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38D-051 (3) =� a,. QVENNEVILLE 6 ROOFING 'V SIDING 'V WINDOWS BT 160 Old Lyman Road•South Hadley,MA 01075 1. 1.800.NEW ROOF • 413.536.5955 Winner of the Email:info@ 1800newroof.net Website:www.I800newroof.net 2010 MA Construction Supervisors Lic.#070626 MA Registration#120982 TORCH AWARD Member of the Home Builder's Association of Western Mass. CT Registration#575920 Member of the Building&Trade Association Proposal Submitted To: Date Phone#'s C: 5osc , Le -� 9 3�' ��' H: y03 . 58`1- /hoc. w: Street Email: City,State,Zip Code Proposal to furnish and install the following Nr,Uj V IVk V S P)0L( (h nv t1 V�rtic �� Skj �IS{1\ pjo l+'S1cc1C/ J?G Ask us about affordable bank financing We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ d 000•ao ) ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are I '' k.�t Down Payment($ 6 t'''v,` ) satisfactory and are hereby accepted.You are authorized to do work as specified. 305 t Payment will be 113 down at start of job,and balance due oyp n completion. Balance Due Upon Completion($ 3 3 3•U'' ) Date: ;D 1S Signature: A,44 l %lJ^ r Date: 30 1 Estimator:(Print Name) )eo 7 Sr Ia (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 Ouenneville Roofing will not be responsible for debris or dust in the attic or storage areas. The CommonweaM of Massachusetts Dtpardrattnt of industrial Accidents Off"of invadgadens 6010 Washbigton Street Boston,MA 02111 www.nraMS.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricbins/Plumbers dnnti M lnformatiou ?lease PrintLeetbly Dame(Btrsiness/Organiiation/lndividual): Adam Qjwaville Roaiirio&SW!ng 1 M Address- 16o old Lyman Rd t City/Statc/Zi bola A 01079 Phone#: Ai-eyou as employer?Cbeek the•appropriate box: Type of project(required):. 1. 1 am a employer with 15 4. C] I am a general contractor and I 6. ❑New cpnstruction employees(full and/or part-time)." have hired the sub-contractors 2.® 1 am a sole proprietor or•parom- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-connectors have g. ()"Demolition working for me in any capacity. employees and have workers' [No workers'comp.inswtanae ,comp. insurance.Z 9. ❑ Builditag addition required.) 5. (] We are a corporation and its 10.0 Electrical repairs or additions 3. ] 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 MOL 12:[g Roof repairs insurance requited.]t :, c. 152,§1(4),and we have no unployeas.[No workers' i 3.Q C7ther c�tti .insurance tiu+od. •A J applicant that chedts box N r mast also till out the section Wow showing their workers'oompeoaldoa potioyt bfo mmtitm t Hdnnwwttas who submit this aPFiftvit indicating they art:doing all work and than hire outside contractors must submit a new affmhvit indicating such. that check this box mast attached an additional sheet showing the name of the mb-oonvactors and state whether or not those entities have if the sub-cont<mcton have=44oyees,they must provide their workers'com*pocky at al ! an er�lpioyer drat its p+vvirt workers'a>t#pei or.�nrrwsct♦r jars'ag teltlptio�lea. Below it Aepot9v ad job acre 1 ce Company Nani ,4fM b�ute,s .lrtsut�r►crs Policy#or Self-ins.Lic.#: AWC4007012861-2015A Expiration Date: M&- Job Site Address: 1 /rl 1—h r7 City/StatelZip: , �}' ) Q laco A"a copy of the workers'compataatioa.-polky declaration pop(aho%4 g*tlte poUcy 4imber and expkadoo date Fat I,to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition•of criminal penalties of a finQ uR to$1,500.04 and/or one-year imprisonment,as well as civil penalties in the form of s STOPMORKORDER and a fine': of tip to 5250.00 a day against the violator. Be advised stmt a copy of this statement they be forwarded to,theoOffiee of Jav#stigations of the DIA for insurance coveage verification. I d4 hereby rer4ry arm and pees/stns of prrjirry dw tats fit formation PrOW&W above Jr rare and rnrnwf�,y Pbdm �a S # ul -53 S setal use qtly. Do not wrke,,(n this area,to be cox#%fed by city or town official �ity or Town: Permit/License# ft Ing Authority(circle one): oard of Health 2.Buildimg Department 3.City/Town Clerk 4.Electrical Inspector.S.-Plumbing Inspector i.Other 4atact Person; Phone M: 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 8/21/2017 Address Expiration Date A- 413-536-5955 Signature Telephone 9.Registered 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 413-536-5955 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....... Q�D 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 Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ([] Siding [O] Other[CI] Brief Description of Proposed Work: Remove existing skylight and install new skylight in existing jam. Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet 6a. 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 Susan Levin 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 10 �� k 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. 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 O DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW e YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW e YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 e IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only © � 0 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability p ,tins&Gas o64 hampton, MA 01060 Two Sets of Structural Plans IMA p one 413-587-1240 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 41 Winthrop St Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Susan Levin 41 Winthrop St Northampton, MA 01060 Name(Print) Current Mailing Address: 413-584-1806 See Contract Telephone Signature 2.2 Authorized Agent: 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 com feted by ermit applicant 1. Building $2,000.00 (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) $2,000.00 Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date 41 WINTHROP ST BP-2016-0472 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-051 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2016-0472 Project# JS-2016-000781 Est. Cost: $2000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 9496.08 Owner: LEVIN SUSAN B Zoning: URB(100) Applicant: ADAM QUENNEVILLE AT. 41 WINTHROP ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON.10 1712015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE SKYLITE 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 10/7/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner