32C-010 File#BP-2017-0186
APPLICANT/CONTACT PERSON ADAM QUENNEVILLE
ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY01075(413) 536-5955 ()
PROPERTY LOCATION 116 MAIN ST
MAP 32C PARCEL 010 001 ZONE CB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT 'r
Fee Paid ‘35c 7a 4570) Mat
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL NEW RUBBER MEMBRANE ROOFING 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
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Pennit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Pennit 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.
_ Versionl.7 Commercial Building Permit May 15,2000
3._7 Department use only
City of Northampton Status of Permit:
AZ 8 20161
Building Department -Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT NORTHM1�ProN INSPECTIONS
Jorthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 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
Map Lot Unit
116-118 Main St
Northampton, MA 01060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Matthias Naegele PO Box 54 Hadley,MA 01035
Name(Print) Current Mailing Address:
413-896-9574
Signature See Contract Telephone
2.2 Authorized Aoent:
Adam Quenneville 160 Old Lyman Rd.South Hadley,MA 01075
Name(Print) Current Mailing Address:
413-5365955
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $ 13,000.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) j51 �l�l 0Y6 ��I
5. Fire Protection � /d �` /J
6. Total=(1 +2+3+4 +5) $13,000.00 Check Number ylr �� Jpara
This Section For Official Use Only �y `
Building Permit Number Date a /
(Ir I
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
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 0 Existing Wall Signs ❑ Demolition 0 Repairs Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign❑ New Signs 0 Roofing® Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work: Remove existing roof material and install new rubber membrane roofing system.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 ElA-3 0 IA I ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ® 2A 0
E Educational ❑ 2B I ❑
F Factory 0 F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A 0
I Institutional ❑ 1-1 ❑ 1-2 0 1-3 ❑ 3B ❑
M Mercantile ❑ 4 0
R Residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 0 5-2 ❑ 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
Ftoor Area per Floor(sf)
1m
god 2nd
3b 3,d
4th 4m
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 0 Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
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 ,o
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 DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O 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 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 O NO it
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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
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
Version1,7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Matthias Naegele ,as Owner of the subject property
hereby authorize Adam Quenneville to
act on my behalf, in all matters relative to work authorized by this building permit application. RR
See Contract ?Hite
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 N 4,,
Signature of Ownerr//,AAggenntt - 9141
Da e
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Adam Quenneville CS 070626
License Number
160 Old Lyman Rd.South Hadley.MA 01075 8/21/2017
Address %{/� Expiration Date
/ ,-, 013-536-5955
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 0
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: 116-118 Main St Northampton, MA 0106C
The debris will be transported by: USA Hauling & Recycling Inc.
The debris will be received by: 15 Mullen Rd. Enfield, CT 06082
Building permit number:
Name of Permit Applicant Adam Quenneville Roofing &Siding Inc.
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
TE7-.4ir—�l Department of Industrial Accidents
,_
Witt-
1 Congress Street,Suite 100
e ,_
' Boston, MA 02714-2017
w.
- wwmass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/organizationnndividua0: Adam Quenneville Roofing & Siding Inc.
Address: 160 Old Lyman Rd.
City/State/Zip: South Hadley, MA 01075 Phone#: 413.536.5955
Arc you an employer?Check the appropriate box: Type of project(required):
L®1 am a employer with 15 employees(full and/or part-time)
7. Q New construction
TO I am a solo proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp.insurance required.] 8. Q Remodeling
9. ❑Demolition
3.0i am a homeowner doing all work myself [No workers'comp.insurance required.]:
10❑Building addition
CI I am a homeowner and will be hinng contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
proprietors with no employees_
12.❑Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 3. Roof re airs
sub-contractors sub-conctors have employees and have workers comp.insurance.:
® p
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther
152,41(4).and we have no employees.[No workers'comp.insurance required]
*Any applicant that checks box UI must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of tile sub-contractors and state whether or not those entities have
employees. lithe sub-contractors have employees,they must provide their workers'comp.policy number.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob.site
information.
Insurance Company Name: AIM Mutual Insurance
Policy#or Self-ins.Lic.#: AWC4007012861-2016A Expiration Date: 4/29/2017
lob Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by 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.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 midges of perjury that the information providedrote is true and correct
Signature: Date: e/ `(�
Phone in 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.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
L�1 o X BBB—
QUENNEVILLE winner ofthe TORCH AWARD " r'' nnLOER
ROOFING sr SIDING V WINDOWS
160 Old Lyman Road•South Hadley•MA 01073 We are Licensed
1.800.NEW.ROOF 413.5365955 Fully Insured
Email:mfo@lsoonewroornet Website:www.l Ri]0newrooenet Factory Trained
MA Construction Supervisors cc.#070626 MA Registration 10120982 Factory Certified Installers
Member of Dame BuiieersAssoc.of Western mass. CT Registration 6575920
Member of the Building&Trade Assodabon10
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Proposal Submitted To: Date: Phone Ws: 14e12 C: t-rr3- 39c-15-1y
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City,State,Zip Code:
Norr„�e E't re)11 nlccn eISIiS G�� Na�leyJ rn, 01035
Jl Proposal to furnish and install the following:
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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 crack of the wood.Adam Quenneville Roofing will not be
responsible for debris or dust in the attic or storage areas. Customer Initials:
Additional materials and labor charges may apply.
›ccustomratedialsnnggeakjfig will be replaced at$3.77 per ft.after rwlinspemon Ask us about
Customer Initials �1�✓\�� affordable bank
X Deteriorated existing dimensional lumber to be replaced at$5.00 per linear ft after full financing!
inspection
Customer Initials
1 'Alarranty Options: 1 Year 5 Year le Year
wepropo.herebymmre.n matem,amlabor-rnmdetein accordance mat aimed specifications sop ter s. Total Due:($ 13000 .pq
ACCEPTANCE OF PROPOSAL':The above prices,specifications and conditions area PACP-w own Payment:($c115501'OVI
satisfactory and are hereby accepted.You $aurhorisd to do work as specified. Balance Due Upon Completion:IS 0500'cu
Payment will .el 3 down at signing and baerce'due uponcorpleti0
Date'.p► Signature:/ \ �. <� e
Date:O 1a1�I Estimator:/(Print Name) X•O y.El-� — (Sign Nam )!// Tr—
Estimate r honored for sixty(601 days from above date.
DAM2cb'QUENNEVILLEYEP
ROOFING Ny SIDING
160 Old Lyman Road • South Hadley, MA 01075
www.1800newroof,net V 413-536-5955 V info@1800newroof.net
Commissioner Hasbrouck August 8,2016
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the roofing
project at 116-118 Main Street in Northampton because the work is of a minor nature,will not affect
health, accessibility, life and fire safety,or structural requirements and is impractical in that the cost of
control construction is considerable when compared to the cost of the proposed work.All work will be
completed within the prescriptive requirements of 780 CMR.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 Rd.
South Hadley, MA 01075
CT HIC#-575920 V MA HIC - 120982 V MA CSL -070626 V RI Reg. #- 36301
D AM 2coQUENNEVILLEveP
ROOFING S I D I N G
160 Old Lyman Road • South Hadley, MA 01075
www.1800newroof.net Y 413-536-5955 V info@l800newroof.net
The structure is greater than 35,000 cubic feet and requires controlled construction, however because
the work appears to be minor in nature and will not affect health and safety issues we can accept a
request for a waiver from controlled construction however the letter needs be accompanied by a letter
from a registered design professional, Architect or Engineer, describing the proposed work. See text
below.
"Mass code chapter 34,sections 606.2 and 606.3 do not require engineering for this project"
I request that you grant a modification to waive the requirement for control construction for the
project at 116-118 Main Street in Northampton because the work is of a minor nature,will not affect
health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of
control construction is considerable when compared to the cost of the proposed work. ((I have provided
a stamped letter from a registered design professional in support of this request.))Thank you for your
consideration.
Respectfully,
Y "
Adam Quenneville
Adam Quenneville Roofing&Siding Inc.
160 Old Lyman Rd.
South Hadley, MA 01075
CT HIC#-575920 V MA HIC#- 120982 V MA CSL -070626 V RI Reg.#- 36301