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17A-113 (2)
LiiA Aft W CA'Mt � i QUENNEVILLE www.t800newroof.net ROOFING 3' SIDING Y WINDOWS We Are licensed 160 Ofd Lyman Road•South Hadley,MA 01075 Fully hatred ROOF • 413.536.5955 Email;Wog 1800neammol.net Website:wwW.1800ne1vrool.net Factory Trained MA Construction Supervisors U.1070825 MA Registration 9120982 Factory Certified Installers Member a the name Srpder'sMsoatstaa of Western Ness CT Registration#576920 Member or the ewlrexe a rradoAssoblatbn PAC,38710 I Proposal SubmUted To: Dale Pbane I's C: KO P/ t#Crfc -i s 01,43 [f: sir —y� Pee.?IO Street Email: (City,State.Zip Code r Special Requtremenls; od Alpo 06147--- lid Recover 0 Strip 0 Layers Complete.Root System > We shall acquire all appropriate permits far all(Nock 18:1 Home exterior and landscaping to be Protected ecking and dispose of. Do not De - . •- •= -• . ad at$3.47 per sq.ft.alter full Inspection. alt eaves,valleys,chimneys,pipes and skylights a mIt81tiblb"-TertSynihetic)underlaymenl over remaining decking area Instatt Metal drip edge at eaves and rakes(IrCiwhileibrownICOPPed E r shingle on all eaves and rake edges BBB Wr Install new pipe boot flashi .44Z• copper)/vents er install Snow Country• Cobra r•led vent ridge vent Winner or the 2010 ToseR AWARD Shingles: (8 nails per shingle) �� Shingles 0 25 year 0 30 year 0 50 year Color_ F Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 lull years(See our warranty coverage) (? GAF System Plus warranty 0 GAF Golden Pledge warranty Chimney Options; M Lead Counter Flashing 0 Water Seal&Tuckpoint 0 Rubberized Crown 0 Motel Chiingey Cap we propose loamy to famish meredafa aro tabor-cwmplare it accordance with shove mocanaU5 sa br ire sum or Total We($ ,) ACCEPTANCE OF PROPOSAL;The above paw,epacIEcations and candlllons ere eantrae1ory end are hereby accepted.Thu are authorised to da wait as Waled. y '� wvn p � � ) Payment yll0 be in doein al aerial lob,and 1 due upon e*Mplt tiara. (Balance Due` Completion(S Dale: /1 ! StgnatUre: �t . _ .de .►.+r►� lar�.r. Oats: °iiai�'`4i' Estimator:(Print flame) (344-06-- .5-1449/3e-le.--tag" n Name) Eelimatea are honored for sixty(60)days from above date ' ATTENTION HOMEOWNERS:Monte cover all personal belongings In the onto,garage ore mega areas due to the possibility 01 rooting debits or duet coming In through cracks of the wood.Adam Qvennevllle Roofing will not be responsible ter debris or dust In the stile or storage areae. The Commonwealth of Massachusetts --- Department of Industrial Accidents a,=At=.:t Office of Investigations . = 1 Congress Street, Suite 100 ':fi _ Boston,MA 02114-2017 "'•�.t www mas&govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Adam Quenneville Roofing&Siding,Inc, Address: /100 Old limQn T.Cx_GQ. City/State/Zip: 01075 Phone#: 3"5360-09.55 Are you an employer?Check the appApriate box: Type of project(required): 1.IS I am a employer with 1 c 4. 0 I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. C1 Demolition working for me in any aci employees and have workers' g Y ty 9. 0 Building addition [No workers' comp. insurance comp.insurance.: 10.0 Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.cig.Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] _ Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy intbrmation. t Homeowners who submit this affidavit indicating they are doing all wrec and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. .7 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A 2" I1\ 111 _ tl & soraneslr- Policy#or Self-ins. Lic. #41\14)C.4007o1aApt ape)A Expiration Date: Li —a2.9'��I L/ Job Site Address: '"f CQ .L lY•Q.. Aii'e Yu-0— City/State/Zip: 61pA t t f JI D(O4 a Attach a copy of the workers' compensation policy dedaration page(showing the policy number and expiration date). Failure to secure coverage as required 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. Be 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: �/ / �— ' Date: 9I5IL3 Phone#: L 1 3-53 - G9 c c Ofcial 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#: Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780..CMR.11011} _ Independent Structural Engineering Structural Peer Review Required • Yes 0 No SECTION 11 OWNER.AUTHOR IZATION-TO;BED COMPLETED WHEN : -- OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING:,PERMIT I, , � _ _ _ as Owner of the subject property p� n hereby authorize ___.