46-034 (2) /Al,TEN'i I I
Q U E N N E V I L L E www.1800newroof.net
ROOFING ♦ SIDING ♦ 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 Phone#'s C: 1413-- 9 77—6 30
M G 6L H: W:
Street 9 KAPP N L N
l& -/S F-6P 9Y A_V - 50tn1 fJ MA 01673
City, State,Zip Code Special Requirements:
N09 P)W M4 0/060 ,
L_] Recover . Strip Q Layers ALI, OF ({60_5E
C 17 1,J P—i 06F vbi7-)F t0.551"i °
Complete Roof System
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. G
( Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
(gj Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
Install(151b.felt Syntheti nderlayment over remaining decking area
Install Metal drip edge at eaves and rake (8' 5") hl /brown/copper)
C
Install manufacturer's starter shingle on all eaves and rake edges BBB
71 Install new pipe boot flashin standar /copper)/vents �-
�X Install Snow Country obra Iled vent ridge vent Winner of the
2010
l TORCH AWARD
Shingles: ( 6 nails per shingle) � M
Shingles ❑ 25 year ❑ 30 year ❑ 50 year Color
Ridge cap shingles
Warranty Options:
We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
VLead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ 5 QI...C./ )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are CO Down Payment($
satisfactory and are hereby accepted.You are authorized to do work as specified. I '541 a+�O
Payment will be 1/3 down at start of job,and balance due upon completion. Balance Due Upon Completion($ / 4 )
r
Date:_ Signature:
Date:_ _Estimator:(Print Name)_ (Sign Name) C
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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass. 02111
www.mass.gov/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 Road
City/State/Zip: South Hadley MA 01075 Phone#: 413-536-5955
Are you an employer?Check the appropriate box: Type of project(required):
1. l am an employer with 15 _ 4. U I am a general contractor and 1 6. I; New construction
employees(full and/or part time).* have hired the sub-contractors 7. I Remodeling
2. 1 am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. 1 Demolition
working for me in any capacity. employees and have workers' q. -1 Buildin addition
[No workers' comp. insurance comp. insurance. + g
required] 5.1.1 We are a corporation and its 10. i I Electrical repairs or additions
3. i' 1 am a homeowner doing all work officers have exercised their 11. l_) Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] f c. 152,§ 1(4), and we have no .FN<Roof repairs
employees. [no workers'
comp. insurance required.] 13. Other_
*Any applicant that checks box#1 must also rift out the section below showing their workers'compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that cheek this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if
the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant 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. Lic. #: AWS40070128612014A _ Expiration Date: 4/29/2015
Job Site Addressl__(o /�_ �_ _ _ City/State/Zip: ,VkA
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 152 can lead to the imposition of criminal penalties of a fine
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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification. _
I do herby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: i�ldb I 11
Print Name: Phone 4. q1 — �;!>b"�/
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license#:
Issuing Authority(circle one):
I.Board of Heath 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
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 8/2112015
Address Expiration Date
413-536-5955
Signature Telephone
9.Reaistered 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
ld�_ Telephone 413-536-5955
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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....... n 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 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[o] Other[o]
Brief Description of Proposed
Work: Strip existing rocring 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 and or addition to existing housind, 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
Michael Lachapelle 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 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
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
s
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
arkin
#of Parking Spaces
.. .
Fill: G
volume&Location 1.......... ... _..._ __. . _ _ _ l .. ....................
A. Has a Sp9ciaL Permit/Variance/Finding ever been issued for/on the site?
NO U DON'T KNOW YES
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book Page and/or Document#'
B. Does the site contain a brook,body of water or wetlands? NO DONT KNOW ® 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 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:
.......... -
E. Will the construction activity disturb(clearing,grading, exc ation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
0 rtr>�ep use only
It of Northampton Status of Fermlt
�! uiy 1c ng Department rb tl nv6iMy wfrrtit
212 Main Street S+ vr�r7Septi ,Avllt)ty
Room 100 atdrdll Atilll 4
---- Northampton, MA01060ettrUC#utns
Electric. P,i rri l to&M°"
i�a 4a-3-587-1240 Fax 413-587-1272 Pk4tlSit '"Iatt
0 ther Specifjr ,
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
16-18 Ferry Ave Map Lot Unit
Northampton MA Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Michael Lachapelle 8 Karen Lane Southampton MA
Name(Print) Current Mailing Address:413-977-6930
See Contract
Telephone
Signature
2.2 Authorized Agent:
Adam Quenneville 160 Old Lyman Rd South Hadley MA 01075
Name(Print) Current Maili
((«-s3r�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 15,000 (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) 15,000 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
16 FERRY AVE BP-2015-0232
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block:46-034 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-2015-0232
Project# JS-2015-000434
Est. Cost: $15000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq 1): 6838.92 Owner: LACHAPELLE MICHAEL A&LYNN M STARR
Zoning: Applicant: ADAM QUENNEVILLE
AT. 16 FERRY AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.•812912014 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 8/29/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner