38B-073 (4) A
QUENNEVILLE
DICI L',r.n<'.n r..tadr SOUi'1 `.I.., PV
., 1»l, "E. ?,)�l ,(i.,.,
I request that you grant a modification to waive the requirement for control construction for the
project at 227 South Street in Northampton because the work is of a minor nature,will not affect health,
accessibility,life and fire safety,or structural requirements and is impractical in that the cost of control
construction is considerable when compared to the cost of the proposed work.
Respectfully,
Michelle Dodge
Adam Quenneville Roofing&Siding Inc.
160 Old Lyman Rd
South Hadley MA
01075
fig`{ Cr-n" 'ur. InC; StIp ,°vi" ,;S i IC.'-J �,t.:� '.i
i
Q►UENNEVILLE
ROOFING IV SIDING 'W WINDOWS
160 Old Lyman Road a South Hadley,MA 01075 BB$
1.800.NEW ROOF a 413.536.5955
EmaiC into*1800newroof-not Website:www.1800newroof.net Winaer of the
MA Construction Supervisors Lic.#070626 2010
MA Registration#120982 TORCH AWARD
Member of the Nome Builder's Association of Western Mass. CT Registration#575920
Memher of the Budding 6 Trade Association
Proposal Submitted To Date Phone#'s C:
i
iShanna Patit 5/11/14 'H: 413-584-6309 w:
Street ---------- -- ------mail: — ------
227 South St.
City.State,Zip Code Job Name/Location:
Northampton MA
Proposal to furnish and install the following
Get all permits necessary.
Remove old flat roof and replace with new EPDM .045 rubber. Job will
consist of installing 1/2" fiberboard C-6 edge metal fully glue
rubber down and tie in all flashing where ever necessary.
Ask us abour
affordable bank
financing
We propose hereby to furnish materials and labor-complete in accordance with above spedficat*ns for the sum of:Total Due(S 7'150
)
ACCEPTANCE OF PROPOSAL: The above prices,specifiatlons and conditions are ( Down Payment($ 2,300 I
satisfactory and are hereby accepted.You are authorized to do worst as Nwillied.
Payment will be 11 down at start of job,and balance doe upon completion. Balance Due upon Completion(S 4,850 )
Date:8/8 4------Signature:
Date:_8_/8114`Estimator:(Print Name)DuStin Peters (Sign Name)
Estimates are honored for sixty(60)days from above date
ATTENTION HOMEOWNERS:Please cover ail personal belongings In the antic,garage or storage areas due to the
possibility of roofing debris or dust coming In through cracks of the wood.Adam Quennevilie Roofing wiR not be
responslWe for debris or dust In the attic or storage areas.
n► Comxwweah* of MasiocAjacm
Deparime"I of Ind"Joial A ccidenn
Office of 1xvinfigaii,01vt
600 Washmg4aft Street
A" 02111
W"W.mas.&govIdiv
Workers' Compensation lusur=ce AKubvit: Rididers/Contracturs/Flectric&ans/Phimber-,
Applicant Information Print
Name Le6bb-
(BuSWM10rgSuuAnoW1nd,v,&u1) Adam Quefioeville RooRoofing Siding 111C
Address. 160 Olt] L ym,w Road ------
MA 0 10 15 536-5955 536-595
Are yoo as employer?Check the&PP—Prillift box,: Type of project(requireolf)
I am A employer WlEb 4 E:] I am a gooftal cOOA'Ockx And 1 61 ❑ New conswuction
have bued the sub-couftacUxx
employees(W And/or pon4ime).•propnetot or par
❑
I am a vole lu
le partner- on ihe auached sheet 7, 0 ReIrnodeling
ship And have no employees
Tbese sub-contractors have 8. Demol►tym
employe" And have workers'
WO&Mg for ME Lu Ary,capacity 9. Bluldmg x"U00
q3*WWxe.
- ,I
(No Wot-1cm,COOT. insurance ance Comp
J JO.E) BeCtrICal r"US CX AdKhh0oX
5 ❑ We we a corporation and ILI
requIvred.
officers have exerused dmsr plurzaving frpm" or 8"tloml
3,Ll I am a bomeownet do 4"%wxiL
of W excu"oo per MOL
arywif (No workers'comp. r* ITN Roof repe'rus
c. 152, §1(4),mad we have 00 : —
Wsurance requard-I , 13EOtber
empkrfem- (No wadws'
coaw- i-smaraoce-T-ed_)
*Any appikam fteschaKAs bag#1 east W"tWom a*melon blow dmnriag*a&w"*WI'cGW1P@ft"d0ftPftlk-Y WfOrm"t""'t
I H0000WOKS who sob"&&AffiA,"hwksoag*,Y M dim 0,0*aw MOM NMI .. ceattacIm name Cuban*A new&Mdm*W43C scag rocs.
�C*oa*cwn slave cock dAII%bens aorea ariarhad o sddltlsrsl lbovdiawbis day umaefsee no-conawlantaId Care W%~or*at*"*aWhiies ko"
I am an empi"Wr that is pro-441(v workers'cong"W'Adon Iftsurmac"for$my'WW1,70M BolowhilthopoficyaAd fob sihr
infon"alipm
insurance Company Naaw AIM Mutual (ISU(allce
AVVC
po,Acy X x Self_uxt, I_J '40010128612014A 4,29/15
c
Job Site Addffess-)a I-,�9-41 SA-1
Anaclk A copy of tlbe,worken'compeasad"policy declaradea page(M&OWing the policy aamber and expiration date).
Fadure to secam coverage as required under Solboa 23A of MGL c- 152 can lead to Ow nKpasiboal of criminal POW11blift Of a
Erne up to 51,500.00 And/or oar—yew unpionamaf,As Wea As CMI peaakles m the from of a STOP WORK ORDER and It fine
of up to$250.00 a day Against the violator. Be advised 6M a copy of this stnk=wnt may be ftwwarded to the Office of
Invesupboas of the DIA fax marmc,ctaverxe,va,6Ww.
I do krrvby con-01 seder tk ns and periahies ofpm*ry#*a(As informativo pro And ebvvv is a and c.,Ircf.
sktrtrnete. _�_—�r�// _---------- -___--i?ass�.- _ 8���E-" � ---- -_ __
413-536-5955
—0, 1),no(wrier in(kit dr*d,so JW Wio'd tr city or town official
City or laws;
L53kiag Authority(circle one):
1. Board of Heald► 2- RaiWiag DepArrawat 1. Ckyfrwu Clerk 4. Electrical Lnspeclor 5. Mumbiag inspector
6.Odwr
Contact Phone
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Sharma Patit
as Owner of the subject property
Adam Quenneville
hereby authorize =to
act on my behalf, in all matters relative to work authorized by this building permit application.
See Contract
Signature of Owner Date
Adam Quenneville
I, ,.........._.............. __ 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_pen_alties of ury. _
Adam Quenneville
��..� _. m_. ew--
Print Name
Signatufe of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
m ,a
Name of License Holder:;Adam Quenneville CS 070626
�.. _ m, w.
License Number
160 Old Lyman Rd South Hadley MA 01075 08/21/2015
Address Expiration Date
(413) 536-5955
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 G) No 0
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
�e
Name Area of Responsibility
Address Registration Number
Signature Telephone I Expiration Date
9.3 General Contractor
Q g g
Adam uennevtlle Roofing& Siding I nc. Not Applicable ❑
Company Name:
.Adam Quenneville
Responsible In Charge of Construction
160 Old Lyman Rd South Hadley MA 01075
Address
(413) 536-5955
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
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 DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES
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 NO 0
IF YES, describe size, type and location: Business sign out front
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO e
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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.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❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing El Change of Use❑ Other❑
Brief Description Enter a brief description here. Strip existing flat roof section and install new EPDM rubber
Of Proposed Work: System
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify: _
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
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)
1 St
1St
2nd i
2nd
3�
3rd
_ 4
4th m
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 Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[:]
SG
O,
��Dy
Versionl.7 Commercial Building Permit Ma 15,2000
City of Northampton ta,, of FVrmit
Building Department r# ci#�kiw
t,
212 Main Street � + i � kt�
A "
it d F P n a
so
Room 100tz
Northampton, MA 01060
one 413-587-1240 Fax 413-587-1272 > lo � tu
�
��
N♦ ., y' it u ».n h` rc t� tl� at i�
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
227 South St Map Lot Unit
Northampton MA 01060 Zone Overlay District
f
v. ,. Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Shanna Patit 227 South St Northampton MA 01060
Name(Print) Current Mailing Address:
(413) 584-6309
Signature Telephone
2.2 Authorized Ascent:
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 $7,150.00 (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) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0185
APPLICANT/CONTACT PERSON ADAM QUENNEVILLE
ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY (413)536-5955 Q
PROPERTY LOCATION 227 SOUTH ST
MAP 38B PARCEL 073 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL NEW CPDM RUBBER ROOF SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing
Accesses Structure
Buildine Plans Included:
Owner/Statement or License 070626
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION PRESENTED:
,/Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolitio lay
Sig re o But ding Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
227 SOUTH ST BP-2015-0185
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-073 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-2015-0185
Project# JS-2015-000349
Est. Cost: $7150.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): 23217.48 Owner: NORTHAMPTON VETERINARY CLINIC REAL ESTATE TRUST LLC
Zoning. URB(100)/ Applicant: ADAM QUENNEVILLE
AT. 227 SOUTH ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536-5955 O Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON.91512014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW EPDM RUBBER ROOF SYSTEM
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:
FeeTvne: Date Paid: Amount:
Building 9/5/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner