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
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.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