18C-150 • BP-2023-1074
20 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-150-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1074 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
WILDE HSE LLC D A SEXTON
Est. Cost: 7350 ROOFING 106265
Const.Class: Exp.Date: 03/08/202
Use Group: Owner: M C ILLANE, MICHAEL T&FLORENCE
Lot Size (sq.ft.)
Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING
Applicant Address Phone: Insurance:
45 OLANDER TR 315-569-7761 6HUBOW55113923
NORTHAMPTON, MA 01060
ISSUED ON: 08/10/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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 ,2 . C 'r
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi ner
REC�
�l�Ea
The Commonwealth of Massachusetts 400
Board of Building Regulations and Standards 1F8R20
• Massachusetts State Building Code, 780 CMR oFNoq 8U`�Dr ICIPAL
TrY
Building Permit Application To Construct,Repair,Renovate Or Demolish a r.1�Alip•
•
One-or Two-Family Dwelling o10 4
This Section For Official Use Only
Building Permit Number: 5P"4,13 14 7 9 Date Applied:
A-)#ZZ,5 // .2 6-110"260
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
7r wet/km/is, I•IssrwtaMp}tri Mit (AMA_
l.l a 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 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerr of Record:
VI\CirwaeA c ohtlk.c‘e. or •o %plcar, ,MA O18100
Name(Print) ity,State,wZIP
2e vicm-bt,4 '\Al y13-ZIo-'Csa s -e.o h,\bina.CQ_c yocAsk,,na.i.
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ki Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':
fan-- ytP\oesxgeA4 on c.."-rtrt- )(Vole.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1.Building $ 1350 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town A lication Fee
2.Electrical $ ❑Total Project Costa(Item)6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fenneccs m
Check NojO6•b Check Amount: t40 Cash Amount:
6.Total Project Cost: $ "7 t%a 0 Paid in Full 0 Outstanding Balance Due:
r SECTION 5: CONSTRUCTION SERVICES
i Construction Supervisor License(t.SL) ���y,s A1a1��
Sc w,�� I License Number Expiration Date
List L Si_. t dpc tsee below) IV,
o. `n 01 er
No.and Stree, Type y I— Description --
L' ,ric:ted(Buildinits on to 35.000 ctr, It i
NearANct n keA P% ()tots 0 j R 2estricted i&2 Family Dweiling
City/Town,State,ZiP II M Masonr
y
RC , Pooling Covering
WS 4 : u..iriw and.S ding
SF (lid Fuel Burning Appliances
3l6 - t 114 SS15Yx+,Q S4.x otxr'oa •sa m I sulation
Telephone l;:�aur„ti,cllti ;, f D olition
5.2 Registered Home Improvement Contractor(HIC) 26gylt) y 136 `2AS
\Pit1t& ik, CILA CioXkon Ret3Cl5 4 6:41 { MC Registration Number Expiration Dale
IIIC Company lame car Ill'Regi trains Name
Oksdbr j �a t2seileoribectos .ndi'1
No.and Street Email addrelt
010406 36-5109-1,14)I
Cit(Town. tate.ZIP Telephone
SEC ION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Co tpensation insurance affidavit must be completed and submitted wi[h this application. Failure to provi e
this affidavl will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR SUILDLNG PERMIT
I,as Owner kif the subject property:hereby authorize Was. vSt tyk, 'D$A Stttiv
. to a on myiiliehalf,in all matters relative to work authorized by this building permit application.
NV)t;ho,AA___C.2,x,Akra.t•a-• 12143
Print Di Lle% ,rc) D:,:
_ _ I
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering ty name below.I hereby attest under the pains and penalties of perjury that all of the information
contained i this application is true and accurate to the best of my knowledge and understanding.
I c e.(4+o► VrOgle, 2023
Print Owner or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Ow er who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not r- ste-ed in the Home Improvement Contractor(HIC)Program),will gel have access to the arbitration
progra or guaranty fund under M.G.L.c. 142A.Other important information on the HiC Program can be found at
v,W11 ni.,.<S. r)% uca Information on the Construction Supervisor License can be found at\\ ''.,N AP,
2. When ibstantial work is planned,provide the information below:
Total floor ea(sq. it.) (including garage,finished basementiattics,decks or porch)
Gross livin tl area(sq. ft.) Habitable room count
Number of{I replaces Number of bedrooms
Number of ;throoms Number of halfbaths
r
Type of he."ng system Number of decks(porches
Type of coil ing system Enclosed_ Open
3. "Total '-oject Square Footage"maybe substituted for Total Project Cost"
City of Northampton
y'� 5 Massachusetts
•'
tq DEPARTMENT OF BUILDING INSPECTIONS y ;r 212 Main Street • Municipal Building j ,tea
Northampton, MA 01060 �s'Ny1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accorda -ice of the provisions of MGL c 40, 554, 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: 08ks Maan SN. Hak,,scy osoyo
The debris will be transported by:
Name of Hauler: p,ts,Kou �,,,,\�\„ VJ c-.. ..L.r_s
Signature of Applicant: S-r -(,--6JO,C,2x, Date: 8Jgf24.3 _
II •
The Commonwealth olMassa -- '
Department of Industrial Art' ents
1 Congress Street, Suite 110
Roston,MA 02114-201
www.mass.gov/dia
%'$.users'Compensation Insurance Affidavit:Builders/Con actors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING IJTHORITV.
' i , i ire :I ' . ' .t 0';
Name (IittsinessOrgani7ation,1lndividuat): \ \de, IASF, t..j(tom .1 A ceYcan „nq k Stagy
Address: y5 Oke�•x 'N. JJ
City/State'Zip:_ ebn MA ciegoo Phone#: ,5-col--nt i
i 1 f ---7
Are lifts ast mpioyer'(lit&ewe appropriate lax: Type of project(requir d):
1.01 am a employer with employees(full and/or part-time).* 7; 0New eonstructiol
2 Di am a,:,IC prjprk[or orparutership and have no employee;working for me in 8. Remodeling
.toy eaio e;ty.[No workers comp.insurance required.]
I 9. ❑Demolition
3.❑lam a homeownerdoingail work myself:[No workers'comp.insurance required.)'
10❑Building addition.
-CI I`,orncowner and*aline haringe,nr work to conduct all w k on myrop perty. I will
:n,tt-that all..a'xeea.s either has e workers"ii. p.xs,.tetsi^s�.a,te or are sole 1I.0Electrical repairs radditions
prop>jetors with no employees.
12.a Plumbing repairs r additions
5 igi am a general contractor and i have hired the sub-contractors listed on the attached sheet. 1
These,an-contractor; have employees and have workers'comp.insurance.,
13.5§Roof repairs
(,.❑We ale a corporation and its officers have exercised their right of exemption per MGL c 1-I.❑Other
152. I(4),andwe have no employees.[Noworkers'comp.insurance reauaed.}
k
"Any applieahrthat checks hos r4t r must also fin out the section h;.low'slaaw-ingtheir workers sn°rnr s:aenpolk--y information.
Htineaur.ers whosubmitthisattdavitindicatingtheyaredoingalworkandthenhireoutsidecontractorsmustsubmitanewaffidavtindicatingsuch.
/Contractors at check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entiti have
employees. f the sub-contras orshave employees.they must provide their workers'comp.policy number.
I am an a 'foyer that is providing workers'compensation insurance for my employees. Below is the policy an job site
informati.
Insurance Irompany Name: " rnQ AUZ --rnailft r►Aj 4, VC ;Alrnitciro.
Policy #o Self-ins. Lie. #: lD N��QW Fr��� l?,a� Expiration Date: (SU(a1(�14
Job Site A dress: otV \t4C aiA* - 1�J City/State:Zip: r641com IAA a1�100
Attach a py of the workers'compensatioti�policy declaration page(showing the policy number and expiration date).
