18-039 11/11/2014 TUE 15: 15 FAX 2001/001
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SEXTON ROOFING AND SIDING CO.
AWWjextonroofing.cQm
ow _
Setting the Standard
P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
I
C 413,539.9906
MA HIC# 118239
S1JBMITTED TO Mauna Brennan PHONE 586-4239 DATE 11-8-14
STREET V Antily Lame JOB NAME Bast of garase,ttom back donnex bao main
CITY STATE ZIP Northam on MA. JOB LOCATION
SIRYTON ROOFING HEREBY suBMITSSPECIFICAnoNS AND EsraiATES roYt.
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Inspect roofing deck and replace as needed. ($2.75 per s4.ft.)
3) Install new metal edging to rakes and eaves of roof. (Brown)
4) Install ice and water shield on eaves(61), around chimney,vent stacks,skylights, in valleys, at
intersecting roofs and entire upper back dormer.
5) Install##15 synthetic roofing felt on remainder of roof,
6) Install new flanges over existing vent stacks.
7) Install starter shingles on eaves and rakes of roof
8) install IKQ Architectural style roofing shingles as per manufacturers' specifications.
9) Install new metal flashing on chimney.
10)Install new cap over ridge vent.
11)Supply manufactures lifetime warranty and SRC 25 yr. workmanship warranty.
ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND wORKMANS-COMPENSATION.
19e f rap lit hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of:
Seven Thousand Five Hundred Dollars($7,500,00)Payment to be made as follows- Due in full upon completion
All Matudal is guaranteed to be as specified. All work to be completed in a Authorized
workmanlike manner according to standard practices, Any alteration or 91gt<etAre
deviation hom above specifications involving extra costs will ba executed only
upon written orders,and will become an extra charge over and above the
estimate. AU agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted
our control. Not responsible for water damage during conWuetion- owner within(14)days.
to Pay re omuible legal fees for sort- a ment and applicable Interest.
SM99taace Of VW00 tall The above prices,specifications r '
and conditions are satisfactory and are hereby accepted. You Signature
are authorized to the work as specified. Payment will be
made as outlined above. Signature
Date of Ac lance, //
CSSL-099689
EVERETT J SEXTON k
PO BOX 6327 =
HOLYOKE MA 01011
10/05/2015
O=ce 0f Co s- `, _{f�,r_� d u= .ss Regula�ion
10 p _,_
B o Lo s 02116
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it=1oTI: 2/15/2015 T� 207s86
SEXTON ROOFING CO
EVERETT SEXTON ---
P.O. BOX 6327 - - - --
HOLYOKE, MA 01 041 =-
CERTIFICATE OF LIABILITY INSURANCE DAT``MM/00."-Yy
08,'0412014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI,1
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEC
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the palicy(fes) must be endorsed, if SUBROGATION IS WAIVED, subject to
l fne terms and conditions of the policy,certain policies may require an endorsement.. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRCDUCER 04931-0U1 —TCOtdrACT
PNAMNE
Universal Insurance Agency Inc
Y AIC.No.En (50$)752-9333 (508)752-9303
374 Belmont Street EM
Worcester, MA 01604 Aoll NESS" — — ------, —�-
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INSURER A_A.I.M.l0utuai Insurance Company 76158
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116 Chaple Street IvsuaERO.
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INSURc'R
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY Tti' THE POLICIES OF INSURAN-.E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME1 ABOVE FOR THE P01 1(-Y R �D
INDICATED. NQT1'JIT Nr.NG ANY REQUIREMENT, -=RM OR CONDITION OF ANY CONTR.�CT OR OTTER DOCUMEA QT WITH RESPECT "umi- HIS
CERTIFICATE k"lAY BE cu OR MAY PERTAIN, 7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER^"S.
EXCLUSICiJS AND COId.DiTlvNS-OF.3UC.H POLICIES 0AITS SHOWN MAY HAVE BEEN REDUCED BY Pn"!D CLAIMS
Or?, U `:CE` POLICY 14LIMBER � Y EFF A ycf x
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DESCRIPTION OF OPERATIONS i LOCATICNS I`JEHICLES(Attach ACOPO101,Additional Remarks Schedule,if mare space Is required) �
I
CERTIFICATE HOLDER CANCELLATION
Sexton Roofing
i
700 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Holyoke,NIA 01040 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988-2010ACORO CORPORATION.All rights reserved.
The Commonwealth of Massachusetts
r�
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print]Legibly
Name (Business/Organization/Individual): L� �.()n.c4Fi }, 1 t n o nl'
Address: A H) o_I of Oe
City/State/Zip:.( 1P l( I,d ��i� w?L� ffl a o)I J I Phone#: (t1 I q q3-9 `, Z7 q
Are you an employer?Chedk the appropriate box: Type of project(required):
1. '3 I am an employer with 4. L I am a general contractor and I 6. New construction
employees(full and/or part time).* have hired the sub-contractors 7. _ Remodeling
2. L I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. _Demolition
working for me in any capacity. employees and have workers' g. Building addition
[No workers' comp. insurance comp.insurance. *,
required] 5.7 We are a corporation and its 10. _ Electrical repairs or additions
3. i= I am a homeowner doing all work officers have exercised their 11. = Plutbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required]; c. 152,§ 1(4),and we have no 12. = Roof repairs
employees. [no workers' 13. = Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensatign policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
?Contactors that check this box must attach 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ff t —
Insurance Company Name: 1111 1_ (�T h j n' �'1 S( ra�_ 1 o n?c a�LA
Policy#or Self-ins. Lic. #: V 1,1A C)o- G�11 V j ��i Expiration ate:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date).
Failure to secure coverage as required under Section 25a of MGL 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
$250.00 a day against violator.Be advised that a copy of this statement maybe follvarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify under the pains andpenalties of perjury that the information provided above is true and correct.
Signature: / t i Date:
Print Name: l ; 1 c:� �) I '7U1�9 Phone+:
V
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license#:
Issuing Authority(circle one):
!.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact person: Phone#:
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
S.t www.mass.gov/dia
Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/In(iividual):
Sexton Roofing Co.
Address:P.O. Box 627
City/State/Zip: Holyoke, Ma. 01041 Phone 4:413-534-1234
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. Q I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construption
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees , These sub-contractors have 8. F-1 Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp. insurance comp:insurance.$
required.] 5. rj We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required.]
*Any applicantthat checks box#1 must also fill outthe section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration 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 u thepains and penalties ofperjury that the information provided above is true and correct.
Suture: Date:
Phone#: 4135341234
Official 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#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: --'2
The debris will be transported by: ��
The debris will be received by: LV ;�2,- _
Building permit number:
Name of Permit Applicant - / Z
Date Signature of Permit Applicant
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors C]
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[p]
Brief Description of Proposed
Work: � �AV49 /�C��i��� .2�1 //��1 �!�/il'�! las
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 followina:
a. Use of building: One Family --ve 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 OR BUILDING PERMIT n/
I, �✓ae-o �ed 11)VAI r:q as Owner of the subject
property
hereby authorize l
t �on my behalf, in all matters relative to work authorized by this building permit application.
/
Signature of Owner Date
I, as Owner/Authorized
Agent hereby declare fhat the statements And information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the paii 4pe al ties of perjury.
Al:� f-A i✓
Print Name
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
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/Findin ever been issued for/on the site?
NO ® DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (D— YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained 0 , Date Issued:
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 ® 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 W
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
FL�i NOV � Department use only
City of Northampton Status of Permit:
Vz j.a,`,ouilding Department Gurb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability 13 2014 'IWI� Room 100 WaterNVell Availability
-�V rthampton, MA 01060 Two Sets of Structural Plans
M on 41 -587-1240 Fax 413-587-1272 Plot/Site Plans
Gas lnspecticns 7pton. t o;,0s Other Specify
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
Z4 lie- Map Lot Unit
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nam rmt) Current Mailin Address
� � M �����
Telep o e
Signature
2.2 Amthorized A ent:
Name(Print) CLWrent Mailing Address:
53 y
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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) Check Number (�
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
27 EMILY LN BP-2015-0563
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18-039 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-2015-0563
Project# JS-2015-001077
Est. Cost: $7500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(ssq. ft.): 40859.28 Owner: BRENNAN MAURA JO&DENNIS T YASUTOMO
zoninc: Applicant: SEXTON ROOFING CO
AT. 27 EMILY LN
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.11/14/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SH I NGLE 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 Siiinature:
FeeType: Date Paid: Amount:
Building 11/14/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner