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35-117 (2) -- Vropo5�� !G A division of Sexton Home Improvement Co, MA HIC #118239 CT HIC #0605383 www.sextonroofing.com Since 1985 _ SUBMITTED TO" `� .� J G f— p STREET Q x,47 4 r— JOB NAME CITY STATE ZIPCODE ��/ 0 "�_ O� dG JOB LOCATION Proposal to furnish and install the following Re-Roof &--Tear-Off J Main House j Garage -i Shed Complete Roof Preparation 4---'Home exterior to be protected by tarps and olv,%ood /d Shrubs. landscaping, trees to be protected Entire existing roofing material to be removed to existing decking, Including flashing, etc. 46"-S-ite to be cleaned everyday with roll magnet debris removed at project completion Deteriorated existing decking replaces at$2.50 per sq.ft � Install all nev: deOrr:�,.1gp ,pe P� Y� � �`�Whi, /Brown metal dri edge installed at eaves and rakes Ta' F-8 J F-5 J Rake Ed e elashing will be installed where necessary(see Special Requirements) 6 Install new pipe boot flashing J Bathroom Exhaust Vent ,.� eflash chimney with new lead A"W­e shall acquire all appropriate permi s etc, for all roofing ,%crk Complete Roofing System r Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north) _J 3' 4_T­' Z YO Leak Barrier installed at valleys, aroun J penetrations and chimneys to protect critical areas A-Install Roof Deck Underlayment on remainder of roof J � #15 Felt Sca�ynthetic Felt Shingles 4� J / IKO � GAF -i CertainTeed -1 50 year � /!' etime Color t..!4aeC'Gre 1 GI Install Attic ventilation system _j C&.p over Ridge Vent J Roof Louvers ' - Warranty Options Ole-Cl-) 7/ J We guaranteed our workmanship for 25 full years CL)( HG /e I 7 d Ue.,j Hie fllropo5e hereby to furnish material and labor-complete in accordance with the above�ecifications, for the sum of: --- dollars($ J.PAYMENT TO BE MADE AS FOLJLOW�S v/ All Materaf Mater is guaranteed to be as specified. All work to be cornple'ed in a workmanlike manner Authorized according to standard practices- Any alteration or deviation from r.00ve specifications involving extra costs will be executed only upon written orders,and will becc ne 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 ray responsible legal fees for non-payment and applicable interest of 1'h per month. Withdrawn by us if not pted within days. [CA1ttr:pt:ance of Jro�lo8af-The above prices,specifi rations and conditions Signature ctory and are hereby accepted.You are authorized to do the ecified.Payment will be made as outlined above. tance 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. f sJ ► J CERTIFICATE OF LIABILITY' INSURANCE DATEiMMILD;rYYY ' 0810412014 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, TH1: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY 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 certificate holder is an ADDITIONAL INSURED,the policy(les) 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). PRCDucER 04931_0011 cor racT NA E: 1 Universal Insurance Agency Inr a1 �K*,8x4: (548)752-9333 F is rao. (308)752-9303 374 Belmont Street EMAIL : Worcester,MA 01"604 — NSi=�3I sac cctnloco ERACE_��_ INSURER A ..A.1 M.fAutual Insurance Company 261158 (INSk`RED --- ( ALGCorlstluc'aor,Inc 1-119suRER3: �I 116 Chaple Street Cherry Valley,NIA 01 611 I_It SLL E F COVERAGES CERTIFICATE INUMBER: REVISION NUMBER: THIS IS TO CERTIFY Tr( THE t 01-! IES OF INGURAN E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA'4 ED ABOVE FOR THE PC ICY r R'00 INDICATED. NC i PAt=! I j'hG brG ANY RECLAREMEvT- =RM OR CONDITION OF ANY CONTP,ACT OR 0—iHER DOCUM=FJT '00TH RESPECT T rJ'r fo'A IriS CERTIFICATE n AY BE i'SJED OR MAY PERTAIM, THE INSURANCE .AFFORDED BY THE PCLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIMS, E CLUSL^N,°..h%,JO>`:QND' `I 'dS vF SUCH POLICIES,U,,'1A T3 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IiPS`R .� ow,N U 'CCc ONSR USR POLICY NUMBER _—� P(]L`rf E=F PDL?C't ExP 1 AiTS s TR {ihFSR�VvYD �{1dMlCI!"}flY1'Yj�{tihlrDDrY'CY{l' 1� { C Gc IERAL UArfL iT' F.-- t fl I AIJTDM061LC Lt„r,LI I% — EUPi(Pr ALL eclr'A r 1 jlj' R 1J17BF2 LLA LIAS EXCESS L = C EEC r---- IfI�RKERSCG'tdPlsfd A !1 — -----------r------�_i .— X ANGEMPL tERS L.A3l�a c„ =rA` 1,000,000.00`, A F t _ F N r r.a VWC-100-6017679-2014A 7123)'2014 j 7123/201 itdardatorr'.nPHI f 1,000,000.00 �r.L DS 1,000,000.00{ DESCR9P110Pi OF ATICNS I VEHICLES(Attach ACORD 101,Additional Remarks$chodule,if more spaca is required{ i 1 i CERTIFICATE HOLDER CANCELLATION Sexton Roofing 700 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Holyoke,MA 01040 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE f ©1988-2010 ACORD CORPORATION.All rights reserved. • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U9 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 1 r_ Name (Business/Organization/Individual): AddressJ. _hg �T- City/State/Zip. ^ ' � r { �? �r y} t � r C' i� I � � �!t I i (.� � �ter (���o� I Phone#: j�{ ( i 1 t ' Are you an employer?Check the appropriate box: Type of project(required): 1. -i I am an employer with 4. C I am a general contractor and I 6. New construction employees(full and/or part time).* have hared the sub-contractors 7. __ Remodeling 2. E 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' 9. Building addition [No workers' comp. insurance comp. insurance. t required] 5.'-J We are a corporation and its 10. Electrical repau-s or additions 3. F 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]t c. 152,§ 1(4),and we have no 12. Roof repairs employees. [no workers' comp.insurance required.] 13. - Other *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. tHomeowners 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. f I Insurance Company Name: f % ��1 L�-M 1X15( (j(I.CII(1 CO— �.L �c n U Policy#or Self-ins. Lic.#: I��l��:l���- �}��1`� �Q `, {�� Expiration gate: l i3z?I 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 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 fonvarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: � l Date; PrintName: ; / �Q? i�'7CiJ�9 Phone#: 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 Heath 2. Building Department 3.City/Town 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 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 4:413-534-1234 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I _ 6. F-1 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. ❑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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 131-1 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 insurance coverage verification. I do hereby certify under a pains and penalties of perjury that the information provided above is true and correct. Si ature: 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: l�Y'�{ � x: I(;�'J �'el // License Number �, c� /GL Adtlress Expiration Date SignatLffe Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ vl C Narne Registration Number Address Expiration Date Te I e ph on e,220 � 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....... M-' No...... ❑ 11. - Home Owner ExemiDtion ' The current exemption for"homeowners" as extended to include wner-occu ied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an ' dividual for hire w o does not possess a license, provided that the owner acts as supervisor.CMR 780 Sixth Edition ction 108.3.5. Definition of Homeowner:Person(s)who o a parcel and on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwe ing,a ched or detached structures accessory to such use and/or farm structures.A erson who constructs more than u owe in a two-year eriod shall not be considered a homeowner. Such"homeowner"shall submit to the Building cial,on a form acceptable to the Building Official,that he/she shall be res onsible for all such work un r th buildin ermit. As acting Construction Supervi/nDeath)ence on a job site will be required from time to time,during and upon completion of the work for which s issued. Also be advised that with referen 152(Worke ' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resultiof the Massac setts General Laws Annotated,you may be liable for person(s) you hire to perform work for yo rmit. The undersigned"homeowner"certifies and assumes responsibili for compliance with the State Building Code,City of Northampton Ordinances, S ate and Local Zoning Laws and State o assachusetts General Laws Annotated. r Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing EEr Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other[p] Brief Description of Proposed / Q Work: J pld'/O/h �YiG[ e D1,G,61— S;/7�2- 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 4 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, 4A 6,CY2 C),_( as Owner of the subject prollerty hereby authorize Sa 9;� to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 u r t ains and penalties of perjury. int Name 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) r #of Parking Spaces A Fill: volume&Location A. Has a Special Permit/Vari�NO/Finding a er been issued for/on the site? NO ® DONT W ® YES Q IF YES, date issued: IF YES: Was the permit corded at the Regist of Deeds? NO Q DON'T KNOW 0 YES IF YES: enter Book Rage and/or Document# B. Does the site cont in a brook, body of water or wetlar s? NO ® DON'T KNOW YES IF YES, has a ermit been or need to be obtained frot the Conservation Commission? ,4 N/edb obtained 0 Obtained 0 , Date Issued: 0 C. Do xist on the property? YES ® NP 0 Iribe size, type and location: D. Are proposed changes to or additions of signs intended foi\the property? YES Q NO 0 Iribe size, type and location:E. WiI tion activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only of Northampton Status of Permit: ing Department Curb Cut/Driveway Permit 2 Main Street Sewer/Septic Availability, Room 100 Water/Well Availability pton, MA 01060 Two Sets of Structural Plans Electric,F'+� tJfb G3- 1240 Fax 413-587-1272 Plot/Site Plans NGflhGrr''G 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 complet6d by office a-e4-"-JSe4'1 _ Map Lot Unit- f���F7C e (j11,4 Zone Overlay District ' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: re—4)7- -1�6 C 0 3J- D,6, CIO-C-egc-,e� Name(Print) / Current Mailing Address: 7LC d '. Telephone Signature 2.2 Authorized Agent: �Y :S J -r 14) I V j4 UAg- Name(Print) Current Mailing Address: ^` U a L/ 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=0 +2+3+4+5) d,6 Check Number. ,3.5 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 30 DREWSEN DR BP-2015-0658 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 117 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-2015-0658 Project# JS-2015-001259 Est.Cost: $5600.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 6490.44 Owner: KOCOT PETER V&SHAUNEEN Zoning-: Applicant: SEXTON ROOFING CO AT. 30 DREWSEN DR Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON.1211212014 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 12/12/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner