16C-020 Q U E N N EV I L L E www.isoonewroof.net
ROOFING 'W SIDING W WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075
1.800.NEW ROOF 413.536.5955 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: 1113 30``JYLI
S<c-:t 10 31 1`f H: W:
Street Email:
3l 5 C 5-'r
City, State,Zip Code Special Requirements:
T[ccC Mu'1 Only
❑ Recover Strip 0 Layers
Complete Roof System
We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected f/
Strip existing roofing to existing decking and dispose of. Do not Do. /VouS c
Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
�] Install(151b.felt Syntheti nderlayment over remaining decking area
Install Metal drip edge at eaves and rake 8' /5")(white Q copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
Install new pipe boot flashing(standard/copper)/vents _r
Install Snow Country Cobra rolled vent r ge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
Shingles ❑ 25 year 'Y 30 year ❑ 50 year Color
Ridge cap shingles
Warranty Options:
><We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
❑ Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
c
We propose hereby to furnish materials and labor-complete in accordance with above specifi if 5
ons for the sum of:Total Due($ o GO )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are P-C°—IA Down Payment($ d
satisfactory and are hereby accepted.you are authorized to do work as speclfied. �o� 7/},�
Payment will be 1/3 down at start of job,and balance due upon completion. Balance Due Upon Completion($ )
Date: o' Z I Signature:
Date: 10 )1 1`1 Estimator:(Print Name) Scv ti 5ec41cok- (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 Commonwealth raj-Massachusetfs
Deparlmew of Industrial Accidents
office of/itvestigations
hl)ll Washington Street
Boston, Mass. 02/11
Workers' Compensation Insurance Affidavit: 13uiltiers/Cons rectors/Electricians/('lutnbers
Applicant Information - _. _ Please Print L,eglhlv
Adam Ouenneville Roofing & Siding Inc.
}Irltt' llSusincs>iOrit;uncatnm/Initivuiu;il)
Address: 160 Old Lyman Road
Cit South Hadley MA 01075 , 413-536-595.5
y/Seale/Gip:
Are woe an employer? Check the appropriate box: Type of Ilrolect (required).
I. X I ;fill an employer with 15 4 i I ant it uencr tl Contractor and 1 to 1 New construction
employees(lull and/or part little).' have hired the suh-contractors
7- Remodeling
2. 1 am a sole proprietor or partner- listed oft the attached sheet.
ship arid have no employees These suh-contractors have R. 1 Demolition
working, lot me in any capacity. employees and have workers g- Building addition
lNo workers' comp. insurance comp. insurance. $
requirc(ij 5.; We are a corporation and its 10. ! (_;lectrical repairs or addilions
? I sill if homeowner doing all work officers have exercised their I I. Plumbing repairs or addl(ions
myself (No workers'comp. right of exemption perm MGI.
insurance required) t c. 1 52, § 1(4), and we have no I )l"('0of repairs
employees. (no workers'
C0111p. In 0111CC
Snrance required.+ _
•Any applicant that checks box#1 most also rill on(the section helow showing their workers'compensation polity information.
tHomeowners who submit this affidavit Indicating they are doing all work and then hire outside contractors must suhrnit a ilex affidavit indicating such.
+*Con(aetors(hat check this box most attach an additional sheet showing the name of the sob-contractors and.ctate whether or not those entities have employees. If
the soh-contractors;have employees,thcy must provide their workers'comp,polio number.
/ant an emp/over that is providing workers'compensation instrance for ntr entploYees. Below,is the polio'and joh site
infortnati(m.
lnsurancc Conlpany Nan1c. AIM Mutual Insurance
AWS400 701 286 1 20 1 4A 1 4/29!2015
I'olicv tJ ur Self-ins. Lic_ r7 F.x llratiun Dale:
loh Site Address: 3�, City/Siate//,ip. ,�(Q(�(JZ
Altach a copy of the workers' compensation policy declaration page (shov`'ing the policy ournber and expiration (date).
Failure tut secure coverage as required tender Section 25a of N161. 152 can lead to file imposition oI�criminal penalties of a line
up to $1.500.00 and/or one year imprisonment as well its civil penalties in the Donn of a Sf`01' W0RK ()Rl)l:it and it I-nc of
$250.00 it (fay against violator. lie advised that a copy of this slatcnlent rnayhe forwarded to the 011icc of Investigations of the
D[A for coverage verification.
l do herhv certill'under the pain.,amt penalties afperjury that the ilt/itrmation provider/above is true and correct.
.5! 'NUl7lI'N. Oate_
l'rirr!,Vurni. ► i hone
_ _----- ---- ---- -- - -- - -- - ------------ - ---- — - --— ---- - -----
official use only Do oat write in this area to he completed br cifr or town official
Cily or'1'awn: -- -- -- Ile rorif/license k:
issuing Authority(circle one):
I.Board of Heath 2. Building DeparUnent 3. Cifv ffown Clerk 4. Efecirical inspector- 5. Plunthinl; inspector
6. 0lher
(contact person: Phone
----------- --
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: 1 Not Applicablle� ❑f
Name of License Holder: N"Lm \ h r1+i��\V� CS` O I 0(0
License Number
YM- obkbQ�s
Address J Expiration Date
`113 53b SASS
Signal Telephone
9.Realatered Home improvement Contractor: Not Applicable ❑
�� . -k)W� pia
Company Name
c Registration Number
1 loi uA �Y�c.-A k
� A
Address J Expiratiod Date
Telephone91;53G-S9'55
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....... No...... ❑
I1. - 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 ED
Accessory Bldg. � Demolition ❑ New Signs [0] Decks [p Siding[O] Other[0]
Brief Description of Proposed ( \` ��,+ (►i
Work: �,xQ QX15kk�nc Q,�a_ '�.F tooL, G \,l "OS�a�t� CXL'1 C�hkkl ,C'h1�1e5
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If Now house and ar addition to existinsa hou insa, 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 ARGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 5 CJL� �QS511 (Ne v- as Owner of the subject
property J hereby authorize h v\� 1`C
C-'\ �lickkf\ In C
to act on my behalf, in all matters relative to work authorized by this buildir4 permit application.
o hX'41114
Signature of Owner Date
1 A C�6m �vut+nnrt J�1 , 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.
Sign d under the ms and penalties of perjury.
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
F
Frontage
Setbacks Front
Side L:,---- R _._._ U1,—, _.J R:
Rear ? _-
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved i
_, _.
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 Q
IF YES, date issued:=
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book ! Page_ and/or Document#!
B. Does the site contain a brook, body of water or wetlands? NO a DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:„mm C. Do any signs exist on the property? YES Q 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:
i —.._ .... .._ ... . .... .._............... ,._
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 Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton Status-ofPermit
11 U �
ilding Department OurbCutlC3rivewayP rirttt
s,
12 Main Street Sewer + ptiAvailaCipr
WaterWell Avaitability.
Electric,Plumbing&Gas Inspect�on� ROOM 1��
Northampton. �oioso ampton, MA 01060 two Sits of Stueturat Ptar*
MA
}?rtS
phone 413-587-1240 Fax 413-587-1272 PIbtlSItwPIans
Other wpecy..,
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
371 Spring St 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: �,
S(a�' ft Swxi�T �-1 I .art V k o'rR v-U 0 (OWL
Name(Print) J Current Mailin A dress:
`11�A 30-NAy1
Telephone
Signature
2.2 Authorized Agent.
Name(Print) Current Mailing Address
�1yLA
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building Q (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) Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
l
ill
I
I
it
II
371 SPRING ST BP-2015-0497
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16C-020 CITY OF NORTHAMPTON
Lot: -00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-0497
Project# JS-2015-000929
Est.Cost: $5500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 39378.24 Owner: MESSINGER SCOTT J&JANICE M SZYMASZEK
Zoning: URA(101,/) WSP(101)/ Applicant: ADAM QUENNEVILLE
AT. 371 SPRING ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.1012812014 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE GARAGE 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 10/28/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner