23A-002 1: rapo at
SEXTON ROOFING AND SIDING CO.
A division of Sexton Home Improvement Co.
(413) 534-1234 _ P.O. Box 6327
FAX (413) 539-9906 ►�' ',�;;11.. Holyoke, MA 01041
MA HIC #118239 i���11111. CT HIC #0605383
www.sextonroofing.com
Since 1985 /
SUBMITTED TO oft% /Q��IJAIJG PHONE. °' 77 --3 DATE eF� /��
STREET 35 C%a.. 5%- JOB NAME / G�'� `ei'7/Llst/C(/<!� 111
CITY
STATE / A 8��
ZIPCODE Q � JOB LOCATION
Proposal to furnish and install the following •
❑ Re-Roof c Tear-Off Main House ❑ Garage ❑ Shed
Complete Roof Preparation
UV-Home exterior to be protected by tarps and plywood
[Shrubs, landscaping,trees to be protected
Entire existing roofing material to be removed to existing decking, Including flashing, etc.
r�Site to be cleaned everyday with roll magnet debris removed at project completion
/
l Deteriorated existing decking replaced at$2.50 per sq.ft
❑ Install all new decking/type:
Whit'Brown metal drip edge installed at eaves and rakes LF-8 ❑ F-5 ❑ Rake Edge
New flashing will be installed where necessary(see Special Requirements)
❑ Install new pipe boot flashing ❑ Bathroom Exhaust Vent
❑ Reflash chimney with new lead
rp,We shall acquire all appropriate permits etc.for all roofing work
Complete Roofing System
IK-Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3'
q✓Leak Barrier installed at valleys, around penetrations and chimneys to protect criti al areas
lVInstall Roof Deck Underlayment on remainder of roof ❑ #15 Felt Synthetic Felt
Shingles > p
VIKO ❑ GAF ❑ CertainTeed / ❑ 50 year 1' Lifetime Color
❑ Install Attic ventilation system ❑ Cap over Ridge Vent ❑ Roof Louvers
Warranty Options
We guaranteed our workmanship for 25 full years
11,il ern 1011C hereb to furnish material and Labor-cQmplete in accordance with the above specifications, for the sum of:
,�. !%.e Zr y / 6 -e -X dollars($ 2crL)" )•
PAYMENT TO BE MADE AS FOLL•WS
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 above 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 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Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not accepted within days.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-payment and applicable interest of 11/2%per month.
ski
(liacceptante of 3ropoord-The above prices,specifications and conditions Signature 40P�
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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
(;{ Office of Investigations
1-1, 1;74; { 600 Washington Street
C t.
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organi7ation/Individual): L C,on3- 11.��••
CJf
Address:614 Pcou,P1Q
City/State/Zip: 00 CC ()to4Phone#: (.Q f - 01A-3
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. El 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'
comp. insurance.# 9. El Building addition
[No workers' comp. insurance p
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
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: T.1 I , _. _, ' I 1 0 • 111 n
Policy#or Self-ins.Lic.#: ROC: 1 ! en-(9013 8i Expiration Date: ,c�L ]
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: c�y�IO4 Aili1 Date:
Phone#: U (D19 1 -943 -R599
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
•— Office of Investigations
1 Congress Street, Suite 100•• _��_�_ Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organi7ation/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):
4. I am a general contractor and I
1.❑ I am a employer with 6. ❑New construction
employees (full and/or part-time).* 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. employees and have workers' 9. ['Building addition
[No workers' comp.insurance comp.insurance.t
required.] 5. n 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.❑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: i.5 W65 Di--G/ 57 City/State/Zip: Ort"-ef-c- ad.
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 D, or insurance coverage verification.
I do hereby certify and the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date: b ) b._/
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: 44-/1Ej€e-7' k- ,/i1 75 r
Pt--) 661 Co 50) -7 l
License Number
Address / Expiration Date
6
Signature Telephone
9.Registered dHome Improvement Contractor: Not Applicable❑
Company N me / Registration Nmber
/ /c(, )1A-A/ 443Ji ss Expiration Date
Telephone 651/4/" 3 y
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 ❑
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. El Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0]
Brief Descrip n of Proposed
Work: 144-e/ l c4 t-i€e Lt ` 1.47 P
S' d'J 4--ci f'/f0a-c.,
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, r;it ,as Owner of the subject
property � j , � �j
hereby authorize i�et4 0(1-&-li ' fT J
to act on my behalf, in all matters relative to wdrk authorized by this building permit application.(l/3
Signature of Owner Date
I,p 5xt1 `��� `c ��o ,as Owner/Authorized
Agent hereby declare that the statements and informatiofi on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the ains and penalties of perjury.
Print Na�
k /261 /3
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW a YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW e YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES ® NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO G- °T
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
D Building e Curb Cut/Driveway Permit
if / 2 Main Departm Street nt
Sewer/Septic Availability
/'1�_• Room 100 Water/Well Availability
' 2 920/2 No , ampton, MA 01060 Two Sets of Structural Plans
Electric,
PhOhe 413-5. 7-1240 Fax 413-587-1272 Plot/Site Plans
Ncr/ c x Other Specify
APPLICATI. .4, 't:OPPj UCT,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
" s f'V&li2(tcd
Zone Overlay District
/
( Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ems,
3,41//, P9C O M c%DD& 3 ;"me ►.0o S i /ateY.e .. .
Name(Print) Current Mailing Address:
ell-P.410. 4- /Q a.°our` eephone
Signature
2.2 Authorized Agent:
w
et) CJI. GPI f> _ -_
ame(Pint) C rrent Mailing Address:
v /Z 3 V
Signature ..e,....._ P
Tele hone
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
6. Total=(1 +2+3+4+5) "3 33O — Check Number jQ/d 9 t> c
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
35 MEADOW ST BP-2014-0559
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-002 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-2014-0559
Project# JS-2014-000933
Est. Cost: $3300.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq.ft.): 26745.84 Owner: PERLMUTTER SAUL E&SUSAN R ZONDERMAN
Zoning:URB(97)/WP(5)/URA(3)/ Applicant: SEXTON ROOFING CO
AT: 35 MEADOW ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234
HOLYOKEMA01041 ISSUED ON:10/31/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE FRONT HOUSE 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 10/31/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner