38B-151 (2) QUENNE VILLrE vfw w.isoonewroot-net
ROOFING V SIDING V WINDOWS We Are(-caused
160 Old Lyman Road•South Hadley,MA 01075 Fully Insured
1.800.NEW ROOF a 413.536.5955 Factot Trained
Email:info@I800newroof.net Website:www.1800newroof.net y
MA Construction Supervisors Lic.0070626 MA Registration 9120982 Facctxy Cettifiac Installers
Member of Me Home Butkl 3 Asaodel"Of western Mass. CT Registration 0575920
Member of the Budding 8 Trade Assoiedw PP."3371 G
Proposal Submitted To: Date 828rt4 Phone 0's C. li—�
I I
Mr.Robert&Tamar Fields _ H: W �-
Street Email:
65 Columbus Ave columbusgang@varizon m —_--
Ciry,State,Zip Code i Special Requirements
Northampton MA Strip all shingles on d sepam;e:oofs.
Asbestos to be ren*,red by!icensed cantractor(Abide). j
Recover 0 Strip Layers
Complete Roof System
2 We shall acquire all appropriate permits for all work
6a Home exterior and landscaping to be prof clad
Garagr
Strip exis'.ny to existing decking sc1d dispose of. Do nc<!30.
Deteriorated existing decking will be repta,3d at$3.47 per sq.ft.after fuss 1 i5o6ction.
J Install Ice&Watct Barrier at all eaves,valleys,CHmneys,pipes and skyiicnts
Install(151b,felt/Synthetic)undteffayment over remaining decking area
® Install Metal drip edge at eaves and rakes(8"/5')(white/brown/copper)
Z Install manufacturer's starter shingle on all eaves and rake edges 33(3
Li Install new pipe boot flashing(standard/copper)/vents
* Install Snow Country or Cobra roiled vent ridge vent Winner of the
2010
0 Install proper soffit ventilation TORt-'YT AWABM
Shingles: (6 nails per shingle) Lifetime
GAF ----Shingles (]25 year 030 year 0 50 year Color
GAF_ ___Ridge cap shingles �•
Warranty Options:
Q We guarantee our workmanship for 10 full years(see our warranty coverage)
GAF System Plus warranty 50 Year Non-Prorated material and labor coverage.
❑ GAF Golden Pledge warranty
Chimney Options:
0 Leau Counter Flashing 0 water Seal&Tackpoint 0 Rubberized Crown 0 metal Chimney Cap
we propose hereby io furnish materials and labor-complete in Areordame with above specifications to::,e,,om.af:ToUa C L e($ 12,475.00_ —
ACCEPTANCE OF PROPOSAL: The above prIces,specifications and conditions are Dc Nn Paym,-nt t$.- 4.158.33
satisfactory and are hereby accepted.you are authorized to do work as ap 8:1:5:67
Payment Will lie Inow at start of job,and due upon wmpletl Out J"o-,r"npleui n(g
Date:10 1,16 Signature:_ -------__--.--
Date: 112814 Estimator.(Print Name)Adam Quenneville (Sign iName)
Estimates are honored for sixty 160)days from above date
ATTENTION 140MEOWNERS:please cover all personal belongings in the attic,garage or storage areas duo to the
possibility of roofing debris or dust coming in through cracks of the wood.Adam Ouennevitie Roofing vr7!not be
responsible for debris or dust in the attfe or storage areas.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Of ice of Investigations
600 Washington Street
Boston, Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
t Applicant Information Please Print L�ly------
Adam Quenneville Roofing& Siding Inc.
Name 113usiness/Organiztuiun/In(livichtal):_ _ --- --- ---- - —
Address: 160 Old Lyman Road
City/State/Lip: South Hadley MA 01075 Phone#: 413-536-5955
� — I Type of project re aired
Are you an employer. Check the appropriate box: Y{ ( 9 ):
I. JG I am an employer with 15 4 1_' 1 am a general contractor and 1 6. 1 New construction
employees(full and/or part time).* have hired the suh-contractors 7 ; Remodeling
2. _! 1 am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have S. I Demolition
working for me in any capacity. employees and have workers' 9, 1 Building addition
[No workers' comp. insurance comp. insurance. $
required] 5.1 We are a corporation and its 10. 1 Electrical repairs or additions
3. 1 am a homeowner doing all work officers have exercised their I I 1 plumbing repairs or additions
myself [No workers' comp. right of exemption perm MG1
insurance required] t c. 152, § 1(4), and we have noL&oof repairs
employees. [no workers' 13. I Other
comp. insurance required. -- --- ___
*Any applicant that checks box ell must also fill 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 check this box must attach an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If
the sub contractors have employees they must provide their workers'comp,policy number.
I am an employer that is providing workers'compensation insurance for my,employees. Below is the police'and fob site
information.
Insurance Company Name: AIM Mutual Insurance
AWS40070128612014A 4/29/2015
Policy #or Self-ins. Lic. #. --- - --_---- ._------- – _ __ _-__ Expiration D tee:
n r U _\ R
Job Site Address: �{? 1 �tLW _ _ __ ('.ity/State/%ip. 1,,,t 1�1Ct,"w:Ot,� ,
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 ot'MGL 152 can lead to the imposition of-criminal penalties of'a fine
LIP to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 inPrtnation provided above is true and correct.
Print Name:
Official use on!)? Do not write in this area to be completed by city or town official ----- -��
C'il,y or"Town: — Permit/license
Issuing Authority(circle one):
I.Board of Heath 2. Building Department 3. Cityri'own 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 8/21/2015
Address Expiration Date
J---- 413-536-5955
Signature Telephone
9.Realstered Home improvement Contractor: Not Applicable ❑
Adam Quenneville 120982
Company Name Registration Number
160 Old Lyman Rd South Hadley MA 01075 _ 3/25/2016
Address Expiration Date
A---:::� Telephone413-536-5955
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25CM)
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 buildN permit.
Signed Affidavit Attached Yes....... No...... ❑
i I. - Home Owner Exemotion
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 buildint=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 E] Replacement Windows Alteration(s) ❑ Roofing ❑
13 -
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[p]
Brief Description of Proposed
Work: install 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 Ni hcauee and or addition to exlstinsa housinu. Cemplete the followinsa:
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 Fields 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
I, Yh� t 4.- C' as Owner/Authorized
Agent hereby declare that the statements and information on the fakgoing applicatioeare true and accurate, to the best of my knowledge
and belief.
Signed under pthe pains and penalties of perjury.
04(i a Cr UP i7/l.E� LA
Print Nfime
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 ___J L.[..
Rear
Building Height
�...
Bldg. Square Footage %
Open Space Footage % --- ,
_.... _. . -G
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location '
A. Has a Spe ial Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES 0
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Pagel and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0/ DONT 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 NO 0/
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 tion, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_17
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�rtmein � n,y
"wilding of Northampton 8t #u , i ' It
!wilding Department Gt `Cutll ri ayF'
' 212 Main Street dtiyrltivtla }r
Room 100 611 AV
�ectcs so ampton, MA 01060
&Gtns
o a ng - 87-1240 Fax 413-58 7-1272 N ton,
:
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
65 Columbus Ave Map Lot Unit
Northampton MA Zone Overlay District
01060 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Robert Fields 65 Columbus Ave Northampton MA 01060
Name(Print) ( Current Mailing Address: 4135843084
at t �l`{c Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address
�,7 -5-\1:s
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 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 at.a .✓
6. Total=0 +2+3+4+5) Z)-LA u_ Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
65 COLUMBUS AVE BP-2015-0458
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 151 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catego!y: ROOF BUILDING PERMIT
Permit# BP-2015-0458
Project# JS-2015-000858
Est. Cost: $12475.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 12240.36 Owner: FIELDS ROBERT G&TAMAR TAITZ FIELDS
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT. 65 COLUMBUS AVE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.1012112 014 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:
FeeTyne• Date Paid: Amount:
Building 10/21/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner