25A-082 (13) 23 COOLIDGE AVE BP-2018-1058
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-082 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateaory: ROOF BUILDING PERMIT
Permit BP-2018-1058
Project# JS-2018-001910
Est Cost$10400.00
Fee:$40.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(so.ft.): 6621.12 Owner: PACk-ARD JOSEPH JR&GERALDINE
zomrue URB(100)/ Applicant: SEXTON ROOFING CO
AT: 23 COOLIDGE AVE
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01641 ISSUED ON:4/18/2018 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:
FeeTvye: Date Paid: Amount:
Building 4/18/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Buildine Commissioner
APR I T ' g OO F
Depatryalt use on
City of Northampton Status of me
Building Department CurbC sn o
--
�, ,1 212 Main Street Serer/Septic Availability
' l Room 100 WatediVell Availability
Northampton, MA 01060 Two Sets of Structural Plains
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 7 -SITE INFORMATION 60- t
1.1 Property Address_ nThis section to be czariplifed by office
Map 0 Lot Unit
Zone Overlay District
shin St District Ca District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owne�of Record:
�rC� r(A Y,rK✓R/J 2� CoaAe. f .
N/aar�n,(JPnnt) I CurrtM Mwl� Aldtess:
L/L1c� Teleplpne `�8 L/ -( "Z
Sgrature
22.2 Authorized Amat,
2+-k4o..
Wme(Pn Garth Mailing Address-
Signature Telep.
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 4�/V
5.Fire Protection
6. Total=(1 +2+3+4+5) vo Check Number a0c
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature: �'/r$�/0
/� �—
Building Cmn loner/Inspecla d Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Atleration(s) ❑ Roofing
or Doors 0
Accessory Bldg. ❑ Demolition ❑ New signs I01 Desks (D Skiing(0] o#er[Dj
Brief Description of Proposed - 7
Work: /ti-f, .1.-r�'l_�/1�•OCL Fr.c Lr`V� �L.x.� 4 if—.
Alteration of wasting bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.N 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 afta:hed?
d Proposed Square footage of new construction. Dimensions
e- Number of stories?
f Method of treating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance- Masscheck Energy Compliance form altaited?
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 cmdorm to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Pnvate well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, / -rPrr U Ac k Q Q O .as Owner of the subject
prop�y
hereby authonze !-rte ^� �r
to/a/c'tJon m/y behalf,(in alter tt /- ve ro work a rized by this building permit application.
l LAIN rN "' �Z. � , L1//// /
Signatatum of Owner p C nate
f ( XIP/��}T K�✓ ✓IF L as Owner/Authonzed
Agent hereby are that are statements and nfmnnatlon on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the
(nlpains
//and penalties of perjury.
Print NC,
SignaNm of OwneHAgen Dat
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of Liurerre holder: / —//'l/e. 14
q�
License Number
Po ' ).� � 5.5 -7 IL rnl, i!At
Aldres:�> IE pirellan Date
Signature Telephmie
8.Reubtemd Home Improvmnmto, Not Applicable ❑
RegL ' 3 9
C n Name Number
Address
Eviration Date
h�k�� (,�� rA/k Telephone
SECTION 14 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,§M(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...... ❑
City of Northampton
Y
� f Massachusetts
r1ttPAR9ffiVr OF WILDIEV "SPSCPLram
212 l n Street a l cipal Building up�
�\ NorUM1 tw, M 01060 eyh 371^`n
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modemization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-exisb'ng owneroccuped building containing
at least one but not more than four dwelling units.. or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: ' I( Gd t�4_ Est.Cost: /Z -Q
Address of Work: "14- 4r,_.e
Date of Permit Application: qzay (! 3-
r
I hereby certify that
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain):
Building not owneroccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent
��offthe owner: 7
1/4' Y 'Q x to Z'C44 r oY� a Z4L--
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
9. ffiBalfSlrr OF emrw� nrsnsc Xi 3
212 Nein Street onmicipal Building �y
NorVheupt n, M 01060 �`ac
Debris 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.
The debris from construction work being performed at:
P'D L c u /r W,a.2 S i
(Please print house number and street name)
Is to
�be disposed of at:
L:! ( re �i 4O>jt�ab
-ease pont n�arM locatron of faciM1y)
Or will be disposed of in a dumpster onsite rented or leased from:
Ce�o� /�, 3 ,�a,s,��
( ompany Na and Address)
1�`/14k
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
Apr. 11. 2018 8: 27AM No. 0246 P. 1
Vropogal
SEXTON ROOFING AND SIDING INC.
(413) 534-1234P O. Box 6327
FAX (413) 539-9906 Holyoke, MA 01041
selttonroofingfif hotrnail,com CT HIC#0605383
AAA HIC#116239 www.sextonroofing.com
Since 1985
SUBMITTEDTO C MME SO' �Ii DKE
STREET �. xxa NAME
GUY
TE ` ,pB LOCATION
ZIPCODE
Proposal to funsiah and Install the following Ewa-
❑ Re•Roof I�Tear-Oa y- Main House gi�Gatage ❑ Shed
Dornpl"floor Preparation
111gorne exterior to be protected by tarps and plywood
t✓Shrubs,kndscaping,trees to be protected
pr Entire existing roofing material to be removed to existing decking,Including flashing,etc.
Id Site to be cleaned everyday with roll magnet dells removed at project completion
lS Deteriorated existing decking replaced at$2.50 per sq.h
❑ Installalln docking/type.
V whi: ro=tal drip edge Installed at eaves and rakes Aef-B O F-5 ❑ Rake Edge
ave flashing will be installed where necessary(see Special Requiremems)
ll"install new pipe boot Flashing ❑ Bathroom Exhaust Vent
a/Regash chimney with new lead
❑4Vo shall aoqufm all appropriate permits alc.for all mofig work
Complete Roofing System
JKLeak Banner Insteaed at ail nares to protect from Ice dams(ell meet codes in the north) O 3' 51.1'
0✓Leak Benner installed at valleys,around penahations all chimneys to protect critical areas
tY`rMtall Root Deck Underlayment on remainder of roof ❑ 115 FOR �nthatic Fell
Shingles
pe* ❑ GAF O CertainTeed O Tamko / ❑ 30 year ❑ 50 year Ull-fIRWIme Color-
Attic venlgatlon system Wtap ower Rklge Vent O Roof Louvers
Wa qty Options
�/We guarameed our workmanship for 251u11 years
Of 11tbpbat Wr±jy to furnish materlo and labor-complete in accordance with the =tions,for the sum of:
rawwnroaa,ws NvL e✓
N Mawmwewbauamrowepemw Nwamg.msr.twawwgnwwenw,xw Authg20tl
Chang b eYNYe Witlbl MY WMbn M1 Mwna Mn 10C<yMubn YMM9
m.mwwna.,emaea tab wm wwnades,wwwaemrenwm eros w S ,,s
men.ernrNaaemnawrroi+wensa.+.cennaaawM'amwmnm. NW.TnNOrtW+N nmY4
bktwma1w,ereonew brwwamraw Ngo 4vmmaOMib bpw,eepwude YPl waeb yginyyaa ayuaMmplatl Nora, dM.
dl� M1ba.
9ntilanaa at ffap"d-The above prices,apecdcaliaw and odAWS Sgvlure
are xpelacbry all are hereby aompled.You we mfiwrbed to do eve /
work as specified.Pat+nem"I be made as ouwrwd above.
Dave d� slpwwre
ATTENTr0N HOMEOWNERS:Pi.wvw as pwaorm De"ings In Ne e111o,Swage or ebraee erNe dW W IN posswlliky d roolNg&V.or duel
corning in mmasn Ina ttacys of tc wood. Swten Reeang and aitli�g will rwl tie resporwaM(or dee.ls or pion M Vw avic or elonpe arwc_
� Z\- ComrJwni'ieaZth oflflassnchxese� '.
1)epu�tmeni oflttdustrialAccidenir
- . Ojjzce of Jnves�Yg�:ans .
1Congrars Street, suite l0d
- Bostm,_AfA021774-2017
Y✓N^.'1.'I sI goy/re .. .
Workers' Comp'cns?tion 7nsotance9�l,�vit:B�lders/Coatr�ctora/�lectricia�c/Pl'anb ers
ylia2nt73forma{ion. Please_PrLlt Leel'b�
Nle ga mesp ga � m ): Sexton Roofing & Siding Inc
A_dLess: P ._0.. Bos 6327
City/Stai=..✓7jp: Holyoke, MA 01041 Pha=en. 413-534-1334
9re pats an emploperP ChecL=the appropriateboa: - 'lppe oEprojed(regnirel4);
1.❑I am a er�yloyer 4. ❑® I an ageae[alon4acr�aI . ,6. ❑17ew cons'cawaa .
employees (mIla�orpaxtne)= have h'hed4uasaL-conaacima
IE] Iso xaoleprapi¢or ospaYser-- . listed antte atrched sheet 7. ❑12mnod-lag .
sLjp andYraye no employees nice.srl' a +,-+�'haye• $.'❑Dcmolition .
Prig for mein saY oapB y.• �P�7'eu acorpx
M11 31.7.Wa tax' 9. []'Bu addition .
[17o vrark:cs' camp.mscsance comp:.insurffice.2 -
reqased] 5. ❑ We are abo M&Y,s 10.❑Electocallspafis or a3aiEm
3,❑I.ahome ,a cr domg x11 Work ofice_`s.Late esercised$leir 1L❑Phft b giepass =AHU s -
eti owoll=' cOmp. > of exealptioap¢MGL � ❑ xep
msrsmce rreps d]i C. 152:§1(4), mdWebagem a moi asx
- emplayacs. [Nopgodzts' 73.❑ Oth¢ -
c :+�saancc regtse3] _ .
,°A YaoP�mtmt eh�L�#Sma+talm.n"2 out§r.mcti�belnWs�Smeiw¢ken=ovmpwsdionpobcy':.rm...,:�
1H®4mmcnwbc sdewt4 r,<::mai abn,.mcyac domgaRw�mdthmhm oomdc co�acDasnms2mtffic a➢cx',cffidaYLmdwa:mgeuh
#Ce¢traeSaa Pont check'mab¢cnmst�chedmaddilirnilshcdzbawmgtacnmcvfztc mbcvdacMn mIls�e wnc�i ccmndIDme mtiticsbapc
e¢pleyeet.7E$e rub-cmtzevae'b?vc caW]cy�R�]�YPde Poets wo3xo'eosp.PohuS'n®bcc
I am an employer Otat tir ppvidmgw�gerY campm.re�tt m.rraaxcejorttry errtplvyee,v, BeivW v'Jiepolicy cad jab sde. .
'Lnsrnmce Ca�pffip Noma: ' .
7eb Sit Address C1ty/S'a31zi2:'f'f'z
LU, 01 a copy ofatWOj3:M3 compmsatson policy declarxtionp age (sho"�'g 3e poLcpnnmber and ezpiva:ion date).
Fmlact to secure coyerage m regale miler S.cbca 25-LofNiM e.152 emleaflmZ .irT.syrion of.®ioalpmatt;_as ofa
fse tip to. 1,500.00�d/orme-years!ptisa�enY, as WcIl as e_'rytlpmeltiesm�efi
of a STOP WORT ORDP.P.and ajhe
ofnp to WO,00 a day aahs. He adiii'scd�i x copy oiEais st=.temeot11V be iax7ELdtato Duca of
l�vesLigatirn�s oinieDIA_fns fnsma-co coverage vmiicuiom .
I da hereby coiify adder flr.epefpejwy foal Ole informo:ionproyid oyeubu'm�d corrzri
54eaaiee' z �'-- Date
Phaac# 4135341234 -
OfjScinlrobe only. 'Do nui w ffa m this men,in be colrp_ld d by may'or ofjsdul
. GSip nr Town: .Permi7License fi .
Issuing Authority(cute one):
1.Board of%ea1tli2.3aiidingDep artmmt3.Citp7ToR Clerk 4.Electricallnspectac S.Phambing lvapecfnr'
6.Other
Conh.rtP erson: Phone fi.
DA,rtu
The Commanwealth of Massachusetts
Department oflndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information
Please Print Le 'b
NmeBmires/OTg; oowtadiridual): 3 1
Address: 1LD WTerLNp� /
n I I G
City/State/Zip: ffl� J�OCd , M461 ., Phone#:
Arree you an employer?Check the pproprfate bon Type of prn]ect(required):
L[ tam a employer with � 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).• have hired the sub-contactors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees 'Deese sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers' 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 thea 11.El plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]i c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required]
•Any applicant that checks bon#1 must also 511 out the section below showag thew workers'compensaboo policy information.
t Homeowners who submit this affidavit indicating die,are doing all work ond(hm hive outside contractors must submit grew affidavit indicating suet.
tCotmactors that check this box must auoc an additional sheet showing the name afihe subcontractors and slate whether orrat those entities have
employees. Uf a sub-wotracmm have employees,mey mart providefie'v workers'wrap.polity number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she
information.
Insurance Company Name: X00r
Policy#or Self-ins.Lic.#. ��I')' / U—�— 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 ofthis statement maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
Ido hereby ce ' unde the pains and penalties ofperjury that the information provided above is true and correct
L.
Sgn n Date
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Toxo: 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#:
t,7�1 L/110
s►o® CERTIFICATE OF LIABILITY INSURANCE1 °0246201°8
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 INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the poliglies)must have ADDITIONAL INSURED provisions or be endorsed.
H SUBROGATION IS WANED,sub)eetto the terms and conditions of the policy,certain policies may require an endorsement, A statement en
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER °mEA- ISABELE CORDEIRO
NAME:
Br0.zway Insurance pxoxE .978-0555991 FAA N,:978-055-9934
345 Main St Unit B1 EDU�L ,inf rdzxg9 imumnceagency.com
Tewksbury MA 01876 ensu AFORemGCOVe m. xacr
11URERA:ATLANTIC CASUALTY INS CO
seas. HHURER B:ACE AMERICAN
PJS SUPERIOR CONSTRUCTION INC
MSURERC:
66 WATER ST APT A msUBER D:
MILFORD MA 01757 mwREa 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 CONDMONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OFINSUMNCE ,N Lwyep� POUCYNUMBER =M
P06M � UNTIE
COMMFACWLGENEMLWBIUTY EACR DccLmRENCE 52,000,000
cLAIMSM40E O CCCUR PREM SES Es emurenre $100,000
MED FIT IAnY me perem) $$,000
A L117002783 03108/2017 031OW2018 pERSOMLaAov INNRY $1,000,000
GENLAGGREGATELIWTAPPLIESPER: GENEMLAGGREWTE 52,000,ODO
PIXICY�jEo- ❑LOC --UOTE-COMP/OPAGG $2,000,000
O ER: r
AUTOMO&LEUABNnY CEOMB�I� SINGLE LIMn $
ANY ADTO BODILY IWURY(Per Ea—) $
OWNED SCNEDDLEO somLr lNNRv(PnartlEmry i
HUFOS ONLY AUTOS
RED NAONAWNE° PROP TYDPMAGE f
AUTOS ONLY AUTOS ONLY Pve¢I.
UMOXELLAW CCCUR EACH OCCURRENCE S
R Ess Me CWMSIMDE AGGREGATE S
OED RETENNONE S
W°RNERSC°MPENSATON ✓ BRINE O�TH-
B AND EMPLOYes UABWTT YIN
oFYPEOCRIETioBER'Axculo 0 E. caw 6S62USSH25120-2-17 DW02f2017 08/028018 ELEACHAccmENT $1,000,000
(ManEabry In so EL DISEASE-MEMPLOYE S1,000,ODD
rcya.a
DESCRIwasPOON OF OPERATIONS oeiw ELDISFASE-POUCYUMIT $1,000,000
0
OFSCMPn°N OFOPEAAn°NSILDCATN)NSI VENBAFS(ACAROLW.Aa6b,w Rnnartr s MLib,may MatlaRban amore spamwraquircGI
CARPENTRYIROOFINGISIOINGIPAINTING.
CERTIFICATE HOLDER CANCELLATION
SEXTON ROOFING&SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
102 PINE ST-PO BOX 6327 - THE E IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WON THE POLICY PROVISIONS.
HOLYOKE MA 01041
SEXTONROOFING@HOTMAILCOM AUTIIOR®REPRESENI
®1988-2015 ACCORD CORPORATION. All rights reserved.
ACCORD 25(2016/03) The ACORD name and logo are registered marks ofACORD
Pr,Ou¢E using F,maB,ss Web S,Awa2 vA—FwmsB,csc,m(c)"Pm C-PuCYshes a00.1W-19D
.a`coao CERTIFICATE OF LIABILITY INSURANCE DATE WZM011
HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
ENDS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHD
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT:It the certificate holder Is an ADDITIONAL INSURED,We policy(his)..at be endorsed.If SUBROGATION IS WANED,subject to Ne
orms and conditions of the policy, coram policies may nquln an enOGnemenL A statement on this CeNOwte does not wa(.F HIM,to Ills
artlBmte holder in lieu of au.N end.1 ement(e).
PRODUCER CONTACT NAMEAtal Hutchinson
Oresbylnsuranc.Agency,I.F. PHONEIAIL.No,E ht4ll F7HB000 1 FES(AIC,No):
PO Box 718 E-MAIL ADDRESS:chufl.minsamatumsbylim.com
West SpdnglblL,MA 01089 INSURERS AFFORDING COVERAGE NAICe
INSURED INSURER A:COLD,lmumsa Co.,-, 3999S
series RooMp and Sidln1 m: INSURER B:
PO Box B)xir INSURER C:
Xolycl e,MA 0104133x7 INSURER O:
INSURER E:
WSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSVMNCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEUMOVE FOR THE POLICY PEWOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY OONTFUCT OR OTHER DOCUMENT WITH RESPECT TO WMCH 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 NAY HAVE BEEN REDUCED BY PAID CI-AMS
POL¢YEFF POLICY ESP
MS OT eUse DATE DATA
1Tq NPEOFINSURANCE NSRO AND POLICY NUMBER Mean" N.V. UNITS
A X-1 COMMERCIAL GENERAL LIABILITY 101PNO00715503 SG-5D17 6GS2OI8" EACHCCCURRENCE 51,00. .000 .
CLAIMS MAGE % OCCUR DAMAGE TO RENTED S1OODOO
PREMISES Ea Qcwnenu
MED E%P(Any one persm) S5.000
PERSONAL S NOV INJURY 51.000.000
ENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE C.00OOW
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OTXER:
COMBINED SIGNED LIMIT S
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DESCRIPTION OF OPERATIONSbeaws ELOISEASE-POUCYLIMIT E
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ALOg01%.AEJIN-1 P—rNe SFMeuly 11—1—1—lF slumd,
CERTIFICATE HOLDER - CANCELLATION
TOM"GIAmnerst
SHOULD ANY DFTHE
LLINEABOVE OIVERED IN POLICIES
ORTANECANCELLED BEFORE THE
IDENS.EXPIRATION DATE
TIEREOF.NOTLE WILL BE DELIVERED IN ACLOROAXLE WffN THE POLICYPROVI51OX5.
AUUJT�H0/RIIZ�EDREPRESENTATIVE
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AL0RD 25(x0111111) , - - 01988-3014 AC0R0 CORPORATION.All rights reserved.
The ACORD name and logo are rsgleUrod marks of ACORD
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type. CoWra tori
Registration:. 116239
SEXTON ROOFING & Siding Inc Expiration: 02/14/2019
P.O. Box 6327
Holyoke, MA 01041
Update Address andretum card Mark mon forchan9a,
- - ^�-^+•••^� ^ �mMmmenr �f nzs ra.d
Qorram-nw aghpr Maasachusetts
j Orvision of Professional LicenSure
Board of 8uildiny Regulations arta sfacrards
Constructipc:slip4i$spr Specialty
CSSL-0946&9 `9., ��ires: 1010312019
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EVERETt'JSE](i'ON +- Y
PO BOII 03U!
HOLYOKE MA Ut041 J'
Commissioner
CONNECTICUTSTATE OF
HOME IMPROVEMENT CONTRACTOR
EVERETT J SEXTON SR
102 Pine Si
HOLYOKE,MA 01040-2411
SEXTON ROOFING&SIDING CO _
LIG_efl N _ E ETN T"XP! E
H3C..0605383 T2// 0112017 11/30/2018
SIGNED __..-'�.(._'-`�__-