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23C-017 A %® �� =S J QUENNEV'ILLE ROOFING 'V SIDING 1W WINDOWS 160 Old Lyman Road•South Hadley, MA 01075 1.600.NEW ROOF 413.536.5955 Email:info41800newroof.net Website:www.1800newroof.net Winner of the 2010 MA Construrtion Supervisors Lic.#070626 MA Registration#120982 TORCH AWARD Member of the Nome Builder's Association of Western Mass. CT Registration#575920 Member of the Building&Trade Association Proposal Submitted To: Date Phone#'s C: chc° i i C Z,- -----(A o l`) H:H13- 5?(,-1©11 W: _------ Street Email: 6C1 +P- G i 00 AC)I C C, City,State,Zip Code Job Name/Location: I Proposal to furnish and install the fullowing +'1,�;� (.nt i E( uC`v it G �f:(,•-..\ `` 1 0 J ! JJ y Ir`I1 Y, (y'..C.1 Z;ctG.t \14 4 'T 7,..r, CI. r eC 1 r t- � �' _-- 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($ '80 ,CK) ) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I P c1r k-16 t 141 -I6 Down Payment($ 1 D00 C'0 ) satisfactory and are hereby accepted.you are authorized to do work as specified. ! Payment will be 1;3 down at start of job,and b ante asue uponQcomp) lion. ( Balance Due Upon completion($ _�' ) I 1 /S G ii, F~ f �. Date:- �--Sinnature: -f��_��L,L�Z � -- - 4 ------ 7Date:�j 11� Estimator:(Print Name)_��' Jr J (Sign Name) - Estimates are horored 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 ir,through cracks of the wood.Adam Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. The CaAtt+ntl>xw kk of Massachttstm -- - Deparonew of lmdus&ia1 Accidents O,ltce of 1wvesd9ation5 6N Waskinsaw Stmer Boston, MA 02111 Workers' Compensation Insurance Affidavit: RaiMars/Contracture MiectniciansJPlumbers Atplicant Information ___ ------------------------___--- Pkase Print L,elpibly Name(HwmessOrgatuzan«vindiv►dtul): Adam Quenneville Roofing 8 Siding Inc. _^-------�� Address: 160 Old Lyman Road City/StatdZip: Smut, Hadley MA 01075 Phone 413-536-5555 ll Are you on employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 15 4- ❑ 1 am a gal coatractoc and 1 6. []New construction employees(full aod/or Part-time),* have hired the 2.El I am a role Proprietor or partner- listed on the attached sheet T [] Remodeling ship and hove no employees These have 8. []Demolition working for me m awry capacity, employees and have worYers' 4. ❑Building addition [No worloera' comp. instrsnce COtl°°p-au�O�-1 5. [] We are a corporation and its 10.❑ Electrical repaua or additions 3.❑ I am a homeowner doing all woof offices have exercised their I l,lnmbm6 repairs or additions myself (No workers'comp �of won Pei MOL 12. Roof-p-= insurance required.) ' C. 152,§1(4),nod we have no employees (No waraexs' !3.❑Other -------------___-- coop. inataraaoe required.) 'A.y applksw erw caster eon#1 vest.two till out the mcdoa below Aowtag aarr wwdan'compmassdoo polky Jokwmmauco. T Namsowasr w>to sabiok&i,staAeva w acstkq dwy an&dais an wad said Aaa s lira oMaide cowwwn want sabmk a saw atlidsrlt indicatnag mce- :CowKmn attw cbdr dds bow mau wtwcbe m widtdsasl obw stiorrla{dam soma of doe sat-caeracaa ad awn wbobst at oos thou endties face e pWyw, u the-16. crows beam amployun,dory won pnriis dk* wadws'comp.polky usher. 1 set d easpl"W that is Pfle$Q stn rror'hen'nrwgaewattlea ttssxnawce for My eetp/eytes. Be1o+s'tar the porky sad fob slte in ormatieft Insurance Company Name: AIM Mutual Insurance AWC40070128612014A tioa Dal: 4/29/15 Policy N or Silt-ins. Lac.M. _ hsptra —_------_.._----- Job Site Address: _ t�{r S\cam '__-------_.__city/Sttiawz*: r�k Lk YhA 0Ob� Attach a copy of the workers'cosmpowntiou policy aileelairatdom pap(siowtsag the pricy slumber mad expiration date). Failure to-cum coverage as regrsired under Suction 25A of MQL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 A%Wcw one-ysjar irnprisomumt,as won as civil penalties m the fbrm of a STOP WORK ORDER and a fine of up to$250.00 a day against flu violatm. Be advised dnat a copy of this statement may be forwarded to the Office of investigations of the D1A for iasurasoce coverage verification, 1 L hereby,cerg6,xxd the prints awal prndttes of perfxty that the information prvvlitwt Ibs►M b&w and correct E'baot:q 413-536-5955 OffIc of xse*m4,. Do not rerttr/or this avwa,is be complrtod by d4 er low,ea(JleiaL City or Town; _Perosk/Lkease M`_ —�__-- Issai SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Adam Quenneville CS-070626 Name of License Holder: License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/2015 Address Expiration Date 413-536-5955 Signature Telephone 9.RanIistered Home Improvement Contractors 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 413-536-5955 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(l) 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 D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0] Brief Description of Proposed t)Gy Work: Strip 2 layers off of rolled roofing are and install new roll roofing system /WW Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New Douse and or addition to ex stina'housina, 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? 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 Robert Gibowicz I, as Owner of the subject property hereby authorize Adam Quenneville roofing&Siding Inc. 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 Zoe �G 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 pai s and penalties of perjury. ;4d(,artNQ Print Nam C� Co 113)i q 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 ) E� Side L:. _... R. . L:' R 1 Rear _.-.... a f 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 IF YES, date issued:[ .._..... IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 011% YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 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 0 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 Q _.z ....... ........... ....... 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 U NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Ctaprtrrienlu o1y pity of Northampton status f to larm ' wilding Department Curb VQ_nv, �y��y PerrniL u .lUi t b 2014 212 Main Street SeweflSpttcAttailbility t1 Room 100 Witerl4Vell Avai[Abilit Electric,Piumbfng&Gas Inspect; hampton, MA 01060 "Strutbl Para " Northampton,RSA 01060 - 87-1240 Fax 413-587-1272 Plot/ it6lp1o6i ' Otl r j eol 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 541 Riverside Dr. Map 0?3 Lot J q Unit Florence MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Robert Gibowicz 541 Riverside Dr.Florence MA Name(Print) Curagri- L"ress: 1. "d-e Telephone Signature 2.2 Authorized Agent: Adam Quenneville �p ,r,-�-.S;GQct� DX 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 3,800.00 (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) 3,800 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 541 RIVERSIDE DR BP-2014-1351 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23C-017 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-2014-1351 Project# JS-2014-002268 Est. Cost: $3800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 34978.68 Owner: GIBOWICZ ROBERT A&TERESA Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE AT. 541 RIVERSIDE DR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.6/17/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL NEW ROLL ROOF SYSTEM 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: FeeTy e: Date Paid: Amount: Building 6/17/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner