36-133 (3) MR&AM VISA
Q V E N N E V I L L E www.1800newroof.net
ROOFING ♦ SIDING W WINDOWS We Are Licensed
160 Old Lyman Road•South Hadley, MA 01075 Fully Insured
1.800.NEW ROOF 413.536.5955
Facto Trained
Email:info@1800newroof.net Website:www.1800newroof.net Factory
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: y/ —js)-572,2✓
KEN N�71(+LvRF1�q y H:46-5 OF Y- 7576 W:
Street Email:
319 �P-00KsrO ccr2
City, State,Zip Code Special Requirements:
(?F,,n0Uf- SST Df F{ + po na7-
] Recover X Strip Layers f�JT fAC K-- r r..)
Complete Roof System
We shall acquire all appropriate permits for all work
Home exterior and landscaping to be protected
Clq Strip existing roofing to existing decking and dispose of. Do not Do. `G�B� o �`T '
Deteriorated existing decking will be replaced at$3.47 per sq.ft.after full inspection..'0
LRI Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights
L'C Install(151b.felt/ ynthetic nderlayment over remaining decking area
* Install Metal drip edge at eaves and rake 8" 5" (white rown/copper) \
* Install manufacturer's starter shingle on all eaves and rake edges B(1$$
LEI Install new pipe boot flashin standard opper)/vents _r
f Install Snow Country Cobra lied vent ridge vent Winner of the
2010
TORCH AWARD
�
'r► .
Shingles: ( 6 nails per shingle) j c(
Shingles ❑ 25 year ❑ 30 year ❑ 50 year ColorX h�UGW G
Ridge cap shingles
Warranty Options:
K We guarantee our workmanship for 10 full years(see our warranty coverage)
❑ GAF System Plus warranty
❑ GAF Golden Pledge warranty
Chimney Options:
❑ ❑ Rubberized Crown
Lead Counter Flashing El Water Seal&Tuckpoint El Metal Chimney Cap
We propose hereby to furnish materials and labor-complete in accordance with above specifications f he sum of:Total Due($ � )
ACCEPTANCE OF PROPOSAL: The above prices,specifications and conditions are to Down Payment($ ZAP )
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
,upon completion. Balance Due Upon Completion($ _ )
Date: '7 3 / Signature; & +�t/Y�SOt'yt -
Date: 7 D ( Estimator:(Print Name) 3*'V 1Z-(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.
The Comjnoffww4h of Massackasem
D�-,p artwent of Industrial Accidents
Oflke of Iff vesfiga6oas
600 Washington Street
.l Boston, MA 02111
wvsw.mas.LIvWdia
Workers' Compensation hnurauce Affidavit: Baikiers/Con"cturs/F.6ctriciaa&Tkmbers
Applicant Information Ftease Print Legibly
Name(BU=w&V0rgAUUA,UxVIAdr.,,Id"I): Adam Queoneville Roofing 8 Siding Inc_--
Address: 160 Old LymariRoad
city/statrjzip: South Hadley MA 01075 Phone 413-536-5955
An you an easpleyer?Check the appropriate bex: Type of project(required)
1.0 1 am a employer with 15 4. F—I I am a genes-al conuackir and 1 6. ❑ New construction
employees(fun have hired the sub-contracton 7. Remodeling
2. listed on be attached sheet.❑ I am a Pok proprusot or parVw-
listed ship and have no employees These sub-contractors hm-.-- 8. Dernolitwo
wodm* for me in any capsetry employees and have worims' 9. ❑Building addition
[No worimrs' comp. msuratwe cowp•ins�" A& 10J—J Electrical repairs additions
r-p-ed.] F-1 We am a corporation and
3.❑ I am a boax%rarner doing&U work officers have exzroxed dwsr I I.0 Plumbsug repwi or additions
myself (No workers'comp. right of exemption per MGL 12.XL-?.00f repo-ws
insurance required.I C. 152,§1(4�and we have no 13.0 Other
ewployeft�[No vmdcers'
comp.insurance required,I
*Any WpIkaw ibst cbKU box#I wav dw An ow elan mcdos below sbmiag their waders'COMIPONUden POUCY gtkwxwtMIL
I Hewawww%who vAw*"uffidevo hkbcmftg dwy an 4"M mill wed sad Ibew him mt"casaraI wrt asau 9,*,,k&M,"Mi"t tsdic.m;race
:Costracews Ow chwA dki,box moot wtechiMll=ed4kh"ibm showing do now of W wdo-cat ton and MR or not am"*aselti"kff"
-q,M) s. If dw mb-,c—bx"=Wllayeeo,dry samp-0642 dmk wal4n,coaq.poNcy nowiber.
jam an pra+�dlnj wf*,",C#ff9wKxwU"IM=IVncg for wyrmpLwy#m Below ilthepoacy and job sits
information.
Insurance Company Name, AfM Mutual Insurance ---------------
po1wy#0r5.eIf-Ms Lc.,t.--AVVC40070128612014A EVuatxonD*&eI 4/29/15
Zip
Job Site Address:— ctty/staft(
� IF
Attach a copy of the workers'cosapagasstigs psiky&wj&r&doa par(chewing the pWicy*umber and expiration date).
Failure to secure coverage as required under Section 25A of htGL c- 152 can lead to the imlpoa� a of critninal penalties of a
fine up to S I,500.00 and/or oce-yew iwprisocamixt,as well As civil pcoakies in the fbnn 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 state esit may be forwarded to the Office of
Investigations of the DIA for muwance coverage vai&mhon.
I do Jr rwrl�under the Prins and Peffabies efPwrJury that the irif*rmation proviAmd abv%v is&no and correct.
411 -536-5955
0
Official xw only. Do no wrior in this area, bw cosspiood b y r Ilvwx Ifficill
y,city
City or Tc"ra; Perwait/Lkenwe N
ity or
,Insiat Authority(circle out).
UK, 9
1.Beard of Health 2.BwMiag Departn"At 3.Cky/Town Clerk 4. Electrical Inspector 5. Plumbing Lnspectoc
Odier
tact Persea. ?U*nc
EC6-0:1�0 6
SECTION 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: IQJJ�� 41k^r--ayW� C.5 _ 0,10 (0
License Num er
�Zj
Address Expiration Dat
Signature Telephone
9.Registered Homl Improvement Contractor: Not Applicable ❑
Company Name y Registration Number
(,��A� a-S I(x0
Address Expiration Date
Telephone
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 I] 1 9
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[O] Other[p]
Brief Description of Proposed
Work: -1 h,e
J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If Newhouse 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 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? 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, r U L as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, AAa r'ti+ uC ►ter vv� t , 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.
Print Name
&ILI i I`
Signatur f er/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
Frontage .... . . ,......
Setbacks Front
Side L:� . y R:` L: . R.:
Rear
Building Height a
Bldg. Square Footage _ °/U
w..€
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces �.•... .. ....
Fill:
volume&Location
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 DON'T KNOW /—A YES
VU
IF YES: enter Book F Page- Document#,
B. Does the site contain a brook, body of water or wetlands? NO 110 DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
0 C. Do any signs exist on the property? YES NO
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
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 0 NO Q.
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
D p ftrxtent use only
. t City of Northampton t 4 " ft��
Building DepartmentulDrivw,ey �rrrid P 't �a
AW
— 52014 212 Main Street �urtept� t �`
ti;a n tPe
Room 100 ate' ' *Oila�fti�
Electric,Plumbing&Gas inspection orthampton, MA 01060f° nisi Pa�
Nor thampton.tJIA so - -587-1240 Fax 413-587-1272 ( lo�it 'lans x
319 BROOKSIDE CIR BP-2015-0163
GIS#: COMMONWEALTH OF MASSACHUSETTS
MapBlock: 36- 133 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-2015-0163
Project# JS-2015-000285
Est. Cost: $5950.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(scLft.): 35327.16 Owner: ELKAS KENNETH A&LORETTA A
zoning: Applicant: ADAM QUENNEVILLE
AT: 319 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.81712014 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE MAIN HOUSE 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 8/7/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner