23A-220 SEXTON ROOFING AND SIDING INC.
(413) 534-1234 6ZP.O. Box 6327
FAX ( 1 6 Holyoke, MA 01041
saxtonroofing @hotrnai{.cot» lit CT HIC#0605383
MA HIC #118239 www.sextonroofing.com
Since 1985 _
SUBMITTED TO PHONE e4 Z DATE t't — 12--1
STREET (i(„) G JOBNAME
STATE ZIPCODE �_�wC ,� UI,I JOB LOCATION
Proposal to furnish and Install the following EMAIL
❑ Re-Roof '4 Tear-Off ain House ❑ Garage ❑ Shed
Complete Roof Preparation
dome exterior to be protected by tarps and plywood
4--Sfirubs, landscaping,trees to be protected
Ire existing roofing material to be removed to existing decking, Including flashing,etc.
I e to be cleaned everyday with roll magnet debris removed at project completion
eriorated existing decking replaced at$2.50 per sq.ft
❑ Install all new decking/type:
4--Whit Bro metal drip edge installed at eaves and rakes d''J�F-8 ❑ F-5 eke Edge
,0115w flashing will be installed where necessary(see Special Requirements)
stall new pipe boot flashing ❑ Bathroom Exhaust Vent
-Mash chimney with new lead `?rl�
,gL-.We shall acquire all appropriate permits etc.for all roofing work
Complete Roofing System
4rteak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' 4.6'-"'
e-'Ceak Barrier installed at valleys,around penetrations and chimneys to protect critical areas
Mall Roof Deck Underlayment on remainder of roof ❑ #15 Felt LF-Synfhetic Felt
Shingles
4�—KO ❑ GAF ❑ CertainTeed ❑ Tamko / ❑ 30 year ❑ 50 year 4-6fetime Color
&—Innstall Attic ventilation system 6-1C�ap over Ridge Vent ❑ Roof Louvers
Warranty Options
Ole guaranteed our workmanship for 25 full years
We Vro ose hereby to furnish material and labor-cor�plet in accordance with the abo pecifications,for the sum of:
�2 dollars($ 7,606 ).
PAYMENT TO BE MADE AS FOLLOWS
All Material is guaranteed to be specified. All work to be completed in a workmanlike manner Authorized ---IJ
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Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not acc ted within days.
non-payment and applicable interest of 1 V o per month.
�captanct of tropogat-The above prices,specifications and conditions Signature
are satisfactory and are hereby accepted.You are authorized to do the
work as specified.Payment will be made as outlined above. r
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.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 15OA.
Address of the work: / -7 N&?c ' S/
The debris will be transported by: C"0,4142 leA /0i s®05.IF
The debris will be received by: 0,07,E �1`� !//S ,+�05✓a-�
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
—- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
5� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
/` Nn.-�,no-.L-wn T_nc ,
Name (Business/Organization/Individual): i
Address: �'—i-
City/State/Zip:� ��1'?_((!, Pi Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
LY I
1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part imet .* have hired the sub-contractors
2.r_1 I am a sole proprietor or partner- listed on the attached sheet. $ 2 ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. . workers' comp. insurance. 9• ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.F1 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.❑ Other
'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation 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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy information.
I ram 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. #: 1,1 I , 4 . " ! I �J i 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 trace and correct.
f
-": Date:
Si ature: f
t
Phone 4:
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 Inspect o 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
The Commonwealth of Massachusett's
Depa-rtrnent of IndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
-Boston,A A 02114-2017
wivw.I;casE.gi,,Idz*.
Workers' Compensation lusuuxauceAffidavit:elders]Contractors/lvlectricia>vs/Plumbers
Applicant formation Please Print iLe�ibl�
_ NaIl18 (BusinesslOrgaaization/Individual):
Sexton Roofing Co.
Address: P. O . Box 6327
City/State/Zip: Holyoke, Ma. 01041 Phone 4: 41-3-534-1234
Are you an employer?Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. FEN] I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New consru�tion
2.❑ I= a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling
ship and have no employees , These sub-contractors have g. Demolition
working for me in any cap4city. employees and have workers'
[No workers' comp.insurance comp:insurance. 9. ❑Building adcj t on
d.uire
re q 1 5. [] We are a corporation and its 10.[]Electrical repairs-or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions
m self. o workers' comp, right of exemption per MGL
Y � P 12.[]Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.[] Other
comp.insurance required]
*Any applicantthat checks box#1 must also fill outthe section below showing their workers'compensationpolicy information.
t Homeowam who submit this affidavit m eating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such
*Contractors that check this box must attached m 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
lam an employer that is providing workers'compensation insurance for my employees.. BeZow is the policy and job site
information.
Insurance CompalyName:
Policy#or Self-ins.Lic. #: Expiration Date:
Yob Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and eipirattion date).
Failure to secure coverage as required under Section 25A of MGT 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 ofthe,DIA for insurance coverage verification.
Ido hereby certify under thepains andpenalties of perjury that the inform ation provided above is true and correct.
Signature: D at e:
Phone#: 4135341234
Official use only. Do not write in this area, to be completed by city or town off vial.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor; Not Applicable ❑
Name of License Holder: 1� P��Z � ''U !7414 �
License Number
I L.Z AM -1 t 6 k-t /,/,x ez
Address Expiratio Date
V '{ 7 ��
Signature Telephone
d.Home Imorovernent Contractor. Not Applicable ❑
v4c tv &64141
Comoanv'Nanne Regi tration Number"
Address Expiration Date
Telephone �Z
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...... ❑
I L " :dome 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 ❑d
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[Oj Other[�]
Brief Description of Proposed s
Work: /) .CtS'�/r2f
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 housino, +CC m1plete 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, Pq o L r as Owner of the subject
property
hereby authorize pi
to act on my behalf, in all matters relative to work authorized 15y this building permit application.
A ature of Owner Date�—
1, �C-1G_tj I-s:e as Owner/Authorized
Agent hereby declare that the statements and information on the foregbing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
C
Signature of Owner/Agent Da e
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
arkin
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding r been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Reg' of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavetron, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
pity of Northampton
wilding Department
t
+ 212 Main Street "� V'15
t
+ Room 100 , E
i 4
++ ort ampton, MA 01060
3-5 7-1240 Fax 413-587-1272
t "
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
�` / �� / Map Lot Unit
7 ��vV •�/ l4 ey r Zone Overlay District
Elm St.District ` CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Curren Ming Address:
a �✓4 C
x � -t' �- Telephone
Signature
2.2 Autkorized Acient. Iq,, ,/ )
Name(Pri P6 IF Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS 7F
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) , U Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
17 NEW ST BP-2016-0896
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-220 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-2016-0896
Project# JS-2016-001516
Est.Cost: $7600.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq. ft.): 12414.60 Owner: THALER PAUL S&LINDA G BATCHE
zoning: URB(100)/ Applicant: SEXTON ROOFING CO
AT. 17 NEW ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234
HOLYOKEMA01041 ISSUED ON.111212016 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 sienature:
FeeTyne: Date Paid: Amount:
Building 1/12/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner