17C-163 /A7A A
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QU EN N EVI LLE www.1800newroof.net
ROOFING 'W SIDING 'W WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075 Fully Insured
1.800.NEW ROOF 413.536*5955 Facto Trained
Email:info@ 1800newroof.net Website:www.1800newroof.net Factory
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:'//3 530- 6511)
j I`I H: W:
1cc
Street Email:
City,State,Zip Code Special(fRequirements:
ripr ^Cl' Cry
❑ Recover KStrip FJ]Layers
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-tom=� '°�` -��r�
Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection.
Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights
l Install(151b.felt(Synthetic) nderlayment over remaining decking area
[�❑ Install Metal drip edge at eaves and rake 8" 5") (white/brown/copper) \
Install manufacturer's starter shingle_ n all eaves and rake edges BBB
Install neQ boot flashingtandard/ opper)/vents �,-
�] Instal(Snow Country o Cobra rolled vent ridge vent winner of the
zoio
❑ Install prop o it ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
Shingles ❑ 25 year 30 year ❑ 50 year Color
Ridge cap shingles
Warranty Options:
❑ We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
[ i Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to fumish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ 7 )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are F'd`c x Down Payment($
satisfactory and are hereby accepted.You are authorized to do work as specified. I 13-71 1
Payment will be 1/3 down at start of job,and bala upon completion. Balance Due Upon Completion($ )
Date: Signature: /
c^ �
Date:I I `_� j c Estimator: nt Name) ) n `iGE (Sign Name) <, t
Estimat sae honored for si 0)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.
4.= Tic' Cunitnotlwealth of Mas.%uchuseto
Department of lrfdusiriul�tc'citlenty
Office of litvestigutiorr.%
600 Washingtolt Street
Huston, Mass. 01111
w w w.mu.rs.gu l'/tlic►
)tVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu ill hers
Applicant Infortitaliun Please 1'r int t.e il)Iv
Adam Quennevllle Rooflny S Siding Inc.
tiAlllt' 11{ i>nris>:(hg;uui,unui;ln ln+lu.ill _
Address. 160 Old Lyman Road
Soule Hadley MA 01075 I,ilt))tey: 413-536-5955
1
Are Noll an employer' Check the afpropriate hot: I � hype of project (re(tuirett):
( X i am an errnploycr will? 15 1, 1 ant it�;cncral conirac(tn and I l, Nck, cunwruilinn
enyikryces(full illid/or part (tore(_ have tired (he suh-conitaoor.
7 Kcnn+dclnry
I am it soft: pr'opricurt or pariner listed on the attached sheo.
N11111 and have nn eml)lovecs I hose sub-conlraclors have K 1)e111u1111011
—(-king Ivy nac in ant cap;lc ilv cn)pioYecs and have Workers'
t ) 13u11dnrg addrinnt
jNo workers' comp. insurance comp. Insurance. ,
r'cyulreef� 4_; We are a corporation and 115 I 10. i I{iectrical repair.<11 atlelr(rons
1 ;rill a homeowner doing ill work officers have exercised their
I I Mmlihul l repalrs of addlllons
nlvsclf (No workcrs' comp right of excill I'll iun perm MGI,
nur
uuicc required c t 152. III), and we have no KWoot (Cpalf
employees. jno worker:
<, i
comp. insur<incc require(L)
ne eit plicrnl that checks hot N1 most also rill out the section below showing their worker%'compensation policy Informa n
tio .
Homeowners who submit this aMdavit Indicating they are doing all work and(heft hire uulside ronlrarinrs most submit a new afrldavil indica(inl;su(h.
;Coataetors that e►ak lhh box must attach an additional shttt showing the nanx of(he sub-con(racrors and stare whether or not chow entities have rmplolres. 11
ihr vtb-conirs(lor%have employee.%they must provide(heir workers'coop,oolkv amber.
l rim air empl))rer Ihoi i.c providing workers'compensation insurance/or nn'emplrtreev. Uelrow i% Nye pulirr aril joh rite
Ilt�l!/nrll rl U/I.
ln,urirhi( onipall) Nilotic AIM Mu10,11 Insurance
„llir n,a "C11-ms_ 1,1c 4 AWS400 70 1 286 1 20 1 4A f-.xll(ri(lion 1)iIIC '1/29/2015
— S -
],It) Site Address 01y/Sfilw/4111: 'F�(ye I C. v kc--,)
•Vlach a copy ol'the workers' compensation policy declaration page (shoy.inl; tilt poitcy uuniber 111141 cxpiralion (date(,
I :blurt• to ,ccurc covcr;ige ;t, teyuned under ~tenon 2i1t of M(il. ) i2 trio icad I1) the 11111)u"ilion of criulin,tl pcll,lftlr, of ;i fillc
,1I, n. xI.Sf111-Uf1 andlgr o(lc tear inlpriSOMI)Clrl i1S Well aS civil pun;ilties lit the form of it 51'(-)i' W(_)RK OW(WR ;Intl is f+nc (it
25u,Ou
it da) ag;lins( violator, fie advised that it copy ul'this Stalentent nlavbe ti)rvvarded tit life 011ice of Invcsli;aliens of the
I)lA lot coveragicverification.
/ elf, herhr cerfi/`r under the pain.%anti penalties oflierjur), that the in_ l,rtnation provic/ed abiliv' is true'uilrl twrre'cv.
�t�reNbr, � �
11� x'13 2>L
l'e tit! y+rteh' & � l')rr tli
UJjiciul u.Ne urlll+ Do not ivrite in this area to her completed b•v cify or Inwn o C-ii,11
( it% nr ins.it: I'rnni(/license q:
Issuing A(idmrii) (circle(file):
I.Rom rif of Hettill 2. ISuildinc Delmitrncn( 3. (_�ily,T(Pwn Clcrk 4. tacc(rical inspecim 5. 1'iu Ill hoif In.pccIII �
h. ()(her-
( irlt(Ho Ilcrstill: -_.`-_t'holic 4: - i
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 8/21/15
Address Expiration Date
r`---� 413-536-5955
Signature Telephone
9.Rea I listored Home Improvement Contractor: Not Applicable ❑
Adam Quenneville Roofing 120982
Company Name Registration Number
160 Old Lyman Rd South Hadley MA 01075 3/25/16
Address Expiration Date
�4-1 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 buil ' g permit.
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 ID
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0]
Brief Description of Proposed
Work: Strip existing roofing 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
6a1 If New house and or addition to existing housing, complete the follow na:
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
Joseph Chandler
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 II I(Aq
Signature of Owner Date
Adam Quenneville
I , 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 rider the pains 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
Frontage . .. ... .
Setbacks Front
Side L.. _. .A R:'- L. ..._. . , R:
Rear __ _ w"
Building Height
Bldg. Square Footage - %
.,
Open Space Footage _ % w.
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location "
.._....,, �.e....
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW
t--%% YES
IF YES: enter Book Page° and/or Document#
_. ..
B. Does the site contain a brook, body of water or wetlands? NO Q 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 , 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:
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 e
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
n Department use only
`81 of Northampton status of Permi>
uil ing Department Curb Cut/Orivewa Permit
2y
Main StreetewerleptAvailabllity �.
G
�`� oom 100 WaterNSlell -vailablllty
n�& .� �
orthampton, MA 01060 Two Sets of Suit ral l Gans `, fr
Eye N phone 413-587-1240 Fax 413-587-1272 PIotlSite Plans
t7ther Speoify
F- 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
71 Chestnut St Map Lot Unit
Florence MA Zone Overlay District
01062
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Joesph Chandler 71 Chestnut St Florence MAO 1062
Name(Print) Current Mailing Address:
413-586-7750
Telephone
Signature
2.2 Authorized Agent:
wi
Name(Print) Current Mailing Address:
�---- (Ai 3-S S Q--mss-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
6. Total=0 +2+3+4+5) 00 ca Check Number 36 Z6 `J
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
71 CHESTNUT ST BP-2015-0549
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 163 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-2015-0549
Project# JS-2015-001053
Est. Cost: $8300.00
Fee:$35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 8102.16 Owner: CHANDLER JOSEPH&PATRICIA A
Zoning. URB(100)/ Applicant: ADAM QUENNEVILLE
AT. 71 CHESTNUT ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.1111312014 0:00:00
TO PERFORM THE FOLLOWING WORK.STRI P & SH I NGLE 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:
FeeTvpe: Date Paid: Amount:
Building 11/13/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner