29-045 Proposal
www.sextonroofing.com
4� ffro - MAS TE 14
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SeuinL, lht Standard
MA HIC # 118239
SUBMITTED TO Wendy Ellerbrook PHONE Mike 774-721-6480 DATE 9-22-14
STREET 23 Pioneer Knolls TJOB NAME
CITY,STATE,ZIP Northampton,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.fL)
3) Install new metal edging to rakes and eaves of roof. (8")
4) Install ice and water shield on eaves(6�,around chimney,vent stacks,skylights,in valleys,and at
intersecting roofs.
5) Install#15 synthetic roofing felt on remainder of roof.
6) Install new flanges over existing vent stacks, l new kitchen exhaust,and 2 new bathroom exhaust vents.
7) Install new flashing kit around existing skylight.
8) Install starter shingles on eaves and rakes of roof.
9) Install IKO Architectural style roofing shingles as per manufacturers'specifications.
10)Install new metal flashing on chimney.
11)Install new cap over ridge vent.
12)Supply manufactures lifetime warranty and SRC 25 yr.workmanship warranty.
—� urnish material anc labor-complete in accordance with the above specifications,for the sum or':
Hundred Dollars ($10.500.00) Payment to be made as follows: Due in full,upon completion
* ne as specified. All work t)be completed in a Authorized
��o pia to standard practices. An y alteration or �
g p y Signatures t-,
c...cations involving extra costs will be executed
-1d will become an extra charge over and above L'
- 711t-,[S contingent upon strikes,accidents or delays Note:This proposal may be withdrawn by us if not accepted
_ Nar responsible for water damage during construction. I within(14)days.
-esi=.s:a?e legal fees for non-payment,and applicable interest
�Fptin,ce�of Proposal The above prices,speci°tcations and
_- _-;o:-:s are satisfactory and are hereby a_cepted. You are Signature
_--=,zed to the work as specified. Payment will be made as
_,-!:fled above. Signature
are of Acceptance.
.1 Office of Gon_ `•Al —� s e� tsiness Regulation
10 p aik Pima- StitL 517 0-
B 02116
Tone Im_• .cT,�mz '��=• nor ReglstatioII
Re-zii5T=iiorL: 118239
D6A
'�iraaon_ 2/15/2015 Tr' 207888
SEXTON ROOP[NG CO -
EVERPTT SEXTON - ——
P.O. BOX 6327
HOLYOKE, MA-01041
PS-CAi G 56M-0404-G101216
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Rcnil;ttil�ns
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_ Ucense: C5 SL
`?rc RQS-r led to: RF,WS
EVERETT SEXTON ---1
Po BOX 6327 ---j
HOLYOKE,MA 01041
Expiration: 10I5I2015 ------j
l r=: 7523 -
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,�Ile<� V CERTIFICATE OF LIABILITY INSURANCE
oatt(mmruDMll�
oarDS�2o13
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 SY 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 aertlflcate holder Is an ADDITIONAL INSURED,the pollcy(iee)mint 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
certficate holder in lieu of such endorsement(s)-
PRODUCER 04931 -001RNcT
Universal insurance Agency Inc DoE: (50$)752-9333 �c.No: (5DS)752-9303
374 Belmont Street $
Worcester,MA 01604 NAIO
A.I.M.Mutual Insurance Company 33758
INSURED
ALG Consbucdon Inc
24 Prouty Lane
Wom&ster,MA 01602 INSURFZ I!
r:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD
INDICATED. NOTVM'HSTAND►NG 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,
L TYPE OF INSURANCE ' D POLICY NUId9ER � � � jP(j LIMIT$
GENERAL UAINUTf EACH OCCVRRENCE z
COMMERCIAL GENERAL LIA91ITY. DAMAGE TOR NTED $
PREMISE
CLAIMS-MADE OCCUR MED EYP(Any one pereonj 3
PERSONAL&ADV INJURY 9
GENERAL AGOREGATE S
EN'L Aa6REGATE LIMIT PRODUOTS-GOMF/OP AGO S
OLICY Rb OC
AUTOMOBILE LIAOILITY M9INED INGLE LIM S
ANY AUTO BODILY INJURY(Per Person) $
ALLOWNW SCHEDULED 90DILY INJURY(Per acoldenO %
AUTOS AUTOS
AUTOS N N OWNED PR RTY D GE S
AUTOS
S
UMBRELLA LAS 4O00UR EACH OCCURRENCE S
2xDE96 LUIfi CLAIMS MADE AOOREGATE S
DED RETENTION S S
E.L.EACH ACCIDENT S 1 00D,000-no
A gNY CROPR16�Di3fP4f��f�� 1 (EGUTIVE NIA VWC-100-6017579-20'13A 712312013 7/231201't E.L,DISEASE•EA EMPLOYEE $ 1,000,000.00
(Mentlrttory In NW) F�
DEtigC R1PTI014
OPERATIONS below E.L,DIMEASE•POLICY LIMIT 5 1,DOO,nO�.l�4
r,p PTION OF OPERATIONS I LOCATIONS!VEHICLES(AiE-01 ACORD 101,Additional RvmerKil Schetlmv,it more■p�cs b revufredl
CERTIFICATE HOLDER CANCELLATION
Sexton Roofing9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE
918 Hampden 5trast THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Holyoke,MA 01040 ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REFRE51'-NTA7IVE > �.a.. ��-
..,.6 nn4 n in=n r:nap RGTI .All right$reserved.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
� _ n
Name (BusinesslOrganization/Individual) : (j�, �i �l_1 1 t n J._-no
Address: 1 l� ( ,t DIE "„:A—
City/State/Zip: � 12,A ( 'IaC1 Phone#: q L4'3
Are you an employer?Checl the appropriate box: Type of project(required):
I. =i I am an employer with 4. C I am a general contractor and 1 6. New construction
employees(full and/or part time).* have hued the sub-contractors 7. Remodeling
2. C I am a sole proprietor or partner- listed on the attached sheet.
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, 9. _ Building addition
required] 5.7 We are a corporation and its 10. Electrical repairs or additions
3. C I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] c. 152, § 1(4), and we have no 11 Roof repairs
employees. [no workers'
comp. insurance required.] 13. = Other
*Any applicant that checks box Nt must also fill out the section below sbowing their workers'compensatipn policy information.
}Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
}Contactors that check this box must attach 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 1 l r
Insurance Company Name: {-1� m '1(,i T�, t k'��5(,l El (I" P__ 0 C,/ 11
Policy#or Self-ins. Lic.#: �� -�� - ;�n M w' q—rx i Expiration bate:
.lob 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 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
$250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify under the pains and penalties of perjury that the inforntatio provided above is true and correct.
Sign ture: r Date:
Print Name: „� ( ; (� , ) (� %r��%1,9 Phone#:
V
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license#:
Issuing Authority(circle one):
I.Board of Heath 2. Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact person: Phone#:
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
_ Boston,MA 02114-2017
M =•' www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Sexton Roofing Co.
Address:P.O. Box 627
City/State/Zip: Holyoke, Ma. 01041 Phone#:413-534-1234
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I
6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees , These sub-contractors have g. ❑Demolition
working or me in an capacity. employees and have workers'
g Y P tY• 9. F1 Building addition
[No workers' comp. insurance comp:insurance.$
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.F1 Other
comp.insurance required.]
*Any applicant that checks box 41 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 ins ance coverage verification.
I do hereby certify under the a' s andpenalties ofperjury that the information provided above is tr a and correct.
Signature: Date: l
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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ID
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding[0] Other[El
Brief Work Description of Proposed 0� � 1,4C,6 !S
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the followin :
a. Use of building : One Fam• Two Fa ily Other
b. Number of rooms in each fami unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new cons u on. Dimensions
e. Number of stories?
f. Method of heating? Z Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliant Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. f wetlands? Ye 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 .,z {!� Ci as Owner of the subject
property
hereby authorize Cl
to act on my behalf, in all matters relative to work authorized b4 this building permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing 4plication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
&'V rc If T J
Print Na
Z/J(
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/Findi n ever en issued for/on the site?
NO 0 DON'T KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at t Regist of Deeds?
NO 0 DON'T KN Q YES
IF YES: enter Book ge and/or Document#
B. Does the site contain a bro , body of water or wetlan 7 NO ® DON'T KNOW Q YES 0
IF YES, has a permit en or need to be obtained from t e Conservation Commission?
Needs to be obta' ed ® Obtained o , Date Issued:
C. Do any signs e ' t on the property? YES 0 NO
IF YES, d cribe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO o
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
n ity of Northampton Status of Permit:
ilding Department Curb Cut/Driveway Permit
OCT z 20 4 212 Main Street Sewer/Septic Availability
ROOM 100 WaterMell Availability.
N hampton, MA 01060 Two Sets of Structural Plans
N orthham am o n,,M
esetrt F' Q 587-1240 Fax 413-587-1272 Plot/Site Plans
N o
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: )
Map Lot Unit
Zone Overlay District
1 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing ddress: �11
'j 94 -/4j Telephone
Signature
2.2 Authorized Agent:
Ic
Name(Print) f Current Mailing Address:
53Y/c�j Y
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
23 PIONEER KNLS BP-2015-0387
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-045 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-2015-0387
Project# JS-2015-000703
Est.Cost: $10500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sg. ft.): 11979.00 Owner: ELLERBROOK WENDY J
Zoning: Applicant: SEXTON ROOFING CO
AT. 23 PIONEER KNLS
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.101312014 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 10/3/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner