32C-045 AUNAK .
QUENNEVILLE
ROOFING VV SIDING 'v WINDOWS
160 Old Lyman Road,South Hadley,MA 01075
www.1800newrood.net V 413-536-5955 V info @1800newroof.net
October 23,2015
I request that you grant a modification to waive the requirement for control construction for the ES 86
Pleasant St- LLC. at 86 Pleasant St 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,
ED
REU-
Adam Quenneville
Adam Quenneville Roofing&Siding Inc. OCT 2 305
160 Old Lyman Road
South Hadley, MA 01075 OF RUIVING'NSPECno"
ORT}{.MprON MA 01060
V RI Reg#-36301 WINNER OF THE
9 MSC LIC.#-010626 y
V MA CONT LIC#-120982 .! BBB Torch Awards
V Cr CONST LIC#-575920 BB&, Trust • Performance * Integrity
y
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/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. ORestaurant/Bar/Eating Establishment
2.0 I am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incl.real estate, auto,etc.)
employees working for me in any capacity. g Non-profit
[No workers' comp,insurance required] p
3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp, insurance required]* I L0 Health Care
4.0 We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 1 12.54 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 Whitney 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 nd penalties of perjury that the information provided above is true and correct.
Signature: Date: tQ ho
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 .
MAIN
illy � ��
Q U E N N E V I L L E www.1800newroof.net
ROOFING V SIDING 'V WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075
1.800.NEW ROOF • 413.536.5955 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 10/1/15 Phone#'s C:
_ _
Street Email:
86 Pleasant_Street
City, State,Zip Code Sp
Northampton,MA 01060 'Shingle upper section including side dormer only.
Soo s F.
J Recover ® Strip ❑ Layers
Complete Roof System
1 J We shall acquire all appropriate permits for all work 14
V Home exterior and landscaping to be protected
W Strip existing roofing to existing decking and dispose of. Do not Do. Any other sections
V Deteriorated existing decking will be replaced at 3 pier sq.ft.after full inspection.
M Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
LV install(15Ib.felt S nthetic underlayment over remaining decking area
[J Install Metal drip edge at eaves and rakes 8®5")M brown/copper)
f2 Install manufacturer's starter shingle on all eaves and rake edges $�$
W Install new pipe boot flashin standard opper)/vents _r
V Install Snow Country or CobrA rolled ven idge vent Winner of the
2010
Install 2 layers Astec Roof Coating on rubber roof section only. TORCH AWARD
Shingles: (6 nails per shingle)
GAF Timberline Lifetime _Shingles R 25 year ❑ 30 year ❑ 50 year Color____.—.►�t mac/
GAF _Ridge cap shingles
Warranty Options:
,V We guarantee our workmanship for 10 full years(see our warranty coverage)
L1
Chimney Options:
Lead Counter Flashing ❑ Water Seal&Tuckpoint C_] 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($ 6,875.00 }
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are Down Payment($ 2,291.66 _}
satisfactory and are hereby accepted.You are authorized to do work as specified. 4,583.34
Payment/Iwill 1/3 d r-.Siggnature:rt of job,and balance du upon mpletion Balan Due Upon Completion($ }
Date: G� � _
Date:-10/_..15 , Estimator:(Print Name) Adam Quenneville _ (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.
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: 86 Pleasant St Northampton, MA 01060
The debris will be transported by: J.Tinnerello Waste LLC 777 Silver St. Agawam MA
The debris will be received by: J.Tinnerello Waste LLC 777 Silver St. Agawam MA
Building permit number:
Name of Permit Applicant Adam Quenneville Roofing & Siding Inc.
Date Signature of Permit Applicant
Version l.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ES 86 Pleasant St., LLC 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 /D 40/ry
Signature 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 periury.
Adam Quenneville
Print Name
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
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:
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
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW ® YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW ® YES Q
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 ® YES o
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.
Version l.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 Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work:
Remove 500 s . ft. of roof material on back side of building 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 ❑ 58 E]
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)
152 1 52
2nd 2nd
3rd 3rd
4th 42n
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[:]
Version 1.7 Commercial Building Permit May 15,2000
.— Department use only
City of Northampton Status of Permit.
Building Department Curb Cut/Driveway Permit
i 2a� 212 Main Street Sewer/Septic Availability
Room 100 WaterMell Availability
ortham ton, MA 01060 Two Sets of Structural Plans
SP
p
ING�
o .%01 G 3-587-1240 Fax 413-587-1272 Plot/Site Plans
�H�prN h9A�1
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
86 Pleasant 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:
ES 86 Pleasant St., LLC 86 Pleasant St. Northampton, MA 01060
Name(Print) Current Mailing Address:
Signature See Contract Telephone
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
completed by ermit applicant
1. Building $ 6 875.00 (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 =0 +2+3+4+5) $6,875.00 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0552
APPLICANT/CONTACT PERSON ADAM QUENNEVILLE
ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY01075 (413)536-5955 Q
PROPERTY LOCATION 86 PLEASANT ST
MAP 32C PARCEL 045 001 ZONE CB(100)/
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 500 SQ BACK SIDE OF ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
BuildinpPlans Included•
Owner/Statement or License 070626
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOYMATION PRESENTED:
pproved 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
Demolition Delay
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.
86 PLEASANT ST BP-2016-0552
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2016-0552
Project# JS-2016-000908
Est. Cost: $6875.00
Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO:
Const.Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 7013.16 Owner: ES 86 PLEASANT STREET LLC
Zoning: CB(100)/ Applicant: ADAM QUENNEVILLE
AT. 86 PLEASANT ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:1012612015 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 500 SQ BACK 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:
FeeType: Date Paid: Amount:
Building 10/26/2015 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner