31B-207 98 STATE ST BP-2019-0229
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU.Block: 31B-207 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# BP-2019-0229
Proiectit JS-2019-000368
Est Cost $13400.00
Fee'$40.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sa. IT): 5924.16 Owner. KITTO ANDREW
zoning:URC(100V Applicant: SEXTON ROOFING CO
AT: 98 STATE ST
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.8122/2078 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 Deuartmen[ 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:
FeeTVDe: Date Paid: Amount:
Building 8/22/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�F
- City of Northampton
EC end use,DNy
-r- ->' Building Department Curb
212 Main Street AUG .c
��. Room 100 WaterMlellAHaim Y
Northampton, MA 0106 Plane
phone 413-587-1240 Fax 413- 87-Mgr eua
HAM
APPLICATION TO CONSTRUCT,ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6 P— I d�
1.1 Property Address: This section to be completed by office
}
90 OaA/v l Map� Let a07 Unci
Zone Overlay District
Elm SL District CB Disbfel
SECTION 2-PROPERTY OWMERSHIPIAUTHORIZED AGENT
21 Owner of Record:
Name(Print) Cur Mailing Address:
-73/g
Te
1 �2P � 77�3 ephone
Signature
2.2 Authorized Adam'. /
�>
Name(Print) Cumerd Mailing Address:
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 8
3. Plumbing Building Permit Fee
L, O�
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 613, ZkblQ Check Number
This Section For Official Use Only
Building Permit Num Date
Issued:
Sig re:
Building Co i ma/I.pectm a BUYdirga Dale
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors D
AccessoryBldg. ❑ Demolition ❑ New Signs [D] Decks [q Siding[Ell Other[CA
Brief Description of Proposed
Work: ramadP nn�w�/�rna /l/'&4
Alteration of existing bedroom_Yes No Adding ew bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing-cotnolete the following:
a. Use of building.One Family Tyro FamilyOther
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 stones?
f. Method of healing? Fireplaces or Woodstoves Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 1Dn ft.of wetlands?_Yes No. Is construction within 100 yr. floodplain_Yes No
I. 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 AGENTORC /�-y CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Q%dajo Y' as Owner of the subject
property / ,,////''�I,,
hereby authorize �(�dO4 �'l A1,7C �/0?/ - /l
to act on my behalf, in all matters relative to wo oozed by this bu ding permitpplicahon.
/�a)k%/y� J���
Signature of Owner (� �J Date
J/1(I as Owner/Amhonzed
Agent hereby declare that the s '
encs and inf on on the oregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perlury.
Fi/OJ7L J
Print Name
1 �i6 fid
Signature of Owner/ lint Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licenwd Construction
Supervisor: Not AAppli(mbllee ❑
Name of Licanso Holder: (�//�� `✓ �(�X � l 1� / / 62 X 7
License Number
Adtlnss l/ Erwiratlon Dare
ZF/3
Signature Telephone
8.Re btered
Improvement:Contractor: Not Applimble ❑
PY a tb a 7)L2Q Qa �nN
m
Comoanv Nae -- RegistrationNumber
M &x
Address �j Expiration ate
Telephone Y��//� �_3�-ia3v
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.182,§28C(8))
Workers Compensation Insurance affidavit must be ximpleted and submitted with this application. Failure to pmvide this affidavit will result
in the denial of the issuance of the builtlin permit.
Signed Affidavit Attached Yes....... No..... ❑
City of Northampton
Massachusetts
c
z
1SPAR48ffiVS OF =LDZBG ZRSP ZORS i
212 Main atreat a Mmicipal Building i C°
Nortaaapton, M 01060 ti f 0
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,
impmvement, removal, demolition, orconstnrction of an addition to any pm-existing owneroccupmd building containing
at least one but not mom than Pour dwelling units....or to structures which are adjacent to such residence orbuilaing'be
done by registered contractors.
Note:if the homeowner hast contracted with a corporation or LLC,that entity must be registered
Type of Work: 76e41--? Est.Cost: ) 3 i lkjo
Address of Work: k l<
Date of Permit Application: /o /
I hereby certify that:
Registration is not required for the following mason(s):
_Work excluded by law(explain):
Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
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:
Fl �iY �vh� ll���w � � SM�Ft �i it //8 39
L
Date Contractor arae I 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
s Massachusetts'
1' 1_ DSpAaflBaT OF BDILDI IBBp XQra M1
232 1pin hi •Mlmicipal Huildinq
Nol@��tpn, !P 03060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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:
9F k S -
(Please print house number and street name)
Is to be disposed of at:
0 ASeug� LUA3trr ?UU ing,A s . ' ,o7L1)1rkk a,4
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
USA
(Company Name and Address)
0/'//�
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.
The Commonwealth ofMossachuseas
Department of IndustrialAecidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/then
K'orkers'Compensation Insurance Affidavit:Builders/Contra r./Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leribly
Name(Business/Owuniza ion/Individual):Sexton Roofing&Siding Inc
Address:P.O. Box 6327
City/State/Zip:Holyoke, Ma, 01040 Phone#:413-534-1234
Are ym an employer?Check the appropriate hoz:
Type of project(required):
I.❑I am a employer with emploYeea(MI and/or part-time) 7. New construction
2❑Iemasoleprowie orpurmersldpaM vem mployeeswo[king formein 8. ❑Remodeling
any capacity.[No wakens'comp immawe reguncil I
3❑tam ahomcewrer doing ell wok myself lNo wakers'mmPhaurmcerequiredl' 9. El Demolition
10❑Building addition
4 n am a tamaowtcs and will be shape oeskeo,aturno.c topensi all work on my pmpenry. 1 will
nwrethau all conaactors eahennave cookers'compernabon raemarce or me sole lLE]Electrical repairs or additions
proprietors with no uvployees. 12.[—]Plumbing repairs or additions
S.Qlam ageneml contractor a xi l have hhed the su .chcctom listed on the atmchd sheet
These have 13.0Roof repairs
sub-carrlmctars empl,.and have wokers'camp.ituurmce.
6.❑Weareacory rarcnaul M officerhaveezemiadthehnghtof«emptiouper MGL c. 14.❑Other
152,§I(4),a�wc have nen employees.Mo wokeni comp.nourancerequied]
JL
'AnY apphoae that checks boz ql must also 51I out mexcaon below slmwiag they workers'compewtion polity iNmmatiom
1 Homwwners wM submit Itis affidavit mdimtiog they are doing all wink oral thw h n,omslde cotmactots must submit a new addavb iMimang such
=Contractors that chaak chus box mast aaached an a&hdon l sheet Showing flu name aft subcormmmrs act state whdhrr or not tMse artium have
amployces. If the subcomractors have employees,[bey menet provide tlrcv cookers'camp.polity number.
I can an employer that is providing workers'coanpensadon insurance for my employees. Below it the policy andjob site
Info-
-da-Insurance Company Name:Travelers Property Cas Co of Am
Policy#or Self-ins.jLic.#:7PJUBGG078988212 Expbztion Date.6/4/19
Job Site Address:%Jr� S4 ze J City/StatdZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification. -
I do hereby certify u fhe paim andpenalties ofperjury that the information provided a is true and correct
Siimature: Date.
Phone#: !�/3-S-3 V- /Z 3 V
081cial use only. Do nor write in this area,to be completed by city or town official.
City or Town: PermittLicense#
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#:
�\ The Commonwealth ofMmsachuwm
Deparhnent oflnduslrialAcchtenis
1 Congros Stred,Suite 100
Boston,MA 02114-2017
B ..massgov/dia
WWorkers'Compensation luaraece Alfdavit:BnDders/Contmelors/ElectrimosMombem
TO BE FILED WIM TIRE PERMITTING AUTHORITY.
Aoolieaml.lormation Please Print Lee!
Name(BusisFD gad>ariooanf idml):LDG Homes Improvement Inc
Address:18 Spring SL let floor
City/State/Zip:Milford. Ma.01757 Phone#:(774)214-6239
Areym as mauve Ctrrtcflc ppmpriea W.
Type ofproject(regained):
1-Ql�aemploycwiths emplayaa(rva md/wpwt-eme)e
7. Now construction
2❑I am a sok p,opkmr orpamvahip aodhavem�oyees workbg for vie m
nos'�M.IN.•seas'comp.bwem¢.ai i l
S. Remodeling
30®a lmmeowcr ming au w mpd£[Noawkas'comp.ksraaoa n aired[ 9. ❑Demolition
4.❑Iam aAmireowra ad will he hmog m swans m mMucs au wmkmmy pmpct, fwall 10[]Building addition
crone Weill momcLwavWwhevewmkms'cmpeosromvamao¢or are swe 11.0 Electrical repairs or additions
paprieton wiW m empbycv.
12E]Phmbiug repairs w auklitiors
5❑tmo egecal mnnextumidlhove bud We subcmiWx4wsBard ao Weanchedsheeh 13.QRoof
These subcmWxwnhmmplryea mdlavewvdm'wmp..1 repairs
6.❑We m a cxpar rnaM momccsheveexcsciad flebrula afexaoprim Wa c. 14.[-]Other
152,§I(4),ov1 chaveneaplg®-[No wohas'mmp.imiaaoasegtmMl
•AvyappltraRWm chaJvboz#1 crus ebo a1 matlm xmmtbebwshowogshemwodms'mei polky kfanmtiwr
1 Homaowaas who submittiu emdaviniMimtita;Wry aedokgall wwlcand Wen bite omNecomu4m nuc submrtamwaBideva®iiotagsuch-
tCnn4actws Wm rlrst W u box mint macMd m addiriwnl aMn showing W e vane of W e vb-w�maclors avd sme wMlr or rot tlmu emioes have
emplryees. Ifde submmackrshaw mplayses,Wry vnurpmvide Wev waheo'mn policynaaber.
f aroma emylayn i4atirproWftgwarkers'cornpensabon imau efor my employeex Below is the policy ardjoh site
information.
hnsmance Conpmry Name:Travelers Indemnity Company of America
UB-1K196202-18 0221/19
Policy#w Self-ins.Lic.#: Expiration Date:9 �I
Job Site Address: C u��� City/SbtdZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy numberacd expiration data}
Falme to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fine up to 51500.00
and/or ore-year imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a
day against the viol .A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for iasnramce
coverage veriticati
I do hereby ffiepains oadpenad#er oflurjury fhnttha iaforradonprosidedabq✓e it hue ardcorrert
i
ature: Date: / {
Phone 1 39
Offidd ase only. Do am wrierinthis area a be comple"by my or sown official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Bolding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Penson: Phone#.
CERTIFICATE OF LIABILITY INSURANCE oATEnNm01YYYY)
19
TE IS ISSUED AS A NATTER OF WFOR TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRNATIVELY OR NEGATIVELY MEW E 11 OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSDTUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI,AUTHORIZED REPRESENTATIVE
OR PR O AND TH CEULTFl TE HOLDER
INPORTANT:NIM aNtMwls Mlev Is an ADMONAL INSURED,Me I IRy1Ms)must M emlonale. It SUBROGATON 1.4 WAIVED,suBjact to
br11M anew in Sat lM much
enueaN Pa(s). n6T lagWm elle MMo1sMnMlt Astatementwthis ECiHgwte dos nM wnhT rights to
Ilre certificate llOiear in lieu of wdl elltlO a.
PRODUCER CONTACT
NATE
A COSTA INSURANCE AGENCY PHONE I"
2 FRANKLIN COMMONS (AA:.K4 E.Q: (AM•NaK
Ea
FRAM IGHAM,MA 01702 ADDRESS:
783BY RIMRERISMAR)RDMGCWFlNGE MACE
SQUIRED NSURERA: TRAVELERS MDETMDYCIX.IPANYOFAA¢RMA
LOG HOMES IMPROVEMENT INC INIZURER a
WSURER C:
e SURERD:
18 SPRING ST 15TFL M9HmER E:
MILFORD,MA 01757 MSURERR
COVERAGES CERT wMN69a gEV1EHQI NUMBER:
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CERTIFICATE HOLDER CANCELLADON
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BEFORE TIE EXPalAT10N RITE1HE1a_OF,MlT6ENBLBE DEIAERED
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10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type Corporation
SEXTON ROOFING &Siding Inc RegGaepon: 118239Expiration: 02114/2019
P.O. Box 6327
Holyoke, MA 01041 -
Uptlate Addrns NM rtWm caN. MalxieaSon for Ot,xlge.
COmrtgnW¢dl(h Of Md55dC1i454ts
M,nsen OI PoOIISSIOOEt IKBndpr¢
anard Of aullding Regulations and Standards
ConstructioRSttpeNsor Specialty
CSSLo99609 _ EEPiras: 10/0512019
EVERETT 3 SEXTON a
PO f10X633T%
HOLYONEMA 010!1
COMMi5sioner
STATE OF CONN
HOME IMPROVEMENT CONTRACTOR
EVERETT j SEXTON SR
102 Pipe St
j HOLYOSE,MA 01040.2411
SEX"ON R FLNG 8 SIDING CO
LI .l E O. ;P�TIV %TIRE
xlc.ot;osasa >z/� olizol7 nisoizols
SIGNED ~—_---•
�rn�lDsa[
SEXTON ROOFING AND SIDING INC
www.sextomroofing.com
VKO ZMASTER
Setting the Standard
P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
E 413.539.9906
MA HIC# 118239
sextonroofinZ@.hotmail.com
SURMITTED TO Andrew Kitto PHONE DATE 6/18/18
617.733.7319
STREET 98 State St. JOB NAME
CITY STATE ZEP NardantanowMa. JOH IACATtON
SEXTON ROOFING HEREBY SUBMITSSPECIFICATIONS AND ESTIMATES FOR:
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Inspect roofing deck and replace as needed. ($2.75 per sti.ft.)
3) Install new metal edging to raises and eaves of roof.(811)
4) Install ice and water shield on eaves(61),vent stacks, in valleys, Chimney,skylights, and at intersecting
roofs.
5) Install#15 synthetic roofing felt ou remainder of roof.
6) Install new 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) Install new cap over ridge vent.
10)Supply manufactures Lifetime warranty and SRC 25 yr.workmanship warranty.
ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS.COMPENSATION.
We Jrrpose hereby to furnish material and labor—complete in accordance with the above specifications,for the amount of
Thirteen Thousand Four Hundred DOLLARS($13,400.00)Payments to be made as follows:Due in full upon completion
All Material is guaranteed In be n specified All work to mroplaud in Authorized
workmanlike manner a¢mding use standard practices. Any alteration or Signature
deviation firm above spedfrratiom mvohang extra cons wgl tc execund only
upon wnttn onhna,and will became an extra dtatge over and above dse
estimate. NI agnxmenu mntinga t upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted
ourmnrul. NIXresportsibleforwaterdamagedurkgc nucfion. Owner within(14)days.
to py re ible kgal Pca for andpment.and likable intact
PAOCt tate of VrttpmAl The above prices,specifications
and conditions are satisfactory and are hereby accepted. You Signature
are autho-ized to the work as specified. Payment will be
made as cuttined above. Signature
Date of Acceptance. S l0