Failure to cure coverage as required under MGT..c. 152,§25A is a criminal violation punishable by a fine up to S I.500.00
and/or on year imprisonment as well as civil perm his in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day again the violator.A copy of this statement may be forwarded to the Of Ice of investigations of the DiA for insurance
coverage verification.
I do hereby rertifi'under the pains and penalties of perjury that the informal on provided above is true and correct.
Signature: (Dale: 819 J2,11
Phone; • 3)5-—slog-?'Itvi
Official use only. Do not write in this area,to be completed by city or town official.
(:its or Tossn: Permit/License#
' Issuing Authority (circle one):
I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
+6.0th.,r
Contact Person: Phone#:
ACORD Client# DATE
rrr CERTIFICATE OF LIABILITY INSURANCE 07/25/2023
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 CERTIFIC 4TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certi'icate 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
MA AIF
PHONE 978 726-9830
I-INSURANCE GRO-JP INC (A/C,No.Ext). _
EMAIL gcamossatoCi-insurancegroup.net
799 GORHAM ST ADDRESS
LOWELL, MA 0185: INSURER(S)AFFORDING COVERAGE NAIL
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.NOTWITHS LANDING 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 ADDLI SUER POLICY EFF POLICY EXP
TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DOYYW) (MM/DD/YYYY) LIMITS
A GENERAL LIABIUTV EACH OCCURRENCE S 1,000,000.00
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00
MED EXP(Any one personl
CLAIMS-MADE `X I OCCURS 5,000.00
IMA395923A 8/25/2022 8/25/2023 PERSONAL 8 ADV INJURY $ 1,000,000.0o
GENERAL AGGREGATE S 2,000,000.0
N'I.AGGREGATE
t t LIMIT tAPPLIES PER'. Products Completed Ops Agpregale $ 2,00o,DOo.c0
POLICY r !PROJECT�'_;:c
COMBB AUTOMOBILE LIABILITY Eaccuodeii SINGLE LIMIT
I $ 100,000.00
ANY AUTO BODILY INJURY(Per personl $ 20,000.00
ALL OWNED --SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident)
Auros AUTOS $ 40,00010
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS (Per acndenD $ 1.00,000.00
C UMBRELLA LIAR OCCUR , EACH OCCURRENCE
EXCESS LIAR CLAIMS-MADE AGGREGATE
DEC RETENTION S
D WORKERS COMPENSATION WC STATUTORY OTH
YM
AND EMPLOYERS'LIABILITY LIMITS ER
ANY PROPRIETOR/PARTNEREXECUTIVE E.L.EACH ACCIDENT
oPEIceR,MEMeERExauoED n/a $ 1,000000.00
6HUB4N86974323 3/26/2023 3/26/2024
(Mandatory In NH)
E L DISEASE-EA EMPLOYEE $ 1,000,00o00
It yes,describe under
DESCRIPTION OF OPERATIONS below £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 authonzahon is given to pay
claims for benefits to employees In states other than Massachusetts if the insured hues,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 th s 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.govAwd/workerscompensation/investigations/
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY
SEXTON ROOFING CHANGES OR CANCELATIONS.
45 Olander Dr., Northampton, MA
GUILHERME CAMOSSATO
1/1 CI 1988-2010 ACORD CORPORATION.All rights reserved.
,----N .
Accuzio CERTIFICATE OF LIABILITY INSURANCE ., compwalown,r,
THIS CERTIFTCA PE IS ISSUED AS A NA i te.N OF INFORMATION ONLY AND ac:NEENts NO FRONTS wpm ThE CERTVICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY CR NEGATIVELY /WSW EXTEND OR ALTER THE COVERAGE.AERTROED EY THE POIXTES
BELOW. MILS CERTIFICATE OF INSURANCE DOES /40T CONSTITUTE A CONTRACT BETWEEN THE Igo INSURERS, AUTHORIZED
REPRESENTATME OR PACCUCER,AND THE CIERTIRCATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED.tele poricypies)must have ADDI1TONAL INSURED!previsions or be endorsed.
If SUMMATION IS WAIVED., ettalliCr in the terns Find=Mittens tat die pultmt Certain policies may remakie wiendwsement. A stieterreent on
*is merIghtebt deers not=MAN%Odd to Me mangle:ire Solder in Kau of wren erctorseamits).
PROCMCIfiv CMITACT SOMEINIVROLIE
PONT INSURANCE INC L ov.et,tr.. . AISTIMI eamiffitAit_
E.MAIL-
A****M_ 111100110141011161Are.trra
T103 DOMMONATE H V E MIBUMIMMAEMAROPAC-C$101EMIGE IMMO
, BosTaN WA C22M1111`1 asingutA, AiliIMITUOil NS CO . 33758
MOM $1011MMEIB:, 4
EGAGENERAL COKSTRUCTION hide misimic: :
imonsw.-
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s OTIS ST APT/ Ineomalwz
kilLFCRIT MA 31'757 PeAMPERMF= 1!
COVERAGES CERTIFICATE NUMBER: 997535 REVISOR NUMBER%
Mita PS M atirTF'r IFE POLICES-CET INSLAANCE LISTED eELOVII" ,IAAIE-Mat-ISSUED,TO TAE INSURED NAMED AECNE FOR 7IHE POLICY MOM
• thialCATE.E4 SOTIOTHSTAKEMG Aiktr iRESAILMEEMENT,ram all CONOVTION OF MO CONTRACT OR OT,PtV'DOCLIIMEOLT WITH RESPECT rO WHICH THIS
LIMFICA,TE.tinAY"SE ISSUED OR'MV4,•-,PERTAitt$, Tf,-,IE iNSUMMICE AFFOACIEO le,,,, THE PDODES JESCAtEED HEWN:IS SUBJECT 1-c) ALL THE TERMS.
EI,TraDtslONS.Mk.)COMLIFfrIta Or StICH;PEXICIES:LIUTS SHOWN MAY HAVE BEEN REDUCED SY PAID:CLAMS
7, PAPE OFIN&MMAKE mirliriliril—mat POMP MOIMMEill IMININIIWYPPA ALIMOCAMPASII LAM
,!! 'tOSIMMERCFAi.4ILLYALMALMAMPAMT ' 11
li MICH C.A:CialfrENCE. :e CAI/S.440F 7-1=Pi ) ' ! faikeitit.'Li REA i LO
..;imEresEsifn - —- it
!i.MEMO>,i+ny 6RellsiceP 1 i X
i: WA. ‘VERSON&&A£YV 11011Pv $
1
Sait_..K.,ersivs•,.:la,tr*MUM PM , il BIENEwit.4GGREGEE ':$
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0 POLK',0 jr,...c- LOC I,PREMIX:TS-MUM/.AGG1 s
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111:BeBentine t i a.Agusfprimil, 1( WA AnaREGIOE 1
etHeiratartE 11 i I , $
.iiilitainerelailiPallinant
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1 • SPUTIrrE k I ex i
A 5 1.040101M
MC esmarrefte 4 AMOY "WM
AVIISCPMETOR,,0 ArN,FMEMPZ.FgAtE R „ . ,IEL-Emowzieitste-
. -..o=4,-;EtromBes - triV1-7 SW OM VSICIORAGG:GaMMIM GSVPS113 =MGM t
rindavegy, lot owt,t2. 1 EL MEM*-EA EMPLOYEE!$ 1,0150,000
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il 1 ,Ei;,.eftitetelii--muceuurc f°s tom=
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PESCIAPIO*OP!OPTIRA ROAR!LONLIMIMIMPMENNILEN. 4ACOM2 1M,Atmitkorat MormalkwStlredukt,00meitm-MMictell t morn*war hymn:mama
itioriten'Carpensatiort benefits,veil Oa pact n 102.5sachusetts templorw.t turfy,.FtireUlarlt PZ Errismertart WC 2i3 CD 06 Eis no audicrizaticrr isgmen to play
dams far benefits to employees IT states father then Messackusedsd V7e enured hires,or hes heed those etrployeesoutside of Riewachusetts-
Pus,catilicalweEtritUratrii Mina%Mili policy in lame on lho Was rat tiros orealicabe Zee Satiate(teems Me expiration d me tie etCAY*priicy preatdes the
issue date a taw a rtiticete of iffstrancei. The ,itstUs e tis,;.,:tpierat;:tt caw tie manikin:11 laity WI aus-reotilm4 ffie:Pkluf of CiA.erage-Cavera3e-Verifi .itior
Seam":witd,x teem Inass.itttituted4surkers-farmertsatintmt:vesucpamoreL
CITRATE WILDER CAREEULATION
N
SPSSALISMEN OF ME MOVE DESCISEEMPULICIES SE CACE-LED BEFORE
THE EXPIRATION DATE THEREOF, NoticE WILL RE DELIVERED IN
ACCORIMPRoLVITIFINEPoLicY Plifttirettoros,
Vilicte HISE L.C
45 Otander Or
$1117611111111131MMIE
! '—,D,,_ IL
Northampton MA 01060 Darold I&ii. /*if CPCLI.Vide Piesident—RiLuOtbat Market—WCRIBMA
CISIEW261.5'ACIDIMI CORPORATION. Al rigtes.reserved.
ACORC 2S OF4/VA6AI 31 The ACORGAmmeami law ant teeliiisset weft of ACORD
..i•..a� DATE(MM/DD/YYYY)
(Rt1 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 3Y THE POLICIES
BELOW. THIS (:ERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATI\E 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 SUBROGATIOP 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
NAMEEric Dembinske
ORMSBY INSURANCE AGENCY PHONE o,E,tt. (413)737-0300 FAX No)
E-MAIL -- ---
ADDRESS: edembinske@ormsbyins.com
P 0 BOX 718 INSURERJ AFFORDING COVERAGE - NAIC#
WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666
INSURED _
INSURER B
WILDE HSE LLC INSURERC:
DBA SEXTON ROOFING &SIDING INSURERD:
45 OLANDER DRI E INSURER E:
NORTHAMPTON MA 01060 INSURERF:
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 POLICY PERIOD
INDICATED. NOTV/ITHSTANDING 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.
INSR ADDL SUBR POLICY EFP POLICY EXP LTR TYPE IF INSURANCE INSD WVO POLICY NUMBER imoornrrn (MM/DD/YYYY1 LIMITS
COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $
__ MED EXP(Any one person) $
NIA PERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY L_ PECOT- I - I LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIAR LITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per aocidant) $
-_
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per acci�_
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $
, DED RETENTION$ $
WORKERS COMPENSATION X PER OTH PERTUTE
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PA OFFICER/MEMBER E CLUDED?ECUTIVE N/A N/A N/A 6HUBOW55113923 06/01/2023 06/01/2024 E.L.EACH ACCIDENT $ 1,000,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF O°ERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
N/A
DESCRIPTION OF OPERA TIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,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 in,urance 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
ACCORDANCE WITH THE POLICY PROVISIONS.
Sexton Roofing and Siding Inc
PO Box 6327
AUTHORIZED REPRESENTATIVE
' Ltd`
Holyoke MA 01040 Daniel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA
.4 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Licensee 1)etails
Demoprphic Information
Full Name: SASHA MARIE WILDE I
Owner Name: I
License Add•ess Information
City: NORTHAMPTON
State: MA
Zipcode: 01060 ,
Country: United States p
License Information .
License No: CSSL-106265 License Type: Construction Supervisor Specialty
Profession: Building Licenses Date of Last Renewal:
Issue Date: 7/6/2023 Expiration Date: 3/8/2027
License Stab.is: Active Today's Date: 7/7/2023
Secondary L cense Type:
Doing Business As:
Status Chanqe Reason: License Issuance
Prerequisite Information
No Prerequisite Information
............N No Available Documents
THE COMMONWEALTH OF MAS CHUSETTS
Office of Consumer Affairs and BD* SS Regulation
t t3Da Washington Street-Sul 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type U.0
cto%1rabcn 21e475
hry..C1 ir$$,.L,C ritio Ui lG2b
0 li<'A SEX ON R0OFINO t15044
46 0•LASDiCt l
NORTMAPAPTt3N MA D3104
UPdate 1tddros4 art:Lotion Cant
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NciaaTto TON+,.MA 011GA
Undanar»taryr Not valid wilt iout signature
I
WILDE HSE. LW
SEXTON ROOFING A D SIDING
1FM0 45 Olander Dr
Noi ii amptort, MA 01060
4111P Mr,
Setting the Standard are Ras
p. 413.534.1234 MA RTC*zawo info@sextonroofing.com
SUBMMED TO r,IC e I 1 I 1,1 OsliONE 4)zx z 1 ,3 3.3? 11 DATE 64'211'223.'13
STREET ZO t,Mn-10•14 EMAIL VA c1,14,.It cuiLLe— OMC4`14
ary,STA-1E21P sorthampron,MA 01060 coo I field
SEXTON R HEREBY SUBMITS SPECIFICATIONS AND ESTI:MAI ES FOR:
1) Strip era&remov e misting siungles and dispose of in proper landfill
2) Inspect roofing deck and re2tace as needed 4). S.7001 per sheet
3) Insizaa new metal edging to rakes and eaves of roof.(white)
4) IrLvfaLr ice and water shield an eaves 4:61.vent stacks,in valleys,.thlrniy t intersecting n)ofs..
Install synthetic roofing underlayment on remainder of roof.
6) inkirea new flanges fro er existing vent stacks.
Install starter shingles on eaves and rakes of roof.
8) Archrtec":.iral.sty le roofing shiniOes OR Manufacturer Match ..per manufacturers specifications.
9) Install new cap over vent
10) Reflash abutting chimneys.
SU;194 inarilufactizes LiMime warranty and SRC 10 yr..workmanship w Cry.
Al vt.NTION HOMEOWNERS:Please cover all personal belongkrigs in the attic,g.i -.or storage areas doe to possible roofing debris
or dust corning through cracks of wood decking.
Sexton Roofing shad apply, for permits.
We propose here to fur material and tabor-complete in accordance with the above specifications.broken out on the page
bekw
Payment due in full upon completion
All Material is guaranteed to be as specified. All work to be completed Authorized
in a ridurtanae manner according ro,oandard practces, 4w Signature di
alteration or de%latijh trorn above specifbcawris nal-chin extra ccrsts
will be exenrtei er41- Appan.wri_tren .XtjAn.1"%,and will bad arl extra state Fossa Thts may be w tthdraw n by us it net accepted within
charge over and the estimate_cax%riAcEs-va,101:SAKILS 4.',10,4YVIVOIC
•
V ION EGETAT 'MARKSPN SE MAY HE UN,W4lerABLE kNIC WE kftv_HELD RAWLESS- (14)daYs•
Not resparl.ubie r?b ate-damage J...urrng corstrucriiart.„ Owner to pay
responsible legal fees for non-payment,and applicable interest
Acceptance ofProposal The above prices,specifications
arld OariditAXIS sanstactory aVA.are hereb). ACCEpteti 'too sigrattze
are authorized to do the work as specified. Payment will be
made as ouldaned a Sfture
Date of: 4, I't. •