24A-067 (3) Q V E N N E V I L L E www.1800newroof.net
ROOFING 'W SIDING W WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley,MA 01075
1.800.NEW ROOF • 413.53605955 Fully Insured
Email:info @1800newroof.net Website:www.1600newroof.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: ! 13 3,;�_a I9
M I CtJA41- 5•IdAi 6406% H: N- 7j p / W:
Street Email: /
6 I r DGKw�G�D I 1`1-^ 5 � eS cr c� vto �Ct-F
City,State,Zip Code Special Requirements:
l06 v �c 9*1"4 ` An4Qn.AA
Plywo-b eigck Pot++A
❑ Recover Strip X Layers »Gb Qlyvoc,U
C�,11� Vtl'Pif f1�.�h A^b
Complete Roof System' *bV+A a't
We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected Ft"o 9.11-9444 t LtF-
Snt`aa I v-§ 04. uPRsC
Strip existing roofing to existing decking and dispose of. Do not D0.
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 y-GjOe pUr tit 544&t+
Instalkl5L"f /Synthetic)underlayment over remaining decking area of r!2 CDX Pluto
Install Metal drip edge at eaves and rakes(El 5 whi brown/copper),
Install manufacturer's starter shin le on all eaves a9d rake edges $$B
Install new pipe boot flashing( tand /copper)/vents
Install Snow Country Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: (6 nails per shingle) L H b 1,�;�1t►• f$u*�j
Shingles ❑ 25 year„ 30e�twi r ❑ 50 year Color Si
�opF Ridge cap shingles
Warranty Options:
K We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
00
We propose hereby to fumish materials and labor-complete in accordance with above specrficV-1s for the sum of:Total Due($ 7,51bo ^)
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are 40 fa-11-A °--
Down Payment($ _40-M )
satisfactory and are hereby accepted.You are authorized to do work as specified. ��%/x, �/ pC
Payment will be 1/3 down at start of job,and balance' ue up pletl alance Due Upon Completion($ i )
Date: ?/15 Signatur
Date:-rte'_��5"Estimator:(Print Name) �S� (Sign Name)�a
Estimates are honored for sixty(60)days from above date 536 !�2 le
ATTENTION HOMEOWNERS:Please cover all personal,belongings In the attic,`garage or:toc age 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 of Massachusetts
Department of Industrial Accidents
T
Office of In
600 Washington Street
,fir,/` Boston, MA 02111
www.mas.s.gov1dia
Workers' Compensation Insurance Affidavit: Bijil(lers/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Hanle tF3usinessiC)rganizationlfndividual): Adam Quennaville Roofing&Sidln Inc.
Address: 160 Old Lyman Rd
City/State/Lip: South Hadl _ _ Phone #:—_413 ;}x,9 ------ _
Arc you an employer'Check the appropriate box; TN-pe of project(required):
I.[2 I am a employer with 15 4. ❑ I am a general contractor and I
employees(full ancfr'ar part-tintc).*
Have hired the sub-contractors 6. ❑ New construction i
2.❑ f am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have
! 8. ❑ Demolition
working, for me in any capacity_ employees and have workers'
(No workers'comp. insurance comp. insurance.+
y. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
1❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp, right of exemption per MGI_ 2 r-
C, 152. §1(4).a i� LJ Roof repairs
insurance required.) and we have no
employees. (No workers' 1?•❑ Other — _— -- --
comp. insurance required.]
*Any applicant that checks hov u I must also fill Ott,the section below slowing their workers'compensation policy information.
Y homeowners")to submit this affidavit indicating they are doing all work and then hire outside contractors must subnnta new affidavit indicating such
*contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
cmplo�ces, if the sub-contractors have employees,they must provide their workers'comp,policy number_
l am an emplt�yer that is providing workers'compensation insurance for my employees. Below l's the policy aced job site
information.
Insurance Company Name. AIM MAu l� ins-grance
Policy #or Self-ins. Lic. 4: AWC4007012861-2015A Expiration Date: 4/29/16
Job Site Address:_W-- `G� I�} P. @tx .l__/r�
� � _— _—City/State/Zi
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dale). t ��V
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties ofa
line up to S 1,500.170 and/or one-year imprisonment.as well as civil penalties in the form of a STOP) WORK ORDER and a fine
of up to S-250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the MA for insurance coverage verification.
/do herehf,certify under the parrs and penalties of perjury that the information pro ided above is true and correct.
mature: — -- ---- _—_.—.-- Date:
Phone 4:
Official use onlh. Do not write in this area,to be completed ky city or town ofj vial.
City or Town: Permit/License#
issuing Authority(circle one);
1. Board of Health 2. Building Department 3. City/Town 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: u a m l 1 u Q n n e y I i i t?_ l_- 7T bg C(421(4
License Number
d t NO 7 'S W�I la
Address Expiration Date
Signature Telephone
8.Realstered Home Imorovement Contractor: Not Applicable ❑
A b t � 12-011 Z 1 u I I
Company Name J Registration Number
i tin GIB L Litufti`7'-PA fli tth bit -i N N 010-15 C; '2CJ►Ire
Address Expiration Date
Telephone(���-
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....... Ild 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 I Alteration(s) ❑ Roofing Q
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [lam Siding[0] Other[a
Brief Description of Proposed
Work:Strip exsiting 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
sa.if New house and or addition to existing housing, 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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Iy 1 1 L y,1 1 O 1 as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building ermit application.
Signature of Owner Date
I, Xclung Gila y j I Lp 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 perjury.
A. &M ayway. l i p
Print Name
1ZL1 (,;,'1� Js
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: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(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 O DONT KNOW Q YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW (�) 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:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
--------, Department use only
--
"? City of Northampton Status of Permit.
Building Department Curb Cut/Ddvevvay Permit
212 Main Street Se%wr/Septic Availability
Room 100 Water/Well Availability
-- ,�-N rthampton, MA 01060 TWO Sets of Structural Plans
Electriorin m �� -587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify'`
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
MA N bloc) Zone Overlay District
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Michael Feinberg 61 Ridgewood Terrace Northampton, MA 01060
Name(Print) Current Mailing Address: 413-584-7187
_Su- Oofi 17 r--i- Telephone
Signature
2.2 Authori zed�Anent: f 1 �,,
MOM t�'l.t� Yl�\/i I �E�_ i T`I�"1L1 hib Ci L-um �n 2 � &tjiJ li 1 AAA
Name(Print) Current Mailing Addr s: c s
tf
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 7,580 (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) 7,580 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
61 RIDGEWOOD TER BP-2015-1303
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-067 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-1303
Project# JS-2015-002394
Est.Cost: $7580.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. A.): 8363.52 Owner: FEINBERG MICHAEL S& SAUDRA A KATZ-FEINBERG
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 61 RIDGEWOOD TER
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:611612015 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 Sisnature:
FeeType: Date Paid: Amount:
Building 6/16/2015 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner