24D-300 (2) 27 HILLSIDE RD BP-2019-1278
GIS4: COMMONWEALTH OF MASSACHUSETTS
o:Block:24D-300 CITY OF NORTHAMPTON
Lot: -00 1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categ_orv; ROOF BUILDING PERMIT
Permit SP-2019-1278
Proiect# JS-2019-002069
Est Cost'59800 00
Eee: sap 0o PERMISSION IS HEREBY GRANTED TO:
cons[ Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot$izc(so. it): 8973.36 Owner: ZALESKI PHILIP T&.CAROL G
Zoning: URA(100)/ Applicant: SEXTON ROOFING CO
AT. 27 HILLSIDE RD
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 5344234 WC
HOLYOKEMA01041 ISSUED 0X:5/14/1019 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF
POST THIS CARD SO IT 1S 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: Ofl* 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:
FeeType: Date Paid: Amount:
Building 5/14/2019 0:00:00 540.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use ally
City of Northa pton gWeIll
�.. . Building r; Permit
/ 212 Main St AY 1 3 2Room 100 I llityNorthampton, MA 1 ural Plans
phone 413-587-1240 Fax 13 6fiAi nor���
nn'
Other Speafy
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION �• /d 7
1.1 Property Address This section to be completed by allies
: n
d` � 1� �j Uif
�7 Ui ll Sr o4 0 /-
Map Lot
Zone Overlay District
Elm SL District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGEthT
2.1 Omer of Record:
Q� it 22Psk '
ame(Piin/i) �� / Current ailimy�dres � u�
hF/CCrJ ? + est Telepho. <<
Sig tum
2.2 Authorized A ent: 0
Name(Prim) Cueent Mailing Address:
Signa urs Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bparmitapplicwnt
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 1
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit NumW
ssued: �Fl Q
Signature: /qW
�y ) I
Building Cmomissionedlnspector of BuMirgs r� Dare
l'a
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolical,
New House [:] Addition Replacement Windows Alteration(s) 0 Roofing
Or DOOM O
Accessory Bldg. ❑ Demolition n New/Signy/s�(O] Decks Iq Siding/lql Other[Q
Brief WorkDesaiptbn of Proposed
;E0 AqA ve y/'td( AeG AI c� �lli S� //!-a �!�/ ✓!q(� i'LGO�
Alteration of existing bedroom_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Adachetl Roll -Steel
it If New house and or addition to existing housing, complete the following:
a_ Use of building:One Fani Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
-
C Is Mere a garage attached?
d_ Proposed Square footage of new ons ion. Dimensions
e. Number of Stories?
I Method of heating? Fireplaces or Woodsloves Number of each
g Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
1. Is construction whin 100 It Hands?_Yes o. Is construction within 100 yr. floodplain_Yes No
j. Depth of basement or lar floor below finished gentle
K Will building orm to the Building and Zoning regulations? Yes_No.
L Septic Tank_ CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETEDWHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 4,11 7, -as Owner of the subject
pr rty
hereby authorize ✓iJ U��-
to act on my beha0,in all matters relative to work authorized flythis building permit 11716n-
QATUM of Omer Date
I J� .��/" / <7 ,as Owner/Authorized
Agent hereby declare that the statements and information on Me foregoing application are true and accurate,to the best of my knowledge
and belief.
Sig under the pains an nalties of perjury
PnM Name
Signature or OwramAgem Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed ConsWction SSuoewlis�osr-: � Not Applicable ❑
Name et License Holder: 6b�L -4 (� ' � ,V-))71 L/ S 2 9 96
bcense Number
Address E�imtion Date
1
Signature Telephone
S.R"Istered HomeUlirnprovement Contractor: NotApplicable ❑ p,
C n Name� Registrationr
V��c, X G3 -;) - / 5 � 2 /
Add1i1ss Expiration Date
6q i Telephone v/?J
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,5 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 Affidavit Attached Yes......- UP-' N, - ❑
SEXTON ROOFING AND SIDINGINC,
(413) 534-1234 P.O. Box 6327
FAX (413) 539-9506 Holyoke, MA 01041
sexton roofing @ if otrnalLGOfn CT HIC#0605383
MA HIC#118239 www.sextonroofing.com
Since 1985 p
SUBMITTEDTO / '2.9 G e S A- IPHONE �- DATE O
STREET �- i JOB NAME
ZIPcESIAT
ODE () LU j'� JOB LOCATION
Proposal to furnish and Install the follllowiing EMAIL
0 ea
U Re-Roof r-o8 in House ❑ Garage ❑ Shed
Complete Roof Preparation
ar`ilome exterior to be protected by tarps and plywood
❑'Shrubs,landscaping,trees to be protected
pKEntire existing roofing material to be removed,to existing decking,Including flashing,etc.
❑rsite to be cleaned everyday with roll magnet debris removed at project completion
L&,15-etehomted existing decking replaced at$2.50 per sq.ft
❑ Install all new decking/type:
hk rown metal drip edge installed at eaves and takes a-f8 ❑ F-5 ❑ Rake Edge
tNew flashing will be installed where necessary(see Special Requirements)
❑ Install new pipe boot flashing ❑ Sadtroom Exhaust Vem
lire#ash chimney with new lead
u4We shall acquire all appropriate permits one.for all roofing Work
Col "ate Roofing System
Leak Bander installed at all eaves to protect from ice dams(and meet codes in the nosh) ❑ 3' 318�
k Banner installed at valleys,around penetrations and chimneys to protect critical areas
U�'nstall Real Deck Underlayment on remainder of roof ❑ #15 Felt B-Synthetic Fell
Shingles
Ar-VK0 ❑ GAF o CenainTeed�� ❑ Tanker / ❑ 30 year ❑ 50 year xa-LlFetime Color C
-1/Gstall Attic ventilation system W-15ap over Ridge Vent ❑ Roof Louvers
Warnipty Options /
uiir�Vfha guaranteed our Workmanship for 25 full years
Et J)mp tat reb to tumish terial and labor-complete in accordance with the aAp ems§� ficaflogs,for the sum of:
tae fiAaO Ali daarsA$ 7fy5��D- ).
..emro� ra,.nwa y ;.J -a o
MM6lertulkga,aMeeE bEexapecRetl. ellxnYw EemreMellnavwb,WYila manrer Authorized
aan,brg d aa'AarJ paNtes. NY Llenlw w dm�n lmm acme 4rle2aye im iMrg
ann emis'cin l,e®nad wlv wmi wnlwn aaeie.ane..a lrewrean mre mei9e mer are
awevlemeeawnelne.r Mw.ea�reaeamoewmgsa wduemvnpA�Mnwm�mww,snw.�o..m�iaer� moo d. TWfe
wt.:This p
Indelible
onforewe
to 11orwounibar his,Mn
b, wdMkawn lynagnor arceved witnm days.
ole mi reMmt,ms
¢I¢tptml[t uf�t#pawl-Th eabowtpdces,specifv tion condiions
are sartsfecloY=-
a1M are hereby accepted_you are authorized to do the anneal. ^/J 1 C +I
work as specBied.Payment will be made as oNlined above. Th,W "lUY_�
oawaaa�pwia Sgreture
ATTENTION HOMEOWNERS:Please cover all personal bekogings in the allic.garage or storage areas due to the possibility of roofing debris or dust
coming in through the cracks of the wood Seiton Roofing and Siding will not be responsible for debris or dust in the attic or storage areas.
City of Northampton
Massachusetts Aye' °4c
4 212 a carr o BUTi> znsaacrrars i
�\ zlz Nein beat . lWn 01l 9uildi,g `gyp C':
NoitTeerlton, ea 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.I.Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion,
improvement removal, denuo0ort orconstruclion of an addition to any pre-existing avner-occupied building conlaming
at least one but net more than four dwelling unds....orto structures which am adjacent to such residence orbuddind'be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: Est.Cost:
Address of Work:
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 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 PACE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I 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
Massachusetts
't ➢212a S O HOI icx ZPBmlC g y.
212 [Nin Sheat •M.iciyel Builtling Vyr
c'm
xoru�tm, xw 010so
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:
2 � �.LZ_ �R Al[1 '�/
(Please pont house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or wilill be disposed of in a d�upmpsterAonsite rented or leased from:
/-GS �l '/' � /J r. �,1: n. GY/PC �Lv� S
(Gompany Name and Address)
S")9j/`L
ature of Permit Applicant or Owner Dat
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.
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�\ The Conutzonwealth ofAfassaehuset(s
Depar(neent oflndush*lAccidents
1 Congress Street,Suite 100
Boston,MA 02714-2017
wwtamacegov/dia
Ww.,.rs'Compea b m Lsarauce AtSdaviC BvMers/Contr ctoNElect ieiaas/Plumbem
TO BE FILED WITH THE PERII0717FING AUYHORffY.
ApoEont L(ormatiou Please Print Lesibly
Name(BusmenorguousausaandmdualyNRC Construction Inc
Address: 66 Water St Apt Z
City/Stabdzip:Milford, Ma.01757 Phone#:774-287-1485
Mc yea ase W"O Cbedr tk apprVnale bac Type ofproject(required):
I Qaam aemplge wrth4 miployas(full md/arpart-fie)' 7. E]Now eousimetion
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propriamswdhrw..Pl � 12.❑Plumbing repairs or additions
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lnfarrrmnoa.
Insurance,Company N.-Atlantic Casualty
Pofiry#or Self-ins.Lic.#:R2WC947397 Exphation Date-8/16/19
Job Site Address: City/SudejZ.ip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to segue coverage as required ruder MGL c.152,§25A is a criminal violation punishable by a free up to$1,500.00
and/or one-year imprison m ad,as well as civil penaltics in the form ofa STOP WORK ORDER and a free of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office oflmesogaome;ofthe DIA for insurmce
coverage verification.
I do herebyc�derikep®a and penahm ofperjmythat the brformakon provided above a bneaad correct
S' afore' Date:
Phone 0.'7A-287-1485
Official we only. Do not write to the,arm,to be completed by city or town official
City or Town:. Permit/L]cease#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3,City/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: - Phone#:
A CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE IS ISSUED AS A LATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CETITIFICATE DOES NOT AFFSMATNELY OR NEGATIVELY AMEND, EXTONO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLIER
IMPORTANT: RIM cerl8ob holder ts an ADIXIgNAL INSURED.Nle peli:YTg)nNet love ADDITIONAL INSURED povlskoras«be erclorsed.
H SUBRIX'.ATpN IS WAIVED.subject to IM tsrrm LAM carrrb5ms ar the pdry,mrMin Po0rJvs maY n:grdre an erxbrsment A stM Mit on
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CARPENTRY,ROOFING,PAINTING
CERTIFICATE HOLDER CANCELLATION
SEXTON ROOFING&SB3WG INC sHolx^AxroFTHEAeovE DEscRIeED POLICEB aE •.,,FI Fn BEFORE
PO BOX 6327 THE EAPBADON DATE THEREOF, NOTICE w01 BE OELNERm IN
ACCpFtDANLEYYIPI TNEPDl1LYPROV6xTNS
102 PINE ST
HOLYOKE,MA 01070 AurxolrffnnaTNE
sEX oa�DoFing2horms;LCowt
®1988-2015 ACORD CORPORATION. All rights nserveD.
ACORD 25(2016H3) The ACORO name and logo are registered marls cfACORD
namve,.y Fac e�wen SOMs w,rivvsBm[m IN�Fuex+xy emus-IED
Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type G-P-JD-
SEXTON ROOFING&SIDING INC Eypwab=
02/14
02114(L0
P.0-BOX 6321 -
HOLYOI¢,L4A 01041 _.
UPd Zf—arxt Rebrm OLE.
EVERETT J SEXTON SR HOME McROVEMENI'CONTRACTOR
PO BOX 6327 EYERETT J SEXTON SR
HOLYOXE,MA 01041 102 Pu¢Sr
HOLYOBE,MA 01040-2411
SEXTON ROOFING&SIDING CO
LI .IR NOVE —exR—R 5---
HIG060SM3 01/2018 11/30/2019
sicNEO
Comoonor n of uassaehus
Oivislon of Rofwoonal Lrcansure
Boa of BuOrOng Regula0ons arM SlanU rds
Construction Superdsor Spemalty
CSSL-099689 Expires: IOMSM19
EVERETTJSFX N
PO BOR WV
NOLYOIE MA NO" - -
CorOmfssiooer C4