17D-012 (53) 1�.1
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www.i 800newroof.net
t� IQUENNEVILLE ROOFING 'V SIDINGt 'V WINDOWS
160 old Lyman Road•South Hadley,MA 01075 We Are licensed
1.800.NEW ROOF • 413.536:5955 Fully Insured
Emall:info*isoonewrgof.net Website:www.1600newroot.net Factory Trained
MA Construction Supervisors tic.#070626 FAA Registration#120982 Factory Certified Installers
Member of the Hpme S Wer'shseadatlon of Western Maw. CT Registration 11575920
Member of Hte Bolding&Trade Association P,P.C.30710
Proposal Sugmitted To s
3 : Date Phone V C:
A"broul( ArtrMr t1) 314115 H: -?77- /SP6 W:
Street Email:
Icti L (`td wbe+he149 atAkcv.,."Jnjtfies.e
City—!state,Zip Code Special Requirements:
(-10 r6vc ASS Too or.i ho-i5C 176-),
ni S Qu tPf e
is f1w r�t1r. 'S'cLQ
Recover (R Strip RLayers t) _
v .
Complete Roof System'
0$ We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected
Strip"existing roofing to exisfing.decking and dispose of. Do not Do.
Deteriorated exJsbng decking will be replaced.at$3.47 per sq,ft.after full-inspection.
Install Ice,&Water Barrier at all saves,valleys,'chimneys,pipes and skyiights
Install(151b�"fblt/t4ateOgyundedayment over rarnaining decking area
Install Metal drip edge at'saves and rakes(8" whit rown/copper)
9 Install manufacturer's starter shingle on all eaves and rake edges
®.Install new pipe boot flashing. nda copper)/vents
Instati Snow Country.or Cobra rolled vent ddge vent Winner of the
2010
TORM AWARD
Shingles: (6 nails per shingle)
er�'�' Shingles ❑25 Year 0 30 year ❑50 year Color
fC e.4 Ridge cap shingles
Warranty Options:
We guarantee`our workmanship for 10 full years(see our warranty coverage)
❑ GAF SyA� warraniy
GAF*6n gewarranty
Chimney Options:
❑ Lead;Courtter Flashing ❑ Water Seal&Tuckpoint ❑Rubberized Crown ❑ Metal Chimney Cap
-a
We propose hereby b furnish materials and labor aorrg ew in amordanoe'with above specifications for the sum of Total Due($,5,-7 7 5.ey ) '
ACCEPTANWCF OF PROPOSAL: Tile'above prk:es_spiseficadons and:conditions are Down Payment($ 1) 13- uV)
set rpry enl�a"hereby accepted.You are nce Otis ad to o work as spa
de 1/S down trr start of 104, d balance due upon comp tto Balance Due Upon completion($ )
Sao-OD
Date: / J Signature;
Date: J rs Estimator:(Print Name) ✓e (Sign Name)
Estimat, re honored for sixth(60)days from a6we date
ATTEtiT16k HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the
possibility of roofinadebris 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
Adam Quenneville Roofing&Siding Inc.
Name(Business/Organiaationllndividual) fi
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. I am an employer with 15 4. U I am a general contractor and 1 6. U New construction
employees(full and/or part time).* have hired the sub-contractors 7. 1 Remodeling
2. i 1 am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. ', I Demolition
working for me in any capacity. employees and have workers' 9. I Building addition
[No workers' comp. insurance comp. insurance. T
required] 5.1_i We are a corporation and its 10. 1 1 Electrical repairs or additions
3. F, I am a homeowner doing all work officers have exercised their 1 I. Li 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. ri Roof repairs
employees.(no workers' 13. I.1 Other
comp. insurance required.]
"Any applicant that checks box 01 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 most 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.
Insurance Company Name: AIM Mutual Insurance
Policy#or Self-ins. Lice#: AWS40070128612014A _ Expiration Date: 4/29/2015
Job Site Address: 1 �Y t City/State/Zip:_ z VAA C3\C
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: Dale:
Print Name: Phone t+:
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.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact person: Phone#:
Version].7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
� _.. . , as Owner of the subject property
u�
r
hereby authorize �'�^ i'1e"'� e �' to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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 pertura! _
Print Name
_........ ........
Signature of weer/Agent bate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
n _. ._,
o 1
Name of License Holder. r` n1f :� n .. .. _ R...me. _.
License Number
tj
Address Expiration Date
; : H\3 53 ^ .SC6 -
Signature r Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§25C(6)) -T
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 qN No
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
i Not Applicable
I
Name(Registrant)
... _
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
_..... �_..._.... _ . _ ............ r.
i
Name Area of Responsibility
Address Registration Number
I
Signature Telephone Expiration Date
_. �.. _.. ......... .. ___............
w ...
Name Area of Responsibility
....... �, _ z
_...
Address Registration Number
Signature Telephone Expiration Date
� tl
Name Area of Responsibility
_.._._ s ..
Address Registration Number
.._.... ��.. . �._ ,,......_
Signature Telephone Expiration Date
s p t
- -- m,a.-.---.�"°� r._........— ....._.... ___e.., _ .. -._..,,,....m.._ .....,, _..v: ...._..E C................ .. ......... ,..,....,m. .... ..........n n.ww....,.. m......n
—n
Name Area of Responsibility
g
Address Registration Number
_ ..... ,
Signature Telephones Expiration Date
9.3 General Contractor
_ i Not Applicable ❑
Company Name:
Responsible In Charge of Construction
k�- ` , . __ ., ,. ` .. �o 1 .
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
{
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofingf4 Change of Use❑ Other
Brief Description ;Enter a brief description here, ;,,��
Of Proposed Work: ' e-oc�5th 5�" BLS c•✓lc� �t F\cam r�� c�S tUt(x 45c�-� ti
A7113 as��Y��''��-✓ J. _. _ _. �_ .,
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 El A-2 El A-3 El 1A 11❑ A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility El Specify:
)
M Mixed Use ❑ Specify:
S Special Use El Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
n , . . .,
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): _ Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1 S `
1 St
St
2nd .
2nd
3rd
3
4th
Total Area(sf) Total Proposed New Construction(sf)
i
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Version l.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front m
Side L R:,-.,._ L: ....� .
Rear
Building Height
Bldg. Square Footage %
Open Space Footage _. % 7
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: '
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES
i.._.
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO z7N DON'T KNOW C) YES
IF YES: enter Book , Page_ and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
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 Q
...
IF YES, describe size, type and location: �7,
D. Are there any proposed changes to or additions of signs intended for the property? YES i NO
E
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 Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
D6p rt41 is Se �
C�tl, f Northampton tatua rskPeril r
841 g Department Lurks CutfDrly ay'P trmlt � ry
Main Street ewer) eat`tc Auallabtlltr
MAR 2 oom 100 WatedW-olI Avai(eblilt ? `A
�=
ha pton, MA 01060 Two,Sets cifPStrlaclurel ilerts^ ' ,
Electric,Plumb 240 Fax 413-587-1272 Plot/ ltlans �
Northam o f �
t7tar Specity' * r 40 3
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
�CA I Map Lot Unit
C
O:-Zx' Zone Overlay District'
°m... _._ ' Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing,_
Signature Telephone LW V'S • — 1
2.2 Authorized Agent:
Name(Print) Current Mailing Address: .
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building cj��� O,9 (a) Building Permit Fee
w -
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) -�
5. Fire Protection ..... . -
r Check Number l
6. Total=(1 +2+ 3+4+5) �
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0899
APPLICANT/CONTACT PERSON ADAM QUENNEVILLE
ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY01075 (413)536-5955 Q
PROPERTY LOCATION 491 BRIDGE RD- 1702 TOWNHOUSE
MAP 17D PARCEL 012 001 ZONE URB(100)/WP(28)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building,Permit Filled out
Fee Paid
Typeof Construction: STRIP&SHINGLE FRONT SIDE OF ROOF
New Construction
Non Structural interior renovations
Addition to ExistinC
Accessory Structure
Building Plans Included•
Owner/Statement or License 070626
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO �kl ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
i Delay /C
2;�(�J
Signature of u' d' fi ial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
491 BRIDGE RD- 1702 TOWNHOUSE BP-2015-0899
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 17D-012 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildlnq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit# BP-2015-0899
Project# JS-2015-001735
Est. Cost: $5775.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(scl. ft.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP
zoning URB(IOOL/WP(28� Applicant: ADAM QUENNEVILLE
AT. 491 BRIDGE RD - 1702 TOWNHOUSE
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:312612015 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE FRONT SIDE OF 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:
FeeTyve: Date Paid: Amount:
Building 3/26/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner