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32A-207 (2) r QVENNEVILLE ROOFING Mr SIDING W WINDOWS 160 Old Lyman Road•South Hadley,MA 01075 1.800.NEW ROOF 413.536.5955 Email:info 0 1 800newroof.not Website:www.1800newroof.net Winner of the MA Construction Supervisors Lic.#070626 MA Registration#120982 8010 Member of the Home BwldePs Association of Wsstem Mass. CT Registration#575920 TORCH AWARD Member of the BuNdkp d Trade Assodadw Proposal Submitted To: Date Phone#'s C: Eileen Reed 7/23/14 H:413-584-1451 W: Street Email: 30 Butler Place creed@propertymanage.com City,State,Zip Code Job Name/Location: Northampton MA 01050 Proposal to furnish and install the following Get all Permits necessary. remove old roof on the upper right back side as you look at it for the street. Match to old shingles Barkwood is the color 50 year GAF HD Ask us about affordable bank financing We propose hereby to furnish rmteriaw aril labor-complete In accordamm with above specMkations for the sum of Total Due($ 6,4 0 0 ) ACCEPTANCE OF PROPOSAL: The above Prices,specificatlons and condMlotn arc Down Payment($ 2,10 0 ) satisfactory and are hereby sotapted.You am authorl»d to do work as N$P=W :d. 4, 300 Payment will be 1/3 darn at start of rob,and balafrce due co nplslion. Bahux*Due Upon Completion($ ) Date: Signature: Date:7/18/14 Estimator.(Print Name) Dustin Peters (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 possiblitty of roofing debris or dust coming In through cracks of the wood.Adam Ouenneville Roofing will not be responsible for debris or dust In the attic or storage areas. The Comaw*vaUk ojMasracbtkacMj - Deparoadw of lwdusoial Accidents Office of Lrves4rsfions 6" wilkingsaw S,tywi Basion, MA 02111 ",w.mass.poWdia Workers' Compensation insurance Affidavit: Banrikiers/Cont"ctur-s✓Flectric ans/Plumbe" ApWkaAt [reformation -- _ _._._._ -.- Pkase Print Le b!y �fl>[2Y(liu�a�„'Ck�C>u#pAy(�t��,hyl).- -Adam (�uenneviUe ftoohny 8 Siainy Inc Address I b 0 CIf,I l CIIY 1aG10C1Z.tp. 5uuin t4iJiey Y�ir1 01015 �7ty�xyC --"� A�-yon Mn emplsyer?Cl.eck the appropriate bo:: I Type at project(rcgairrd) 10 1 am a empioycx watb 15 4. ❑ 1 am a geoasl conaraca« and 1 I � 6 New construcum employ""(fall aodJar Pat-isms).• have blood Wt wb coriRracnors ❑ 1 am a role praor of pa weu. lasted oa be Attached sheet. 1 L]pnet R�axadetln6 ship and bave no employcet That xub-cooersctars have R. ❑ Lkmow"' noshing for me M soy capaary employees sod have wvrlrrr s ; 9 E3tul adcLacxr (No wortus'comp, mstssncc comp. �-1 �6 regoue�d 5. ❑ We arc a corporsum and is IO.L ] E7cetncal relaans a addsaona 3 ❑ I am a hioAaeowoer dcaag all wart ol'fkws have exercised their 1 1 L Plnmbeag repurx or addsUacv. wywdf. (No worths'comp rtght of exampkoa Pe MOL I Rnolrela+xx msnrance regwred. c. 152, f 1(4)� :mod we bave no employees.(No wod°en'' 13 ❑Other camp. i LuKaoce.regtrred.) 'A.y•sVKw Aut checks bee w I ran sl,o sit ow da mKom ba*aw rawtal*a*wurten'compass MeaawWwmw who udmM AW 05AMvt iaAKafts Amy an*a"i an*aa MW am taaa oasaaVAs caasscmn smote aiI A a rw sdldara Indicecaod coca -Ceww aws Cho Chad&#I tws eon arradnl s 466 aural rlaw show*%seam aaire of Aaa sab-oam nn rl mne W%V6 r of est Awe WAft*%trrrz .wplcrten [low swb-caat wn%nv ampbyeaa,dwy aasw porW dwk waa'tien'camW.p lky asss'i . Idol an ensplryvr rhat is prwvldlv WeAtrs'Compawraliow ltassrramed for Rey ffmplwywrs. 11 WOW 1s th.pe llcy'"djob sir, iwt forwrasivft Iasurmee Company Name, AIM Mulutil Insurances Potrcy M cx Self-aoi_ L.rc s AW(..40010)28612014A 1 ac{xtatwa L)ak. "'29i 15 Iota Sale Address:__-__ � . - Gt .� ( C . U 'knack a copy el the workers`cwaapaasades peulltt jociarsdom per(a *Win$ the Policy dmmsbar sad ezpa-at date). F adore to mcum coverage as required under Soetive 25A of MGL c 132 can Seed to the imposition of critumal pca&Jtws of s fine up to S1,500.00 and/or oat-year rrapnroomeat, as won as civil peoaities w me fiorm of a STOP WORK ORDER and s fine of up to$250.00 s day agsswt the violator. Be advised tact a copy of this stataxnecd may be forwarded to the Office of Invesagataoas of dw DU fow wa amce coverage veri6cstxoo. I do heroby•cerfo,unde^r�rk,.