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31A-070 210 ELM ST BP-2016-1546 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31A-070 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-2016-1546 Project# JS-2016-002637 Est. Cost: $8600.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sn. ft.): 15333.12 Owner: NELSON MICHAEL D&JENNIFER JACOBSON Zoning: URB#OO)i Applicant: ADAM QUENNEVILLE AT: 210 ELM ST Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:8/2/2016 0:00:00 TO PERFORM THE FOLLOWING WORK: REMOVE EXISTING ROOF MATERIAL & INSTALL NEW ASPHALT SHINGLE SYSTEM Apporved 8/1/16 for like and kind replacement of roofing 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: grid/Ie /Natio 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1546 £}C fu.,, AND APPLICANT/CONTACT PERSON ADAM QUENNEVILLE P RO Pa €©P `1 • ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY (413)536-5955 O PROPERTY LOCATION 210 ELM ST MAP 31A PARCEL 070 001 ZONE URB(1001/ 0 ¶d THIS SECTION FOR OFFICIAL USE ONLY: 6 K PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ICH)//''77�� Fee Paid C ICA 35 a q 7 `TV Building Permit Filled out Fee Paid Tvpeof Construction: REMOVE EXISTING ROOF MATERIAL&INSTALL NEW ASPHALT SHINGLE SYSTEM 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 INF9RMATION PRESENTED: Approved 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 LZ01C L or. 14TQ'f Permit from Elm Street C mmission Permit DPW Storm Water Management Demolition Delay �6 Signature Building Official Date/f/ 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 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 -SRE INFORMATION 1.1 Property Address: This section to be completed by office 210 Elm 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: Michael Nelson &Jennifer Jacobson 210 Elm St. Northampton, MA 01060 Name(Print) Current Mailing Address: 413-548-5608 See Contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old Lyman Rd.South Hadley, MA 01075 Name(Print) q Current Mailing Address: /y/h� 413-536-5955 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee $8,600.00 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection i-// 6. Total=(1 +2+3+4 +5) $8,600.00 Check Number 36—o/77 �f'.Yi 1T This Section For Official Use Only 36 aq 1 Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings 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 O YES o IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Akeration(s) ❑ Roofing 2 Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding[DI Other[0] Brief Description of Proposed Work: Remove existing roof material and install new asphalt shingle system. Alteration of existing bedroom Yes V No Adding new bedroom Yes V No Attached Narrative Renovating unfinished basement Yes ✓ 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 a 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 Michael Nelson&Jennifer Jacobson ,as Owner of the subject properly hereby authorize Adam Quenneville to act on my behalf, in all matters relative to work authorized by this building permit application. See Contract b f a 3 3] (P Signature of Owner Date 1111111111 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 to133b Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Ouenneville CS 070626 License Number 160 Old Lyman Rd.South Hadley,MA 01075 8/21/2017 Address Expiration Date 413-536-5955 Signature Telephone 9.Reolstered Home Improvement Contractor: Not Applicable 0 Adam Ouennevrlle Roofing 120982 Company Name Registration Number 160 Old Lyman Rd.South Hadley,MA 01075 3/25/2018 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 G No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 The Commonwealth of Massachusetts i"=�; =+1 Department ofIndustrial Accidents "llll= I Congress Street,Suite 100 +?ii•= .,' =PP= ,` Boston,MA 02114-2017 tack„ wwm mass.govidia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMrITING AUTHORITY. Annlcant Information Please Print Legibly Business/Organization Name: Adam Quenneville Roofing& Siding Inc. Address: 160 Old Lyman Rd City/State/Zip: Snuth Hadley MA 01075 Phone#: 413-536-5955 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 15 employees(foil and/ 5. 0 Retail or parttime)` 6. ❑RestaurantBar/Eanng 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. [No workers' comp. insurance required] 8. 0 Non-profit 3.0 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]** 4.0 We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees. [No workers'comp. insurance req.] 12.2 Other Roof repairs *Any applicant that checks box#1 must also fill out the section below showing their wo kus'compensation policy information. "If the corporate officers have exempted themselves.but the corporetion has other employees,a workers'compensation policy is required and such an organization should check box Nl. 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 Site 740 City/State/Zip: Holyoke, MA 01040 Policy#or Self-ins.Lie.# 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains nd penalties ofperjury that the information provided above is true and correct Signature: Date: tcb-3 Igo Phone#: 413-536-5955 Official use only. Do not write in this area,to be completed by city or'town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other iI Contact Person: Phone#: www mass.xovidia L° LJ /U sss QUENNEVILLEWtheero,T—TORCH AWARD 1 VISA EMIlml; e ROOFING W SIDING W WINDOWS 161/01d Lyman Road•South Hadley•MA 01075 We are Licensed 1.800.NEW,R00F • 413.536.5955 Fully Insured Email,info018D0newroofnet website;www.1800newroof.net Factory Trained MA Construction Supervisors Lic.#010626 MA Registration 4120982 Factory Certified Installers Member Of the Home uWestern mass. CT Registration#575920 Member or be Buildmt&Made Association PPC 38110 Proposal Submitted To: Date: 1.451jb Phone#'s: C -'I)-5`B-51..o3 int ckaz.14JCISe^ Iann. tc Jocoe;n- H: IN: Street: Email: aK) ci, 5e _ City,State,Zip Code: Special Requirements: NaFICP_6io-. cfA 0 I6(eO Ad2,i�e, ant j7or. reefs oO17 (��..n�� PROPOSAL FOR: /—/ S oD<-s + -C Sm�(.II S lopes deer \r1r U GARAGE OTHER S R RECOVER NEW GUTTERS layers: 0 2 3 4 Plywood Included: Yes or No 1 Tear off SLATE or SHAKES COMPLETE ROOF PROTECTION SYSTEM: P(ntr G-;to•. )17Lu OC Orr r<fZ XWe shall acquire appropriate permits for all workna.l kc a; TICS co:r rr A Home exterior and landscaping to be protected Coa1 t,,iru SL/lii)hi} „1 CarVic. ,$ Strip existing roofing to existing decking with full inspection DO NOT DO: 'c All project waste shall be removed by dumpster(dumpsterfor contractor use only) IL(.f5 Deteriorated existing decking will be replaced at$311 per sq.ft.after full inspectio ustomer Initials: . Ai Install ice&Water Barn at all eaves 316',valleys,chimneys,pipes and skylight q11 X Install(151b felt Synthetic underlayment over emaining decking area X Install Metal drip e g a eaves and rakes /5') bite/brown) % Install manufacturer's starter shingle on all eaves and rake edges } Install new pipe boo vent accessories 8 Install ridge yen -Snow Country obra ro ed/4'Baffled/Poll Shingles:(standard 6 nails per shingle) L &1 - C.Or Shingles 25 year 3k51) edr 50Year Colon_ S/o.I_ C (oq( Ridge cap shingles ' Warranty Options: h We guarantee our workmanship for 10 full years(see our warranty coverage page) - GAF System Plus Warranty ad_ GAF Golden Pledge Warranty AQRS Recommendations: Lead Counter Flashing _ Water Seal&Tudtpoint Rubberized Crown Metal Chimney Cap Replacing old skylights forwaiver must be signed) Mason- work Clic waiver must be signed) _ Heated panel roof system . Insulation Ventilation I. . Opted out of AQRS recommendations Customer Initials:. we propose hereby to turn materials and labor- mplee.n accoranwith aboe spent canonsthe molt Total Due---(5$(.00.0 ) ACCEPTANCE OF PROPOSAL:Theabove prices,specifications ce fications and conditions are r..4 4?-^.'n” Down Payment:(S/ `O. ) satisfactoryand are her y accepted You are authorized to do work as specified. Balance Due Upon Completion:I$!6Ott - ) Paymemsoillll wn bb 1/3 at start ofjob,and 6y(n ue upon co I �(n.. / , Date.: Y/'/S lCsignature[. 1 'IL o' � t/1'ZA Date: (v t!5(K Estimator'(Print Namel Mark A(eL (sign Nemel /t / Estimates are honored for sixty 1601days 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 Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. Customer Initials: