35-282 • Jjropoat, -
A division of Sexton Home Improvement Co.
.. O.
IMP MA HIC #118239 _ �a��1111. CT HIC #0605383
www.sextonroofing.com
Since 1985
SUBMITTED TO C72,41, (S1/54A) 4i,z9, S PHONE 5'5'7-cJ F'S-/ DATE F t_5--/j'
STREET ' Sy/ ;11At_I L441C L44 JOB NAME
ZCTI-;O tom'
SATE
IPCDE f t c 4P h.c_P 1 MA- JOB LOCATION
Proposal to furnish and install the following
❑ Re-Roof GK-Tear-Off 44---Main House 13---Garage ❑ Shed
Complete Roof Preparation
(Home exterior to be protected by tarps and plywood
Shrubs, landscaping,trees to be protected
I Entire existing roofing material to be removed to existing decking, Including flashing, etc.
/Site to be cleaned everyday with roll magnet debris removed at project completion
VDeteriorated existing decking replaced at$2.50 per sq.ft
❑ Install all new decking/type:
i C i /Brown metal drip edge installed at eaves and rakes 17F-8 ❑ F-5 ❑ Rake Edge
w flashing will be installed where necessary (see Special Requirements)
:V.-Install new pipe boot flashing u� Bathroom Exhaust Vent
Reflash chimney with new lead
7/We shall acquire all appropriate permits etc.for all roofing work
Complete Roofing System
e
urLeak Barrier installed at all eaves to protect from ice dams (and meet codes in the north) ED 3' '/17,4/741 /Z i=2 P-0,-11
i Leak Barrier installed at valleys,around penetrations and chimneys to protect critical areas /t CAt, 1i,,06 rn4
Install Roof Deck Underlayment on remainder of roof /7-#15 Felt Synthetic Felt
Shingles
Y IKO ❑ GAF ❑ CertainTeed / ❑ 50 year `"3 f ` '' �..1-, 2N ; f-)y Lifetime Color
'Install Attic ventilation system e—Cap over Ridge Vent ❑ Roof Louvers
Warranty Options
17-We guaranteed our workmanship for 25 full years
inl t hereby to furnishyw aterial and labor-complete in accordance with the above s ecifications,for the sum of:
`722' 7'Z i$'4 7 . Gt , Q/2 t2 doll rs($ /U, G. ' ).
PAYMENT TO BE MADE AS FOLLOWS J J
All Material is guaranteed to be as specified. All work to be completed in a workmanlike manner Authorized /
,�.
according to standard practices. Any alteration or deviation from aoove specifications involving
extra costs will be executed only upon written orders,and will become an extra charge over and Signature
above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Note:This proposal maybe �_-_,
Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not m y e accepted within days.
non-payment and applicable interest of 1'/2%per month. y y
ittteptauce of firopooat-The above prices,specifications and conditions Signature , _ € er t:. ,
are satisfactory and are hereby accepted.You are authorized to do the \
work as specified.Payment will be made as outlined above. k.,4:
Date of Acceptance ":,t, -. Signature r ; s , ' /•
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.
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
, = Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
•
Name (Business/Organization/Individual): A 0-0 a ._•
Address:0A Qcou -ane.
City/State/Zip: tIDn (C ()o4Phone #: (,Q\ - A43 -q5 on
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
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. employees and have workers'
[No workers' comp. insurance comp.insurance.t 9. ❑ Building addition
required.] 5. ❑ 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 13.❑ Other
employees. [No workers'
comp.insurance required.]
*My 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.
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: • • , . _,_ _I / 1$ P, n
Policy#or Self-ins.Lic.#: WWe—\C-5L ! (YR-a013A Expiration Date: 1 M
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 under the�pains and penalties of perjury that the information provided above is true and correct.
Signature: (UA( �� Date:
Phone#: Lon -9143 -9599
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#:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1i' Office of Investigations
1 Congress Street, Suite 100
_. E_
Boston,MA 02114-2017
SV'y,< www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Sexton Roofing Co.
Address: P.O. Box 627
City/State/Zip: Holyoke, Ma. 01041 Phone#:413-534-1234
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub contractors 6. ❑New construction
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. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp.insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 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#:
•
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: PII-Crc---6-1- V'�Z?/1--i '9
License Number
PO , 66x Ca 3 16 7 /d/5-1s .,
Address Expiratio r5 Date
Signature Telephone
9.Registered Home Impr vement Contractor: Not Applicable ❑
SQ k—kin.) C) d z '-1 CCU //j 3 F
Comp nv Name Registration Number
.4 - 6 cP 3 --7 0 yO /CL_ , 444 7//J7/s---
Address Expira if on Date.,,c Telephone,.•20 -01 5/73
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 Y 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 E
Accessory Bldg. ET Demolition ❑ New Signs [D] Decks [Ea Siding [D] Other[0]
Brief Description of Proposed nn J // /�
Work: '`�l� riYf 5�� /1"197e OC), `
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 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
I, (_ /)h kcc ,4-1/4c Lt ,as Owner of the subject
property
hereby authorize \. 2 1/4-01A-1 Z,c,Irt U1.41 10
to act on my behalf, in all matters relative to work authorized by this building permit application.
&11,-,files--.31 cl/k
Signature of Owner Date l
I, U-krtAU 2 ( b.N O"`"?`' C ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains a d penalties of perjury.
c,.>ct 44-)
Print Name
Signature of Owner/Agent Dat
r^^s
R ECE - ��l --� \ \,
■ I Department use only
CEP a $ 213 ity of Northampton Status of Permit:
wilding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
ElectriNo ctions
thampton,,MA 01060 Room 100 Water/Well Availability
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
6 5 y LAO j L A gg Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Cie 0l J 4 00/ 5 6 S /Lf LA-k- -- Cie/Rea/ice , ‘444 Name(Print) Current Mailin Address:
✓ 4 e-4 4 & ce -7 - 67 /
�C� Telephone
Signature
2. uthorized Accent:
? -(- tR6dt �-t�J C PO - edx 7 1lakc %
Name(Print) ` Current Mailing Address:
„_ 53ç/_ / ; 3(/
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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 iq ti�H e i+r 6. Total= (1 +2+3+4+5) /' 4 VO6 Check Number
This Section For Official Use Only �c
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
6 SYLVAN LN BP-2014-0363
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-282 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-2014-0363
Project# JS-2014-000611
Est. Cost: $10400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq. ft.): 42383.88 Owner: ADDIS CRAIG E&SUSAN LYNN WILLIAMS ADDIS
Zoning: Applicant: SEXTON ROOFING CO
AT: 6 SYLVAN LN
Applicant Address: Phone: Insurance:
P 0 BOX 6327 (413) 534-1234
HOLYOKEMA01041 ISSUED ON:9/24/2013 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 9/24/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner