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23A-123 (5) 20 MIDDLE ST BP-2017-0334 GIS II: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A- 123 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 ti BP-2017-0334 Project JS-2017-000547 Est. Cost:$4000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq.ft.): 13503.60 Owner: WYMAN GINA Zoning: URB(IOOY Applicant: SEXTON ROOFING CO AT: 20 MIDDLE ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:9/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE GARAGE SHINGLE ROOF & FLAT PORCH ROOFS 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 9/12/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: /1_4Gv Building Department Curb Cut/Driveway Permit v g % 212 Main Street Sewer Septic Availability % Room 100 WateriWell Availability a3�% Northampton, MA 01060 Two Sets of Structural Plans oklo�� phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: n This section to be completed by office ((9 v m\detle � Map Lot Unit c\o( j QQ. y11-F Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jnr l ( ) mi le ({ ne Nam ( nnt) ,� /1, ry, Current Mailing Address: c C)C 1 C Q C 4 Telephone Signature 2.2 Authorized Agent: ��-��rl PXXVic-01) ine ft) FOL 4911 -!o) OC.Q ITA 0 IDLYName(Print) `/ Current Mailing Address: ) I93ySignature - 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 y(/� /� 6. Total=(1 +2+3+4+5) .L1 ))07).00 Check Number /54717 -44.0 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding 11D] Other(0] Brief Description of Proposed ' Work: (-Qc\ e �c 1Ce Sh1(vole rcrA-1 nnri -1 - path o-xr5 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 CONTRACTORAPPLIESFOR BUILDING PERMIT I, CR] (1 Q Lean ,as Owner of the subject property t� /1 hereby authorize 5 [7.Y1 ` (,Y (f U to act on my behalf,in all matters relative to work uthorized this buildi g permitapplication. C`b (Qr+ () C Ch q1‘r�� Itp Signature of Owner Date I, ,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. Print Name Signature of Owner/Agent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: cUQree-4- 4- 2,K on License Number U s39:9 \gDOZ i In vloq n\s Address Expiration Date �t 5 - 134_ Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 5e6On of) t(1Q Company Name vv Registration Number Po i3O b3a' +c16K1(.2 OVA ( Address Expiration Date Telephone 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 andel Local Zoning Laws and State of[Mars\sacch� efts General Laws Annotated. Homeowner Signature C. Jt f(y (IN Cl 1 lc 1� Q 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 150k Address of the work: Q (f Ark Nlorzlicte Im l The debris will be transported by: 0M?19_.LL P cC'n The debris will be received by: Oct pk '-t T ISQ)O"LL Building permit number: t 11 ) (ill of Permit Applicant 12)(401\ m� • • Date Signature of Permit Applicant The Cor'r,2onrleaTtiz of Voss',oho et:s D©Dartrnen of lndus:n 1 Acc..ionts _ Office of_Tin,esziganons �! 1 Congress Sheet, St. 100 - BosiotJ$y4O277a 2077 - aau- -mass gon Workers' Comp ems aiionir,mr,.rance A'rdavtt.Brlaers/Confr tns PLcnbers kDnHcant7rform anion Please Print Le hl- iffiedpuness/Or nvahcrrmdticvlg Sexton Roofing & Siding Inc . A a--ess P . O . Box 6327 Cr v1SateiRi, Holyoke , MA 01041 -_c_n 413-534_1234- Are you ennicyer2. 3 the anindynate box - rype of;reject -_er; 1 in I am a enployerwrth3- Wine-g n to tracor -dI employees (toll maim'pmt- save:,i. a 'v =uT1 ontrzc :r. 6 _ 2.'J7)-) a c troyl =axu er. - listed r-" e 'LaO sheet 7. H nenoce1 nn 1-'1 veao mrl ees =r sliD-C=07=h 8 LJ Denlua w rkms or-A a v _a icup... en for es �dh e .sms' Ealinga 1:14cw .` ..s' cncrcr.Tcaimce 7 We • iporaa La :c 1. IJ e 71 y _ .aduaai 3.L T a aho ccoc-s : arm,Mwork °ace=ha'v€.ecce sa*=e;_ 11.L?1-tunitttz:coats cr z _cam-. ,I rrysell. fl ow ▪ x_' compnEat o_ex=don erMat cr 'nFof ops ei a.152, $iAl, and,we have no — - innc�ce z^� _] - e ., - ?lcY ees. :7o warxerss — cc_n.inslTance_eqii;ed 1 c r a ec=a n t -�mD the eecpon entow shv ;heuw lc ntcido Hy um- m_ ▪. .wncwhs . s*cni b- =IS: th.aan Lca eaLl som a] grIzra=i Iln- .a _zc-r lm art anew r.caoa-s jcave Kari:v.mato_.**1 ' ms.'a♦-+-he an manonal±ak wn€fo . .,nb .,a a✓ln _ a'....ae@ec _ ottrua ..�.... _a e enploy-es- Ellie suo onto t c..h =1:10y -City nope >rodct'zLne paCcayn=ht- I9R ca.em5C5.555..):R r . -gra ..'Cc-ere e=telt neer ccee ce s ➢' ,.Iea rclro LhECJ r_ SZE as.n nce Cont y NE= PcAry#or]69-c-rns. Lra _ 0-D3tt IDD 55e A_1'nesc. e dEa a copy of tic workers' con-ape>_saccnp.licyd«.ara snrage (sy-wsm-the pcscy=riber a,.Tt^iar..er ? secce coarsaa. s egc_ s airier Section25:55 of MC-i c 15can lead np-c-canc,cf err^pipe=al-nes cf a Sneap to,11500.70 anis:oneyew Mcccomacc as Wallas civil .nar_es an be ifs=et--aC_.^_ .g CBDEF,`e,afe of III:to$250 39 da -,cclacc. Be _cc'as ▪ acart efsvr,tccement may befo_r_ ats Once of Inve a-saons o_'fe D▪_4 fsr-lore, cove: ; nreccucatn d alay occupy acadc tkE„cotes a : tes o p --__ rnua c,-. o : above abos c .,.ca ._ _ CM\ Saccia se. �L Date AOf I� Those# 4135341234 t �/ Official use oray Do not write ra tins area, to he ecr, t_Ked by ciy or fawn o! cea2 - City cr Tc trn: Pe'-7Lj.:ense`r Issuncg Authority(nide one) El Board of Health; 2.Brain;mita ort 3.C}y(PownClock - lElecticalianyncitor. 5 Plrnn ag7m_ecxr 6. Other . ContactPerson. - Phony#; _ - Der., 11":Flieiod of miu.s..t ,i ..o _I: - Ofjr of Invests s ARM a 600.r✓asnoagtoza Srreet _ Bostmt, MA 02777 s- •' www.mass.gov/dia Workers' Compensator Insurance Affidavit: Buil ders(Ccntractorsrlecticia s/_+Ptumbers Applicant Information Please Print Le ib)v Name(Business/OrganintiorNoUviduD)f z G,a^ (4;4_, eC Address: ( .4 4' of / -� C?r d Co rite/State/Zip: �LG�EI; 1.'7U_6Va,.nn P_0-hP 01 . - 1 fS .j` -,.e you an employer? Check Bee appropriate bot : Type 01 adaidadit idamidasa 11 Irr, a e ,c e: with 4. ] I am a zwidal co_c ro d I Sa d sub .,.tee,., ❑ e-sr, eoelose s 1.4.4 m r pant-time)_' — J� i a „cop to pa:reef- huedo L attached soma Remodeling stip and have no employes Thosesuh oon+ra t have 3 ❑Dens'iao_ employees andh have orkers: rNgorhmes d] orae am.i7r [ o seers' comp insurnce coma ns nee. v n Building z j o. 5. l❑ -we me 001-2.03s9,,,,and ,B I 10.]Elect-Mal rop=sors micas 3 _ I am a Eoneowner doing a Li work o5cershve exercised their 1 '.❑Plumbing rep= or -Ididons myself [No wormers' cam . rightd£eze±pion per h4CL y p 12_i7Roofrepe=s insurance reeaired, t _ e 152, 41(4),and we have no _ employees. [No workers' I 13.ff Other 5id;n_i comp. insurance required.] 'Rryzpp G-eonflat checks hex#1 must also 51l out be secdoo below showing their worker'conpensau on Riley inform-misc. iora!own eve who sub mil this aLldavit indiratiao they are d okra ell work aid 6:n hire outside contractors must sube.il a new ardaeit indicalin g such. tont-actors that check tis box nous:attached an ad di ticnal sheet showing the tame of;he sub-con escort and sate wh efhc or nof:hoes entues'hsve employe s. if the tib-coo bractoa have employers,they must provide their woiee.'comppolicy number I am an employer rhar is providing workers' compensation insarence jot my employees. b-'ow is bre policy chd job site irformerioe. / Enact. Company Hie: H /�✓� 4 i J'zt/ S . l , Ph:fcy#orSeli-ins.Liu.: VW C— )(/1 ig90 (Ji(G A Funsio=ooDostei rash/.//7 lob Site Address: Ciry/ShCAZip: Asch a copy of the workers' compensation policy declaration cage [Lapwing the policy number and emL a:sn date). aisle to sec-me ov=erage as :squired under Section 25A ofMCLin. 152 can leaf to the_epositiot of or-ehlha.3 pe_a:res ofa fine up to$1,500.00 aador one-yea imp-isomnent, as well as civil penalties:w the form of a BTO?WORK CEDER ands eine of ap to $250.00 a day against the violator. Be advised Mat a copy of this statement maybe foraar'ded to he Office of _Tnvesdeadons of the DIA for'insurance cover ze verincatioa d do kereby ce-Lfu under the pains and psaelries ofprohorp that the 1pferrnalon provided ahoy is true and err-ace Sir_arre'. _ate: Phone 0: r... 7 g7.C1 � • q c(CI Oficial use only. Do not write in Ibis area, re be completed by city or rows official City or Town: . Permit/Lei cause g Issuing Authority(circle one): L.Board ofHealth 2.Buil ding Department 3. City/To-in Clerk 4. Electrical rnrpenlor 5.Plumbing Inspector 5. 0.ther Contact Person: Phone ACORD CERTIFICATE OF LIABILITY INSURANCE w'e lMMvmwmt ‘...^^-- 03/18/2(116 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(los) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain polities may require an endorsement A statement on this certificate does not center rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Leandro GUlmaraes UNIVERSAL INSURANCE AGENCY Arc hie ENI: (508)Tse-9333 FAX EMAIL (wC NO ADDRESS: leandro nunwersalinsagency com 374 BELMONT ST_ vesuRE-SIAFFOROB:GcovERAE NAr_a WORCESTER MA 01604 INSURER A: AIM MUTUAL INS CO 1 33758 INSURED INSURERS: I ALG CONSTRUCTION INC INSURERS: 1 INSURER D: 116 CHAPEL STREET rztaRER E_ _ CHERRY VALLEY MA 01611 INSURER r: I 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. EXQOEIONSS AHD CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. "RI ADDL SUER "' FDLIt',1' F OUST E)G I TYPE OF INSURANCE II - OLICYNIJMBER JMM001YYW.1 IMMooryttl LIMITS �CaNMERGAL6ENE>&LLta3.Litt ( EACHOCCURRENCEIS DAM4 TUR" m CLAIMS-MADE — OCCUR PREMISES1 _ J I $ _..... t MED EXP rAirr one pewool S — NIA 1 PERSONAL ei BOO INJURY $ GENt AGGREGATE LIMIT APPLES PER I •GENERAL AGGREGATE, 5 r POLICY! I JET i LOC PRO)L TS COMP/OP AOG $ II ]OTHER �. I 15. I AUTOMOmLELW80.RY i 'COMBINED SINGLE HMt i . IANY AUTO i 1 BODILY INJURe(Per per I $ (ALL OWIEs f ,SCHEDULED . AUTOS NON-U N/A = !BODILY ROPE INJURY(Perch s E NDNOwNEn PROPERTY DAMAGE y IHIRDA�IU- �AIO I �rEer accident) UMBRELLA Liao 1 OCCUR F ( EAORURR NOE I5 . EXCESS LIAB I OCCCLAIMS.MADE ! N/A AGGREGATE I$ • I OE ' I RETENTION 5 lI 15 IWORKERS COMPENSATION V PER I GTH, I A D EMPLOYERS'LIABILITY YIN] ^ A VYfi EP ePROP a¢. MER/EXC.w..Tv IMA .EL EACH ]t 1,900,000 A O n� e EXCL I NSA WO VW010060199052016A 0311212016 'tZ20tZ ifyes,d ry Np - u s .E EMPLOY=es 1,000,000 DESCRIPTION One OPERATIONS blas E.L.er DISEASE/POLICY bier j s 100000 NIA F . I DESCRIPTION OF opERATIpN51 LOCATIONS 1 VEHICLES IALORD At AaalUonal Remxrks 5_'M1¢tlula may be avacM1ntl if more space is required) Workers"Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 D6 B,no authodtation Is given to pay dawns for benefits to employees in states other than Massachusetts it the insured nines,or has hired those employees outside of Massathusets.. 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 Errs certificate of insurance}. The status of this coerage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www_mass gov/Iwd/workers-compensationlmvest'igations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST AUTHORIZED REPRESENTATIVE er iA HOLYOKE MA 01041 Daniel M.Cro9ey,CPCU,Vice President—Residual Market—WCRIBMA ©1858-2014 ACORD CORPORATION. All rights reserved. ' -""T De 1'64"Al` Thr ACORD name and logo are registered marks of ACORD SEXTO-2 OP ID:ER ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IMMIODPAYYI 07/0112016 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 poiicy(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 bottler in lieu of such endorsement(s). PRODUCER CONTACT Ormsby Insurance Agency Inc. „kXME. Eric Dembinske Eex 698 Westfield St PO Box 718 ace Iso E.u: 413-73T-0300 luc Nm:413.7374617 West Springfield,MA 01090 E-MAIL Eric Dembinske -ADDRESS: • INSURERISI AFFORDING COVERAGE i NAIC Cr Inc. INSURER A,Atlantic Casualty Ins.Co. M suREO Sexton Roofing&Siding,Me INSURER a'.Quincy Mutual Fire Insurance 115067 PO Box 6327 — -- Holyoke,MA01041 -INSURER C I INSURER O: I INSURER E: _ INSURER Fr • 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 /NSR 'IkqDOLLCUBR I dLl OLIGXP PRE 'T'" LTR TYPE OF INSURANCE IWSn4wvo? POLICY NUMBER IMMIDDIYYYYI IIMMNUryYYY) LIMITS A , X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE iS 13000,10)0 D-AD IEU waus+wnE OCCUR 110161002159900 0812512016'06/2SR9R PREML:es/E c5cwa..el .5 100,000 i J __ E EXP IAm,rneP ,cool s 5,000 FPERSONAL A ACV INJURY IS 1,000,000 - nY AGGREGATE LIMIT APPLIES PER'. I GENERAL AGGREGATE 1s 2,000,000 PDLICY -�I LECT I LOC J t{{ PRODUCTS COMP/OP AGO S 2,000,000 I I OTHER: .. I .�-. COMBINED .'JE oSINGLEOMIT £ IAU�TOMOBILE LIABILITY {E MxlNa $ 1,000,tl99 B P ' ANY AUTO I AFV2D6561 105115/2016 05/15/2017 !BODILY INJURY IPer $ AUTOSRED 'Y AUTOS SCHEDULED BODIL INJURY DMAe ¢ f IX wREO AVT as I X YON-0WNE,O PRDP RTV DAMAGE AtRUs 1 rNerpaisZentl 1 E I II IS UMBRELLALIAR I OCCUR ��EACH OCCURRENCE I S I ' EXCESS LIAR I 1 CLAIMS-MANE 1 , I AGGREGATE I $ OED RETENTIONS .... I I ....�.. IWO AND KERS EMPLOYERS LIABTIONILITY i 2R UST' "�. •.. I AND EMPLOYERS 1.1NI STATUTE.� ER ANY PRU%tEMSERsEART EWER CHT/e i MFaCERMEMNH)EXCLUDED? IN(A ) EL EACH ACCIDENT_ 1 S - I(MahtIa PI/411) I E L DISEASE.EA EMPLOYEES yesI If robe under I IDESCRIPTION CIF OPERATIONS rE_.DISEEASE.POLICY LIMITS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional RemaM1I Schedule,may be apache('if more space Is Acquire4I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett SextonACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Eric Dembinske 4)1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD • r LEZ�'` ' ''i rice ,,_ L,- —.._' � i..-r�.SS —ii P--' Di- _ 17nk _ 3LSGS _i CO j' 66 -_1Sic 1 '�2i r 2/15/17 5r aSS TON ROOF:NE CO EVE' is F ?r P -..... M a rusecs c rare • p BJ r o Bpr131»q A pui...uns and S _n„ --"- LitSpse; SL-099589 cps[ro J evia r '-A'acEtEr EVERETTJ SEET I HOL,YOKE MA 01041 _ _ Gomr,lssbpr-r 101E5!2017-^ �/2 17 ' ProSQ,G SEXTON ROOFING AND SIDING INC www.sextonroofing.com .grair MASTER Sating the Standardarro vn►: _�e���` P.O. Box 6327 p. 413.534.1234 Holyoke, MA 01041 f. 413.539.9906 MA HIC# 118239 sextonroofing n,hotmail.com SUBMITTED TO Gina Wyman PHONE I DATE 8-25-16 STREET 20 Middle St JOB NAME Garage,front and but porch CITY,STATE,ZIP Florence,Ma. JOB LOCATION SEXTON ROOFING HEREBY SUBMITSSPECIFICATIONS AND ESTIMATES FOR: GARAGE ROOF I) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed. (52.75 per sq.ft. ) 3) Install new metal edging to rakes and eaves of roof. (8") 4) Install#15 synthetic roofing felt. 5) Install starter shingles on eaves and rakes of roof. 6) Install TKO Architectural style roofing shingles as per manufacturers'specifications. 7) Supply manufactures lifetime warranty and SRC 25 yr. workmanship warranty. FRONT AND BACK PORCH 1) Install%" fiber board,mechanically fastened. 2) Install fully adhered.060 EPDM single ply membrane. 3) Install.019 metal edging and counter flash. 9) Install termination bar to walls and seal. 5) Supply 15 yr. contractor warranty. ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORICMANS-COMPENSATION. WPr 5e'bereby to furnish material and labor—complete in accordance with the above specifications,for the amount of/l Four Thousand Dollars($4,000.00)Payment to be made as folio • e in full upon completion All Material S guaranteed to be as specified. All work to be completed in a Authorized workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only upon wunen olden.and will become an cava charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not respmsttle for water damage duringconsuunion. Owner within(14)days. to oar respmnTk legal kgs for non-payment,and applicable interest.