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12C-120 (2) AMAAK wsa � i Q U E N N EV 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 41 3.536.5955 Fully Insured 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: ,lit")< K 7<7 5-- H: Y )S8Y-Q01) W: Street I Email: /oY 2Ick 17 City,State,Zip Code Special Requirements: / A"-9- "m 0106a 61 (CC bpiR�rPA U� PA BPS ❑ Recover %Strip © 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. K Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection. _ Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights Install(151b.felt ynthetic nderiayment over remaining decking area ® Install Metal drip edge at eaves and rakes/5") hit brown/copper) ® Install manufacturer's starter shingle on all eaves and rake edges BBB ( Install new pipe boot flashing ggiEE opper)/vents —I- L'9-lnstaKj_nowCou`ntr&r Cobra rolled vent ridge vent Winner of the 2010 ❑ Install proper soffit ventilation TORCH AWARD Shingles: (6 nails per shingle) / CA F Shingles ❑ 25 year �30 year ❑ 50 year Color b3cr e Ale GAF Ridge cap shingles Warranty Options: K We guarantee our workmanship for 10 full years(see our warranty coverage) ❑ GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: X Lead Counter Flashing ❑ Water Seal&Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ R600 ) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I Down Payment($ DC-00 ) satisfactory and are hereby accepted.You are authorized to do work as specified. Payment will be 113 down at start of job,and balance due upon completion. Balance Due Upon Completion($ ) Date:_ J,l Signature:�'d v�J K-El e�a.� / 6 �t Date:7/ r& Estimator:(Print Name) 1-4e^f Co e� , (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 Cluenneville Roofing will not be responsible for debris or dust in the attic or storage areas. All . Proposal Submitted To DaL r v►sa �e s�c Street QUENNEVILLE /0 'k >� ROOFING W SIDING V, WINDOWS City,State,Zip Code 160 Old Lyman Road•South Hadley,MA 01075 a<f�. 4, ,a Oho 6 1.800.NEW ROOF • 413.536.5955 Phone#'s Email:info @1800newroof.net Website:www.1800newroof.net H(Nt3)SS`(-1 W: MA Construction Supervisors Lic.#070626 MA Registration#120982 Dumpster Location Member of the Home Builder's Association of Western Mass. CT Registration#575920 Member of the Building&Trade Association Member of the Better Business Bureau AREAS to be SIDED PROFILE COLOR Ul Size Brand tcr-� 1 f,-, Front Clapboard ® �(° —� Siding�/kLV Cr guf_. Left Dutchclap Corners 1-Z A. Back CORNERS WINDOWS&DOORS Right Standard COLOR Other Designer' wnrce Only J Channel 47-1 1' A. J Block AZu[f VIA& Brand Style Color Location Shakes Stone Rounds Yes® No Q If Yes: Vinyl/Wood [29 Aluminum Q =where ing is to be Instalkxl.Adam Quenneville Roofing&Siding,Inc.WILL NOT remove asbestos material. 3/8" Tyvek i/dap 1 / AREAS TO BE COVERED Qty COLOR Front Left Back Right COLOR �,{P Windows'Doors tv�.(!4 Soffit&Fascia Garage/Patio Door Soffit Only — Double Garage Door Fascia Only i Build Out Frame Plain Coil PVC Aluminum Coil Qty Qty Double 5"Soffit 0 Color: fn4.r4 �1 Storm Windows � Awnings up to 8' � Location: Fr o.✓f /'O�-c� Storm Doors Awnings Over 8' Y/N COLOR Burglar Bars' Existing Shutters Wrap Porch Beams In certain markets Burglar Bars can be removed but not reinstalled Wrap Porch Posts GABLEVENTS NEW SHUTTERS Specify the locations: Qty COLOR M Of Paine COLOR Rectangle Louvered Octagon Raised Panel Prove � o� S 1 have reviewed and agree with the job specifications described above. If rotted wood is discovered AFTER removing the existing siding,or if it could not be identified at the time of sale, there will be an additional charge of$4.00 per Sq.Ft.for Plywood and$5.00 per Lin.Ft.for Dimensional Lumber. Customer Signature: Date: We Propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: Total Sale Price$ 9600 Down Payment$ °t-5-C4) Upon Completion$ Y 6 00 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified.Payment will be V3 down upon signing,and balance due upon completion. 13BB Unpaid balances shall accrue with interest at 181/par annum.Purchaser(s)will pay for all costs,expenses and reasonable attom &fees incurred Adam Quenneville Roofing&Siding,Inc.to recover a sums due under this contract TORCH°AWARD any Date: / / Signature: I 2L�rr.,cJ �rka dg�ii° Phone# S Date: VW 5- Salesperson's Signature: , � Estimates are honored for sixty(60)days from above date Please remove all breakables from interior wall surfaces during installation.AQR&S will not be responsible for damage. The Common wealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/,Electricians/Plumbers AI pplicant lnformatio'In :_ - Please Print.Lepibly Name(Business/Organiz dontindividual): Adam Quenneville Roofing&Siding Inc. Address: 160 Old Lyman Rd 4ity/State/Zip: South H6digyMA01075 Phone#: Are you ati employer?Check the-appropriate box: Type of project(required): 1. 1 am a employer with 15 4. 1 am a general contractor and I : have hired the sub-contractors employees(full and/or part-time) 6. `[r New cgnstruction 2.0 1 am a sole proprietor or partner- listed on the attached sheet: 7..❑ Remodeling. ship and have no employees These sub-contractors have g. [D'Demolition working or me in an capacity. employees and have workers' g Y P tY• 9. ❑ Building-addition [No workers'comp.insurance comp. insurance.$ required.] 5. 0 We area corporation and its 10❑ Electrical repairs or additions 3.E] I am a homeowner doing all work officers have exercised their I ED Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 11[5 Roof repairs insurance required.]t ;: c. 152,§1(4),and we have no S, i f. employees.[No workers' 13.39ther comp.insurance required.] - *AAk applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCoomctors that check this box must attached 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'tromp.policy number. 14 an employer that is providing workers'comps w*n hmraace for my mploym Below is i*e policy and job site Ins rartce Company Narge*. AIM Mutivai insurance Policy#or Self-ins.Lic.#: AWC4007012861-2015A Expiration Date: ,4/29/16- Job,,Site Address: 1 a L4 1 t✓ . )bnN-e__ City/State/Zip:p: -4 01 l_ Attach a copyy of the workers'„compensation,policy declaration page(showing the policy pulmber and expiration date). Fai, to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a find tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of alSTOPWORK-ORDER and a fine. of 1r to$250.00 a day against the violator. Be advised that a copy of this statement May be forwarded to.theOffice of 1nvptigations.of the D1A for insurance coverage verification. I ds hereby certify under the paws and penables of perjury that the information provided above is true and correct Si ,ature: Date: 7& �) Phdne Df wial use only. Do not wr1w,4n this area,to be con#ided by city or town offuiat f ity or Town: Permit/License# issuing Authority(circle one): L Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector..5.Flu Inspector f.Other t : Contact Person: Phone#• SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville CS 070626 License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/2015 Address Expiration Date 413-536-5955 Signature Telephone 9. Realstered Home Improvement Contractor: Not Applicable ❑ Adam Quenneville Roofing 120982 Company Name Registration Number 160 Old Lyman Rd South Hadley MA 01075 3/25/2016 Address Expiration Date 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....... t( 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 Gable 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 r SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alter'a'tion(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [Q Siding Other[C j Brief Description of Proposed Work: Remove exsisting roofing system and replace with a new asphalt shingle system.Remove exsisting siding and replace with new vinyl siding. 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, Kathy Kochapski as Owner of the subject property hereby authorize Adam Quenneville Roofing to act on my behalf, in all matters relative to work authorized by this building permit application. See Contract 7 k311 ignature of Owner Date I, Adam Quenneville 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. Adam Quenneville 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: 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 ® DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 Q DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q 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 Q 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. � l ' L'7 Department use only City of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit JU15 EJ 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability {,;; , Inspecti rthampton, MA 01060 Two Sets of Structural Plans '1060 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 Proaerty Address: This section to be completed by office 104 Rick Drive 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: Kathy Kochapski 104 Rick Drive Florence MA 01062 Name(Print) Current Mailing Address: 413-584-1209 See Contract Telephone Signature 2.2 Authorized Aaent: Adam Quenneville Roofing_ 160 Old Lyman Rd South Hadley MA 01075 Name(Print) Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (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) $16 600.00 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 104 RICK DR BP-2016-0097 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C- 120 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catego : ROOFING/SIDING BUILDING PERMIT Permit# BP-2016-0097 Project# JS-2016-000170 Est. Cost: $16600.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq.ft.): 10846.44 Owner: KOCHAPSKI KATHLEEN A Zoning: RI(100)/URA(100)/WSP(loo) Applicant: ADAM QUENNEVILLE AT. 104 RICK DR Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:712412015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & REPLACE SIDING 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 7/24/2015 0:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner