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31A-237 Q U E N N E V I L.LE www.iaoonewroof.net ROOFING 'V SIDING IV WINDOWS We Are Licensed 160 Old Lyman Road•South Hadley, MA 01075 Fully Insured 1.800.NEW ROOF 413.536.5955 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: OP/1C v. H�uv) S - W: Street // Email: 7 c t, t". e Lvfre.e 50C- VetgSS: E0 kA City, State,Zip Coe Special Requirements: G' Recover Strip © Layers Complete Roof System lA 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. * Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection. — Install Ice&Water Barrier at all eaves,valleys,chimneys, pipes and skylights Install(151b.felt Synthetic)underlayment over remaining decking area Install Metal drip edge at eaves and rakes 8&" 5") hite rown/copper) �\ tkl Install manufacturer's starter shingle on all eaves and rake edges BBB Install new pipe boot flashing standar copper)/vents --T.— Instal Snow Count 2010 r Cobra rolled vent ridge vent Winner of the ❑ Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) C+F Shingles [:125 year ® 30 year ❑ 50 year Color __�)A•F- Ridge cap shingles Warranty Options: [] We guarantee our workmanship for 10 full years(see our warranty coverage) f] GAF System Plus warranty ® GAF Golden Pledge warranty Chimney Options: n Lead Counter Flashing M Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due is r � 7 S0 ) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I Down Payment($ 11060 ) satisfactory and are hereby accepted.You are authorized to do work as specified. Payment will be 113 down at start of lob,and balance due upon completion. Balance Due Upon Completion($ q 73 J ) Date: % Signature: Date:_3Y 1 f Estimator:(Print Name) 1C-art r,� . (Sign Name) L 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 Quenneviile 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/Organizatiorn/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.Q I am an employer with 15 _ 4.01 am a general contractor and 1 6.0 New construction employees(full and/or part time).* have hired the sub-contractors I]Remodeling 2.01 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'These sub-contractors have 8.❑Demolition working for me in any capacity. employees and have workers' p Building addition [No workers'comp, insurance comp. insurance. + required] 5.0We are a corporation and its 10. ❑Electrical repairs or additions 3.01 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12.)(Roof repairs employees.[no workers' 13.[1 Other comp. insurance required.] *Any applicant that checks box#1 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. AIM Mutual Insurance Insurance Company Name: Policy#or Self-ins. Lic.#:AWS4007012861.2014A_ Expiration Date:4/29/15 Job Site Address: K-z �c ,. t, City/State/Zip: �Jf .lik,��}�„1 `� e� �t>4Jd 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 tine 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 ofperjury that the information provided above is true and correct. Signature: Date: 5 Print Name: GtiC.I Cell /�I L� Phone : 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): 1.Board of Heath 2. Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact person: Phone#: 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 ...i' 413-536-5955 Signature ture Telephone 9 Returesl Home ltincroyeinenit Lontractor _ Not Applicable ❑ Adam Quenneville Roofing 120982 Company Name Registration Number 160 Old Lyman Rd South Hadley MA 01075 3/25/16 Address / Expiration Date 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 building permit. Signed Affidavit Attached Yes.......' No...... ❑ 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 ✓0 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[p] Other[O] Brief Description of Proposed Work: Strip existing roofing and install new asphalt shingles Alteration of existing bedroom Yes No Adding new bedroom Yes N Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a.1# #`ollo in4: 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 Al 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 3))k-d)1( 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. Sig7A(oy\ l�underthe pair and penalties of perjury. _ t n uL', I L Print Name A to b Signature of owner/ gent 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 �. _. .�_ I w ___r. ..... ...... Frontage Setbacks Front �— Side L.= ,..6 R. . U[ _. R. ..._ i_. Rear �. .... ..°_ -.. Building Height % Bldg. Square Footage � 9 �a.. _.. Open Space Footage w % _ _ l (Lot area minus bldg&paved parking) #of Parking Spaces Fill: I . � . ...volume&Location —11-1111111111-11 . .M. ..... A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW YES 0 7 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES 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 , Date Issued C. Do any signs exist on the property? YES 0 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 Ie 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 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. b partrne tt tt r31y -W ity of Northampton Sftus aermlt �" �� ;, _ ,t` uilding DepartmentCurbutlf "SR��� 1, � 2015 212 Main Street Seweltpt�cAeflb Room 100 1IUat r/1�11e1r" -1ablltt g � tla Electric Plumbin 1 � 9&Gas hs N rthampton, MA 01060 Two etrur niorrnam�1O MA pie` -587-1240 Fax 413-587-1272 P(cttt$tte Cthoi� pecify' s n, - 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 Map Lot Unit 37 Kensington Ave Northampton MA Zone Overlay District_ 01060 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Janice Irvine 37 Kensington Ave Northampton MA 01060 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent. Ilk Name(Print) Current Mailing Ad ess: a j 3—IS 3 t o S Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ,-1 vi (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=(1 +2+3+4+5) 30 Check Number 3 This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date 37 KENSINGTON AVE BP-2015-0873 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-237 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-2015-0873 Project# JS-2015-001694 Est.Cost: $13730.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. 1): 4965.84 Owner: IRVINE JANICE M Zoning:URB(100) Applicant: ADAM QUENNEVILLE AT. 37 KENSINGTON AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:311912015 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 Sienature: FeeType: Date Paid: Amount: Building 3/19/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner