24C-094 (3) 63 MASSASOIT ST BP-2018-1041
GIS# COMMONWEALTH OF MASSACHUSETTS
Map.Block:24C-094 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categom ROOF BUILDING PERMIT
Permit BP-2018-1041
Project JS-2018-001893
Est. Cost:$14600.00
Fee $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor., License:
Use Group SEXTON ROOFING CO 99689
Lot Size(sa. ft.): 6098.40 Owner: MARSTON JOHN
Zoning_ URB(100E Applicant: SEXTON ROOFING CO
AT.- 63 MASSASOIT ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON:411 712 01 8 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: O_1: 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:
FeeTvpe: Date Paid: Amount:
Building 4/17/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
ti of Orthampton status of Permit Department use only
Bu i in Department Curb cWDrrvexay Pemit
Jr 11As,�°2M2 ain Street Sewer/SepticAvanedly
I oom 100 Water/Well Avalabil'ay
Northampton, MA 01060 Two Sets of Sbuchiral Pians
phone 413-587-1240 Fax 413-587-1272 piousae Plans
OHM Specify
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMIONAT6P- ( g _ to r
1.1 ProoeKy Address: This section to be completed by OHM
&S �A0.550`DQty :3+ Map 4qc- Lot 0911 Una
fJ�)e� h a pion, rn a 0 i o Zone Overlay Distric
Elm SL Distritt Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
John rnar5t0n
Name(Pant) Current Mailing Adtlress:
Tea - 9a3—O o4(�
Bigretu2
ephoae
22 Authorized Anent:
£Ino lite - �c 76ox !23oq k)We4 "A ologg
Name(Pan Conan Mailing MHress:
yL�- 53U-I��U
Signialwe Teleplwrw.
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
ownpleted by penndapplicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3, Plumbing Building Penna Fee
4. Mechanical(HVAC) /
5.Fire Protection
6. Total=(1 +2.3-4+5) 15 tz,()0 Check Number /Q'Q'.I
This Section For Official Use Only
Building Permit Number. Date
Issued'
Signature:
euiUing ionerllnspectur of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Or Doors ntOmdows AKendion(s) ❑ Roofing
Accessory Bldg. ❑ Demolition ❑ New signs II71 Decks IQ Siding[p] Otherld]
Brief Des 'ption of Proposed
Work: rYt n� I I e (o(A-
Alleranon of ensfinlg bedroom_Yes_No new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rail -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 a roily unit: Number of Bathrooms%
c- Is there a garageattached?
d. Proposed Square footage of new cons ction. Dimensions
e. Number of stories?
f Method of treating? Fireplaces or Woodstoves Number of each_
g. Energy Conservation Compliance. Energy Compliance form atlached9
h. Type of construction
i. Is construction within 100 fl. tlards7 Yes —NO
Is ce tructton within 100 yr. floodplain_Ves No
j. Depth of basemen or lar floor below finishad grade
k- Will building m rm to the Building and Zoning regulations? Yes No.
I. Septic Tank CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZAT10N-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
NT
I, _)nh)� 1 1 (�r S+o n as Owner at the gorged
property
herebyauha a �0/ dL �( fl � . 1(X ILL CI
to act on my in all matters relative to work aorized by this permit application.
,�L� w h J 000rla(
Signature of Dimer Date
I, L Scxit)q J CY1 U nqo ()_�l4 Q'� A pcq as Owner/Authorized
Agent hereby declare that the statements and information the foregwrigapplication are true and accurate,to the best of my knowledge
and belief
Signed under the pains antl penalties
of perjury.
r
Print Name
1/9/a
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Constmch Ser mw: Not/Applicable ❑
Name of Licaree holder: LaP/P� i- .SPX�/ / 7/od`�
Luxrise Number
?0 4hk
Address J E�kation Date
Signeture Telephone
9.Re Istwed Horrre Improvement Cann-&ctwNot Applicable ❑
Cmpanv Name Registration Number
!0 iho lP3a� 44/1 ti/4 ur04
Atltlress E>�irason Date
Telephone S ,, /o
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§25C(S))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to prwide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes...._ No...... ❑
_ City of Northampton
Massachusetts
)_ ISPaBSlffiiT OF BUZWO ZBBPBCTZOBB 2
212 Nain street m Nuninipel auilaing C�
Northampton, FA 01060
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 most be registered as a Home Improvement Contractor("HIC").
M.C.L. Chapter 142A requires that the"reconstruction,attention,renovation, repair, modernization, conversion,
impmvement, removal, demolition, or construction of an addition to any pre-axisbng owneroccupied building containing
at least one but not more than lourdwelling units....orto structures which are adjacerd to such residence orbuddirxj'be
done by registered contractors.
Note.djthe homeopwner has contracted with a corporation or LLC,that entity most be registered.
Type ofWork: hI_'Ofld(y p Es/t.,Cost
Address of Work: �3 �L�.S�5/)l
Date of Permit Application:
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 of the owner:
- aP "? �i ���ne a./i, -Le. // 239
Date Cont 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
- MdS98Ctn180LL9
s
1. DEPdR� of B!lII.DIHG Z8aP8LTlnaa �
212 Main Street 0 M cipa Building 206
B.rNA ton, MA 01060 'h1 Y'1\^aCe
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:
l
OY -5as�')/ -- 1
(Please print house number and street name)
Is to be disposed of at:// // // !-n �7
(Please print name and locJon of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
MJ/Ir P_J�/S0 /So� /�/) 04,
—�
(Company Name and Address) (J
4�f��
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.
SEXTON ROOFING AND SIDING INC
www.sextonroofine.com
OffO WMASMR
_
Setting the Standard
P.O. Box 6327
p. 413,534.1234 Holyoke, MA 01041
L 413.539.9906
MA HIC# 118239
sextonroofing@hotmail.com
SIRIMDTEDTO O 2S �j PHONE to- qd - GG46 DATE 5/26/17
STREET W Massasoit St JOB NAME
CITY,STATE,ZIP Nordwoptoe,Ma. IOH LOCATION
SEXTON ROOFING BEREHY SUBMITSSPE.CIFICATIONS AND ESTIMATES FOR:
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Inspect roofing deck and replace as needed @$70.00 per sheet. (Add$4,000.00 for an new)
3) Install new metal edging to rakes and eaves of roof. (8")
4) histall ice and water shield on eaves(60), vent stacks, in valleys, chimney,skylights, and at intersecting
roofs.
5) Install#15 synthetic roofing felt on remainder of roof.
6) Install r flanges over existing vent stacks.
7) Install starter shingles on eaves and rakes of roof.
8) Install IKO Architectural style roofing shingles as per manufacturers'specifications.
9) Reflash chimney with new lead flashing.
10)Install new cap over ridge vent.
11)Supply manufactures Lifetime warranty and SRC 25 yr.workmanship warranty.
ALL CONTRACTS INSURED WITH PROPERTY LIAEHAYY AND WORKMANS-COMPENSATION.
Wb P4ow hereby to boorish material and labor-complete in accordance with the abov specifications,for the amount of
Fourteen Thousand Six Hundred Dollars($14,600.00)Pa cuts to be made as£ s:Due in full upon completion
AllMomii]is guaramaA w be as specified. All work to be.,low iv a Authorized
wortrnmlike manner according to standard precnr . Any altvation or Signature
from above spedficatiom involving extra costs will be executed only
upon wrutrn miler ,aril volt become m extra ctwge over and above the
adnate. All agrezmrnte eootiogeut W.strita,arndenrs or octan beyond Note:This proposal may be withdrawn by m if not accepted
orrcontml. No[r pomible for water damage during mnmuctiov. Owner, within(14)days.
W a ie trial fees tin inn-parrrra,soil aophabie mterat.
AhaglLr 4 The above prices,specifications and
conditions are satisfactory and are hereby accepted. You are Signature
authorized to the work as specified. Payment will be made as Signature
outlined above. ^ � p
DateofAcc /[]/
nce. `t 7 O
aaT30 '9
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The Commonwealth ofMassachuseus
Department oflndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dna
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Q Please Print Le ibl
Name(Business/Org.,aatam,,vdivid mt: I l.J ]
Address. up 009 efa , np� fy ' I c�
City/State/Zip: � A 6 � Phone#: � Iry' —O
Are you an employer?Check the ppropriate boa: - Type of project(required):
L fq 1 am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).- have hired the sub-contractors 6. ❑New construction
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 for me many capacity. employees and have workers' q. ❑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.E]Plumbing repairs or additions
myself.[No workers' comp. right of exemption per MGL 12❑Roof repairs
insurance required]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑Other
comp.insurance required]
,
Ary applicmlthat checks box#1must also 511 ora the s.fi.below showing Ne'm workers compeaub.policy imformmom.
t Homeowners who submit this adi liAt indicating they are doing all work and Nrn hire outside contactors must submit anew affidavit indicating such.
*Contractors that check this box must attached rat additional sheet showing thename of Ne subcmilass as and state whether or mu Nose entities have
employees. Ifthe subcontractors have employees,Ney mustpmvide Ne'u workers'comp.polity number.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site
Information-
Insurance
nformati02 (nJ r,n/�
Insurance Company Name: Q- Ir �Mo ]l'm —_
Policy#or Self-ins.Lic.#: tI,V �.� ' pt:lU-�- I Expiration Date: �'- 0 C o
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 imprisons em,aswell as civil penalties in the form of a STOP WORK ORDER and a fine
ofup to$25000a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby ce un de thepains andpenalCies ofperjury that the information providedabove is true and correct
L-
Simature:- Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permlt/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#:
IJ^Vo0
<►o® CERTIFICATE OF LIABILITY INSURANCE oy'nr20018
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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to Me turner and conditions of the policy,certain policies may require an entlorsemeM. A statement on
this certiFcate does not confer rights to the cerOFrate holder in lieu of such endorsemerd(s).
PRODUCER coNE:mer ISABELE CORDEIRO
NP
Brezway InsurancePxoNE .g7g-0555991 P"X NO,978155-9934
345 Main St Unit B1 p-BMAI�:info@bra2Yra insumnceagenc .com
Tewksbury MA 01876 INSu AnLRDINGCOVERAGE xAx:a
INsnRERA:ATLANTIC CASUALTY INS CO
INSume mSURBR..ACE AMERICAN
PJS SUPERIOR CONSTRUCTION INC
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66 WATER ST APT A INSUsuREao
MILFORD MA 01757 LYSURFRE:
INSURERF:
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,
IXC W SIGNS AND CONDITIONS OF SUCH POLICIES.DMU-S SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS-
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Lm POUCYNUMBER M UCYEFF MMOYEEP Uwm
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✓ COMMERCIFLGENERA1-OAoM LJH EACROCCURRENCE 5 2,000,000
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GENLAGGREGATELIMnMPLIESPM GENERN.AGGREGATE $2,000,000
✓ POLIcv��E T [:]LOC PNODOCTs-comproP AGG s 2,000,000
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CARPENTRYIROOFINGISIDINGIPAINTNG.
CERTIFICATE HOLDER CANCELLATION
SEXTON ROOFING&SIDING INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI 190 BEFORE
102 PINE ST-PO BOX 6327 THE EEPIIUTION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
HOLYOKE MA 01041
SEXTONROOFING@HOTMAILCOM Alrmoal�DREPaESExrATrvE
C 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Peoatee ssmREol„s Boss w.n sonn w....Eonkeoss.�Iq Inprtssive ww:nlrg eooaoslsT
a`co�FzoCERTIFICATE OF LIABILITY INSURANCE DATE vzenon
HIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THE
ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,MEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW
HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZE
EPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER
MPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pD11,(hm)..at be eInformed.If SUBROGATION IS WANED,subject to fh
marm and —dltlom of Us pollry, certain F.H.1 a may mgOlm an endonemenL A smoment an this CetllOwte does not confer HERE 10 tlm
er[IRcate bolder in hou of such endomement(s).
PRODUCER CONTACT NAMF:Natnl Hutchlnson
Ormsby Insurance Agoney,Inc. PHONE VAGNo EM:t113RIIa]oo ]FAX( CTND:
POBOe T18 - CNAILADDRESS:kinechimon®emmylns.eom
West Spdngneld,MA 01089 INSURERS AFFORDING COVERAGE NAICJ
INSURED INSURER A:Colony lnsuracm CompanySees,
..mm Rood,and Slding Inc INSURER B:
PO Boz 832T INSURER C:
HolyoIm.MA 01041EET INSURER D:
INSURER E
INSURER R
COVERAGES CERTIFICATE NUMBER: - REVISION NUMBER:
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LUSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REOVIREMENT.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 05SCRISED HEREIN IS SUBJECT TO ALL THE TERMS,
E%CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C1AIM5
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UTOMOBILE LIASIL (Ea aco enl)
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AUTOS AVTOS - Indent)
HIREOAVTOS HNON-OWNED ROPERTY DAMAGE 5 a
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per Tsmm)
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MBRELLA LIAB NR ACHOCCURRENCE S
CESS LIAB 'IMS MADE GGREGATE 5
ED TEMIONS S
WORKERS COMPERSA71DNAND PER H _
EMPLOYEROUABILITY YM STATUTE - ER
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DESDRIPTIONCFOPERATIONSMkw I EL DISEASE m POLICY LIMIT 5
DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES NCONO I.,AOYIIIanal R—Im SCMdula,Ilmam apw 6 r,wra)
CERTIFICATE HOLDER CANCELLATION
Town of Amnersl
THEREOF,
ANY OOFTHE ABOVE
UVERNEDESCRIBED POLICIES
ONDANCE WITH HEOBEFORE THE ROYMOPIRATIOX DATE
1XEtlEDF,XO110E WILL BE DELIVERED INACLOPOANLE WITH THE POLICY PgoVR10X5.
AUTHORIZ'E'DREPRESENTATIVE
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ACERB 25(2014101) - 01988-2014 ACORD CORPORATION.All ri,iftemserVed.
The ACORD name and logo am reglammd marks of ACERB
r'fjr� `(rn/ilTrroi/ronri�/� r��C-'�/�n,l.tn��ct,le�f,1
_ Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Horne Improvement Contractor Registration
Type: Corporation
SEXTON ROOFING &Sidin Inc Registration: 118289
g F�xpiraGation: 02/14/2019
P.O. Box 6327
Holyoke, MA 01041
Update Address and retum card. Markreason for change.
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Conanonwea)th of Massachusetts--�'
l®j Division of Professional Licensure
Board of Building Reguialions and Sfan,ardx
Constructiop.�uUj6jAor Specialty
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CSSC-099669 _ F>;�plres;1010512019
EVEREiTJSEI(TOPI _
HOLYOKE MA 61041i "-
STATE OF CONNECTICUT i
Commissioner t/'w ��f"�
DEP4RTMENTOF
HOME IMPROVEMENT CONTRACTOR
EVERETT J SEXTON SR
102 Pine St
HOLYOKE,MA 01040-2411
SEXTON ROOFING&SIDING CO
Li ./REG 0. FEL E PIF
HIC.0605383 12/ II130120I8
SIGNcb