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31A-304 (6)
BP-2023-0840 26 JAMES AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 31A-304-001 CITY OF NORTH PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0840 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC D A SEXTON Est. Cost: 14610 ROOFING 99689 Const.Class: Exp.Date: 10/05/20 3 FICH AN MARILYN&JAMES D KLEIN Use Group: Owner: TRUST ES Lot Size (sq.ft.) Zoning: URA Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 06/26/2023 TO PERFORM THE FOLLOWING WORK: REPLACE 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I. • r . . )2 . 51-g'1 • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissi ner The Commonwealth of Massachu'-tts "...0)... Board of Building Regulations and S :ndarilif Massachusetts State Building Code, 7:0 �, IC1' ,WY US T OF_©UIC Building Permit Application To Construct,Repair, 'e- . : -'ti' tfr8ae, ;piked ar 2011 One-or Two-Family Dwelling MA oi,.. This Section For Official Use Only Building Permit Number: 4,0-)'3- il'/U Date Applied: n C'-y 6/2 4/9-3 Building Official(Print Name) Signature 0 Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers of te ,&MIS -Ayt- 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private Cl Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: N(a►tt(yy h Fic lnwnceA tki2V4hckrviQl6i1 I (`4,4, ( O1,0 Name(Print) City,State,ZIP a(0 ‘10.nuas 4vt- Sod-SR3-vict ncCind.{n.icl4witl�A 0gw+a.;l.a No.and Street Telephone U Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s)2 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Description of Proposed Work': jtplam Pri4llw3, astL4o,(4 gtliw'lk. rql an hurt).- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ H i lP(C!, 1. Building Permit Fee: $40 Indicate how fee is determined: 2.Electrical $ Jil Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. /O/(o Check Amount: INO Cash Amount: 6.Total Project Cost: $ HI to ril Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES Construction Supervisor License(CSL) W.Aw to ikl;)9-33 %C J `�e,>tk.x% License Number Expiration Date Name of CSL Holder / List CSL Type(see below) gr.{ vis Po •may, ke3Ti No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) ‘A,31 L Ak t. M-A noLk Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ,�1, SF Solid Fuel Burning Appliances 4-‘6-4-‘6-Aw"► �L1`1 SEzhsnYQ��i:1c)nL l (�X.�1.tath I Insulation Telephone Etiiail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) p3iri 0 Igo)2 ,,s \ASE. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name C)k.A ex Mc cA 1,1ci 5e)0-11 rrn-Hry.c.411 No.and Street Email address Nrickw-u,,p WIi \ fin-Slit-?till City/Town,State,ZIP Telephone SECTION 6: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 „1gf No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ,cly1/4 W to act on my behalf,in all matters relative to work authorized by this building permit application. Hari Li n M3Away. f S izod3 Print Owner's Iftne(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. S(61elo. L'Jtic (ofasi Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor(not registered in the Home Improvement Contractor(HIC)Program),will net have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton 1�M .off S`S ,Sj(i Massachusetts A.. r;. ',:_ i ; DEPARTMENT OF BUILDING INSPECTIONS ‘' x 212 Main Street a Municipal Building J<.. Cs Northampton, MA 01060 b""•k:j�'�� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: loakv Nlw,A Sd-. 1 of yKu.4. i AMd4 d{Auo The debris will be transported by: Name of Hauler: asG,u0A-ce) 19-- -i\cxx r L e -t c Signature of Applicant: Jae-- (321o(,-- Date: L0145!c3 _�'\ The Commonwealth of Massachusetts 1 - 1 !I Department of Industrial Accidents =ic in1,= 'a 1 Congress Street,Suite 100 =`:Ili a" Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibty Name(Business/Organization/Individual): \;1aq, \,St✓ Uj.. 11,A Sexkon ' J r,v'tt `.rn,ear,..s... Address: 1455 Q1o.r,aw by- City/State/Zip: Ni pkan, (A dbt o Phone#: 315- Ccoa--1-1(.o l Are you so employer?Check the appropriate box: Type of project(required): 1 am a employer with employees(full and/or part-time).* 7. New construction 2 I am a sole proprietor or partnership and have no employees working forme in il any capacity.(No workers'comp.insurance required.] 8. �Remodeling 3.01 am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9. Demolition 4.[Dmhom eowner a a and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 114:Electrical repairs or additions proprietor with no employees. 12. ]Plumbing repairs or additions 50 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance./ 13.�Roof repairs 60 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,11(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that cheeks box PI must also fill out the 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. /Contractors 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: Tttveitrs M 11kj CI AMU-kc. _ Policy#or Self-ins.Lic.#: 1p 1/4\kAtiyA15.51Vae.A2A Expiration Date: to(► ( 20 214 Job Site Address: o)co Ja,anes Autl.. City/State/Zip:i\ i, N. kx o Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp ation date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to S 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 S250.00 a day against the violator.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 pains and penalties of perjury that the Information provided above is true and correct: signature: ( 3Z-- zD.P s9.___ Date: (olaS/a0013 Phone#: 31 S-S(oq—ille I 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#: ACOROe DATE(aaboo/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 06/09/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(Ies)must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require en endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Eric Detnbinske ORMSBY INSURANCE AGENCY PHONE aEul (413)737-0300 UU,No): Ammo; Bdembinekelormsbyins.com P O BOX 718 INSURER(*)AFFORDING COVERAGE NAIL WEST SPRINGFIELD MA 01090 wsuem A: TRAVELERS INDEMNITY CO OF AMERICA 25688 INSURED INSURER B: WILDE HSE LLC INSURER C: DBA SEXTON ROOFING&SIDING WORM : 45 OLANDER DRIVE INSURER!: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 901203 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADM EXP LTR TYPE OF INSURANCE HAND POLICY NUMBER !IM D fYYYY t WDWYYYYI S COMMERCIAL.GENERAL u11BILrr( EACH OCCURRENCE S AMAGE TO CLAIMS-MADE OCCUR PREMISES EReED ) S MED EXP(Any one person) S N/A PERSONAL i ADV INJURY $ GEM.AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE S POLICY PELT LOC PRODUCTS-COMP/OP AGG $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE I(ABILITY (Es scGQere) $ ANY AUTO BODILY INJURY(Pr parson) S OWNED —SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Par sodded) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY ! AUTOS ONLY (Per ecc d nt) $ UMBRELtAL1Aa OCCUR EACH OCCURRENCE S EXCESS(.NAB CLAIMS-MADE N/A AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION x PERTATUTE ERA AND EMPLOYERS'LIABILITY A OAFF�ICRERMEMMBEREXCLLUDE�D?E � NIIA NIA wA 6HUB0W55113923 08/01/2023 06/01/2024 E.L EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 N yes,describe under DESCRIPTION OF OPERATIONS belgw EL DISEASE-POLICY LIMO' $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addslonal Remarks Schedule.may ba*MOW I more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/wd/workers-compensationhnvestigationsl. CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE . . - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN - ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel M.Cry,CPCU,Vice President—Residual Market—WCRIBMA C 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD Client#: DATE TM CERTIFICATE OF LIABILITY INSURANCE 05/01/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS 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),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the 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). PRODUCER CONTACT Guilherme Camossato PHONE 978 726-9830 I-INSURANCE GROUP INC (ac,No.Ext): EMAIL gcamossato@i-insurancegroup.net 799 GORHAM ST ADDRESS' LOWELL,MA 01852 INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A:GENERAL STAR INDEMNITY COM INSURER B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C: 18 SPRING ST FL1 INSURER D:TRAVELERS PROPERTY CAS CO OF AM MILFORD, MA 01757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:000015 REVISION NUMBER: INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL AODLI SUBR POLICYEFF POLICY EXd TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS A GENERAL LIABILJTY EACH OCCURRENCE $ 1,000,000.00 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person) $ 5,000.00 IMA395923A 8/25/2022 6/25/2023 PERSONAL 8 ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: Products Completed Ops Aggregate $ 2,000,000.00 POLICY {j PROJECT I ILOC COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY I (Ea accident) $ 100,000.00 BODILY INJURY(Pee person) ANY AUTO $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident) AUTOS AUTOS $ 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ 100,000.00 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION$ D WORKERS COMPENSATION WC STATUTORY OTH AND EMPLOYERS'LIABILITY YA LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n/a E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory In NM) 6HUB4N86974323 3/26/2023 3/26/2024 E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 GENERAL LIABILITY:for regular and usual jobs and the certificate holder is an additional insured. Workers'Compensation:benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance).The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WILDE HSE,LLC EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY 45 OLANDER DR. CHANGES OR CANCELATIONS. NORTHAMPTON,MA 01060 GUILHERME CAMOSSATO 1/1 ©1988-2010 ACORD CORPORATION.All rights reserved. AC� DATE(MIIItDDfYYYY) 1..�,. CERTIFICATE OF LIABILITY INSURANCE 05/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the 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). PRODUCER CONTACT min BRUNO ROZEMBARQUE POINT INSURANCE INC /NC N.Eat): (617)783 1160 FAX (A/C,ADDREss: bruno@pointinsure.corn 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE NAIC 0 BOSTON MA 022151111 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: E C A GENERAL CONSTRUCTION INC INSURER C: INSURER D: 8 OTIS ST APT 1 INSURER E: MILFORD MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. USSR TYPE OF INSURANCE ADDL SUER POUCY EFF POUCY EXP W UNITS LIR a n VD POUCY (MWDDIYYYY) (MM/DDFYYYY) COMMERCIAL GENERAL UABILITY EACH OCCURRENCEDAAG $ TO REN ED CLAIMS-MADE OCCUR PRE ISES(Se occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMPfOPAGG $ OTHER $ AUTOMOBILEUABIUrY COMRNFD SINALE LIMn- $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON+OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION XOTN- AND EMPLOYER LIABILITY STATUTE ER S' Y!N ANYPROPRIETOR/PARTNERJEXECUnVE E.L EACH ACCIDENT $ 1,000,000 A OFRCERlMEMBEREXCLUDED? N!A N/A WA VWC10060260282023A 02/11/2023 02/11/2024 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 I)yes.describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schodule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage..Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde HSE LLC ACCORDANCE WITH THE POLICY PROVISIONS. 45 Olander Dr AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel C, 4r� M.Crowlby,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street•Sulte 710 Boston,Masrachusett6 02118 Home Improvement Contractor Registration .Typa, LLC Or-DE r*SE.:LC Rngb 2SA4T0 trador; D B•A SEXTON ROOFING A$WRING Eapragon; 447OQ 25 4$GLAV ER f.•ORTr1AMPTON M.A 113104 r NPdN*Addro s and Rot"Cv 4. THE COVMOtinVt JW OP MAUACnUSETT3 Ofhos of Consumer Affsrs A Wiliness R*guK6on R*gl*1r$tan v*gd for Individual uq only Wore a. HOKE IMPROVEMENT COWTRAC TOR *agitation dabs If Torfnd rotors,to: TYPE::Lc Os/loser Consumer Affairs and&nauuw Rpulsuon lope Washington Wiwi •Cults 710 Boston.WA 03114 'AILDE l+9E.LLC 011%S XTO I WOOfl 4 t COQ 43OUINDEROR (.wrrtk oArA NotttnoMVTgre,MA Gta04.:; Unt001100fhtirg Not voila without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards GonstructiotrS p 1'I6pr Specialty CSSL-099689 Expires: 10/05/2023 EVERETT J SEXTON PO BOX 6327 HOLYOKE MA 01041 Commissioner li, la. WILDE FISE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com 41K0 102 Pine St `.". Hol oke, MA 01040 Setting the Standard =cc y eft alrairanakilm p.413.534.1234 MA HIC#208470 info@sextonroofing.com SUBMITTED TO Marilyn Fichman PHONE 508.523.6179 DATE 06/13/2023 STREET 26 lames Ave EMAIL manilyn.fichman@gmail.com CITY,STATE,Z1P Northampton,MA 01060 roofr SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR 1) Strip and remove existing shingles and dispose of in proper landfill.Clean gutters. 2) Inspect roofing deck and replace as needed @$60.00 per sheet. 3) Install new metal edging to rakes and eaves of roof.(white) 4) Install ice and water shield on eaves(6'),vent stacks,in valleys,chimney,at intersecting roofs and on dormers. 5) Install synthetic roofing underlayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install 11(O Architectural style roofing shingles as per manufacturers'specifications. 9) Install new cap over ridge vent. 10)Reflash chimney as needed. to Supply manufactures Lifetime warranty and SRC 5 yr.workhip warranty. ATTENTION HOMEOWNERS:PLEASE COVER ALL PERSONAL BELONGINGS IN THE ATTIC,GARAGE, STORAGE AREAS DUE TO POSSIBLE ROOFING DEBRIS OR DUST COMING THROUGH CRACKS OF WOOD DECKING. SEXTON ROOFING SHALL APPLY FOR ALL PERMITS IKO Cambridge-($13,860) Owens Comin3 Duration-(14,610) Thirteen thousand efoht hundred sixty dollars 414.610)IS PAYJNENTS TO BE MADE AS FOLLOWS; due in full upon completion All Material is guaranteed to be as specified. All work to be completed Authorized in a workmanlike manner according to standard practices. Any Signature alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.DAMAGES TO BUSHES AND OTHER Note:This proposal may be withdrawn by us if not accepted VEGETATION'MARKS ON HOUSE MAY BE UNAVOIDABLE AND WE ARE HEW HARMI FcS, within(14)days. Not responsible for water damage during construction. Owner to pay responsible lsgal fees for non-payment,and applicable interest. - Acceptance of Proposal The above prices, it � specifications and conditions are satisfactory and are Signature_/�i �! hereby accepted. You are authorized to the work as specified. Payment will be made as outlined above. Signature Date of Acceptance. _