,450 Check Number
This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
321 LOCUST ST BP-2015-0029
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-090 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-2015-0029
Project# JS-2015-000040
Est.Cost: $19450.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 11979.00 Owner: DRAKE DAVID R&KARLA K
Zoning-:URB(,100)/ Applicant: ADAM QUENNEVILLE
AT. 321 LOCUST ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.71312014 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF & NEW FLAT ROOFS
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 7/3/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner