Loading...
25C-232 (6) 159-161 BRIDGE ST BP-2020-0414 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-232 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-2020-0414 .Prosect# JS-2020-000701 Est.Cost: $17000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTONROOFING CO 99689 Lot Size(sq. ft.): 6577.56 Owner: MILO PROPERTIES Zoning: URC(100)/ Applicant: SEXTON ROOFING CO AT: 159 -161 BRIDGE ST Applicant Address: Phone: Insurance: P O BOX 6327 413 534-1234' WC HOLYOKEMA01041 ISSUED ON:10/1/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE OOF 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: 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: FeeType: . Date Paid: Amount: Building 10/1/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner CI ham ton -ea ®o1,�` _ i .� x t � l Building epa ent Curb CutlDr,veway Permrt spar ry ` ` t M in S et. ty ` k : 3 RO m 1 0WaeriVYBIab1{lt�lr kart w yr Tygn -"'(G) am ton, A 01060TwaFSets of Structural Plans T pho N "'I , 240 Fax 413-587-1272 PIotlSlte Pians t f { APPLICATION TO CONSTRIJCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Lfflz SECTION 1 ..'SITE INFORMATION � a0- -7 Thrs section to be completed by office 1.1 Property Address: � v r Map ' C Lot S, a— Unit Zone Overlay.District EIm,St Desttict I -- CB Dsttict SECTION 2 PROPERTY 01NNERSHPIAUTHORIZED AGENT I 2.1 Owner of Record: l0 Name(Print) Current Mailing Address: 537 9 Telephone Signature 2.2 Authorized Agent: Name(Pri Current Mailing Address: -53Y / 2-3y Signature Telephone SECTION 3 'ESTIMATED CON of.0OSTS Item Estimated Cost(Dollars)to be Official Use Only. completed by permit applicant 1. BWildin g (a).Bu,Iding Permit Fee 2. Electrical (b):Estimated Total Co'&t of Construction from.6 , 3. Plumbing Owtd-ift PermltPee 4, Mechanical HVAC 5. Fire Protection 6. Total= 1 +2+3+4+5 ( ) , 666 Cteck,Number � f ThisSection For Official Use Onl Bu,ld,rig Permit Number `' A�L Date f S,gnature # (� 13u,ld,ng Commerhn issiospector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) .. i t .. L __ _ _ _ i • F `e,F. ... Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due TQ Incomplete Information Existing Proposed Required by Zoning Phis column to be filled in by Building Departinent Lot Side Frontage -� Setbacks Front Side R:= L:= R: Rear Building Height Bldg.Square Footage 0/0 s_ Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location)---- -- - f A. Has a Special Permit/Varian /Finding ever been issu d for/on the siOFIN te? NO DONT NOW 0 YES IF YES, date issued: IF YES: Was the per I it ecorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page" and/or Document# B. Does the site c tain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, ha a permit been or need to be obtained from the Conserv tion Commission? Needs t be obtai'l led 0 Obtained 0 , Dat Issued: ��^� C. Do an signs exist on the property? YES 0 NO 0 IF , describe'size, type and location: D. there any proposed changes to or additions of signs intended for the property YES 0 NO 0 IF YES, describe size, type and location: E E. Will the construction activity•disturb(clearing,grading,excavation,or filling)over 1 acre oris it part. a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i . .. _,,� .. ar . , . 6 1 RECTI N 5 DESCRIPTION.OF PROPOSED WORK check al I:a licable New House Addition Q Replacement Windows Alteration(s) Roofing Or Doors C] Accessory Bldg. 0Demolition! 0 New Signs [C3]. Decks Siding[C7] Other[CA Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new,bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Asa if NeHr''la�ise end,.olr=additot>t�toeitistInpeh``oustnq;>cori�pie`te;tlefio�lowin`g: a. Use of building:One Family____ _ Two Family Other b. Number if rooms in eachly u it:. .. .._-, --.--------Number-ofBathrooms C. Is there a garage attached? d. Proposed Square footage of new co ruction. Di nsions e.. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance., - Masscheck Energy Compliance form attached? h. Type of construction L Is construction within 100 ft.o et ands?_ Yes No. s construction within 100 yr. floodplain Yes ' No j: Depth of basement o Ilar floor below finished grade k. Will building form to the Building and Zoning regulations? Yes No. I. Septic an City Sewer Private well City water Supply SECTION 71,=OWNER AUTHORI�A'TION TO BE COMISLETED :WHEN � �� OWNERS AGENT OR CONTRACTOR'a APPLIES FO.R BUILDING PERMIT ; '1 AI'n D 2 G as Owner of the subject property hereby authorize to act y behalf,in all matters relative' to work authoriz d by this building permit appli 'on. s-/- Signature - -Signature of Owner f ate I, G�� '— / 4 / as Owner/Authorized Agent hereby declare that fbe statements and information on the fotegoing application are true ar d accurate,to the best of my knowledge and belief. Signed under the,pains-and penalties of perjury. L Print Name Sig Owner/Agent f Date i . . ... r \ _ i � � 1 ' I i 1 • 4 SECTION 8 CONSTRUCTION SERVICES 81 Licensed Construction S//uo��ervisbr. f of Applicaablee ❑ Name of License Holder: }'�(/G�� aC�l�1�> r v D / ic��lumber (O Q Address Expiration date ignature Telephone 1 isteretl°Morcel ma enE:•Cant ac or yp ...._� •„ TMn ..� w u � Not Applicable Co an a eegistration Number K `5 � l Q �� Address Expiration Date Telephone Yl Z3 SECTION 10:WORKERS'COMpENS�►7ION INSURANCE AFFIDAVIT(M G L c 752,§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....... 0�+— No...... ❑ i City of Northampton Massachusetts DEBAP MENT OF BUILDING INSPECTIONS 212 Main Street ♦ Municipal Building Northampton, Ma 01060 AFFIDAVIT Home Improvement Contractor Law r Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing im, rovements or renovations on detached one to four f�mily homes.Prior to performing work on such ho es,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requ' s that the"reconstruction,alteration,renovation,repair,modernization, conversion improvement, removal, demolition or construction of an addition;to any pre-existing owner-occupied building containing at least one but not more than our dwelling units....or to structures which are adjacent to such residence or building'be done by registered contracto s. Note:If the homeowner has ontracted with a corporation or LLC,that enthy'must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not reuired for the following reason(s): Work excluded by law(explain): _Job under$1,000 00 Owner obtaining own permit(explain): �.Building not o er-occupied _Other(specify) OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCQNTRACTORS 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 142. .SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER411E BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: `I hereby apply for a building �ermit as the agent of the owner: Ig Yate Contractor N me C Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: J Date Owner Name and Signature I i r � J 1 .. '! .,. ., .. .,.L.,Y,,. /_ _ .. .. .. :. e '�'' _ .. Y.. .. •gid�. �• — y':'.. ,. � ., E, i, .. � ._...... .__ _., _ .. _..... .. � � ! i, . , .. '.fir�.�'.. '✓ J t . 1 _. _ ..... .. i , ,. � ., t t: / f ` � e _ '�' .... F � . „ , f: ,. ... City of Northampton � Massachusetts ' M. ,` DEPARTMENT OF BUILDING INSPECTIONS 1 • 212 Main Street •Municipal Building Northampton, MA 01060 lsy jj^4fi 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 BuiOng 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: (Please print house number and street name) Is to be.disposed of at: (PTe—ase print name i-d1ocation.of facility) 1 • Or will be disposed of in a umpster onsite rented or leased from: L fyet-fi f, (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Appli nt or Owner shall notify the Building Department as to the location where the debris,will be disposed. i I ' � n � _ .1 .. ,� i' + _� � \ ,_ �� i 1 .. ; \vt i �, � .. ,. . I i '�i `1 i 'f`7 s t ,k " .i., R0 i t FIN �' ' Ni,JSlDT.5 i , f,� 11 r d5 dv E 5"^ � s+o 4s e ,� _r t k ^r a -.> 1 y `J N'` �� ° -11 I s r s �.., 1 n a s sr, x .F., r 't t n a z �` � , if vwseatt�nroofin��com w f S F .I + P S S $ l ,� 1 f f e, A i i i + r i ' 'v �`� °R1 { I ' '„e Y ' #i 'a° �x _ r'°a s J ,n, �',� 1a , i C p ' kF"c";, Yk �_ .i ,T f 4"( k Ii i i , F .Y } l �. Y I"11" ' .t .fk ti e,'.. ray k 1� e tit! S �. a a = 7 '' r '< ' t+ k' 4� tis F r ° ry J r s b¢ f ,a aat { r is t r L .t. ` J 11 r t y c # t ' w.�.�+• x i. , i i d - i Ay ` p fy��Y11Y��4M�� 1� a O-,v a1 i ,y -A I,—t 'pt ,� F v �etttng ttltnStmnc3�trCl f fk k kin*1 4 '� y.. Y`x ! f .,� iF I _ .'.;F i }� E 5 y FF f. -P`0 i, tk 6327 , { } 4 1 t t t 4 L - R y i i t11 I p,413-'.,534-"t,-.43,4 ,' r Holyoke,-- "01041 °�;r� r '. x s, u�o:t L, r�"*< w f f'`s �; 7 n E E i a i a; kt ,/ t,s'1�t t, Py. ,„t y „ f. 4113339 9946; h, t '1. , M�1Z ld#1lus �i � t a $eX Oiii'OOflii 1i08i�Coin _ .� �n. k t R ; .f t y. 'i t 1 1 '� b x a bt `" �SilB14iITTED To Milo Properties PHONE°� 6379' 1. '7° g� BATE 9/0/19 �, f, t= JOB NAME Rental i'ro � ' a "STR�E1 11 x ," I, --STA ;ZiP` v ' JOB LOCATION '159 161 Bnd a St.Northam ton,Ma. i r r`° SEXTONROOFINoIIEPEBY UB SP Ct�7CA"TjoNS�ANIaESTIR'�ATES�EOR} ` �,� Y< ° ,� ` - e - < , ' b 4 A 'i f o r. . rr 5�t ". F i i i 1 vl s s a.,I 64 } .:s y J5, S'�s v I. w ,ifr., r .n a.,� j, 1)" 5tnp and remove ca"kii shinglesI'll and dispose ol:in-prtrper landfill , ,u�`: ', ;, vi, E t n r 2)k' Inspee`t roofing,- eck and'repIacetas needed ?S'00 per sheet.' I } fd s r f }i r rr , s s , i y tt } vc ,7 k.;. C,. y t 5, 3)' Install new metal cdgtpg to rapes and3eaves t i­11roof(8',, ti.,, ' 4) InstaD ece snd water shield on e�vesF(6'},vent stacks,wt,valleys,chnlnneq,Skyl�6ts and At zntersectsng ` s{{ p e .>v i E; , �Y 1 fi i� ;i i ,4 rvofsa 4 a..e s t t d ,*`t r, s e z i 1 l +r '` Jr Syr '' _ � e p s is n1 .c t ) i " i vio 1 Install#15 synthetic ro i g felt unyremai©der of tool` i _ _ ci s a. 3 r r' ±: i Sj` ;Iasts�ll new flanges'over e�shng:vent stacks., , _ ;;, �, ,Install starter shingles on eaves and rakes of,iKooi± x 1 8) Tr1.ite[! IKO'Arcluxectara!styleroafings4Wn's�aslperfma""T",etnr7ers' specdicat►ons. i a .� r a 9 r ark n rt s r a "' C-, c1A 44) Y } C S+ irJ✓1 f5 a stir tF 9) ReflRSliCllllniley wltlt,newlead flashing. }5 76 6 b k fit ' btA 1 Z �' .f '�4 .i f t J t �. F 'il 11 rI'll 10)Install neI 11w cap oyer edge vent: `� �` '° a , I1)S�ipply<ireannfactaires L�fctrme wa li�#many=and S�Cr5 yr ti workmaieshipwarr�ur r ��° n, �� y r 5t'j, 2 i ' � J A'. cy S .ti yP s. Y ,! Y J d $ F f d y J =T i S d S t ' r,� if 1 t , dJ ��f k s 1- ids ' - .ti a r �`� try r ver s: a a - r \y r � s' a s � f 4 J`i N! ) v;r } 1�3t` t�` 't, t'...f ,r. prl '�' J��fflf'i. , { r ' I'�� ld.. .11 ' W�Pro�vs�hereby to fury>sh mater�ai and labor' compte e m atc�rdance Frith the a6bve speclf ca iu ,I. for t13e amo int ��� Seventeen Thousand Aollaxs( '1000 00) Pa et►ts tQ be made as llI'llovvs Daxe 1 ozx com feta�p ' y � i � t, Pf Att Mmtengl rs guarani Iw to be as s'—m` . at qt work to bo�PTAR.Qt d�in a k "` �� r w '� ^ i "` —,M, M,j'r lteratt of 4 i " '' 3 zea 5> ; workmanae-rdanner Aaorfts to standard�prac ces on �devtaiton ,51gttihtre &aM's ove specifications mdoty ngextra°yeasts wilt be executat W,opon written , . ti ;r , 1. Y, osc� tin '�/lf�/i�.�^^eflp �y}� ,,&,4"y, .��^,Iptn'p�q�+� }. • a i r t y J dl i i':o YAJ.�Ya�•I^'r.7 Wi�AV 6wao V{W LVI�L�NfYV M.Y WI ., 1 �N k I'll��'�>.G�; F '�+ �' �A ty k+ti;'�fl rryil X47'' ' K �' t y � "�� 1"I,agteCiiiCntS Contingent t"stokes,aCCidL'Y[ts of delays t)Cyo- our:Con 1,0"Nott i 'Note, i is pl opt?S�t tl]2ly b�Wtt11t "d tt�►by� 11S ,f� ¢ figgt 9 ..�espaihkf'Ilfar water dannage du,,.r,,ignyg Constigetion.--.Owner to pay responsible legal wlthln(14)days .`� '` .. ` " °' 0 .'fees fbi'Ran t,8T1(I liCable tiitetcst. y;C a 11 i a w iA � f ;r"* r s _ s ' q L +c 'i F �yA� yS r i�1t'. 3,4 ¢ p1 Y ll ��A1:' F iz f 5 y y,`". `45. �. ri i v�.Y t t ,t * 'igi.`"" i in 1 t rr t ''i �cp� /��{(y+ � y���y�q��/j� � q r�VVX+L^ �V,a���ocl co�ofts kt 4+ti a�H L i 'e t > 'trp �^' ,� la' � and eotdri%ta�iis aresatlsf�c#pry a11 nd jars hei+ebytacegtIlled Yate Slg�e ' ' * �,tQ' le �dlS4 r' ,� �i,41 r (b lb �6�+*�,' „ � �- t 3te"'s� ms , S 4 y 1 il ,+F f .i {k } `gg} -rye y-:1 � /q k./'tj._, tr S♦ T $ J e �*kY� v�T+k 4Sa '•2% 1 Ua 4ift '#F tf Al f Cly{* '� Iq % ` r t t �t41.ft'1 Q !.F�Y'}�1 t� ` ::9 t11td.a6�ovo d i is Ir"i RV�►�ACCliVM ( G �. J i d t 'il S ss V H o 7 'h a a .>n�ivT`,'. '�4a. p �s� ti yi ' i.F i "n,Y. 1 {';,t V 17r 1�n i lif 114 7k 411'� J� �j If k Srl W/. ,iii Ste. S t 1n R Y+1 < � 1 M t'f �� P si.. z. - h 1 4sY .r"' hs .g a��rl Ott 1, s, f fit q.., ', r�3 It i� ul kF g rt ik h tk. irl,. t 6' s �"' rt,fill e�' „eG u 1 w`f i<,,f;�k P� ��t*, v X" � e II r rS 3 E'( t r. 1, t'� Y4 vi h n. ..F,k �1 z a t s l a •x } 4�l 'L, d yf 2 t -� e -� r s r6 5}} � a`, w5j 7v"i t ,SYb#� 4I, k "i1`♦I✓,k#>�"�T x a c f{,r'3l+t, y �s` t, 'y q itt Rr t a4s ;t $y r R� �i 4Ua X 1 &11 4% �}s it 1 t � Vel }g r iP i l i F 3t ° `I A,,u 2} � � ,e ;� xi �its �fi ei S 7 Y t r 1,1 � � �� U+ . M Yc h i l a rst�t3F k a..`t i� r w S Ntk,': I k @ - �b l a 1 l d d y e to i �j]�iP f YA i 4`�1, a {M p. 1 o F �'d. ,S `� , f t �' ki s 'F�,�itis °` JY'11ek+tr l� 's$8 �a'Sk$ s' 1 'e K#dl 1 a +, rn ,r vv 1, u'7 +}a g x v w £ .k tiL �Yti �s`s gym is rs� a�Yaj"f ztt ua u. �,� "kt ?ia t'y4ae� F P 11 a t4 a bra ne 5 a +q v 2 ♦, R5'a E f `. k r r r Y, F t'kt s& t.. x Y. „ �` ,ane., ,;:. :�u'r .11tuma=LS`.':ua_Yc, s,a•' a s...� Y' ,t�.n' x,:�...�:.:n.a' 3.�c.. ,I.e I ' 1 s i .. � ( ., . .. _ r r i .. �� \ .. .. t r �� � �-. � . l The Commonwealth efMassachusetts s , Department oflnduslrW4ccidents Office oflnvestigations 600 Washington Sired Boston,Mass 02111 . www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly -,Name(Bushmstorganizationandivi ,_Sexton Roofing&Siding Inc P O. Box 6327 Address: . __ �ityistate/zip:Holyoke, Ma.•01041 phoIIe#:4�13-53�-1234 Are you an employer?•Check the appropriate box: Type of project(requited): 1. Lam an employer with 4.pt I am a general contractor and I 6.U New construction employees(full and/or part time).* have hired the sub-contractors 7_C1 Remodeling 2.0 I am a sole proprietor or partner- listed on the attached sheet_ ship and have no employees These sub-contractors have 8.0 Demolition wonting for we in any capeity. employees and have workers' o workers con 9.Fj Building addition [N p.insurance comp..insurance.;� required] 5_F1 We are a corporation and its 1'0.0 Electrical repairs or additions 3.r0 I am a homeowner doing a}I work, officers have exercised their .eir 11Cf Plambin myself)[No,workers'cone. right of exemption perm MGL g r epairs or additions insurance required]t c_152,§1(4)and we have no 12_XRoof repairs employees.[no workers' 13_f Other comp.insurance required.] 'Any applicant that checks box#1 must'also SII out the section below showing their workers'compensation pol}cy information. -piiomeowncrs who submit this affidavit m"plicating they are doing an work and then hire outside contractors must submit new aflidavitindicating such. .',Contactors that cbmk this box mus[a an additional sheet showing the name of the sub-coutractors and state whether or not those entities have employees. if the sub-contractors have employees,they most provide their workers'wmp.policy number. I am an employerihot is providing orkers'compensrrtFon utsurancefor my employees Below u 7hry and job site InsuanceTravelers Property Casual Com an of Amer Insurance Company Name: � � p y i � Policy#or Self-ins.Lic.#:UB-OG078982-19 Expiration nate:06/04/2020 Job Site Address: City/StawZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date). Failure to secuore coverage as req' bred under Section 25a of MGL 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office ofInvestigati'Pris of the DIA for qqyEMe verification. I do herby Certs_MA der the pains and penalties of perjriry that Ike informad6n provided above is true and Correa _Signature: Date- PrintName: 9w5It-, Phone# Y/3 - <- S, , - P 7— :5 c/ 1 Official use only Do notw 'te in this area to be completed by city or town o' tial City or Town: 1 PeriliMeense M. Issuing Anthority(eircle one): 1.B92rd of Heath 2. Building Department- 3.City/Town Clerk 4 Electrical'Insp ector 5.Plumbing Inspector 6.Other �. Contact person: P one M. I I C RTIFICATE OF.LIABILITY INSURANCE DATEtM 01201 rn .TER PON 7HE CERTIFICATE HOLDER. THIS ATE IS ISSUED AS A NIA OF INFORMATION ONLYAND'CONFERS Na RIGH'T'S U CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR:ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(SL AUTHORIZED REPRESENTATIVE OR ODUCD RTI IME CERTIFICATE HOLDER, PORTANT:If the certificate holderis.an ADDITIONAL INSURED,the poTicy(les)must be endorsed. SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomemen s. PRODUCER f CONTACT c ORMSBY INS AGCY , PHONE FAX PO BOX 718 (AIC,No,Ex* (AIC,No): -OTAL I WEST SPRINGFIELDE ,MA 01090 ADDRESS: . _ 286TF UISURER(S)AFFORDING COVERAGE MAIC# INSURED IMSURERA: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SEXTON ROOFING&SIDING INC INSURER B INSURERC: PO BOX 6327 INSURER D' f 1 ' INSURER E: HOLYOKE,MA 01041 INSURER R l COVERAGES CERTIFICATE NUMBER: REVISION NUMBER-- THIS UMBER:THIS IS TOCHtTIFYTHAT TUM POLICIES OFINSURANCE LISTED BELOW HAVE BEM iSSUEDTOTHEO�UREDNAIIEDABOVEFORTHEPOLICYPEttIODWM TED.N07WfiH5TANDING ANYRwu1RmwT,TERMORCONDIrIONOFANY1C_ONMCTOROTHERUOCUTAENTWRNRESPECTTOWHICHTHISCER wAT€mAYBE1SSUEDORNAYPERTAW.THEDWRANCE AFFORDED BYTHEPOLICIES DESCROWFIIEREINISSUBJECTTOALLTHETERMS,EXCWSIONSANDCONDITWNSOFSUCH POLICIES.LIMMSHOWNWAYHAVEBEEN'REDUCEDBY PAID CLAWS. INSR U POLfcYEFFDATE POLICYOWDATE LTR TYPEOFMSURANCE ' POLICYNUMBER (MM MYYYY) (MNRODIYYYY) LIMBS GENERAL LIABILITY FENERALAGGREGATE CURRENCEGOMMERCUIL GENERAL UABILI(YCLAIMS MADE �OCCUR. TO RENTED_S(Ea oc urrence)(Anyone person) I$ AL&ADVINJURY $ GF-N'LAGGREGATELIMITAPPUESPER: JU is POLICY �PROJECT Q LOQ RODUCTS-COMP/OP AGG $ � I AUTOMOBILE LIABILITY COMBINED SINGLE i$ � ANY AUTO LIMFT(Eaacrident) ALL OWNED AUTOS BODILY INJURY !$ SGHEDULEAUTOS Perperson) ' { HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (PeraccaderM. 1 ROPERTYDAMAGE Is (PeracddeM) i UMBRELLA L1A6 OCCUR EACH OCCURRENCE $ EXCESS LU\B CL MMS-MADFE AGGREGATE $ DEDUCTIBLE g RETENTION$ A WORKERSCOMPENSATION AND CSTATUTORY OTHER EMPLOYERS LIABILTIY YA NI llB-OGo78982-15 0670412019 0610411020' uMITS ANY PROPERIiORIPARTNER/FXECUTM OFFICERMUMSM EXCLUDED? NTA ELEACH ACCIDENT $ 1,000,000 (MandatcayinHH) ELDISEASE-EA,EMPLOYEEj$ 1.000,000 Uyes,describe under DESCMPTIONOFOPERATIONSDeIaw E:LDISEASEL POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATtONSi1:OCATiONSJVE711CLES/REST'RICT1IONWSPECUIL REMS TINS REPLACESANYPRIORCFRTih7CATEISSTOTWCERTWCATEHOLDERAFFECTWGWORKERSCOMPCOVERA E. I THE INSURFD'S MAWORIO RS COMPINSATION POLICY AND TTSLWTE D OTHER STATES ENDORSEMENT AUTHORUMS THEpAyMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS blA EMPi OYEFS IN:STATES OTHER THAN MA.NO AUTHORIZATION IS GIVEN TOFAY FOR BENEFITS IN STATES OTHER THAN MAW1 jItINjUj6* .... ... I BUUES.ORTMFMUElDOeLOYEESOUTSIDEOFMA THIS POL[CYDOES DIOTPRpV1DECOV i GE FOR ANY STATE OTHER THMLI& CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPOtATION DA THEREOF,NOTICE WILLBE DELNERED INACCORDANCEWITH THE POLICY PROVISIONS. UTHORDFD - RES A REP EATT ACORD 25(Y"," The ACORD:name end logo are teglstered marks'of RD -2010 ACORD CORPORATION: AD rights reserved:. .. .�r� . . .. .. .. .. � _ .. ,. . -. � ., ��.. ._. .�_.. ... .. .. ... ....F ��. .�. .._. ... .. ...... .. .. .. .tip.. ., ... .. .. ' L' .. a � � �f ..... ,.. -.. ... .. .� '.l_ ... � � ' � � 1 � .�. .. .. ., ,..;, � � I _ .. � � ' ,I � ... .. ...... _ � ._ y ..,. �: ` -.: ' / ... .. .� � ., ... � .. i .. � e. ............ .r-. ..:. .. .... .. .. .. a.. �. .. ..r .. - - .. .... .. ..-._ � .. ... r '� �.... .. ..... ... .. .t� .. .. � r, � -. k 'Z.......• ... ....... ... ..� .. ..... .._ . .3. :moi :.. . .. .. e ..'.." � :. � � - .. ._ r :. �� .. � _ ----1 S© TO-2 p 1 A D" nA"Ew=wffM CERTIFICATE OF LIABILITY INSURANCE 0711012019 THiS CERTIFICATE IS ISSUED AS A MATTER OF IINFORMATiON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMAIWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE ICOVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B£iWE f•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 ADDTONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED,subjectlto the terms and conditions of the policy,ce"n policies may require an endorsement A statement on this certificate does not confer righIs to the cerdfirate holder in lieu of such endorsement(s). PRODUCER 413-737-0300• acr Eric Dembins to Ormsby Insurance Age� .Inc. � PHONE 493-737-0300 FAx 413-737-0617 698 Westfield St PD Box TIs ko,_ ca+c.Nok W est Springfield,MA 01090 embl'rls S yins.com Eric De=h-"W ce INsuRERisI COVERAGE NAICri iNsuRERA:Colony insurance Co. _ NSDREO INSp�B;Quincy Mutual rreinsurance 15067 xton g$Sidmg,Inc. HolyoQle;01041 INsuRERC: iNSURERD: -- __t INSURERF: COVERAGES CERTIFICATE NUMBER= i REVISION NUMBER: THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN,ISSUED TO THE IiVSURED 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 AiL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TYPE OF INSURANCERIM SU13R POLiCYNUYBER POLICYEFF POLICY ffi umm A X couxEwALGENERALLIABUliY I EACH OCCURRENCE S 1,000,000 CLAIMSMADE N OCCUR 181GLO021591103 06/25/2019 =2012020 DAMAGE RENfEO kl $ 100,000 MED EXP one $ 5,000 PERSONAL&ADVINJURY S 1,000,000 G�AGGREGATE LIWAPPLIESPER: ' GENERAL AGGREGATE 2,000,000 POLICY 0 Ye F]LOC PRODUCTS-COMPIOPAGG 2;000;000 OTHER- B AUTOMOBILE UABnm I COMBINED SINGLE LIMIT 1,000,000 ANYAUTo AFY2065M 05!1512019 05J1512020 BODILYINJURY er erson OWNEDX SCHEDULED AUTOS ONLY AU��TryryOppSyyyy��pp BODILYINJURYIPeraccideM S _ X, 0%6NLY X AUTOSOAILY 1 erPacauerd�— _._._—. .g.__-_ _ ,------.--- UMBREItAUA6 OCCUR EA OCCURRENCE S EXCESSLMB CWMSMADE AGGREGATE DED RETENTIONS q WORICERSCOMPENSAMON PTER �" AND EMPLOYED LUkBRM R ANY PROPRIETORiPARTNEWEXECUTNE YIN TO TO BE SENT SEPERA7ELY E.L EACH ACCIDENT $ �_EFlCERlMEMBEIEXCLUOED? N A EL SEASE=EAEMPLO lf�ryye�a,des�rrnrYy I1O fNr1IrlUnder DESCRIPR NOFOPERATIONSbelar L ISEA -POLICY DESCRiPTIONOFOPERATIONStt='1ONSIVEMCM (ACOrm10I-AdtMimMRemoftSChedu*,mrybeattadeedHnwtesPaCeis-q bem r CERTIFICATE H LDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE�MRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN Everett SextonACCORDANCE WITH THE PO PROVISIONS. : - PXVIOR®REPRESENrA iVE ACORD 25(2016103) I ©1918-2015 ACORD C CORPORATION. All rights reserved. The ACORD frame and logo are registered marks of ACORD i r 1 The Comrnonnealth ofMassachusea.v Department oflndrrs-&WAccidents . I Cotlgress street,Smite I00 Ruston,AIA 02114--2017 www-alus's gov/dia Workers,Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PER:t4IT ENG 1L'THOR17-f. v A licant Information ]Please Print I,e ibly Business/Organization I ame:MNP CONSTRUCTION INC Address:45 EXCAHNGE ST City/State/Zip:MILFORD,MA.01757 Piiane#•508-498-8870 Are you an employer?Check the appropriate hox: Business Type(required): I.(�✓ I am a employer tivitlt employees(full and' 5- ❑Retail or part:time). r 6. ❑Itestauranti3ar.'Eating Establishment ? [am a sale proprietor o r partnership and have no I eMPIq ees working for in any capacity. ?- O.Office andt'orSailes(incl.real estate.auto,etc.) (;Ira-,vork-ers'comp insuranceuired $- req J ❑•'Non -profit �•0 We are a corporation and its officers have exercised 9 ❑Entertainment their right of exemption per c 152,§1(4),and we have no employees. t 10.0 Manufacturing fNa wor•ers camp.insurance r�equiredJ 4.0 We are a non-profit organization,staffed by volunteers, I I.[�Health Care with no employees.(lkq workers'comp,insurance req.j . i2.0 Other CONT CTOR *A"y applicant t checks box#1 mttsr,also till out the section below shmx ng:F.eir Warkers'compensationpniic�'infomyntion T�- ""If the comorateUf€cem have exempt Id thenl�dves,but The corporation has Other emplo}ccs,n LCorkeCS"compensation poli is organization should cheek bo-,:1. C3 required and such an am air em plo er thatis proriiling wortscompPttstrtion insrrrvnte far my ernptnyees Below is the policy irrforirratiniz, Insurance Company?game-HARTFORD UNDERWRITERS INS.CO.TRAVELERS-RMQ Insurer's Address:P-O-SOX-5600 City:'Staterlip: HARTFORD,CT.06102 Policy 4 or Self-ins.Lic-#I K70970fi Expiration,, 13/16/2019 te: Da Attach a copy of the workers'compensation policy declaration gage(showing the policy umber and expiration date). Failure to secure coverage as reg7vired under Section 25A ofMGL c. 152 can lead to the impopition ofcnmina!penalties ofa fine UP 10 51,500.00 and:or one-)Lear imprisonment.as well as civil penalties in the€orm of a ST'QP WORK ORDERpenalties and a fine of up to 5250.40 a day against the violator. Be advised that a copy Of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification: - I do hereby cerli u r p s'gh ties o er" 1 fp ./urt that the in ormadon provided abo►:e is true and correct. Signature: Dater. I� j Phone K:978-403-5942 Official use only: Do not writ fir this area,to he completed ky cit}-ortown official City or Town: PermitlLicense# Issuing Authority(circle one? I.Board of Hcaith 2.BuiWin1llepartment 3.CitylTown Clerk 4.Licensing Board 5 Selectmen's Office 6:Other_e Y Contact Persson: --V; -� Phone#: �tilti�vartass�ov;�dia I ACERTIFICATE OF LIABILITY INSU"r"CE DATE(i�ADOlYYYY) osflanals THIS CERTIFICATE IS ISSUE!AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH7S UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NIEGATNELY AMEND, E)MatD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TWS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATIve OR PRODUCER,AND THE CERiIRCATE HOLDM IMPORTANT_ if the certificate bolder is an ADDITIONAL INSURED,the poficy(ies)must be endorsed, N SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may regsure an endorsement. A statement anShis ter ifJrate does not confer rights to the certificate holder in lieu of such etrdorsemengs). PRoosrcFx Art Calvrllo I ONE FAMILY INSURANCE AGENCY LLCPHO�"�_�,-�-(978)403.5942 ���,� ac eWO128@yahoo.corrl I Ma;n St Suile 15 INSUR04M AMMING COVERAGE � NASCV Lunenburg MA 01462 mumwA.1iARTFORDjUNDeRWRfTERS INS CO `�. 330104 INSURED MNP CONSTRUCTION INC ,Nsotc; rNSUREit 0: I 4S EXCHANGE ST APT 3E MSUIMR e: I � — MiLFORD MA 01757 1 p suitmr-: COVERAGES CERTIFICATE NUMBER: 404083 REVISIONS NUMBER. THIS 1S 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY M ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFS4CH POLICIES. tLiMffS SH01vN h'IAY HAVE BEEN REDUCED BY PAID CLAIMS. -rRR3 rmFor-wsumxcF I 1� LI . 9Rt POLICYNUMBER I POLICY EFF i D� 1 COMMaMALGENERALA MITY E ( 1_ 1 f I:ACPO=RRENC` i s • P!CLAU.M-MADE MI L i,CCCUR j PRESES Man�) #5 rAAED FXW[Aryane R2M) is .. NVA5 I��onlALaaDvlWURY j!s G8,rLAGGREGK#—ELE4ITAwPP1.SSPFtt i + } i GEXS:M'-AGGREGATE it s POLICY JPERG LOC j PRODUCTS-COIAPtOPAGG!S WP � I 7 ! Is �OrM1OBILEtaABAlTY j i 1 CoiSrzmGCELuvrF •S - A14YAUTa #i. E l _ r'•'_" � 3001I.YlN.IURY(PetPases+) ;5 ALL.OVINED. S0*01AL i. i,. AUTOS AUTOS y NIA j 30Or�YF�JUr�Y(PeracdCeny�5 I IAVON- ` I j IPROPMTYDAY.AGE s tslREoav;os 1---I AvroS j � f � (.I?er��na ._ �UM8REl1ALIA$, OCCUR I � s � � �FRtA•IOCCURI2ENCE �5 f)(GESS LtAB 3—+�CI Mb)S)MSE! NIA I AGGREGATE 5 a °DED l +REI0MONS I _ ! 1 ` t 5 WORKERSCQNIAENSA=X I y i 1 X 1P 4 ER I tt1AN0EWLOYE1SLt431UTV YTltjz tt y AhYPROPfMCP PA TMERtEXECUTrV.- 1 Y E.L.EACR AC= Tr A OS 1,000,000 - eFIOERJd LmnRPXCWOEo? NIA I WA NIA 11 �. GS60tlB1K7097064ti 14M6I2018! !1&12049 - tavwrrrameru+r3N) I EL.O►SEASE-EAEMPLOY�'s "1,000,000 I DEESCRiipno desoibe OF OPERA7iONS bet3w E 1 IF-t_DISEAsE-PotccYt.nnrr'S 'I.000.000 NIA ` t 7 1 OESCRD'RONOFQPERATIONSILOCAT1ONStttEFiIGLES raCORO481.AddaianalRenatXSSehedvSe,maybcatlatdsedirmorespaeeisrequircOj Workers Compensation benerds v+81 be paid to Massachusetts employees only_Pursuant to Endorsement WC 20 03 05 B,no authorization is given:o pay clams for benefits to employees in states other than Massachusetts if the insured hires,or has hired those a ptoyees outside of Massachusetts. This cerlificate o€insurance shows the policy in force on the Elate that this cerdicate was issued(unless,the e*ration date on ft above policyprecedesthe issue date of Uft cer'aifiCate of insurance) The Status of Oft coverage can be.monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool atmvw.massagov"dlw4rkers compensa ionliinvestigationst. CERTIFICATE HOLDERI CANCELLATION ` I . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I BEFORE THE EXPIRATION DATE !THEREOF NOITCE WILL BE DELIVERED IN SEXTON ROOFING&SIDI G INC ACCORDANCEVgrrHTfiEP i CYPROvtMONS. 102 PINE ST AUTHORRED REPPX-ZMaAT[YE HOLYOKE MA 04040 -: _I L% Daniel M.Cr`�of4r�ey,CPCU. ,�ce Prnsident—(Residual Il4arket—WCRIBMA ©1988-2014. CORD CORPORATION. All rights reservetL ACORD 25(2014101) The ACORD name and logo are registered marks of ACO ----