____Adam Quennevllle Roofing Oi,Sldlu �Illt..__._� W _.. ._._. _...__.__ .._...__ .___.__�... .._ __.. .__ iao act on my behalf,in,alll-matters relative to work authorized by this building permit application. Signature of Owner Date _- Adam Q( u nn " ,,� ----'-'' -- --- I, _ Adam _� _�C !I� 1U111 ea..._._ ____ ---_.._.��____.__--__r-_.__.._... ,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 perjure._ .._ _,_,__. _ ,_____.T�________.__._,.,_..:_...._,___.___..,____ ___. Prim. ..&-_e_in. w, �_-_-__. _.___. __ �__ __ -.__ ___._ _T me .__.,._._._,_.._...__._._._._ ...___..__; :Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES - 10.1 Licensed Construction Supervisor: Not Applicable ❑ dxm Queanevil a ltoiN &Sidug ci -� - _ __ Name of License Holder:._ . _ ., ,...._a._ ___._.I___..__,._, , _._.. ... /(� ��p��t License Number ,_..._._u.._..IUI. �_____ --�_— - Lice 7©Coa6 Address Expiration Date / ----- -i-113-53 E1 S-5- � pot 1 IC 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 0 No C Version 1.7 Commercial Building Permit May 15,2001) , SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION:SERVICES-FOR BUILDINGS-AND . STRUCTURES S TO CONSTRUCTION CONTROLPURSUANITtO 780 CMR:116(CONTAINING: MORE THAN-35,000 C.F.OF-EWLOSED$PACE) 9.1 Registered Architect: -- ---- -- ` 0 __— | . -• Name --- - Number ` - _� — _ Address _____� � ___ -------'--- • Expiration Date __ __„: Signature Telephone 9.2 Registered Professional Engineer(s): _____-_____-___ . -_-__� � � ________ __` __ ______ _____________ __ � _ __ ___ ______ ____.______ __ ___________ __. Area of Name . --- _ • . Address ____�________' Registration '`,-- - - ,___ , ___ ___.„_________ Signature Telephone Expiration Date -______ -- � � ' — , __-_____- ----- Area Name _______�____ - __'___--__--__-- � �-__________-__' _ __- __ �_____ _________ ___ Address Registration'~^' -------, . • i ____ Signature Telephone Expiration Date -- ________-__ . - . . — ______^ Name amoo/RwponomN� _- _-__' , '---_---_- � � __ _________�____�______ ____________-___ ' t _ - _______ Address Registration _ ______ _____-_ ! _ _ -__ Signature Telephone Expiration Date ,------------'--------�-----'------------------------------� F------�--'------�-----------' • x ' ____ ____ ' _'-______----__---_-__-__-_-_-__--_-_-'-____�_-_-_____--_�� Name _ *ma'�Rnupvmnumny ___�____________ ^ -. -__--_ ______-____ ' __ __ _--- i _ __._� Address � ` gistr���� ''~~ ___ _______ •____ Signature Telephone Expiration Date _ - 9.3 General Contractor ' ---- ------------ --------' -- ' i -- : Not App|�eb|oLJ Responsible In Charge of Constkalla Hadkomor ����� ��� ' -'--------------------------'--- -------JA......_-8�kmu�_ Signature Telephone - | Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTONZONING .. . Existing Proposed Required by Zoning , . This column th ri.filled in by Building Department Lot Size Frontage Setbacks Front . ---, --- Side L:°-----.: R:.—__i LL___' R:'.. _1 ':--- , Rear Building Height 7.,..„_..., 7----- , ; ---- Bldg. Square Footage _____ . Open Space Footage % . . _ (Lot area minus bldg&paved parking) i-----i #of Parking Spaces L. . Fill: (volume&Location) =--------- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book . Page: = and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (3 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: , C. Do any signs exist on the property? YES 0 NO 1,41 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 -,.......-4.:.:,.. .L..: ...-....; ._ IF YES, describe size, type and location: • 1 , ,,: 110.; • ', 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 0 NO a .. _. IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1-7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 , CUBIC FEET OF ENCLOSED SPACE- .' ...... Interior Alterations ❑ Existing Wall Signs ❑ Demolition 0 Repairs❑ Additions ❑ Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign 0 New Signs❑ Roofing l - Change of Use❑ Other❑�� Brief Description =Enter a brief description here. ptyYc-r goo•-%- w` n.IZw ASPl1/4a--tt 14- w • Of Proposed Work:: . SECTION 5-USE GROUP AND CONSTRUCTION TYPE'' USE GROUP(Check as applicable) CONSTRUCTION TYPE _ A Assembly A-1 ❑ A-2 CI A-3 El 1A I ❑❑ A-4 ❑ A-5 ❑ B Business ❑ 2A i ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ - __ __ 3A 1 ❑ I Institutional ❑ I-1 ❑ 1-2 0 1-3 ❑ 38 ❑ M Mercantile ❑ 4 0 R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ I 5A ❑ S Storage ❑ s-1 ❑ S-2 ❑ 1 56 I ❑ U Utility ❑ Specify: _..._...,._._.�..._,�...._.w..,__...._.___,.._........._.._�.._._..____.__.. M Mixed Use ❑ Specify:" ""-""•` S Special Use ❑ Specify: ._ _-.._. ________.,...___..___._._ _ _r .___--_........-..___ .v_._.._..._._.._... COMPLETETHIS SECTION IF EXISTING`-BUILDIN„GUNI ERGOING-RENOVATIONS,ADDITIONS AND/ORCHANGE"IN USE Existing Use Group: ,___._.._ �._,.____.._..._._. • Proposed Use Group: '.___ .._ w..._.__......._.,__.._.._._._._._. 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 Floor Area per Floor(sf) _ 1st s - __.w. _ -_,. ..,_-.._.- .R. • - .__._._...__.-_._.._...._ 2nd , 2nci ._- --__---._.._ __e - -_.__.._ _ ___..__. 4 . .._ 41h _ __ .._.T - 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_lnformation: 7.3 Sewage Disposal System: Public ❑ Private❑ Zone __...__._.„ Outside Flood Zone Municipal ❑ On site disposal system[] ---002111111101A Version1.7 Commercial Buildin! Permit May 15,2000 I _ Departmeht use only City of Northampton Status of Permit: oion \ :wilding Department Cutb-Cut/Dnveway Permit, - - SC? 212 Main Street SeweilSeptic-AVailability ‘ospections Room 100 WateiftWell Availability " • . , hampton, MA 01060 Two Sits otStnicturai Plans t • plunittng t°f,aso-1060 Oec tlorttlam. p one 413-587-1240 Fax 413-587-1272 Plot/Site,Plans OtherSpecify, 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 Cka-Cre_ If-k-tte Map Lot Unit Zone Overlay District Cu Lt4 Erni st.District CS District SECTION 2-PROPERTY OVVNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: TII _i_air...ci6,4fiat+ts„Itil-_ Name(Print) Current Mailing Address: 1173-"-17g- 41/0 * — Signature „ u Telephone 2.2 Authorized Agent: -4--(hfiThLtileAllatil.I tkatklif5 hoo olc p Name(Print) Current Mailins AddIss:_ _ IS * Signature Telephone SECTION -ESTIMATED CONSTRUCTION COSTS item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (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) 6 WO O') Check Number 09 90 34, 166— This Section For Official Use Only• Building Permit Number Date. Issued Signature: Building Commissioner/Inspector of Buildings Date 4 CLAIRE AVE BP-2014-0295 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 113 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-2014-0295 Project# JS-2014-000492 Est.Cost: $6000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sq. ft.): 10193.04 Owner: HUTCHINS KATHLEEN A Zoning: RI(100)/URA(100)/WSP(7)/ Applicant: ADAM QUENNEVILLE AT: 4 CLAIRE AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 () Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:9/10/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:ST RI P & 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 9/10/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner