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17A-047 /\l D) PISA master � DISCOVER Q U E N N E V 1 L L E www.1800newroof.net ROOFING 'V 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 Horne Builder's Association of Western Mass. CT Registration #575920 Member of the Building & Trade Association P.P.C. 38710 Proposal Submitted To: Date Ptione #'s C: (9/ 5, . I FlEkfN Ala 0' -- 4- - - c /Z(_ H: P ,- -7 3 ) W: Street Email: I( - T3 .(W-k At M,OOPISt - hti ''�'}. e,,tij4/ F C City, State, Zip Code Special Requirements: (11.( (CIA1 t MA- 6 (C -- � - 7 , Z?- i 71.i}7C /j _/ CG' � LA` !- Z 2 e 6A41 e ❑ Recover .Strip .Layers 1 4 ' / - A" - "F Ac " --12-- ( „ ='G ( ,. . Complete Roof System )2 We shall acquire all appropriate permits for all work No i SQL " / Cvr-- 64 WM. t g, Home exterior and landscaping to be protected 191 Strip existing roofing to existing decking and dispose of. Do not Do. Deteriorated existing decking will be replaced at $3.47 per sq.ft. after full inspection. V , f% Install Ice & Water Barrier at all eaves, valleys, chimneys, pipes and is -- rr, ' FULL. CC - Install (151b. fe Synthetic) nderlayment over remaining decking area 1 r IA) . /?tV 2 -- le Install Metal drip ed ` eaves and rake (8” 5 ") white brown /copper) Install manufacturer's starter shingle on all eaves and rake edges BBB Install new • i • e boot flashing st nda pper) / vents .......T._ ___. fyllbstal . ow Country • r Cobra rolled vent ridge vent Winner of the 2010 ❑ Install proper • - it ventilation A.Z% TORCH AWARD Shingles: ( 6 nails per shingle) ` f '171 ' ` ..1- -fr Shingles ❑ 25 year ar [l] 50 year Color F� C� JLL& i c `4( ?C Ridge cap shingles 1 r - f 4 - - C=' t wf Warranty Options: ❑ We guarantee our workmanship for 10 full years (see our warranty coverage) 17 GAF System Plus warranty ❑ GAF Golden Pledge warranty Chimney Options: ead Counter Flashing ❑ Water Seal & Tuckpoint ❑ Rubberized Crown ❑ Metal Chimney Cap We propose hereby to fumish materials and labor - complete in accordance with above specifications for the sum of: Total Due ($ 1 - 7 (F? Li ) ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Down Payment ($ Li 2_S S --- ) 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 u n completion. Balance Due Upon Completion ($ `� Y/ ) Date : /`f 1 Signature. • • , � - ° ~ --�' • " r • Date: j l0 /7 - Estimat r: Print Name) ��. ( ) i L�'� (S ign Name) ti.- Estimate ar 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 oflidassachusear Department of Industrial Accidents 1 c, , ,-_ O ffice of Investigations b �l�'= 600 Washington Street . `• t ° `' Boston, MA 02111 ' : .U� wwn mass.govldia Workers' Compensation Insurance Affidavit Builders/ CoafarartforslElecfriciaus /PIumbers Applicant Information PIease Print Legibly Name (B : A del Wl atm m...)! : 1 44 An t Si j el L -�- vie, • Address: I Le O ( 2 J tij M A P1 4/ cityistairiLIp: 5aM4 kh /A /AA oio 6phnne #:_ f l 3 _ C V -515 Are you an emploryer? Check the appro to boX Type of project (required): I. rg I am a employer veith (5-7 4. Q I rut a general contraebr and I 6_ ❑ New construction employees (bull and/or part-time).* have hired the S coatracnors listed on the attached shed 7. Q Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g- Q Dcmolibon working fix me in any capacity. employees and have workers' 9_ [1 Building addition [No workers' comp_ insurance- t ker required-) 5. 0 We are a amporation and its 10.0 Electrical rtes or additions officers have =excised their 3. Q I am a homeowner doing all works 1 I- Phrmbing repairs or additions myscLt No wows' comp. right of exemption par Mg. insurance l'med-J 1 c. 152, §1(4), and we have no 12 Roof repairs employees [No weaken' 13.0 Other _ gyp- -] Any applicant that checks boot ii 1 mast also Sl1 out the section below showing their workers' compensation policy information_ t Homeowners who submit this affidavit i addieaing they arc doing all work and tarn bite outside co*traeo Cie mast submit a new affidavit indicating such. rcontractors that check this bat mast attached an addi0onal sheet showing dm rime of the w and ate what= or nor those ratites have employees. If the sub.contractehs have employees. they most provide their wed era' comp, policy number. I am an employer that isprvvidurg workers' compensation insurancefor my unployeex Below is the policy =JIM, site inforroonO n. Insurance Company Name: AIM m m toad - In Su ra n e...L Polic # or Self-ins. Lis #: ft we, 17 t 1 l k ( 101 Expiration Dom: i l l - N9 6 13 Job Site Address: ♦ ! l j t _ lal- ' 1 � ( `D--- V I C.Q- � iylSiEtle/7 -rP: rm.- 0 10 ‘, 9-- Attach a copy of the workers' , -, -- time policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 2SA of MGL c.. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be ibrwardcd to the Offer of Investigations of the DIA for insurance coverage verification_ I do hereby comfy under the parrs undpenafies ofperjury that the information provided above is true and correct sjgnatlue: : 6 q --) ; Phone #: `I 1 3 6 -6 S - Official use only- Do not rusk zn ikis ram, to be wmplded bP ty c or toms ofe hrf City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2 - Building Department 1 City/Town Clerk 4.. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : a (4 i l (.4.,2 6'1 VI.P L/ I � 7" e License Number Pilo MC - ,c2rt ozl. )I d U I Lk0! 1S e -a t- ao Address Expiration Date � ��lit% Sign , Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Adam Qnennevile Roofing& Siding, Inc. /d-o Company Name 160 Old Lyman Road Registration Number South Badly NIA 01075 3 -- a s- �a 1 44 Address Expiration Date Telephone if /3 5 -5 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) 1 1 Roofing Eg Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[D Siding [0] Other [CA Brief Description of Proposed 511AP . X I t`16,5 3 6"....,:r` rS ° 'Ii-' 145 l ° S 6r1"`-.1) d t i- 5 f a ) 0A- -L ( : -- q Q,t.4 Work: ± Olt Lf ,(.t pit t1 0-?/uhf f1 1-n 54a_ t I )u,c �r G� - (f 4- ' 5y S ,Qyx. , Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. 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 stones? 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 I, ,�'f' u_ -e (-en 1 rn r as Owner of the subject property hereby authorize Adam Qnenneville Roofing & Siding, Inc, to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Adam Qaenneviae Roofing & Siding, InG 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. f cltL t-yi 4 / Le V f /tie Print Name Signs /Agent Date Department use only R E C r 4VE D C' of Northampton Status of Permit Bu ding Department Curb Cut/Driveway Permit 1 4 a! 12 Main Street Sewer /Septic Availability Room 100 Water/Well Availability ► • rt mpton, MA 01060 Two Sets of Structural Plans DEPT. OF BUILDIAMTos3 -5 -1240 Fax 413 - 587 -1272 Plot/Site Plans NORTHAMPT 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 Map Lot Unit F (01( 1,1 Ce M O 1 Q 6 �` �] Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: aiza v FI-e en ri ( n\ F[ar -nc Name (Print) Current Maili d h t O / r, )-0 -4-g_ Telephone Signature 2.2 Authorized Agent: f J t� �' C Acid. v n n i War) tl i i L C Ca o t) /ct bi rncult 2. • JD. Name (Print) Current Mailing Add s: t i(?) - S36 Sign Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /I / � ri 6 (a) Building Permit Fee 2. Electrical r 0 c o l! r . 0 (b) Estimated Total Cost of Construction from (6) 3. Plumbing Budding Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 1 61, r 1 tC 6.0 0 Check Number (Y This Section For Official Use Only r � Permit Number. Date Building Issued: Signature: Building Commissioner /Inspector of Buildings Date ap 168 BRIDGE RD B P- 2012 -0993 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 047 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 -0993 Project # JS- 2012- 001717 Est. Cost: $12766.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 11107.80 Owner: FLEGENHEIMER JEAN Zoning: RI(100)/URA(100)/ Applicant: ADAM QUENNEVILLE AT: 168 BRIDGE RD Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536 -5955 0 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:5/14/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE HOUSE & GARAGE 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 5/14/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner