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16C-011 284 SPRING ST BP-2017-0074 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16C-011 CITY OF NORTHAMPTON Lot: -00I PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-0074 Project# JS-2017-000135 Est.Cost: $9000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq-ft.): 7840.80 Owner: WARD MICHELLE Zoning: URA(1O01/WSP(1001/ Applicant: SEXTON ROOFING CO AT: 284 SPRING ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HO LYOKEMA01041 ISSUED ON:7/20/2016 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: OI: 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: FeeType: Date Paid: Amount: Building 7/20/2016 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 6 s 1o re! /ooc C.4 (oc4c w �` Department use only Northampton Status of Permit: g Department Curb Cut/Driveway Permit Main Street Sewer/Septic Availability II' oom 100 pton, MA 01060Water/Well Availability Two Sets of Structural Plans 240 Fax 413-587-1272 Plot/Site Plans Other Specify LIGATION 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 / p V s/ fg? Map Lot Unit �C 0 7 Zone Overlay District /ozenc e Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: p m1/Cf) e /e to4CO ,() 4Ox 27V ehie /9iRJinawa N1 Namynt) Current Mailing Address: Telephone Signature 2.2thorized Agent: k. M-1-4u, ?nc (t A9 PO - OSox 6 3 ) 7 /hip./4 &OA Name(Print Current Mailing Address: S3 V/ 27V 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 r 6. Total=(1 +2+3+4+5) ded• � Check Number /CC° 0&S C7( This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks [q Siding[O) Other[t] Brief Description of Proposed ,n7 Q Work: ',trate Alas! lei igee c,41,754„, ,e,,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. j Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each 9. 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. 70 Cif e l e 1AJ41iO , as Owner of the subject property P hereby authorize ‘,.?--€ 11s--OW Tri5cl ✓ ct to act on m behalf, in all matters relative to work authorized by this building permit application. Act Ice j- 411 vThi l.a..,..* 7// G //m Signature of Owner �f Date ilillMIIIIIIIIIIMIIIC I. i re/ • SL-e1-46 6 b✓ }L / c.) jLcc (ue/ ,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 and penalties of perjury. Cue re ge u{-sA._) Print Name 7// 6 // a Signature of Ovmer/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: '" Not Applicable ❑ Name of License Holder: T.la6 z�/� 3-Q)L QvU 791, R' g 1 Licese Number L. itio Address Expiration Date _ --,9OVraY'73- Signature Telephone 9. tered Home ImproPve�m, ent Contractor. Is . Not Applicable 0 Corn an'yr�Na ne / Registration Number 0.� - QOk 63 c)-7 ^/ Sr - 17 Address / �/ � � �//�� tt � Expiration Date [4� ly(� tet- (AAA or Q Y / Telephone53Y' /2 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 buildingngpermit. Signed Affidavit Attached Yes IY No 0 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 • .\ The Commonwealth of Massachusetts Department ofIndustrial Accidents _ _ ilirs Office of Investigations— _ _ 1 Congress Street, Suite 100 Boston, NIA 02114-2017 :www.mass.gov/die Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pliimbers Applicant Information Please Print Legibly Sexton Roofing Co. n - Name(Business/Orgaa'anon/Individui)- � Address:P.O. Box 627 City/Statn/Lip'. Holyoke, Ma-0102-1 - Phone#:443-534-1234 Ars you an employer? Check the appropriate box: Type of project(requireq) i.❑ I am a employer with 4. NIl am a general contractor anal employees('>A andior nm btane)f have hired rhe sin-contactors actors 6. New consGa. on 2.❑ Ialaasole pr opnptor or patter- These on the attached sheet 7- ❑Remodeling Mt and haw,ao employees Ther snb:con2 to s have ' 8. ❑Demolition v o?t 2-g {o n any capacity. employees ee_ani have workers' No -- mn.insurzrce comp:i_vsmanc 9- ❑Building add5ar recierf 5- ❑ e a cml:or cu and its 10-❑Ere atrairs or addidos 3 ❑ I am a nom o _ - _wan of-.n r have exercised their 11.1. P mag repa:cs mm =meld (ado '<es camp. r u exemption Tcr MGI 12-- Root repairs c. 1540_'4),and tic have:7,3 'here r _ 13.EI Thine: - mn s- 1\o worsens' comp _is'aan eq' ed) '?ayappI.artthat crocks box ill must monism-tic section bdv s' howingtheir workers'camp casatioo policy inimation. t lloneowaen mho er m.t the afidaTit indocatng say arc forug all work andahenhhe outside contactors ms saomrca now rftdavit indicating sawn teent anus that el,was ff's box mut wracked an additional sheet shoamg shenameof the sub-war/actors and state whether wow those entities lave employees Ifthe sub-cootaebn bake employees, they mustpmyidc thew weaken'comp-pahaynumber. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site mforraadon. Instance Conpsy Name'._ Policy ti or Self-ins.Lic.#: ExpirationDate: fob Site Address.29 y afit 2q51 - City/State/Zip: &Z7 if to 110 Attach a copy of the workers' compensation policydeclaration page(showing the policy marker 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 tine up to$1,500.00 and/or one-year imprisonment, as well as civil.penaobes in the fon of a STOP WORE ORDER and a Sue 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 verficatiom I do hereby certify u OF e pains and penalties of perjury that the information provided above is true and correct Si_ature. - Date: '7A // 6 - pup„i3. 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.BuilldingDepartment 3. City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 16.Other -Contact Person: Phone#: D parf^zz oy .10100striLTZ Ac. -dsnts Office of Invest fors G�=-�= - 600 FPas7-ngto ti Street / - Bostorz, M01 02111 ' www.massgov/dia Workers' Comp ens2tion Insurance Affidavit: Builders/Con,actors/Elect icians/1'lumbers AnnEcant Information Please Print Leritly ZTprne(9usioesl0 paniz=ilpn/radiridczl)f / Cr ur:4-1 c,:1 =-a1(- • Address: //4 /' /IA OE S` 000 Ci /State/Zip: C # eel i �n U_cV e.�n L Ehcno.�: / � _ Ca - C c:°(- G Atte you an employer? Check the,appropriate bo - Type of pojact{required): .-1 4. ❑ lam.a general ,aote,end _.I L 1=a employer .:icY r o. New ccr_stie^e^_ --r loyees(.un za.d'or n-tlsm. s)h. have`w 5 Mesub-contactors U 2.1j 1 a asic t Pr c pui....r- listed D the attached sham 7. Li Remodeling ship and have no employes These s_b-contaztom have [ E. Q Demolition worl:irg for me Z my capacry. employees end have Gv_o lcere' _ 9. E BuildMg addition [No workees' comp.insurame pomp, h¢sum_nce.t regard] 5. ] We are a corporation and its 10.f131ecnical repass or additions 3.n a a homeowner doingal weaknc s hake exercised their 1I,D Plumbing repaiss or additions ri IOf exemption per MGL myselfINew workers' comp. 12d2Roofrem-Ms e 152, §1(4), and we have no km:canoe=quid-edit t13.0 Other 5l�i n et employees,[No word0es' comp. csura=ce required.] !try apo boar:that c c:lz box a must alto fill out the section below slowing their workers'compensation po limy information. I iondswncsubrri this a5davi t in-ca ting they are&oag dl work and then Mn outside conractors must ubmila now affidavit indicting such. , Coneactsthatcheck this bon must attached as additional sheet shoving the name of the sub-contactors and sate whether or not rhos:roti ties lave employees. If the sob-confuorz have employees,they mus:provide their wsd.--rs'camp.policy number Mtn an eniployer rhar is providing workers' compensation insurance for my employees. Below is the policy art d job sire irforrna:ian. • . *sscra ceCo navyName: .1.1 81,4 WI, J „i/S . (r'1 . PoEcy'rorSL-ins.Lic$: C j6/1 G 9O&?OI A Exp:radonDale: /2)//Z 1/7 Ioh Site Address: City/Sate/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy DIE-DOor and expiration dated. Faihre to secure coverage as required under Section 25A ofMGL C. 152 cam lead to the imposition of criminal penalties of a fine up to S 1,5D2.0e and/or one-year imprisonment,as well as cbdi pena1des n the form of STOP WORK ORDER and a die Mop to 8250.10 a day against the violator. Be advised Cm a may-of this statement may he forwarded to the Orae of Oreshaatoes of the DIA. for insurance Cove-ace veriucatlon I do hereby cerffy under the .alas and punchier of perjury rhes the information provided above is true and correct Date: _ Phone ;- itI -1 —Iu �- CI RC 0f7cial use anly. Do nor write in Otis area, to be completed by my or torvn officiaL City or Town: - P ermit/License 8 Issuing Authority (circle one): I.Board ofEealth 7..B mil ding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone 4: SEXTO-2 OP ID: ER acoao CERTIFICATE OF LIABILITY INSURANCE DATE(1 07//01/201601/2016 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 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(ies) 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). PRODUCER CONTACT Ormsby Insurance Agency,Inc. PRONE Eric Dembinske FAX 698 Westfield St PO Box 7�a (NC.No Em:413-737-0300 !(ac No): 413-737-0617 West Springfield,MA 01090 E-MAILE Eric Dembinske ESS: INSURERIS)AFFORDING COVERAGE NAICp IN SURER A Atlantic Casualty Ins.Co. INSURED Sexton Roofing &Siding, Inc. INSURERS:Quincy Mutual Fire Insurance 15067 PO Box 6327 '— ----'— Holyoke, MA 01041 INSURER C INSURER O: INSURER E'. INSURER F: COVERAGES CERTIFICATE NUMBER: - REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. INSR - iAODL$U0ki POLICY EFF POLICY EXP LTR TYPE OF INSURANCE SO IWVO. POLICY NUMBER I(MMNDTYy} IMMIDOIYYYY) LIMITS A I X COMMERCIAL GENERAL LIABILITY : EACH OCCURRENCE 1,000,000 I CLAIMS-MADE X OCCUR :101GL002159900 06125/2016!06/25/2017 PREMISES( ATED PREMISES IdaaoccuPen¢) 100,000 cLun MED EXP(Any one person) 5,000 PERSONAL&ADV INJURY 1,000,000 I GEYL AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE 2,000,000 POLICY J JECT �:LOC PRODUCTS—GOMPIOP AGG 2,000,000 OTHER: I AUTOMOBILE LIABILITY I I CEOMBBIIaEED SINGLE LIMIT 1,000,000 B ANY AUTO I 1AFV206561 05/15/2016 05/15120171 BODILY INJURY(Per person) i, ALLqNED XAUTOSEULED 'BODILY INJURY Per acmoent/ II HIRER AUTOS X NON-OWNED I PROPERTY DAMAGE AUTOS (Per acdent) UMBRELLA LIAR •OCCUR I I EACH OCCURRENCE $ Irl EXCESS LIAB IihI CLAIMS-MADE I AGGREGATE _$ 1 DED RETENTION$ $ WORKERS COMPENSATION - PER 0TH- AND EMPLOYERS'LIABILITY V)N I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT =' $ CER/MEMBER EXCLUDED? NIA - ' I(Mandatory in NH) E L DISEASE.EA EMPLOYEE,$ !lyes,describe under DESCRIPTION O=OPERATIONS()Dow EL.DISEASE-POLICY LIMIT $ • • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AGGRO 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett Sexton ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Eric Dembinske O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • A�oe CERTIFICATE OF LIABILITY INSURANCE DATE,MMIDDIWYIT 03118/2016 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 BY THE POUCIES 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(ies)must be endorsed. H 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 endorsemengs). PRODUCER NDAmE C1 Leandro Guimaraes UNIVERSAL INSURANCE AGENCY 1uc H EMI: (508)]52-6333 box NO EMAIL leandro@universalinsagency.com 374 BELMONT ST. INSURERS)AFFORDING COVERAGE NAJCII WORCESTER MA 01604 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: ALG CONSTRUCTION INC INSURER . _ /NSU RER D' 116 CHAPEL STREET INSURER E: CHERRY VALLEY MA 01611 INSURERF: COVERAGES CERTIFICATE NUMBER: 38399 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. / Y EXP LTR TYPE OF INSURANCE IAINNSDISWVD. POLICY NUMBER IMMrDOURRi YMYYS,(MMOEFF I Cen9YYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO HEN ILO I CLAIMS-MADE ni OCCUR ,I.. PREMISES I Ea occurrence MED EXP(Any One person) II N/A PERSONAL&ADV INJURY ' GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY�I PRO CELT LOC PRODUCTS•COMP/OP AGO OTHER I AUTOMOBILE LABILITY 1OMaBIINEED1 SINGLE LI Mn nANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED II N/A • BODILY INJURY(Per e¢IOaM) AUTOS NON- OWNED UTOSI ,PROPERTY DAMAGE HIRED AUTOS • AUTOS 1 (Per aoap den • I UMBRELLA LIAB OCCUR EACH OCCURRENCE —'I EXCESS LIAB CLAIMS-MADE N/A AGGREGATE DED RETENTIONS 1 :WORKERS COMPENSATIONI IXI',Timm I I EORH AND EMPLOYERS'LIABILITY H A OFFICEOAMEMSEREEAXCCLUDED'EcunVE NIAI NIA ' NIA VW C10060199052016A !03/1212016 03/12/2017 ELEAcry ACCIDENT 1,000,000 (Mandatory In NH) I EL.DISEASE EA EMPLOYEE 1,000,000 If yes,describe under i DESRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT 1,000,000 IWA DESCRIPTION DF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Il more space is rewired) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 2003 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov4wdlworkers-compensationlinvestigationsl. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING ACCORDANCEWITH THE POLICYPROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE HOLYOKE MA 01041 ,"r I)_ 1--' Daniel M.Cr jeey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 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 150A. Address of the work: � SP2/47 3r The debris will be transported by: 4.4ip telt O/ S�oS/I The debris will be received by: jri,,, A k /r s� sit Building permit number: Name of Permit Applicant 2,e— z)ti) lecoilryzi Date Signature of Permit Applicant Vropossat SEXTON ROOFING AND SIDING INC. • (413) 534-1234it = ,,. P.O. Box 6327 FAX (413) 539-9906 r _ Holyoke, MA 01041 sextonroofing@hotmail.com Sams CT HIC#0605383 MA HIC#118239 www.sextonroofing.com Since 1985 ,or alo —1'a•/sem SUBMITTED TO ,c4P/G lu4GrO PHONE (y'/-7_ 9 y-a337 DATE/ S/2s/(G STREET . 2dcix '�. 7+{ JOB NAME Re,i�ri.P -2 ,4s-'/`k0 CITY ^ / STATE •moi /rK ✓'4nc'V7 /NU. JOB LOCATION a, 3f41 ar /eibeeel[e ST TE (� Proposal to furnish and install the following EMAIL ❑ Re-Roof Tear-Off C3,6ain House ❑ Garage ❑ Shed Complete Roof Preparation t Home exterior to be protected by tarps and plywood /,/'N•'l." ia'Shrubs, landscaping,trees to be protected /1 4-(6`) (� S i I Entire existing roofing material to be removed to existing decking, Including flashing,etc. ' l ^1, i�t) iJVSite to be cleaned everyday with roll magnet debris removed at project completion I y /Deteriorated existing decking replaced at$2.50 per sq.it 3 Install all new decking/type: Xr a:rown metal drip edge installed at eaves and rakes ❑ F-8 U F-5 ❑ Rake Edge t ,� r New flashing will be installed where necessary(see Special Requirements) r✓�1 1n 2. Install new pipe boot flashing ❑ Bathroom Exhaust Vent V j 1' , O'Reflash chimney with new lead V'ie-- p/We shall acquire all appropriate permits etc.for all roofing work 1 `_p 1 a Complete Roofing System '"�1'r'` YJ` �D'Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) 3 3' a 0 0,Leak Barrier installed at valleys,around penetrations and chimneys to protect critical areas i 4nstall Roof Deck Underlayment on remainder of roof ❑ #15 Felt v-Synthetic Felt Shingles U I 3 GAF 0 CertainTeed 0 Tamko / O 30 year 04 year ❑ Lifetime Color Install Attic ventilation system ❑ Cap over Ridge Vent (8r-Roof Lowers 41 Warranty Options fWe guaranteed our workmanship for 25 full years 0Ht*ropase hereby to furnish material and labor-complete in accordance with the above specifications, for the sum of: >!fre b > 5 ro. dollars($ ,, Ara — ). vA .saaluwa Thu ' i✓�r!/ p.0 f Up n ��/ /i r4/C� All Material is guaranteed to In as specified An work role completed in a workmanlike manner Authorized according to Standard practices. Any alteration or s,andon from above specifications Involving extracosta will be executed only upon wrlaen orders,and will become an extra charge over and Signature abolbs estimate.Alltereamentscomingom upon stakes rrenta Or responbrymdocoonig. Note:This Not responsible br water damage during%nary❑lion.Owner b pay responsible regal pee br proposal otay he nmmVment aha spoked.interest of Wl%oer month. Withdrawn by us if notaaepte�-dyw�tllli�n�// days. ��f4rrrplancr of rapgsal-The above prices,specifications and conditions signalurj 14:}at rt \, are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. .‘Data of Acceptance Sgnature J 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.