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16A-020 BUILDING 14 & 15
0=AA . QUENIOEVfLLE ROOFING Vr SIDING 'v 'WINDOWS 160 Old Lyman Road,South Hadley,MA 01075 www.1800newrood.net V 413-536-5955 ♦ info @1800newroof.net October 20,2015 1 request that you.grant a.modifi.cati.onto waive the requirement for control construction for the Fairway Village Condominium Association at 504 Fairway Village Road in Northampton because the work is of a minor nature,will not affect health,accessibility,life and fire safety,or structural requirements and in impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.Thank you for your consideration. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for this project." Respectfully, Adam Quenneville Adam Quenneville Roofing&Siding Inc. 160 Old Lyman Road South Hadley, MA 01075 VRl Reg#-36301 WINNER OF THE ® MSC LIC.#-010626 � BBB Torch Awards V MA CONT LIC#,120982 �� 0 CT CONST LIC#-575920 BBB& Trust • Performance * Integrity Addendum to Bid Dated October 13,2015 Between fairwayViillage Condominium Trust And Adam Quenneville Roofing and Siding,Inc. The Cost for Building 14(409,410,411,412,and 413)and Building 15(414,415,416,and 417)is changed to$66,173. The Warranty will be the Goiden Warranty at a cost of$2,520 for a total roofing cost of$68,692. The shingles will be Lifetime Timberline,color Pewter Gray. 1/3 of the total cost,or$20,607.60 will be sent with a signed copy of this agreement,with the balance of$48,084.40 paid within 10 days of completion All other terms,conditions,and specifications of the original bid documents remain in affect except that all other buildings wig be re-bid. Fairway Village Condominium Trust Alan Height,President as Trustee and not individually Date d7 k Ina Luadke,Treasurer as Trustee and not individually Date Adam Quenneville Roofing and Siding,Inc. By: l Q/f'SP Adam Quenneville,Owner Date City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 504 Fairway Village Road Leeds, MA 01053 The debris will be transported by: J.Tinnerello waste LLc The debris will be received by: J.Tinnerello waste LLc Building permit number: Name of Permit Applicant Adam Quenneville Roofing &Siding Inc. ) 0 f 1-? 1 t'g Date Signature of Permit Applicant The Commonwealth of Massachusetts W Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 - „ www mass.gov/dia Workers' Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Adam Quenneville Roofing & Siding Inc. Address: 160 Old Lyman Rd City/State/Zip: South Hadley, MA 01075 Phone#: 413-536-5955 Are you an employer?Check the appropriate box: Business Type(required): 1.® I am a employer with 15 employees(full and/ 5. ❑Retail or part-time).* 6. []RestaurantBar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. M Office and/or Sales(incl.real estate, auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] 8• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11.0 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.R Other Roof repairs *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: AIM Mutual Insurance Insurer's Address: 330 Whitnell Ave Suite 730 City/State/Zip: Holyoke, MA 01040 Policy#or Self-ins.Lic. # AWC4007012861-2015A Expiration Date: 4/29/16 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 c. 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 up to$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 DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 413-536-5955 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 Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia . Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT P'lJ,— MA4Mx2U J 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 Signature of Owner Date 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 s- Signature of Owner/Agent Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville CS 070626 License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/2017 Address Expiration Date 413-536-5955 Signature Telephone SECTION 13-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 Version 1.7 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: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Adam Quenneville Roofing &Siding Inc. Not Applicable ❑ Company Name: Adam Quenneville Responsible In Charge of Construction 160 Old Lyman Rd South Hadley MA 01075 Address �. 413-536-5955 Signature Telephone Versionl.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 Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parkin #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 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 ® 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 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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❑ Roofing N Change of Use❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work: Remove existing roof material from buildings 14 & 15 and install new asphalt shingle system. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 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 ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St 1 St 2nd 2nd 3rd 3rd 4th 4 m Total Area(sf) Total Proposed New Construction (sf) 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[] r Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: ITT 1 � ?�'.5 Building Department Curb Cut/Driveway Permit 1- ` 212 Main Street Sewer/Septic Availability DEPT OF811"I jGIN$PE Room 100 Water/Well Availability NOn'�'' +fiory MAOioso°Ng orthampton, MA 01060 Two Sets of Structural Plans phone 13-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 1.1 Property Address: This section to be completed by office 504 Fairway Village Road Map Lot Unit Leeds, MA 01053 }� �, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: gam S-LiV kpft f*d"1,f &f at-, 1)CAtz' , MA Name(Print) Current Mailing Address: ©lal 413-650-6018 Signature See Contract Telephone 2.2 Authorized Aclent: Adam Quenneville Roofing &Siding Inc. 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 $68,692.00 (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= (1 +2+3+4+5) $68,692.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0528 APPLICANT/CONTACT PERSON ADAM QUENNEVILLE ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY01075 (413)536-5955 Q PROPERTY LOCATION FAIRWAY VILLAGE-BLDG 14& 15 MAP 16A PARCEL 020 000 ZONE URA(102)/WP(17)/WSP(15) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tyneof Construction: STRIP& SHINGLE ROOF BLDG 14(409-413), BLDG 15 (414-417) New Construction Non Structural interior renovations Addition to Existing 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 INFORMATION PRESENTED: roved 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 De iti Signature of Building Official 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. FAIRWAY VILLAGE-BLDG 14& 15 BP-2016-0528 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16A-020 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categor:ROOF BUILDING PERMIT Permit# BP-2016-0528 Project# JS-2016-000884 Est.Cost: $68692.00 Fee: $483.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size sq. ft.): Owner: HAMPSHIRE PROPERTY MANAGEMENT Zoning: URAO02)/WP(17)/WSP(15)/ Applicant. ADAM QUENNEVILLE AT. FAIRWAY VILLAGE - BLDG 14 & 15 Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.1012112015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF BLDG 14 (409-413), BLDG 15 (414-417) 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 10/21/2015 0:00:00 $483.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner