18C-004 726 BRIDGE RD BP-2018-1089
GIS a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 18C-004 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catewrv:ROOF BUILDING PERMIT
Permittt BP-2018-1089
Proiectk JS-2018-001963
Est. Cost: $9400.00
Fee: 540.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sg.ft.): 18730.80 Owner: KEYER GERALD W&DEBORAH HALL
Zoning:RI(100)/RR(100)/ Applicant. SEXTON ROOFING CO
AT. 726 BRIDGE RD
Applicant Address: Phone: Insurance: -
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.412512018 0:00.00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ON MAIN 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 4 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:
FeeTvpe: Date Paid: Amount:
Building 4/25/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
r
APR 2 3Department only,
Cty Northampton Status of Permit;r.,aeansc=cn.. ildi g Department Cwt CuUDriveway Parril
r� FaTrcN.n�Acrca MainStreet SeverlSephic Availability
'I. Room 100 WaterMell Availability
r` Northampton, MA 01060 Two Sets of Sbys
uctursl Plains
phone 413-587-1240 Fax 413-587-1272 plovsde Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISHA..,,ONE OR TWOFAMILYDWELLING
SECTION 1 -SITE INFORMATION
1.1 Pronertv Address- This section to be compl�ple((ted by office
74G �JA t '4v- 1z MapLot 0-0q rut
Zone Overlay Disfflct
Elm SL DisMct La District
SECTION 2-PROPERTY OWNERSHIPIAUTHOWZED AGENT
2.1 Owner of Record
�D_•6/ry L1-o-1( 72f.
CunAdd
�LPt.l.. LJot,'(l.wp-1-w WK
Name(Pont) ent Mailing Add
s*�l- .c
l'Ln•('Y�C'I- ti� .4+��� Telephone
Signature
2.2 Authorized Acent: p L
S eY�i}� QOarLuTIJ /r.T f• [ V . LiQ s .211 fA-(t(�r't . AA4 I-
Cu"m Maiivg Address:
1Lf3 53yf -'q
Sigrauue Teleplwne
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by penmit applicant
1. Building (a)Building Pemift Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee u
4. Mechanical(HVAC) �P
5.Fire Protection
6, Total=(1 +2+3+4+5) Check Number
This Section For Oficial Use Only
Building Permit Number. Date
Issued:
Signa e: /
Building issionedlnspe wof Buildings Bate
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S DESCRIPTION OF PROPOSED WORK(check all applicablel
New Nouse ❑ Addition ❑ Reptacemenl Windows I Alleva".) ❑ Roofing �—
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0) Decks M Siding[Ol Omer[pJ
Brief Description of Proposed
Work &414" w( 0. 11filauji., TZVOr-
Alterstion 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 Ba s
c. Is there a garage attached'
d. Proposed Square foow tage of neconsim or
Dimensions
e. Number of stories,
f Method of heating? Fireplaces or Woodstcves Number W each
g. Energy Conservation Compliance. Masschedd Energy Compliance form absented?
It. Type of construction
L Is construction within 1 .of wetlands? Yes Is construction within 100 yr. floodplain Ves No
j. Depth of basement or cellar floor below finished grade
k. Will building mnfonn to the Building and Zoning regulations? No
I. Septic Tank CitvSe%,i Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS
�1AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I•- lA` "�'�� as Owner of the subject
property
hereby authorize vtq Fwnzt lj ria h
to act on my behalf.In all matters relabve to work autled by this bu ding permit application.
Sgna�ure of(O�wner I� � II �� �//l����� n pate /
I, �f� � ?oU l�.n.[J6(✓IL 1 �1 A'[ .2s) }-f .as Owner/Authorized
Agent hereby declare that the statements and informatio,mon the faregolrg are trod and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
&l (AEl
Print Nam
4l�is�iP
Signa of O,worlAgeM Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License ttetEer: EVE 19-4 S.SEot-rata "ffq
License Number
P-0-60OK ' A nob'41' iu - t- /4
AEE
Expiration Date
a/�on 2aV 241 f
Signature Teletdime
9.Registered Nene Improvement Contractor: Not Applicable ❑
S�I-la,.. 2puC w.� A- S. .f t A,, .f ..- It F Y T. 4
Comoanv Name Registration Number
P0 , ebJL , 2 - ,s
Address Expiration Date
�1a yo Telephone 5'3Y/L'S 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 building permit.
Signed Affidaw Attached Yes....... <Y No...... ❑
i
City of Northampton
Massachusetts Ads °pr
rERananrx or sozrusPc ursescarats �.
212 Main sT.reat a [9mic 1 auiid ng
sortksis,ton, M 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 must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any preoxisbng ownenacarpied building containing
at least one but net more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:ljthe homeowner has contracted with a corporation or LLC,that!entity must be registered
Type of Work: R_ LOCI"If
Est.Cost: ?4 A(do
Address of Work: 79' 69,o4L— Si -
Date of Permit Application: e!//klt f
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:
*1l 000C tw a S1 dr y LYS !! P 31•
Date Contractor N e 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 •�s`p '' �,c�i
{ 1 ARD15P1' OF Bu:rw O I ZCTIOBS
212 thin street .Municipal Bonding
xztha t., M 01060
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:
7�Ge �o
(Please print house n ben and street name)
Is to be disposed of at:
11 gI" 0rgnayaA
lease print names location of facility)
Or
will be disposed of in a dumpster onsite rented or leased from:
IO.KO�G� DtSlouSbL ..�-
oompany Name d Address)
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.
�ro�o�ai
SEXTON ROOFING AND SIDING INC.
(413) 534-1234 P.Q. Box 6327
FAX (413) 539-9906 Holyoke, MA 01041
sextonroofing@hotmail.com Aft CT HIC#0605383
MA HIC#118239 www.sextonroofinq.com
Since 1985
SUBMITTEDTO / PHONE — 6 WE
FEET "NAME
GIN
STATE ZIPCODE OR LOCATION
proposal to burnish
and install the following EMAa
❑ Re-Roof V Tear-Off & FMain House ❑ Garage ❑ Shed
Complete Roof Preparation
Home exterior to be protected by tarps and plywood
&K Shrubs,landscaping,trees to be protected
21"' Entire existing roofing material to be nmroved to existing deciding,Including flashing,etc.
g(/Site to be cleaned everyday with roll magnet debris removed at project completion
Y Deteriorated existing declung replaced at$2.50 per sq.ft
❑ Install all hit new deciding/type:
u.
MWn metal drip edge installed at eaves and rakes ❑ F-8 ❑ F-5 ❑ Rake Edge
ZfNew flashing Will be installed where necessary(see Special Requirements)
Install new pipe boot flashing O Bathroom Exhaust Vent
tp (heflash chimney with new lead
q-�We shall acquire all appropriate permits etc.for all roofing Work
Complete Roofing System
Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the norm) ❑ 3' ld'h,-
�' ak Barrer installed at valleys,around penetrations and chimneys to protect critical areas
Install Roof Deck Underlayment on remainder of roof ❑ #15 Felt ❑ Synthetic Felt
Sh/inyles (�
' IKO ❑ GAF ❑ CertainTeed ❑ Tamko / ❑ 3o year ❑ 5o year a/Ldefirre Color /
wa lnstall Attic ventilation system ❑ Cap over Ridge Vent IYRoof Louvers
Warranty Options
w4ft guaranteed our workmanship for 25 full years
i�r�[op05[hereby to furni material and labor-complete in accordance with the °ve tions,for the sum of
m eEcar 4&10�
/1 dollars($
AN MebdolppbrMea]bbeaz;edl'p].Ab xwkbbmnpkbJin e'awWradie Haupt Autbo zed
aaalmrg b sdriCaN Pavy ay NMutidi rc dwimpi firm aMc�etira'etiwq amN9 Com,.,
min his vM Ea YLaKtl tl'NM'niOn ubi;atl YEeWnpmm4e CW9e vs mb �y`etre
aooueupaztimep.
NdraWrsMf%walwgwnwikwidgwmn Wsnmil¢Ps.anma'bbiblWwdpN�ryds�lppK kbgodwkasxsbMd.
Nodte:Tahki pmupsosaldmaaybep
i
nat'� ow. days.
Fk�
of jkvpos 1-The above prices,speci(rations and corltlitiodrclory arM are hereby accepted.Vou are atMprized to do the
ecified.Payment will lit made he outlined above.
b,� Signature
ATTENTION HOMEOWNERS:Please cover all personal belongings in the alllc.garage or storage areas due to the possibility of roofing debris or dust
coming in through die craole of the wood Sexton Hoofing and Siding will not he responsible for debris or dust in the attic or slomge areas.
�� ,fie Cam'rnoniueaZth aj Nlassachuset`s -. - _
dlep m.ent oflndw�-rialAcciZMt
wj
" . 70�ce aj 1-rzyertig¢tions _ .
' 1Congress Street, Sade I00
Boston,IL4NL7¢2017 _
www.mars.om/•tea -
l�orkexs' Co�p'cns?tion Tn r„rance�l�zvit elders/Contr�ctors/F1ec�ci2nS/Pt'¢nbers
�Plicint73form.a'iea Ple2se pi7Ri LegT�2g
Nie Bcs og snam Seaton Roofing & Siding Inc.
Adl�resS: P . O. Boa 6327 _
.City/St,±e/Z, p.Holyoke, 'MA 01041 Phoae44: 413-534-1234
Are you aIl employer? Chocothe appropriate bo_ - Type of proj ed(regnU.ed):
1.❑l am a emalloy¢W--In - 4, ❑® I am ageneta 6.zd,actm s3I 6. ❑NeW c°nscoce�t .
ongloyecs (mIl aL+dloxpat-tae).- have Lse'dihesnDconhacoas
2-.❑ Isoas°leproy'igox orperaier-. . hsad on..$e •hedshcrtt 7. ❑12?;rodehng .
' ship andhaye no
employees , These ' -contiactoxs ltave n ❑Demolition .
workh'g fox me in any cap3cty.. employees andha7e7.Tkm' �,-���,^.
[N'o w¢ e[s' comp.ins"sance comp:.in caI 9: ❑BinaLl add,Ryon _ . .
regnsed7 5. ❑ We are a omparolion amdtsi. 1D.❑l�e_ebacalxcp3irs or addiiiicns
.esercisedffies
3.❑I am aloome°anex dosofaom]tare
g sllwuk 11"0 Plembmgrepaua or additions'.
m,gseli [_Ta wodcesa' camp. riftofesemptionper MGt, L❑Rnofrep airs .
mnsaace regtired]T c. 152,'§lC4), and we boyeno .
eeuployees. [_Nate' 19.❑ Other
SmplicmLon
£cbccksb<$lscw't alsoa"T oot .ect"rmbclop sLm.,'m4d=°cwasm'covpmsa5onpohcy mfmmd�
taumwwaaswLo sm�itml�a,o::mr:c�,�r'�a�anw�t�amean�oomt..anta�raasx�a»�r,ua�ama:��e.,n
?coat umtezt chccL�is baxmsst siaGhedmaadiltmilshc¢sLvgmiyf naaca�nsotrunhaet®mts�.wLe3er orne-ema�cdmc bsrc
' eem]eyeex..�Eae svbrmhacrms'b?vc cmplvYce4lhe➢mmiFonaetYc¢wo3 n'c p.Pdi°9�b¢
Zam mi empZcyer Aai tieprwi�gY�o—kerY co'mp�crciYonvuvsml.eej°rrry en[pZoyees., BeSmV uthepoZi]'s�,ndjab.r�
_Innirmce Compady Nzma .
Petiryk�Se�-ms.iic.g' H'�s�DTe. :
'lob Site Addrass: Crty/SlTxp: .
A'ta ch a coppaide woxlrers' com_y:nsation polity decL=ra`annp age(shoamg$e pelicy naobex and expir boo,aate).
Fs2meto seca_re coyera, asrcq=edffider Sectio`•25A efMGL c.152 cz?leadin'aze gposaon af.csoinalpenalties of
iso tip ti$1,500,00�dlor ma}'es•"mgtiso�ient, as w°Il as cin`-p°oaliies+ter�e i�d a STOP WOHL OADFT-ani afire
°f�tn�"�SO,OOadry eo"anst'fievio]arnx. Ee alpjsedfosacopy eithiss�eid*�aybe io:�i sded�ffie 0iice of
rsvestg� offfis M fn.4 ce cov¢aew v=Eco= .
1do'nzreby cEriify smde;h.eparhs midprneties elP�Jt%Y fadthe ufarmadonpro�nded nboYe tir true a-nd carrel
phone 4135341234
ojf,-ial v1e only. 'Do not write in this o eq to be wwyZded by dty pr ivWn afj4dal .
GITy or To7ln'. "Termit/Ydcense k .
-A-
1.
A¢thoritp(circle am):
1.Board of M.1'L� 2..BuiltlingDep artnent l CtyfTowm Clerk 4.Rlectri Inspecios. S.Phimhinglnspector
6. 0thex
ContactPerson: Phone#-:
OAvt]
• The Commonwealth of Massachusetts
Department oflndustrialAccidents
of Investigations
60000 Washington Street
Boston,MA 01111
US www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
NatIle(Burins/Organization/Individual):/es_ II0f^^ l
Address: t,]t p W er L/� I ,
City/State/Zip: T A 6 Phone#:
Are you an employer?Check ppropriate box:
].( am employer with the
4. ❑ I am a general contractor and I Type of project(required):
emploo yees(full and/or part-time). have hued the sub-contractors 6. El New construction
2.❑ I am a sole proprietor orpartner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These 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 bomeowner doing all work officers have exercised their I1.❑Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c.152,§I(4),and we have no
employees.[No workers' 13.❑ Other
comp.insurance required]
*Am
y applicant that checks box Ml must also 0out the section below showing their workers''compensation polity information.
t Homeowners who submit Nis affidavit imucating they are doing all work and then hue outside contractors man submit anew affidavit macom,such
tConvamm,Nat check this box const attached an additional sheet showing the name of the subcontractors and state wheffim,u netthose entities have
cmployees. If NesubcontractorsI eemployms,Neymustprovide Neu workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:-QO RMQfioa.{' I
Policy#or Self-ins.Loc.#: lY�/ p�����–�–17 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 DLA for insurance coverage verification.
I do hereby cer ' on de the pains andpenaaies ofperjury that the information provided above is true and correct.
L_-
Sienatme:- Date
Phoneit
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.Citylfown Clerk 4.Electrkal Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
�► CERTIFICATE OF LIABILITY INSURANCE 0212612018yyl
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(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED,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 eadursemerd(sJ.
PRODUCER °o"F°cT ISABELE CORDEIRO
HAME:
Brazway Insurance PRT E L 978-0555991 FAIr Nu:978-055-9934
345 Main St Unit B1 n4o%L s:info bmz insumnceagency.com
Tewksbury MA 01876 INSUNERs AEFORDBIGLOVERAGE xace
INSWERA:ATLANTIC CASUALTY INS CO
INSURED INSUNERR:ACEAMERICAN
PJS SUPERIOR CONSTRUCTION INC
INSURERC:
66 WATER ST APT A INSURERo:
MILFORD MA 01757 mS..E:
msURER 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.
m5R UDR PCONYEFF PoLICYESP
L7R TYPEOf INSURANCE less POUDYNUMRER nanunI MMm U.
COMBERCIALGENENAL.U.'UTY EACR OCCURRENCE 52,000,000
DANA
CIAIMSM EOOCCUR PREM SESOR Mame E1OO,000
MED EXP(My me pesanl $5,000
A L117002783 OW0812017 OW0812018 PERSONAL$ADVIWUNY $1,000,000
GI AGGREGATE LIMT APPLIES PER: GENERALAGGRE. E2,DOO,000
✓ POucv�°Eo- Loc PRODUCTS-COMwoPAGE $2,000,000
o HER: s
AUJOMOBRE Wa1LT" COMBINED SINGLELIMR $
ANY AUTO BOUILY INJURY(Per person) $
AI-TOS ONLY AU(O$
OVMED SCHEDULED BODILY INJURY(PvacJtlenl) f
RIRED NON-0WNEO PROPERTYR4w WE S
AUTOS ONLY AIROGONLY Per a-eeM
E
UYaRE11A L, OCCUR EACHOCCURRENCE $
ESCEss WB CLAIMSMAOE AGGREGATE $
OED REIEMION$ $
WORI(FASCOMPENSASON ✓ PFA 0TH-
ANDEMPLOYERYLIARhfIY STATUTE Eft
13 ANYPSGP IETOSPARTNE.. YI" 6S62UB-SH25120-2-17 00101/2017 0WOV2018 ELEACPACcmFAH :1,000,000
YAFc6/MFw ERExcwDEDx O "IA
(Manaaary m Nu CIPOSEASE-EAEMPLCYE $1,000,000
LIHsP lFPO of ovFRN1.1S LO— EL DISEASE-POLICY LIMF s1,000,000
00
00
OFSLRIPIIONOFOPFAFTR)NSI LOCAl10X51VENICLEs LACOROI%,AOGtlonL Rema,h SNetluk,may0eatla[IletldmorezpzceurtgvirN)
CARPENTRY/ROOFING/SIDINGMAINTING.
CERTIFICATE HOLDER CANCELLATION
SEXTON ROOFING A SIDING INC SHOULD ANY OF THE"I DESCRIBED POLICIES BE CANCELED)BEFORE
102 PINE ST-PO BOX 6327 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCEWTRITHEPOLICYPROVIBIONS.
HOLYOKE MA 01041 -
SEXTONROOFING@HOTMAILCOM AIm1oR®�RFSR/ESj[E,x/rfAJTrvE� j("]
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks Of ACORD
PrxN Eusing Famz B—Web aaTeamw F—BSSUMM(c)ImMeSsNe PutdI a00.10L19P
A
a`cond CERTIFICATE OF LIABILITY INSURANCE DATE E12812(M7
HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TNI
ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCHES BELOW.
HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZE
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER
MPORTANT:11 the certificate holder Is an ADDITIONAL IN5UR60,the P.hcy(oa)must be endorsed.If SUBROGATION IS WAIVED,subject Io the
orong and conditions Of the Falicy, certain policies may ro9u1m an erdonemerl A stale...(on this ca flBcme does .1 Centel Ilghts tO Be
ertlficale holder in lion or,LCh eIrdomemeRhs).
PRODUCER CONTACT NAME:OO)HulcMnsan
Ormsby Insurance Agency,Inc PHONE IAID,NAEatl:l41]D]74900 FAX RVCNo:
RD Be.718 EFML ADDRESS:NActIn.an®oe .Cylna.mm
West Spdn9lleld,MA 01059 INSURERS AFFORDING COVERAGE NAICA "
INSURED INSURER A:Lalony Insurance Company ]9999
S.d-RooOng and SIOIn9In. INSURER B:
PO Box 8327 INSURER C:
Holygee.MA 010116327 INSURER D:
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 NAMEDAHOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY PEOVIREMENT,TERM OR CONDITON OF MY CONTRACT OR OTHER DOCUMENT WIN RESPECT TO WHICH THIS
GERTFICATE MAY BE ISSUED OR MAY PERTNN,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 DIAIMS
1.11CIEFFPOLICIRKP
His, CARE RATE
LTR TYPE OF INSUNANCE N50.0 WYO. POLICYNUMBE0. MMI00rlY LIMITS
A X COMMERCIAL GENERAL LIABILITY 101PKGO02159W2 6RSR0I7 6`250016 EACH OCCURRENCE 51,000,000 .
DAMAGE TO RENTED 51OEMS,
LIAIMS M1IAOE XO OCCUR FREMISES Ea OCWnenW
MEO EXP(Anyoneperem) 55.000
PERSONAL B ADV INJURY SLOdDE00
ENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S"ONGDO
Y POLICY ESM El — PROOUCTSOOMFIOP AGO S2,OLQWO
OTHER:
COMBINED SIGNED LIMIT 5
UTOMOBILE LIABILITY (Ea aaidenD
ANY AUTO - BODILY INJURY(Per perseR) 5
ALL OWNEDSCHEOULED BODILY INJURY(Per 6
AUTOS AUTOS cdden0
HIREDAUTOS NON OWNED PROPE. -.MG 5 '1
AUTOS (P.rac Nd R
5
MBRELLA LIAB CUR EACH OCCURRENCE 5
CESS LIAB LAIMS MADE AGGREGATE 5
EO TENTIONS
WDPKERSCO MPENSATIONANO - FOR NTEOR
Or
EMPLOYERS'LIABILITY YIN
PNYPROPNETORRAATNER/EXENTIVE EL EACH ACCIDENT 5
OFFICEPJMEMSEN EXCLUDED? LiNlA
!Mandatory In NH) OHSCASE EA S
IF yes,desalt.nor., MPLOYEE
DESCRIPPON OF OPERPTIONSCI ELDISEASE-POLICYLIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES PCOa0101.Addlllanal Nam.Ms SNedol,IF mon apaSe b n9uicmd
CERTIFICATE HOLDER CANCELLATION
T.wn.I Pmnem
THERE0 ANY OF THE ABOVE DESCRIBED IN POLICIES BE CANCELLED BEFORE THE EX%RATION DRE
THEREOF,NOnCE WILL BE OEl1VEREOIN ALLOPOANLE WITH THE POLICY PRONSIONS.
AUTHORIZE��D REPRESENTATIVE
VI
ACORD 25(2014101) - C1988-2014 ADDED CORPORATION.All HINTS Reserved
The ACORD name and IOg.are Regbterod HI oFACORD
Office of Consumer Affairs and Business Regulation
10 Park Plaza_ Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Corporation
39
SEXTON ROOFING &Sidin Inc n64rafiMbon: 119212
g Fxpirttfiorc aztaarzolg
P.O. Box 6327
Holyoke, MA 01041 - —'
Update Address and return card Mark rm.n for change,
Co monwealth of Massachusetts
OM"-of Profesawnal Lfoensvre
Board Of Bultding Regutations and Standards
Constructlo,,s�u"or Specialty
CSSL-099689
Wires: 1010512019
a.�
EVERET7JSEXTON a i
PO SOX 63r] -;i
HOLYOKE MA 01"i "' 0J
Commissioner V^"'
STATE OF_^ CONNECTICUT
DEFA
e e
HOME IMPROVEMENT CONTRACTOR
EVERETPJ SEXTON SR
102 roe St
j HOLYOKE,MA 01040-2911
SEXTON ROOFING&SUING CO
'CJ REG d— e c iW E Ptp .,—
MC.0605383 / 17
/ 11/30/2018
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