#pains �and pwn&&n of per,fury Mat the 1q fbrmatti wn prrrllW sbavo is true and correct StsQtn c._ .___tom'._ -- � -1)JI9114 �-d_ 41J-536-5955 00"]n.0 en(Y. De not wrrira in tits,ern, to N coaiap o d by dbr or town * lcial city or urns: Perxale/l�keese a lssal al Aatb*rity(circk oar): 1. Board of Healtik 2. BallA ing pepartotwt 1. Ciq/Iwwa C1er k 4. Heclrkal [nspoctor 5. rtambing lnsperfor b.Other Caamet rersoa: rlsoae X: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Adam Quenneville CS-070626 License Number 160 Old Lyman Rd South Hadley MA 01075 8/21/2015 Address Expiration Date 413-536-5955 Signa fure Telephone 9.Registered Home Imorovement Contractor: Not Applicable ❑ Adam Quenneville Roofing 120982 Company Name Registration Number 160 Old Lyman Rd South Hadley MA 01075 3/25/2016 Address Expiration Date Telephone 413-536-5955 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....... 6 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 Q Or Doors D Accessory Bldg. ❑✓ Demolition ❑ New Signs [O] Decks [p Siding[p] er[[3] Brief Description of Proposed Work: Strip sectionon upper back roof and install new asphalt shingle system 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 X 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 Eileen Reed I, , as Owner of the subject property Adam Quenneville hereby authorize to act on my behalf, in II matters relative to work authorized by this building permit application. Signature of Owner Date Adam Quenneville 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. Adam Quenneville Print Name %:,- -I)'�kIIw Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size u Frontage ........... .........,.. m Setbacks Front _ e Side L: i R. . .. L........ R:a . e Rear _ Building Height Bldg. Square Footage Open Space Footage % --- (Lot area minus bldg&paved _ arkin #of Parking Spaces �— Fill: . - volume&Location a_._._................. ............ _. _ q A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW @ YES IF YES, date issued:-, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book f E Page ' and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO (2) DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO G IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 _. IF YES, describe size, type and location: 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 NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department u e only, - � City of Northampton Status of Permlt; 1C`t; Building Department Curb Cut/priveway Permit 212 Main Street SewerlSptio Availability' Room 100 Water/Weil Auaitability � orthampton, MA 01060 T`iA6 Sett-of,Structural Plans phq.J04j -587-1240 Fax 413-587-1272 Plot Site Plans Electric, um Inc i Atha ;P . Other-spec I .--�- 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 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Eileen Reed 30 Butler Place Northampton MA 01060 Name(Print) Current Mailing Address: 413-584-1451 See Contract Telephone Signature 2.2 Authorized Agent: Adam Quenneville 160 Old Lyman Rd South Hadley MA 01075 Name(Print Current Mailing Address: 413-536-5955 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 6400.00 (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=0 +2+ 3+4+5) 6,400 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 30 BUTLER PL BP-2015-0129 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-207 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-2015-0129 Project# JS-2015-000228 Est. Cost: $6400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ADAM QUENNEVILLE 070626 Lot Size(sg. ft.): 12980.88 Owner: REED CHARLES A&EILEEN O TRUSTEES Zoning URC(100)/ Applicant. ADAM QUENNEVILLE AT: 30 BUTLER PL Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:713012014 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE UPPER REAR 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 Occupant Signature: FeeType: Date Paid: Amount: Building 7/30/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner