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30C-075 �I D DISCOVER Q U E N N E V I L L E www.1800newroof.net ROOFING ■ SIDING WINDOWS We Are Licensed 160 Old Lyman Road • South Hadley, MA 01075 1.800.NEW ROOF • 41 3.536.5955 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: q t3 (=AS 0'107 Sc H bu ) t k H: W: Street Email: 5 ,O B u r-rs PST R D City, State, Zip Code Special Requirements: noRTN0" M A o6 - ZINC STr � �IZa i Soli o=rs - ro. '-r 8 A clC €"' 7754 ovr'r' Z 6Atk Recover Strip 2_ i_Ayc2S GA.)I - K■N6 Zn) . ro•.' (Zooq o N 13r.c1c. born Ea oNL-Y Complete Roof System We shall acquire all appropriate permits for all work X Home exterior and landscaping to be protected Strip existing roofing to existing decking and dispose of. Do not Do. to\-o`c oos6 g Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. Fi Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights s ki Install (151b. felt / Synthetic) underlayment over remaining decking area Install Metal drip edge at eaves and rakes/ 5 ") (white /brown /copper) • Install manufacturer's starter shingle on all eaves and rake edges BBB x Install new pipe boot flashing (standard /copper) / vents _T yI Install Snow Country or Cobra rolled vent ridge vent Winner of the 2010 X Install proper soffit ventilation TORCH AWARD Shingles: ( 6 nails per shingle) �JQQ Shingles [ 25 year (11 f 30 year ❑ 50 year Color S.S rDN C' /!' Ridge cap shingles Warranty Options: [x] We guarantee our workmanship for 10 full years (see our warranty coverage) X GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: ❑ Lead Counter Flashing I t Water Seal & Tuckpoint ❑ Rubberized Crown [] Metal Chimney Cap We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 63 /0 ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are v15 1 1 4 Down Payment ($ 1 SO ) satisfactory and are hereby accepted. You are authorized to da� rk as specified. Payment will be 1/3 down at start of job, an balance due u. ` )'iTi'etion. Balance Due Upon Completion ($ 3s ) Date: / [ I ( I I Signature' Date:_ i ('1L, -` it Estimator: (Print Name) • Yt � -- 31 - (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 Quenneville Roofing will not be responsible for debris or dust in the attic or storage areas. The Commonwealth of Massachusetts _ Department of Inc ustriul Accidents 1 1k: = _' —�1 1, Office of Investigations c � i 600 Washington Street 7::;;-1-117:-;.'": Boston, MA 02111 WWW mass.gOY1di Workers' Compensation Insurance Affidavit Borders/ Confractors /ElectriciansfPlombers Applicant Information i fie n / Please read Legibly Name (B - : A06ttI Qi p nj'; !`ib/4in) t S et 03 j l Yt L' Address: Lv 01J 11 in a n 4 . City /State/Zip: 'f71 kfratitti 111 4- 016 Atone #: ( 3 - 6 —6153 6! S 3-- Are you an employer? Check the appropr box T of project ype (required): I.0 I an a employer with 167 4. ❑ I am a general contractor and I 6- ❑ New consa„rfio employees (full and/or part - time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner listed on the attached shear. y- ❑ Remodeling ship and have no employees . These sub - contractors have g_ 0 Demolition working for me in any capacity_ employees and have swam' 9_ ❑ Buikling addition No workers' comp- insurance P- t 5_ 0 We arc a corporalioaQ and its !(t ❑ Electrical repairs or additions officers have exaCiaed th 3_ ❑ I am a homeowner doing all work 11_ Plumbing repairs or additions self o workers' right of��per 1viG repairs ce �_] t - 1S2, §1(4), and we have no 131:1 Offer employ- [No mutters' camp_ insurance required_] 'Any applicant that checks bean i mad also bl1 out the section below showing their woriase compeaattian policy information_ t Homeowner who admit this affidavit mdiadog they am doing all work and then Etc outside contract= s mast submit anew airshavit mdiediag oak !Contractwa that cheek this bac mast attached an additional skeet showing the name of the sob - contractors and slam whether or not those entities have employees. If the svb-cor6al:tors have rsaployus, they most provide their workers' comp, policy amber. I ate an employer that isprnvirlinrg workers' compensation hzrurance for my employees; Below is the policy and job site 6#ornrafwsL Instuaacc Company Name_ R T M m U to Qd - i n Sly ra n e.L. Policy # or Self -ms. Lic. #: h C r l b 1 2i lot Eamon Date_ i't r a j- ao f a Job Site Address:VsU OAS e14 R - 11 d r,, ,,, °LQ � I " L / T c it 010 (p v . Attach a copy of t$c workers' compensation policy declaration page (showing the policy number and expiration date). Failure to sect= coverage as requkedunder Section 25A of MGL a. 152 can lead to the imposition of minimal penalties of a fine up to S1,500.00 and/or one -year meat; 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 ft rwarded to the Office of Investigations old= DIA for insurance coverage verification. I do hereby ceitijp under the pains and penalties of perjury that the informof:on provided above is true curd correct: Sijgnabue: ; ` Dal=: l ,-13^ 1 ( Phone #: 'i 1 5- S4 -4=i SS Official use only- Do not write in __ 'tea to ba coaryleted b9 city or towns ojf[ciat City or Town: - Permit/License # Issuing Authority (circle one): 1 - Board of Health 2_ Banding Department 3. City/Town Clerk 4.. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: (( Not Applicable ❑ Name of License Holder : �-t 1.14 O f. (L 6 i n-e (, l �-E' '7l2 a-C f License Number J (¢C) n /c t.�( VYl (R v pfiL . �'(tZf.1Y! 6V /.t d £ I - ) 7 141t O (a e - a f - do 1 3 Address Expiration Date �� z� Sign 9 Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Qnennevile Roofing& Siding, Inc, d-o pd- Company Name 160 Old Lyman Road Registration Number Address South Hadley MA 01075 Expiratio -- S 5- a o 1 Telephone o f / 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 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 [l Addition [J Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [0] Brief Des ' stipn of Propos d I • .S 6441 n -/- �u5 C( (1 s< 4 t /1-0-0-a144-`d— - f d Work: I I ' . l � Qt�1� Alteration of existing bedroom Yes No Adding new bedroom Yes No ( Q _ 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_ 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 S .' e k `i v1 , 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. Signature of Owner Date Adam Qaenneville Roofing & Siding, 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. /Cia -14/L 4j uJ c?1 , eV /te Print Name � l/A- r 3- l 1 Signatu erlA gtint ent Date Department use only Ei VED City of Northampton Status of Permit REC Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability �C y 5 20" Room 100 Water/Well Availability • rthampton, MA 01060 Two Sets of Structural Plans 41 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans oF �,� -� • uN, Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELUNG SECTION 1 - SITE INFORMATION 1.1 Property Address: ff This section to be completed by office cite) (1u. r S Pl -1 R ©OJ - Map Lot Unit F t o ire nu. / M b i 0 (.t a. Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: S `ems. 1-1A-v1 fe0 I G i2J . Fl orerto, rA- Name (Print) Current Mailing Address: H X 4 5 - 0707 (o &! Telephone Signature 2.2 Authorized Agent: Fiche vv 0U..e.n vtR- v i l r (a v i61c LL mart es. 50. t-16_414 1 7 titG� Name (Print) Current Mailing Address: 4fr?1- 536 —s /ss Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 6 0 (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 y� 6. Total = (1 + 2 + 3 + 4 + 5) 5 314..0 6 Check Number r2 d 7/6 I'�' J (� This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner /Inspector of Buildings Date 560 BURTS PIT RD BP- 2012 -0576 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30C - 075 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- 2012 -0576 Project # JS- 2012- 000981 Est. Cost: $5310.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 33279.84 Owner: DUNN JENNIFER L & SETH J Zoning: SR(100) //WSP Applicant: ADAM QUENNEVILLE AT: 560 BURTS PIT RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:12/15/2011 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 12/15/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner