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38D-053 SEXTON ROOFING AND SIDING INC. ( 1 534-1234 P.O. Box 6327 (41 3) 539990 Holyoke, MA 01041 sextonroofing@hotmaii.com CT HIC#0605383 MA HIC #118239 www.sexton roof ing.corn Since 1985 ,4'-,q " A SUBMITTED TO PHONE DATE STREET JOB NAME CITY STATE ZIPCODE JOB LOCATION Proposal to furnish and install the following EMAIL ❑ Re-Roof WkT'ear-Off �f' ain House ❑ Garage ❑ Shed ( , Complete Roof Preparation dome exterior to be protected by tarps and plywood *-*Shrubs, landscaping,trees to be protected 4,-Entire existing roofing material to be removed to existing decking, Including flashing,etc. Q2" to be cleaned everyday with roll magnet debris removed at project completion 4--6eteriorated existing decking replaced at$2.50 per sq.ft ❑ Instal(all new decking/type: ,�- 4 hits rown metal drip edge installed at eaves and rakes JF-8 ❑ F-5 11 Hake Edge A—New flashing will be installed where necessary(see Special Requirements) 6Ct'7','J4',"Z ,-Instail new pipe boot flashing ❑ Bathroom Exhaust Vent 6-Reflash chimney with new lead 6/We shall acquire all appropriate permits etc.for all roofing work C Complete Roofing System -/ 4—f-eak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' 4-e" 49"'leak Barrier installed at valleys,around penetrations and chimneys to protect critical areas zf,,lnstall Roof Deck Underlayment on remainder of roof ❑ #15 Felt 0-- ynthetic Felt Shingles X-IKO ❑ GAF ❑ CertainTeed ❑ Tamko / ❑ 30 year ❑ 50 year O<ifetime Colo 6-fnstall Attic ventilation system 0-'Dap over Ridge Vent ❑ Roof Louvers Warranty Options f 7-4S 121 f/ 4/A,�q A'f guaranteed our workmanship for 25 full years e ropoge here y to furni teria! nd lab r-co plete in accordance with the above specific ti for the sum of: dollars($ f�� ) PAYMENT TO BE MADE AS F LOWS rill All Material is guaranteed as specified. All work to be completed in a workmanlike manner Authorizedel according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and Signature above the estimate.Ail agreements contingent upon strikes,accidents or delays beyond our control. Note:This proposal may be Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not accepted within days. non-paymerd and applicable interest of V-%per month. acceptance of fropoal-The above prices,specifications and conditions Signature are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Date of Acceptance Signature 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 the cracks of the wood. Sexton Roofing and Siding will not be responsible for debris or dust in the attic or storage areas. 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: '!5-/ l l v1 Az 6 a S'i r The debris will be transported by: vG l S The debris will be received by: (2;ty 0 t4. C-- Building permit number: Name of Permit Applicant Y�' 'i 16 ,5 _ S� Date Signature of Permit Applicant =` The CoTAnwraweadth of Massachusetts Dip a;,Jrfient of-Indtlstri.calAecidents Office of Investigations 600 Washington Street Boston, MA 02111 5. www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ai -plicant Information Please Print Legibly Name (Business/Organization/Individual): A A �,(1�j j�( l`'�� o n T-no- , Address: City/Mate/lip: �nr�( �I;Z� �Oa �� (2i �. I Lo Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.[5I am a employer with __- 4. ❑ I am a general contractor and 1 6. ❑New construction employees (full and/or part-tune). have hired the sub-contractors 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. ❑Demolition working for me in any capacity. workers' comp. insurance.' 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation 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. tCoatractms that check this box must attached an additional sheet showing the name of the sub-contractors and then workers'comp:policy information. I any an employer that is providing wo;,Aers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �) / I _n j j_r' �7 /�C�' Lbrh,,,or r n Policy# or Self-i . Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (sho lying 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 under tha pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: j Official use only. Do not write in this area, to be completed by city or town official j City or Towm: Permit/License# I Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. ]Electrical Inspect 5.Plumbing Inspector 6. Other / i Contact Person: Phone#: The Comraoiiwealth of/Massachusetts Department of Indv_strialAccidents Office of Investigations. _ 1 Congress Street, Suite 100 Boston,Af4 02114-2017 Workers' ConapensatiomhusuranceAifldavit: BuUders/Con tractors/FlectricianslPlnmbers Applicant Informadon Please Print Lej-iblY Name (Business/Organization/IndMdu4): Sexton Roofing Co. Address:P.O. Box 627 City/State/Zip: Holyoke, Ma. 01041 Phone#:41-3-534-1234 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a_J12 to er with 4. ©-1 am a general contractor and I P Y 6. F New constra�tion employees(full and/or part-time).- have hired the sub-contractors 2.❑ I am a sole proprietor or path er-. listed on the attached sheet. 7. ❑Remodeling ship and have no employees , These sub=contractors have g, �Demolition workin for me in an capacity, employees and have workers' g Y P �.. 9. ❑Building addition [No workers' comp.insurance comp:insurance. required] S. We are a corporation and its 10. Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised tPlumbing heir 11. Plu repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance re ed. t c. 152, §1(4),and we have no ] employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicantthat checks box 41 must also fill oatthe section below sho-wingtheir workers'compensaticnpolicy mfotmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors that check this box must attached as 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 shad is providing workers' compensation insvrance for my employees., Below is the policy and job site information. Insurance CompariyN,ame: Policy#or Self-ins. Lic. #, BxpirationDate: lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declarati on page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can leadto the imposition of criminal penalties of a fine up to$1,5©0.00 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 under the pa•ins and penalties of perjury that the information provided above is true and correct Si attire: 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.BuildiagDepartment 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ 0 Name of License Holder: /�`� ` y. I i� �r'�P 5 License Number Address % Expiration Date Signature Telephone 9.spotered Home Improvement r• Not Applicable ❑ lr�- ) 3C/ ComDaIX N me Registration Number L� - 66) 4 -15-1 -7 Addres /► Y-152 Expiration Date ` V y L 4 Telephone 3 7 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...... ❑ 1. - �me;(owner Exemotion The current exemption for"homeown rs"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engag an individual for hire who does not p license,provided that the owner acts as supervisor.CMR 780 Sixth Editi Section 108.3.5.1. Definition of Homeowner:Person(s)wh own a parcel of la which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family welling,at ed or detached structures accessory to such use and/or farm structures.A person who constructs more an onflorne in.a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Build' Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work verformeiKundhr the buildine vermit. As acting Construction Supervisor ur presen on the job site will be required from time to time,during and upon completion of the work for which is per is iss d. Also be advised that with referpfice to Chapter 152( orkers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not r*lting in Death)of the M\Ste eneral Laws Annotated,you may be liable for person(s) you hire to perform work r you under this permit. The undersigned"home wner"certifies and assumes rer compliance with the State Building Code,City of Northampton Ordinan s, State and Local Zoning LawMassachusetts General Laws Annotat ed. Homeowner Signae re SECTION 5-DESCRIPTION OF PROPOSED WORK all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing �- ,( Or Doors 171 N Accessory Bldg. Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[QJ Brief Description of Proposed Work:_ ll l��iJ-C� �� v1 f /��L' .1� ���/�''L c� K k i? Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.If ow h' e a d-o d it n exist-ing housina.,comalote- the f©Itowin ': 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 ew construction. Bt ens ions 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 1 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of baseme 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, as Owner of the subject property hereby authorize �g of 1 to act on my behalf, in all matters relative to work authorized by this Wilding permit application. Signature of Owner Date I, P S� U t%j'� as Owner/Authorized Agent hereby declare that t statements and information on the foregoing/application are true and accurate, to the best of my knowledge and belief. Signe der the pain and nenalties of perjury. Print Name Signature of Owner/Agent Date pity f Northampton ��xx�� h 3 \ ild g Department g 12 ain Street Edo om 100 aFgv�� o Nsp ampton, MA 01060r € o `NO ne413-587-1240 Fax 413-587-1272 � 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 Overly Di' tri Overlay District Elm St District C8 District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 14e-ck 112 Rye A Name(Print) Current Ma"n r ss S?dd-� <� Telephone Signature 2.2 Authorized Agent: �( v�:� U Crl vl c�( `7 Name(Print) Current Mailing Address: - 3Y /� 3 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 7� 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 51 WINTHROP ST BP-2016-0483 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D-053 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-2016-0483 Project# JS-2016-000811 Est. Cost: $15650.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 69696.00 Owner: SARGENSKI JOHN I&SHARON L Zoning. URB(71)/SC(29)/ Applicant: SEXTON ROOFING CO AT. 51 WINTHROP ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED "IV 10/13/2015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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 10/13/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner