17C-167 (17) 40-42 HIGH ST BP-2019-0968
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mgp:Block: 17C-167 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ROOF BUILDING PERMIT
Permit# BP-2019-0968
Protect# JS-2019-001600
Est.Cost:$12400.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grono SEXTON ROOFING CO 99689
Lot Size(sa.ft.): 16160.76 Owner: GOSS LEE W
Zoning:URB(100V Applicant: SEXTON ROOFING CO
AT: 40 -42 HIGH ST
AoplicantAddress: Phone: Insurance:
P 0 BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.•3MO19 0:00:00
TO PERFORM THE FOLLOWING WORK STRI P & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspectorof Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Semi": Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Find: 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 3/880190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use orgy
City of Northampton Status or Permit
Building Department Cum CutDnveway Permit
212 Main Street Sewer/Septic Availability
:{ Room 100 WatenWell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413587-1240 Fax 413587-1272 PIUtS4e Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER RE DE OLISH A ONE OR TWO FAMILY DWELLING
SECTION,-SITE RFOI TWN A(.9—f?-<?O"
1.1 Property 2019 is section to be completed M ollke
06 /a 1�9� �r Myl Lot X6,7 unit
T 7 [�'
DEPTOF OUllDmf,M PcST1nN5
NOPTHPMI`TON.1> � Desdey District
Elm St District CB District
SECTION 2-PROPERTY ORSIERSMPIAURIORIIE•D AOM
2.1 Owner of RaeoN: '
Name ` l/
P� a 6 �/9N y
u`.ran—��
nnn � �'�I ir!, s o - 9a/t
4-tl/'ar.F �a�f�r„G P A Total
Spnare
22LAugwrized A
Name d Current Mating Addess:
53
Sig lleepltarw
SECTION 3-ESTIMATED CONSTRICTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by beirnit a irant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cat of
Construction from 8
3. Plumbing Building Permit Fee 4
0
4. Mechanical(HVAC)
5.Fire Protection
S. Total=(1+2+3+4.5 Cho&Number .3
This Section For 011klsl Ilse Oitly
Data
Building Permit Num Issued:
Signature: 3 G ZO)9
B ilcling Commissioner/InspePmr of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Mia[Be Completed.Pernik Can Be Dented eue To Incomplete Information
Existing Proposed Required by Zoning
This column w be filled in by
Building Ikrynmant
Lot Sim
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg,Square Footage %
Open Space Footage %
Dat me mins bldg&pwd
p of Paaki.x Spaces
Fill:
volume&l.amtian
A. Has a Special P " /Variance finding ever been issued for/on the site?
NO O DONT RNO O YES Q
IF YES,date is
IF YES: Was permit recorded at Registry of Deeds?
NO DONT KNOW Y6 O
IF YES: enter Book Page and/or Document q
B. the site contain a brook,trolly of wat or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be fined from the Conservation Commission?
Needs to be obtained O Obtai O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of sig intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction accvhy disturb(deanng,gracing,excavation,calling)over 1 acre or is k part of a cwnmon plan
that will disturb over 1 acre? YES O NO O
IF YES,than a Northampton Storm Water Manager ant Permit from Rle DPW is required.
SECTION S DESCRIPTION OF PROPOSED WORK Ichack all a0ulicabbl
New House ❑ Addi0on ❑ Replacement Windows Mlarvid"(s) ❑ R-Rng
Or Doors E3
Accessory Bldg. ❑ Demolition ❑ New Signs 1177 Decks IC] x9 R71 other 1EQ
Brief Description of
Work_ L Pm/. ut .tL.w�.��1,+e c'
ARerahim of existing bedroom Yea_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes _No
Plans Attached Roll -Sheet
sa If New house and or addition to exhd]na housing. complete the followlm
a. Use of building'.One Family Two Family Other
b. Number of rooms in each fam' s
c. Is mere a garage ?
d. Proposed Squar footage of new construction. Dimensions
e. Number of stones
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compile Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction In 100 R.of wetlantls? s No. Is construction within 700 yr. floodplain_Vet NO
j. Depth mert or cellar floor below finished grade
K Will building conform to the Building and Zoning regulations? Yes No
I. Septic Tank_ Cily Sewer Private well City Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as Owner of the subject
property /��� P
hereby authorize \
Rt-'4 1
to act on my beha0,in all matters relative to work aumaizeld by this building pernift a CHUM.
�(e� 7/9
Signature of Ovmer Doe
I, /2 as Owner/Authonzcd
Agem dedere mat the statements indarrnation an the foregoing application are true and acwrate,to the best of my knowledge
and belief.
Sig under the pairhs and penalties of perjury.
✓ IL
Pd
aO.WAgem
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suonvhor: _ (X� NottAAp/p�lic/ablle 0
Name of Ucerrte KsIdw \� i d:L1Ill
Q L p leB tiarlbV
Y C� _ /6
Addmss EWYabm Oate
Sgnalvm Teleplavie
9.Reaistensdl Home Im roveement Con Not Applicable El
p
0.l1c,
1- / /nC// ,l
gem= t
Repissaa— mtNr
Expiration Date
Tem /23�!
SECTION 10-WORItEW COMPENSATION IIISURANCE AFFMVIT(M.G.L.c.ISZ§25g6))
Workers Compensation btsurance affidavit must be completed and submitted with this applicabon.Failere to provide this affidavit will resuR
in the denial of the issuance of the building permit.
Sgned Affidava Attached Yes....... [�' No...... ❑
City of Northampton
Massachusetts
�I ffiARiTRnr of MTILDI I1aP 10115 r�a^sem
212 Nein Sheat • N.—c l Rvildinq
Horne p, , as 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"taconsirucfbn, aderation, innovation, repair, modernization, conversion,
improvement, removal, ciamobbon, or construction of an addition to any praemsang owner-occupied buikkng containing
at least are but not man than four dwelling units....or to structures which are adjacent to such residence or budding'be
done by registered contractors.
Note:If the homeowner has contracted witir a corporation or LLC,that entity mast be registered
Typeof Work: Z01(l4U, Est.Cost /2t S°Od
Address of Work: 4(6 - yah arm
Date of Permit Applicalion:
1 hereby certify that
Registration is not required for the following remon(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building net 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:
1 hereby apply for a building permit as the agent of the owner.
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
�
eMassachusetts
DEPARD OF EDIr.OLPG DNEPE Xws �. n
212 Naim Stiwt aN4ni 01 Builtlin9
orZH CD
\ Nttaspton, NA 01060 HM 3�1^a
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:
�iQ ;�n��
(Ple�se num r street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a ffdumpste//r onsite rented or leased from:
A5,L'c,/i� Iz ., f.lin _ H-✓P!'/6(C/Y(.,-///CSF/.e/U'
(Company Name and ss)
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.
�ru�wgaI
SEXTON ROOFING AND SIDING INC
www.sCxtonroofina.cons
PffoMAUSTER
Setting the Standard i
P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
f. 413.539.9906
MA HIC# 118239
m
SURA TED TO I.ee Goa PHONE 570.7016 DATE 3/1/19
SIREBT 40.43 High St10B NAME
CITY WATEZlP Ma. 10BLOCATION
SERTON ROOFING HERESY SUNMM SPECIFICATIONS AND ESTIMATES FOR.Faoat,bats,wdlef oWs wok mot.
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Install 1/2"4 ply roof sheathing.
3) Install new metal edging to rakes and eaves of roof.(8")
4) Install ice and water shield on eaves(6'), vent stacks, in valleys, chimney, skylights, and at intersecting
roofs.
5) Install#15 synthetic roofing felt on remainder of roof.
6) Install new flanges over existing vent stacks.
7) Install starter shingles on eaves and rakes of roof.
S) Install IKO Architectural style roofing shingles as per manufacturers' specifications.(Dual Corey)
9) Install new cap over ridge vent.
10)Supply manufactures Lifetime warranty and SBC 15 yr. workmanship warranty.
"PLEASE REMOVE OR COVER ALL BELONGINGS IN ATTIC DUE TO DEBRIS FALLING IN.SEXTON WILL NOT BE
RESPONSIBLE FOR CLEAN UP OR DAMAGE.
Wit jrapen a hereby to furnish material and Labor—complete in accordance with the above spedErvtiow,for the amount of
Twelve Thousand four Hundred Dollars 512,400.110 Pa imeno,to be made as follows:Due in full complaton
Al Material u guarantred to be as specified. Aa work to h m a Aud-r{red
workmanlike manner amending to uandard pmmees. Any attention or Signature
deviation from above specifications mvolvmg extra man will be exaased only
upon worsen orders,and will become an exon charge over and above the
efnmate. All agnxmrnn contingeo.upon SviYe,azcidenn n detays beyoM Note:This proposal may be wlthdrawrl by us if not accepted
...Mot TotnSPo.,Wiorwaierdamage tanogCongroonan. Owner within(14)days
M paanublel fees for non-pameat,and Vpbcahle unnet.
'$trpWnte Of J)r0p04a1 The above prices,specifications
and conditions are satisfactory and are hereby accepted. You Signature
are authorized to the work as specified. Payment will be
made as oudined above. Signature
Dam of Acoeputrice.
The Con monweaUB ofM4 arhasetts
Department oflndmo i&Accidents
I Congress Street'Sake 100
Boston,DLA 02114-2017
w ..m gov/dia
Wx`.rkers'Compeusatim inmrance Affidavit:Badders/Conha rslF.lectri^a tm hem
TO BE FILED WfM THE PFJU rrfING ARIHORI
Applicant Infor10260n Plein Print Legibiv
Name(E�edlmiv;dal):Seldon Roofing&SidnR Inc
Adc!c P.O. Box 6327
City/Stafe,7 :Hoyclm.Mo.01040 Phoae 4:413534-1234
AseAmae�lsreY!faeh[Feappsapwte ma: Type of project(required):
LQlamae�toyv weh employees(fon a3trpn"fie}+ 7. ❑New eoasavGioo
p'❑Iv.�aoadarQAft—vp abo,caneorp"r .Wo far.. 8. ❑Remodeling
. zyawu<r-Rao wmlma•romp ter=m*m)
3.❑Imahommw�damgsa wodcmysetf Mowwtm'mmp.bwav�rwlr 9. ❑Demolition
4.❑Iaa shomm�.�maaw�bc6v�cmo-smvmoa�m,ttau.whoomy Pmpmy. Iwai
10 Building addition
eamethdau momdars etlahave wwkm'mmpadmon mavaremam tole 11.0 Electrical repairs or additions
vvvpond ori as mnpl�. 12❑Plumbing repairs or additions
S�i lam a geoval tn ®na ou M1 shed.
-fhea..,�......—._. m.eemWorm,mm.<.mt s•®p ��: 134altllarepara
6❑Weaca mrymmimad m offimshare aarent l6vnglaofo�tioo pe MGL c. 14.❑Odw
lR 4l(al ma w<h..e®e�M�Mo wooed•tomo.��+s�muvea]
'Apr appl�tlm chcdobox rl®stdmm m¢tlmsctimt W.sho+urg d.*.dm'covPevvvtav Pau,man
r xompw�swm abmn maatfware;mi�ogmey aeaoma.0 wod:aNttiev hhe wade eoonaebmaet sohmita�si�aaramai®g ar:h
�Coona.�that eL¢k Wv bas mm amrbd m atldinud sheet shmvmg the vine of tle subms0advz ad ffia whdlc a vd shnx dairim have
empioyeec Iflbesdtmmrsmrs bow:m�loy�they svm R^^��^ods'�p Po�Y omde.
lmn empleyertbafispronidargwortos'eosrWoa inmrvrrceformyenWloyea. Bel"hikepe&tymrdJab.sife
i'foaration
Insurance Company NamomTravelas Property Cas Co of Am
Policy#or Self-ins.'llic.#:7PJUBGo789821/2 Expimtim Dow-
Job
Joh Sire Address: 4'G� 7 a <q N S% City/StatdZrp:a
Attach a copy of�rkers'eompeasation policy declaration page(shawi 19 the policy oondwmad expiration doh)_
Failureor se®e coverage as required under MGL a 152,§25A is a cruomal viohlimpunishable by a fine up to$1,500.00
and/or raw year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up 105250.00a
day agamstthe violator A copy ofthis stateroent may be forwarded to the Office of Investigations of the DIA for insurance
coverage veri ication.
Ido boeby c.*fy nndofh "m®dpmakia cifperfmy dratAe informasowprovided above if owe mdcorr
Simum ne: Dnhc .3�/Z�
Phone#
Oficial use only. Do mot write lnthis mea,a becmpfdadbycity or awn official
City or Tar.: Per aittinme#
Issuing Aathority(cirde one):
1.Board of Health 2.BmldimgDeparhnent 3.C5tylfowa Clerk 4.Electrical Inspector S Ph obiog Inspector
6.Other
Contact Person: Phone#:
i
I
i
The Commonwealth ofMassachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
U1krkers'Compensatior,Insurance Affidavit:Builders/Contracton/Elmtricians/Plomben.
TO BE FILED WITH THE PERK Tf1NC AUTHORITY.
Applicant lnformatioa - Please Print Lev'bly
Name(Bnsmess/Orgmirariodlndividml):NRC Construclion Inc
Address: 66 Water St Apt 2
City/State/Zip:MiBord, Me.01757 Phone#:774-287-1485
Areyou a.e.pbaert Cluck rise appropriate W. Type of project(required):
I.Qlamaemplotvr n 4 employee(fW�/orpart-eine) 7. C]New construction
2.❑I em a Weproprietor w pertcrship and have m employee working fume in 8. F]Remodeling
any rappacity.Oso wwken'romp.lemma m uvedl
i.❑Ionalnmeowies doing all were myself pia woken'romp.mwvse reuhd.]t 9. ❑Demolition
4.❑I®aMmeoWrm ad wdl hhvirs8 conbartorstcondutW woremvry propMy. 1w 10❑Building addition
ensure dm all cme:mn enter have wokm'compm.eo.msmmxe ar aR sole 11.❑Electrical repays or additions
pmpnelors wit w employees
12.❑Plumbing repairs or additions
SQlanagema tar,have lhevehoantla bconeaclonluteov tc atmched ghee[ 13. J❑Roof irs
Thee sob-wno-eaon love emgoyrn aW luvewakm'comp.rew^aaaa-s �
6.❑we..cOryorsn.and a offices haw eec W tev rift ofnemption per MGL c. 14.❑Other
ISz 41(4),ad we haw m mployee.(rip workers'comp.imlemwerryidrd.]
•Ary eppliwm that chttrs box Nl tun elm fill OW to sectlm bdowsbowmg mevwarkee'compeannm poliry'urfarmarim.
1 Bomeowmrs who submit this affidavit indi®tivg try arc daiug all Wark em trn hlro outside casazmn tun submit aueaeffideve indi®e such
tCmtractorsto check tis boxmus[atmched m ddiuoral steel towin8 dmcame of the sub mumetn and stat whetem rot tlase mtitia th rove
employees. If she subeooasmrs haw employees.theYm TRovide tev xadrm'eamp.potiry ambm.
I am an employer that it providing workers'compensation insurance for my eaagdoyees. Below n the polity andjob sire
lnformahan
Insurance Company Name:Atlantic Casualty
Policy#or Self-int.Lia R2WC947397#: / Expiration Date8/18119
:
Job Site Address: //,,—u�[ ,j /h 3% City/Staulzip: Pa
Attach a copy of thdworken'-_essmpep-ssatiiu policy declaration page(showing the policy a tubers erpires' dare).
failure to secure coverage as required order MGL c. 152,§25A is a criminal violation punishable by a fine up at$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 agate the violatoy.�copy olG�Mahe arded to the Office of Investigations of the DEA for insurance
coven verifica0on. Gr'
I do hereby underYnep®rs andpessaMes ofpedury that the informadonprovideda ulrue andeorred
Simature Dau:
Phone#3%4-287-1485 ��rr
Oflicid we only Do not write in this area,to be eoanpteted by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Hnith 2.Building Department 3.City/Tmm Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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a�d CERTIFICATE OF LIABILITY INSURANCE
09/10/2018
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 HOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: if the urti5cate holler o an ADOTTIONAL INSURED,the p li y(ws)must have ADDTITONAL INSURED proveio or l endorsed.
If SUBROGATION IS WAIVED,subject to rile terms and conditions of Ne Policy, certain policies may require an endomemenL A statement on
this certificate does not confer rights to the certificate holder In lieu aT such andorfemerd(s).
PRODUCFA rCia°MmE: ISABELE CORDEIRO
Brazenly Insurance PxaxE 978,ar5vrggT HIN,y78,arFrgg34
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EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UN TS SHOWN MAY HAYS BEEN REDUCED BY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATNJN
SEXTON ROOFING&SIDING INC S WANYOFTIEABOVEM=M MPOLICIESMCANCELLEDBEFORE
PO BOX 6327 THE "PIRATON DATE THEREOF, NOTICE VALL BE DELIVERED M
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102 PINE ST
HOLYOKE,MA 01090 AunaR®RrJrATNE
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®198&2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks o1 ACORD
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Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type Corporation
Registration: 118239
SEXTON ROOFING&Siding Inc Expiration: 02/14/2019
P.O. Box 6327
Holyoke, MA 01041
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Comnommaith of Massachusetts
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Board of Building Regulations and Immiards
Construotio s1fp41visor Specialty
CSSL*99689 Ejpires: 101052019
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POBOX63VI e
HOLYOKE MA'81"l
Commissioner
STATE— OF CONNECTICUT
HOME IMPROVEMENT CONTRACTOR
EVERETTI SF T1'ON SR
102 Piae St
HOLYO%E,MA 01040-24U
SE MROOFING&SIDING CO
G V E
HIC.06U5383 12/—e� 11/30/2038
SIGNED