43-039 (3) t. ...
,___*_______
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7. : -_-_____7 r- Of of Consir e- A " d usiness Regulation
vim Suite 5170
10 p` � Plaza - Suite
Boston. assaccus us 02 116
Home Improve el = Conicfor Registration
__ -- -- Recistra ior:: 118239
___ - _ - Excir_tor: 215/2013 Tr;# 207888
SEXTON ROOFING CO —_ — _ -
EVERETT SEXTON = _- —
P.O. BOX 6327 _ _ =
HOL MA 01041 --
_ - l' ,fir 12.-. .— ..rd... Mark rya =.� =
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PS -CAM 0 50M-04/04- G101216 — — —
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vta >.aehu•etts Department u1 Ptibli `at'et _--________
L Board of Builtlin_ Re�,ui_ttiun�,uni1 �tastt!_tr�l�
t icense: CS SL 99689 =CD
n Restricted to RF,WS ERN
•
— EVERET SEXTON
M r _
PO BOX 6327
HOLYOKE, MA 01041 — __----{
�L- _/J/f Expiration: 10/5/201 1
Tr -: 7523 i
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Vropotcat
SEXTON ROOFING AND SIDING CO.
www . sextonroofin com
41110 - MASTER
tut �� WIN GrrIrm,o
Setting the Standard 1 4
_ P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
f. 413.539.9906
MA HIC # 118239
SUBMITTED TO James Baranowski I PHONE 5703200 3/y1 Z I DATE 1-30-13
STREET 72 Autum Dr. JOB NAME
CITY, STATE, Florence, Ma. JOB LOCATION
SEXTON ROOFING HEREBY SUBMITSSPECIFICATIONS AND ESTIMATES FOR:
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Inspect roofing deck and replace as needed. ( $2.75 per sq.ft. )
3) Install new metal edging to rakes and eaves of roof. (8 ")
4) Install ice and water shield on eaves (6'), 9' on front of garage, around chimney, vent stacks, skylights,
in vallies , and at intersecting roofs.
5) Install #15 roofing felt on remainder of roof.
6) Install new flanges over existing vent stacks.
7) Install II(O Cambridge Architectural style roofing shingles as per manufacturers' specifications.
8) Install new cap over ridgevent
9) Supply manufactures lifetime warranty and SRC 10 yr. workmanship warranty.
10)Install new lead flashing on chimney if needed. (add $300.00)
ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS - COMPENSATION. ALL PERMITS
APPLIED FOR BY SRC
Ei) Insrct1� 2 5r ors (uo V¢:15� � - Ovar 6a'ft-, ruen " (mi So i (>t q�'a, 4{'r
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March 2cb13 S'rcctr 'We moan ropoae hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
Seven Thousand Eight Hundred Dollars ($7,800.00 ) Payment to be made as follows: in full upon completion
All Material is guaranteed to be as specified. All work to be completed in a Authorized
workmanlike manner according to standard practices. Any alteration or Signature
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. All 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 construction. Owner within (14) days.
to pay responsible legal fees for non - payment, and applicable interest.
acceptance at firopo%al The above prices, specifications
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 Acceptance. - L ` y 24,i
Right Fax N1-1 4 / 3 / 20 1 ?. 10 : 05 ! 38 AM PAGE 3 /O03 Fax Server
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A I AND EMPLOI LIABTLITV 1 I Kik 1 STAT:1
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I 918 HAIviPDEN ST I -
TIIE 6 r;P:R.i.ii.TION fLATE 'illa'RSOF. NOTICE AM,L BE DeLNBATED iii
- HOLYOKE, MA 01 Act:awAlso4 Will-. THE POLSCY PROV:BIONN. ,
Al3SHORM ROisectu iv?.
Maci.e.4.
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The Commonwealth of Massachusefts
Department of Industrial Accidents
=-- • Office of Investigations
c y 600 Washington Street
O= Boston, MA 02111
+.�._ ss www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): ,cCo Il-1 R • O Chi ( 11 G Cr
�
Address: P 1
City /State /Zip: �� K , {M O /o L / Phone #: c// 3 S3 (/ sq _
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. gI am a general contractor and I
employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 Other
comp. insurance required.]
Any applicant that checks box #1 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:
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.
1 do hereby certify nd the pains a dpenalties of perjury that the information provided above is true and correct.
Signature: 4 Date:
Phone #: `7 / 5 53 ! / L/
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
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction pervisor: 1F ,.. (O Not Applicable 0
Name of License Holder : G �
\- k , (.''C i 7
p � License Number
80 4 C 3 /
1 / /V64U4/9 of e C T / AO -/_5"
...g Address Expiration Date
Signature Telephone
9. R istered Home Im rovement Contractor; Not Applicable ❑
4 t<c C0// C , /4-
Compan ame Registration � er
Address , l (� Expiration Date
i-k / I )1 g" ��/� Telephone 7 3
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 buildin permit.
Signed Affidavit Attached Yes No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other [0]
Brief Description of Proposed ✓ �� V' � l , J / (e,,,--f.r.i=4/4/44cc/7) Work: � //e is /J �'L l +�` Z,�"
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 is existing housing, complete the following:
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 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 FOR BUILDING PERMIT
V" iQ—S 640 ,E �CV S ``- l , as Owner of the subject
property , t( , �/
hereby authorize '�-cej 1• OV l to act on my behalf, in all matter's relative to work authorized by t is building permit application.
CO Q Cf � -� T- /- / 3
Signature of Owner Date
I, e ,, a s Owner /Authorized
Agent hereby declare that the statements and information on the foregoing cation are true and accurate, to the best of my knowledge
and belief.
Sign nder the pains and penalties of perjury.
e
Print Name
Signature of Owner /Agent Date
"
\ i
Department use only
City of Northampton Status of Permit:
IF-4-AR 4 2013 Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
DEPT.
noNS Room 100 Water/WellAvailability
NORTHAi,,ETON , MA 01060 —. Northampton, MA 01060 Two Sets of Structural Plans
phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
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
?Olt Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
.J1-i S Z.*Qc6AKzai Sr 70.2 t 117Z,A ,O e
Name (Print) //JJ,� l/1� f) Current Mailing Address:
l/i bpi vilge
E . o� / f Telepho
Signature
2.2 Authorized Agent:
.t, �`-. : ( "K;v03,) 1 v
Name (Print)' Current Mailing Address:
3 s"3 / -/ 27
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building z (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 re ./
6. Total = (1 + 2 + 3 + 4 + 5) // , ,,�— ') ' Check Number /yO U 0`35
v This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
72 AUTUMN DR BP- 2013 -0798
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 43 - 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- 2013 -0798
Project# JS- 2013 - 001365
Est. Cost: $7800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(su. ft.): 14505.48 Owner: BARANOWSKI JAMES J & SHARON L GUYOTT
Zoning: Applicant: SEXTON ROOFING CO
AT: 72 AUTUMN DR
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534 -1234 WC
HOLYOKEMA01041 ISSUED ON:3/4/2013 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 3/4/2013 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner