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Card DISCOVER
Q U E N N E V I L L E www.1800newroof.net
ROOFING 'V SIDING ■ WINDOWS We Are Licensed
160 Old Lyman Road • South Hadley, MA 01075 Fully Insured
1.800.NEW ROOF • 413.536.5955 y
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:(4 C3�
Ace , 1���r�4 .Te 3l/7fi.) H:&t35) Sfs"G - W:
Street Email:
Cit State, Zip Code Special Requirements:
fly ;e w e
rJ I,
C: (a X (+t C tu.Ll f:^ F• IFOL.e G A.
f J Recover EX, Strip f Layers ' 6 ,..,. t -Pc P ,
Complete Roof System ° /� S " "'
• We shall acquire all appropriate permits for all work
X1 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 $3.47 per sq.ft. after full inspection.
• Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and skylights
Install (151b. felt / nthee� underlayment over remaining decking area
Install Metal drip edge at eaves and rakes cio 5 ") whit brown /copper)
Install manufacturer's starter shingle on all eaves and rake edges BBB
• Install new pipe boot flashing (standar copper) / vents �—
?s1 Instal(Snow County )or Cobra rolled vent ridge vent Winner of the
2010
❑ Install proper soffit ventilation TORCH AWARD
Shingles: ( 6 nails per shingle)
F Shingles ❑ 25 year [ 30 year ❑ 50 year Color _ ��'f'' -� 6 n«/
4 1 - Ridge cap shingles
Warranty Options:
IA We guarantee our workmanship for 10 full years (see our warranty coverage)
M GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
lt] Lead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ /Q c/ E )
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ a $6
satisfactory and are hereby accepted. You are a d to,do work :s specified.
Payment will be 1/3 down at start of job, and balance • e • T'compl on. Balance Due Upon Completion ($ /G, < l 3 C )
Date: . 3 14Z- Signature:
Date: 3// 14 Estimator: (Print N 4..4 7 1.7 (,�, T t,. (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.
ZZil D p/it\LJ V \ ^"" MaSterp iltwa DISCO/ER
QUENNEVILLE
ROOFING V SIDING ■ WINDOWS 6
160 Old Lyman Road • South Hadley, MA 01075 BBB
1.800.NEW ROOF • 413.536.5955
Email: info @ 1800newroof.net Website: www.1800newroof.net Winner of the
MA Construction Supervisors Lic. #070626 MA Registration #120982
TORCH H AWARD
Member of the Home Builder's Association of Western Mass. CT Registration #575920
Member of the Building & Trade Association
Proposal Submitted To: Date Phone #'s C ,3 6G 5 = S
p
1", 1N`�t'�en f ,nnitct � /fi1*ns 3f Nr/ � H a i58
6 3 W:
Street Email:
City, State, Zip "Code Job Name /Location:
la, elf 414 e * , C .t
Proposal to furnish and install the following
1
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V I l . � 51, /�l✓ C.l r �a4r i ' 50- 43s . -1/ex r %i�'✓ i
Ask us about
affordable bank
financing
We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ , / ,j„l ,,,,`4,,-
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($
satisfactory and are hereby accepted. Y u are authorized to do work as specified.
Payment will be 1/3 down at start of j , a dbalan ue up completion. Balance Due Upon Completion ($
Date: )/ //i Signature: e
Date: 311 7 / 1 'Z Estimator: ( rint Name) c ( • : {rte , (Sign Name) 1 1` ,C�,.,-
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
I'1 i f " O e of InveS1TgafiortS
t +-- % �1g 600 Washington Street
W :�' Boston, MA 02111
:,.a
,� www- mass:gov/lfra
Workers' Compensation Insurance Affidavit Buiders /CoatractorslElecfiricians /Plumbers
ApplirRnt Information PIease Print Legibly
Name ( B ' : A di. vik O l t i nj i f L k44110.)-1-- t S U nl , j_.0 e, •
Address: /L O1c k -y{/Ytan 1d .
6
city/stater-L.41 kfra. tt 114 A- OIb7SPhone #: 13 6 56 - 6i C S
Are you an employer? Check the appropr bow Type of project (required):
I .V1 I am a employer with i 4" C1 I am a general contractor and I 6. D Neon construction
=ploy= (full. and/or part-time).*
have hired die sub -contractors
listed on t e aria
2. El I am a sole proprietor or par tnr r s =hid sheet 7- ❑ Remwdcliug
ship and have no employees Thrice sub-contractors have g_ ❑ Demolition
working for me in any capacity. employees and have workers'
(No workers' camp_ srsurrancc camp_ insurance; 9. ❑ addition
S. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their
3. ❑ I am ahomemmet doing all work 11_Q Plumbing repairs or additions
myself [No workers' right of per MOM
insurance (N �I t comp..
a. 152, §1(4), and we have no 13_0 Otitis
employees [No workers'
camp- izsurance required]
' Al))' applicant that checks box NI most also fill out the section below showing their workers c w:notion policy information_
t Homeowners who submit this affidavit int ing they arc doing el work and dreg hire Deride contractors mint submit anew affidavit indieamag such
= Contndars the cheek this bmc most eft shed ® additessal sheet skewing the mime of tha sorb- eamta'adoe and state whether or nor those entities Layo
employe:. lithe sub-contactors hart employees, they mast pawide their worimrs' comp. policy member.
I earn an employer thus itpnvvidnrg workers' compensation insarurrce for my employees. Below is the policy cord job site
inforriraann.
Insurance Company Name_ R T M m u 1 1 n 5u rt l n a l_
Policy !tor Self -its Lic- #: it 1V C r b 1 2k 6 ID I E Pate: q- g R' a 61 r),.
Job Site Adams: ys L 6 .51, ,� t!tic e_ C tyistate Zip: /1/4 G!0 (G d
AIM a copy of the workers' compensation /d
ta tion policy declaration page (showing the policy number and expiration date)_
Failure to secure coverage zst required under Section 25A of idGL c_ 152 cm lead to the imposition of cziminal penalties of a
one up to S1,500.09 and/or one -year imprisomant, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator.. Be advised that a copy of this sta mi ant may be forwarded to the Office of
Investigations of the DIA for insurance coverage veifitxtion.
I do hereby tort fy under the pains aarfpenabler ofperj that the information provided above is true and correct
Signature: ; Z Dom ` 3-Q3---1
Phone #: q l 3 i t6 -'9 SS
Official use only_ Do not srritt in ibis nv to be com,/eted $y city or toms °1 reini
City or Town: PermitiLicense #
Issuing Authority (circle one):
L Board of Health 2.. Building Department 3. City/Town Clerk 4. Electrical Inspector- 5- Pit:mbing Inspector
6. Other
Contact Person: Phone {l
r =
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: /( Not Applicable ❑
f
Name of License Holder : 1 k')1 f,(� G 1 VL (1; tCe 70 G ? c
License Number
&O rn A ( * 30V-M Eitd I -ymoois
Address
Expiration Date
Lfl �'S3� -S�Ss
Signs" Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Adam Qnenneville Roofing& Siding, Inc, ic)-61 ie
Company Name 160 Old Lyman Road Registration Number
I 3 - - as- ae
Address Expiration Date
l Telephone tf / 3- 5.y,,-S
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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 0
Accessory Bldg. El Demolition El New Signs [0] Decks fp Siding [D] Other [d)
Brief Description of Proposed [�
Work: 5+C ► 4/2 0/ y
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 X 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? 1/ 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
I, !Aid r &lo o 'r / d) , as Owner of the subject
property
hereby authorize Alf I 1 None* 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 Quenneville 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.
»C+1L14/L (U- P t7r1,eV /Le
Print Name
Signatu er /Agent Date
Department use only
\11'; C ity of Northampton Status of Permit
O` � Building Department Curb Cut/Driveway Permit
vo Z 1' 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
ov ' orthampton, MA 01060 Two Sets of Structural Plans
10 1.0!'‘ ) • o ne 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 Property Address: This section to be completed by office
175- Lilly $ , Map Lot Unit
//e/1.r4 / A 6106, Zone Overlay District
Elm at District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Reco��rd: r ) J � /r
GVe� Pre, 6'Vc(1 �/) !J /d! � / s /-4.) (en tv l°
Name (Print) Current Mailing dd ress:
L/13— c — g� - - 7 /73
Telephone
Signature
2.2 Authorized Agent: tt / �n 1
AA vn Ojai vttz tt i i t-e ((D D Oict Lc- may. !4c . rJ" D. H.sit , - /Rek
Name (Print) Current Mailing Address:
tire C36 - 5/S 5
Signahxd Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building f (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= (1 +2 +3 +4 +5) /0 5'3 , Check Number ep,_q5-if b 035-- This Section For Official Use Only
Building Permit Number.
Date
g Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
45 LILLY ST BP-2012-0830
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 270 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-2012-0830
Project # JS- 2012 - 001469
Est. Cost: $10486.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 7753.68 Owner: WARTON WILFREDO & JENNIFER ADAMS
Zoning: URB(100)/ Applicant: ADAM QUENNEVILLE
AT: 45 LILLY ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 0 Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:3/27/2012 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 3/27/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner