17A-216 g
D 1 VISA rd t� f 4 DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING ■ 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 Phone #'s C:
I r" 641;e
Street Email:
qq
City, State, Zip Code Special Requirements:
c 4 " , G /06 I
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❑ Recover I4 Strip
/2„3tr( d� z k . tiff {, ELf
Complete Roof System 4„, ., �r e4-,c s
N We shall acquire all appropriate permits for all work .I
• Home exterior and landscaping to be protected
Strip existing roofing to existing decking and dispose of. Do not Do.
• Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection.
Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
• Install (151b. felt 4 over remaining decking area
Install Metal drip edge at eaves and rakes 63)/ 5 ") (whit brown /copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
L Install new pipe boot flashing Olandar copper) / vents
• Installow Country) r Cobra rolled vent ridge vent Winner of the
2010
Li Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle) /
Shingles L 1 25 year L 30 year ❑ 50 year Color _ _S 1�
Ridge cap shingles
Warranty Options:
g We guarantee our workmanship for 10 full years (see our warranty coverage)
• GAF System Plus warranty
GAF Golden Pledge warranty
Chimney Options:
Lead Counter Flashing [ Water Seal & Tuckpoint X Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ i 783 )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ 6 0 0 0
satisfactory and are hereby accepted. You are authorized to do work as specified. / --
Payment will be 1/3 down at start of job, and balance due upon completion. Balance Due Upon Completion ($ / 3 7 SS )
J
Date: (C>J/i Signature: (��� k fir'. � J �c t . <,
Date: '14 f Estimator: (Print Name) AL/ / 'T % GISign 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 Quenneville Roofing will not be
responsible for debris or dust in the attic or storage areas.
The Commonwealth of Massachusetts
Department of Industrial Accidents
it gr Office of Investigations
tifil 600 Washington Street . ;5�? Boston, MA 02111
T > : www.truiss..gov/dia
Workers' Compensation insurance Affidavit Builders /Contra_ctorslElectriciaus /Plumbers
Applicant Infox-matioxl / �. Please Print Legibly
Nae (Businnsrorganirafion/ Individual): A Cid vik Una ' tl , 1 � , 60 10 r i ''
m .1 1 C.`.
/ � y + /
Address: f (e 0 (� t, 0'1 ail] .
-- __ -
City /State/Zip: 5 Ill'
1 d
ad 4 o /U7Phone #: _ ' 5`I s
Are you an employer? Check the approp , to box.: Type of project (required):
1. V4 I am a employer with _ 1 6 4. C1 1 in a general contractor and I 6
employees (full and/or part-time).* have mired the sub contractors ❑New construction
2. El I arse a sole proprietor or partner- listed on the attached sheet 7_ ❑ Remodeling
ship and have no employers Theme sub -contractors have g_ ❑ Demolition
working for me in any capacity. employees and have workers' 9. Building
[No workers' comp_ insurance comp_ insurance l ❑ lding addition
�] 5_ [] We arc a corporation and its 10.111 Electrical repairs or additions
requir
3. ❑ 1 am a homeowner doing all wank officers have exercised their 11.[] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof
t c. 152, §1(4), and we have no
insurance required_] employees. [No workers' 13.❑ Other — —
comp. insurance wed-]
`Any applicant that cheeks box #1 rand also fill out the section blow showing their workers' compensation policy information_
t iiomcowne.rs who submit this affidavit indicating they act doing all worm and then hire outside contract= must submit it new affidavit indicating such_
:Contractors that check this box nmst atracbed an additional sheet showing the mane of the sub - contractors and state whether or not those entities have
employees. If the sub- contractors have corployees, they must provide !heir workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. ,below is the policy and job site
infnrmrwdiorz. r
Insurance Company Name: AIM ir ti "Id l tit _-1- t S /it. r it e-k-
Policy # or Self -ins. Lic. #: / E 1.0 C / 10 / eta cf' 6 /1) / Expiration Date: - 9q -) 6 r A
Job Site Address: r 7 ( t t l(( n o t - 4 1 U _ U_ City/State/7 inA- U to (p , -
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to sea= coverage as re=quired 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_ Bc 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 unnd the pains and penaftf of perjury that the informntic n provided above is true and correct
Signature:// , 'L.- __ Date: (z. - !7 - I 1
Phone ii: l i " 6 � te� � q�S
1—
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_ EIectrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
-- ___- Phone
'MO *OW Pe Ft f t AO' Or
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House E] Addition ❑ Replacement Windows Alteration(s) n Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding [D] Other [D]
Brief Description of Proposed
Work: 5 /` f (al_ `V)171 s
Alteration of existing bedroom Yes No Adding new bedroom Yes 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
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. floodptain 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
t, r- It Y1 r I �' r / `t'r , as Owner of the subject
property
hereby authorize ma Quota big & tiW% IK
to act on my behalf, in all matters relative to work authorized by this building permit application.
cOri Y ef' 4tieir i 6 - /5- /r
Signature of Owner Date
Adam Queue& Roofing & Sidisg, Inc. , 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.
Aida 1 -e i/; (p
Print Name
Signatu f f ner /Agent Date
'.
•
"34 '
4
•
gEGEN Department use only
City of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit
J 1120 \\ 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
s oitieltr iS ► • - ampton, MA 01060 Two Sets of Structural Plans
' ..-- • 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 Properly Address: This section to be completed by office
16(1" N o r= 1--A \ fl p r r-e-et Map Lot Unit
I" (U (.__ t 1 MA- 0 10' )- Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
1.1/--61 0 r Fi-en r - r :51/ North Ma pf -t-- Flor41 ee P1
, �--
Name (Print) Q Current Mailing Address: ,
I
,)-e -t- CLOq - , t G 1 /'l - / Q d:- lac( Telephone fl ( 2 g-q /7 - �U G
Signature t ( ) /
2.2 Authorized Agent:
Ado Quin* Roo* & Si d, Inc, (( l d L at ci 1 2-c t , Hid ( , a
Name (Print) Current Mailing Add s: ,
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building / iyl,7 b z o (a) Building Permit Fee
2. Electrical L y! (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) f '7 ) r] ec, ad Check Number c)! /5, 35-
This Section For Official Use Only
Building Permit Number: I sssuu
ed:
Signature:
Building Commissioner /Inspector of Buildings Date
r
154 NORTH MAPLE ST BP- 2011 -1070
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A - 216 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP- 2011 -1070
Project # JS- 2011- 001722
Est. Cost: $19785.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 19558.44 Owner: FRENIER ELEANOR B
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 154 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON :6/17/2011 0:00:00
TO PERFORM THE FOLLOWING WORK :STRIP & SHINGLE 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 6/17/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner