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30B-064 (2) 288 RIVERSIDE DR BP-2020-1017 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-064 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-2020-1017 Proiect# JS-2020-001720 Est.Cost: $7800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sa.111 6316.20 Owner: RODRIGUEZ NAOMI Zoning: URB(100)/ Applicant. SEXTON ROOFING CO AT. 288 RIVERSIDE DR Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:3/13/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-RE-ROOF SECTIONS OF 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 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 3/13/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 'A. 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office /7L 0 0" �J! ��SO Map Lot Unit V /` Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 21 ,Owwn,,e,,r�of Record: qI q -7 (, /45), �,19 ,,� 3,1 , ��p�,,e v .1 A `�." D&' ee AlA tJ N'l C� %t'��" I t' 'lam v Name(Print) r Current Mailing Address: �y � ,f�✓t ��.�{h Telephone Signature 2.2 Authorized Agent: Name(Print) Current 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 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) _ Check Number This Section For Official Use Only Building Permit Number: a Q 10 7 DateIssued: Signature: 3 Lo Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) .. _. �t.'• ,� k "l' ( r yam` •i wa...-.. �.•..r�MIA.::r.......w� rs�x.'w ...w. w�-r r. `:.+1^�f�aw Y✓- .�'rr '. -4. -:Vw.. .r,..,<,nrw. ue. .O��.f'nr:.w#r�rea .rr:. ®ri , .. .. � .. .r .. �. .y,ryy�. .... .Y.•r .r• ..•d.n �n....M.r.-..... .q.... u-.. �� �.. .: ..:. tl.n Y....r.1' Jrvr•� ., .. ...�.. .. F...r .... ... 4 .Rw-�f+:TN ., ... ... r r J. r 1. .. ._. ._. _ a .�� � .'r :r+ . . _ .,�. f. ��:YK. ...... . ,._... .. _ .. .� .�, .... , " r � _ .. , '• r�1 � .; _ ... .. ,o F..... ..... ...� ..._ �, r .'.r�..� ,, Y Y.: ... ..... �. .. .... .. .. .. .1 .. .. _.. �.. .. .. ... ..- ....., �. .. :.... .. .: .. -. ....� ...e .�. .. : 4, � �; _ _ ;,•,r -• i ... ".� ..4 .. ._t.. .. � , t ,� �2/` ' ., .. k � � r r .. .. v,- .. :. .. .. - ..-- 'u.,....... .. 1 a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors F-1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[O] Other[o] Brief De pt of Prop9se _ Work: lsE Alteration 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 Famil Two Family Other b. Number of rooms in each family it: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construct ------Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. sscheck Energy Compliance form attached? h. Type of construction i. Is construction withi ft. of wetlands? Yes No. Is constr ion within 100 yr. floodplain Yes No j. Depth of bas ent or cellar floor below finished grade k. Will bu fling conform to the Building and Zoning regulations? Yes N I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r I, ✓1 as Owner of the subject property hereby authorize (V'2 �}- Si d �� ✓(,/� t lct on my behalf, in all ma ers relative to work authorized by his building permit ap licatio . ,4-�f .�L'x y Signatur"of Owner D to _6 1 A� , as Owner/Authorized Agenf hereby declare that th4 statements and information on a foregoing appli ation are true and accurate, to the best of my knowledge and belief. Sign under the pains aZena/Ities of perjury. �a .w k'( Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder:P,,") i) Lic�Number Address Expiration Date Signature Telephone 9. Re istered Home Improvement Contractor: Not Applicable ❑ CRMany Name Registration Number Address , Expiration Date < <! 't `� - Telephone o(o?`/ 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 Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts DEPARMWT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building . Northampton, MA 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 pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of WorkEst.Cost: Address of Work:, •'L— Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a buildin rmit as the agent of the owner: ,Lf-- Date t Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature r -.. .. .. .... Ni.... n...�.,.,.-.. nµ..a+.S...uw ,....� a„y.,...r...ayy,w,.,... �..1wn.•�w.r a.,tia�x«...... ♦w....,� ., ..rr•�„-•.. •...«,..-. ..n. ' a: ox 771 #•',.,, xr :. '+. `'r,x:4'' �'' , :r; :�: `a?# -`� a�'i'ix.` •t T;S� �'.�•':i +��#'� 1,.'.=i�'s i:; .,�t.?' :w.."� f tif,_ t .*r" t p:,1':K' S' 's Jt' %� ld .+r`y +4 4 i;` �n F3 *#4►I;)4; 't.iist i4 . 1A, ,'i'z t- . .?4e'.�. *d.,#$' ; 1r! f�: ;i dt: !•, ?'';' r.:= ,l�' t'}'• n;•r' ,?�t.':r :+>g���?r.,��s ':ft {y r{w,.`�'_a t�. r .. .r�i f...fY !� ,�C�'' ,d S.�.' �'..i�i��• r��'.f-s�Ct �'itj ��E�p.i 3' #�.i#s¢!„a`i.r�'". ,I 4.��.f'. 1%s.' '� ►.�,.' • `•,.tp�'� ' '. �;'a 'r •!✓ 'r4:x'��"s t 'N'a f :). "',P 1'. F4's •► � 'r .� :k .. C; _i;i' ,3�t. ,'t. �t"r!,t �! � i k'.. �{)�If« t.n"��7�?i:� �• ... ... lei• .ri��'i. ,f �.- - ' a e.. .. � •x,•rx-, ��+'rrb:! _.e"a# v'r'#ar �`{ • �.'k wt ': ii Y*z.�. .;rt` F }.-'v'` � '`y'� t} ...: •t'.".a'►r" _ty .- :•} -�;5 --,A.a+r` .. ,-Fa— At . ': ' lit, .ter .'• s �, .,i , s'.}'•' ,, i1!4' i, 'l4Jz: rt«.'': S.•..:(_ a� 4,i tt .y,y, ,, xr. .,"'st•5 ;elft r'x'.`''� .x" .}(,.t ' - - .:5t. �S�.i31+'..r;� i► (,,* `� ,a i.1�Y�8i�t'lr�b ,- } l - � .k.as�.t ,j&ti; r � City of Northampton Massachusetts a4'rS r' +a DEPARTMENT OF BUILDING INSPECTIONS 'D , A i / 212 Main Street •Municipal Building A Northampton, MA 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: (Please punt house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: t L4l< (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 Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. ell Cb�Ce ©f Eer Aftrs ,and Business I� WO shrngbn Street-Sin Bes-on_ Massach0211 e 710 �uta�tou u HOme lr prover �1 a amOF ROOFftaF S® If}tG fNC Vis - jCmporaiion �Q=�`a1 F_: MA 01041 r 239 t:artL x 6327 IfOME IMPRO�MFNT • •i HOLgp Sig OZ1 EVECox J SEXTON TRA CTOR " 102 pine HOLYO�� 1 010 St SotqUA x-2411 aOp G XDINO Co 111C.060538312 off«' -- -_-- sl�N� 1/2019 '�-----���;- 1113012020 -_ Canmonyrealth of Massachusetts Qtvision of Professional Licensure J Board of Bulking Regulations and Standards Constructio�rkftor Specialty CSSL-099689 EVERETT J SEXTON Expires:90/0512021 PO BOX 6327 HOLYOKE Nip 01041 low 6,i IL Commissioner 1 - _ The Commonwealth of Massachusetts ■ Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,Mass 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - - _- - Please Print Legibly :dameBusiness�o Sexton Roofin & SidingInc ( rgani7ation/Individual)�_ 9 Address:P.O. Box 6327 City/State/Zip:Holyoke, Ma. 01041 Phone#:413-534-3234 Am yon an employer?Check the appropriate box: Type of project(required): 1.U I am an employer with_ _ 4.A I am a general contractor and I 6..1 New construction employees(full and/or part time).* have hired the sub-contractors 7.l.Remodelin- 2.�', I am a sole proprietor or partner- listed on the attached sheet. 11 ship and have no employees These sub-contractors have S.U Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.+ 9.U Building addition required] 5.17 We are a corporation and its 10.U Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their myself [No workers'comp. right of exemption perm MGL i 1.C Plumbing repairs or additions insurance required]t c. 152,§ 1(4),and we have no 12_XRoof repairs employees.[no workers' 13. i Other comp.insurance required.] -- ---- - - *Any applicant that checks box#1 most also fill out the section below showing their—worke — rs'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ Contactors that check this box mast attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub--contractors have emplovees,they must provide their workers'comp. olicy cumber. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Travelers Property Casualty Company of America Insurance Company Name:-__ _ Policy#or Self-ins.Lic.#:UB-00078982-19 _ Expiration Date:06/04/2020 Job Site Address: City/StatwZip:_ _ 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 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 of Investigations of the DIA for coverage verification. I do herby certi�der the pains and penalties of perjury that the information provided above is true and correct SiRnatrrre: �. lie, Print Name: f V ky '77'" c-r,, Phone#- Y i 3 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): I.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person- Phone#: r !:,,s40s.: .*5., ,r�.'a.1, <r' k:.;.r r"*..w,"e, t min ► x'. c+, sr; c ip�r c �a� 1+. �k� • '('1iF. Yt�..1. ':'tya..�tTs'zi:J,�'i '1.1?E'�YAt�.'p1.�,w:cl', ..1, t �+��•' 1. ';l?i,A,;:t,'�';r't'.�i�. ;''�L�:'•}, "."�4Ti,1� i.!''±11ra.>• .*{„�:.'- 'ex. • �. ,d. j7 j1 t�. may: ;;Y;, r, }•k',. .�dit'P tss. 't' �c y 1. 5 art`a i,-'s . C _ •• .. .t'� 5 ee3 1.. . 1 '�s .'1 .}7 ' {Sf'.;,{. •,t - "- ° if;;r.. 7�` .. t.'. .. a�.. ..J ayn :f. +.'11't�i,r; :r.7`tr,;•q ^Ji' ,,. '��a^)2 a'.}it � £, „r;> >4�s: �: t� .1.�'�li;�' '; I•#_.. , ;,rfli !*�3y.- ...fg Lr�'da11,c,(tie.K.A�.`1F rev dal t: ..5�%'.�1 o-�r�;t:7 •���, �'a`�.,.•.1::1t:A.a�+Tr t ul!['' ":le�,*`i1.'G:� 'ti.f `�,e'.i'!f r. aa,�-}:S;rt,i' .i t std; .e:'t ' .. Z y'-'. . .:��5•. , - - '. , ,Saint. w? VIA s. r `,33..'t. < a'x1�tl�' .. t !}:.:r i,•lati Ii-.-._'Ad4 a' t .. t'. } .:5':' .1�.*.a;.3 r .._,�4"RF{:, ,lr:r's� i; ':,4 ?1P.>f}''- pt a, t�At #-.r:, ,,.. .�..� a :•'.F k' 1�:'s '.l .;2'.. r.q•Kd' .r •i .'Lr: a+ e'ir F 't ,i. } .' J a lam A n no w a C, f Afj ♦,t? i l¢. - .. ,. st �'.:F::.l%•. .. -IFt , 0-4 • : � 1 M. ... _ ' 1 is 1 •:K �' .t '. ,t: ^.!, a tit z.r': - , i t. ., :41 at r ..l.� f `-1.�: a .•SY'q•r:a;.cf' ^.' .. . - J'. .. $:� -. ... y r 1 � 1 1---1 ° CERTIFICATE OF LIABILITY INSURANCE DATE 0611012015) (MMIDD/YYYY) TMLS.CMTIFICATE 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(ies)must be endorsed. If 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 endorsement(s). PRODUCER CONTACT NAME: ORMSBY INS AGCY PHONE FAX PO BOX 718 (AIC,No,Ext): (A1C,No): E-MAIL WEST SPRINGFIFIA,MA 01090 ADDRESS: 286TF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A_ TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SF,XTON ROOFING&SIDING IN(' INSURER B: INSURER C: PO BOX 6327 INSURER D: HOLYOKF,MA 01041 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 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. UJSR IkDDL 3UBR POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE 1NSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY CH OCCURRFNCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR_ DAMAGE TO RENTED $REMISES(Ea occurrence) ED EXP(Arty one person) $ GEN'LAGGRFGATE LIMIT APPLIES PER ERSONAL&ADV INJURY $ ENERALAGGREGATE -$ POLICY PROJECT I.00 RODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY $ Per accident) NON-OWNED AUTOS PROPERTY DAMAGE S Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAIMS-MADE AGGREGATE i$ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UD 00078982-19 06104/2019 06/0412020 LIMITS ANY PROPERITORIPARTNERIEXE-CUTIVE 17-1 N/A E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes•describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATtONS1LOCAT10NS1VENICLESIRESTRICT10NS1SPECUiL ITEMS TIES REPLACES ANY PRIOR CERTIFICATE.ISSUED TO THE.CFRTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA ElvPLOYEFS IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BEdNEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES.OR HAS HIRED EMPLOYEFS OUTSIDE OF MA THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENT ACORD 25(Mill 5) TUe ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. ! -� SEXTO-2 OP ID: ER ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY-YY) `� 1 07/10/2019 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 hokfer is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,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 endorsement(s). PRODUCER 413-737-0300 CONTACT Eric Dembinske ' Ormsby Insurance Agency,Inc. PHONE A413-737-03M TFr�c 413-737-0617 698 Westfield St PO Box 718 -or-No,Er¢ West Springfield,MA 01090 ef�Ytl�LnS Eric Dembinske - ----- -- -- --- - IINSURER NSURED IN ,,, ney Nut"Fire Insurance 15067 eXton Roofing&Siding,Inc. ---- ---- -- PO Box 6327 INSURER C: Holyoke,MA 01041 - — fISURER 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 NAMED ABOVF FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHFR 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 CONDfT10NS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE SUBIR POLICY EFF�POLICY EXPLTR f .—. L�1� A X COMMERCIAL GENERAL LIABILITY F1ACH OCCURRENCE 1,tb0,� —CLAIMSMADE X'I OCCUR 101GL002159903 06/251201906/2012020 DAPR MAGE$rEIrED.,�,o l -- 100,000 00-0,0005,000 i PERSONAL s ADV Itr,IURY t 1,_ AGGREGATE LMNiAPPLES PErt G AGGREGATE _ i Z.�.000 ppR�Q�.. POLICY[ JECT 1 LOC PRODUCTS-COAPIOPAGG S Z'�' OTHER B AUT'OYOBILE LIABILITYtLa IBX-moi SINGLE LWT 1 s��i ANY AUTO AFV206561 05115M 9 j 0511 W2020 BODILY KJURYPw - — OWNED SCHEDULED ' _ AUTOS ONLY X ►ApU7NN0ppSWi/yNN�� BODILY IWURY_Pier_.____ _ idw PROPERTY DAMAGE X 01%ONLY X A..��UTOS ONLY i (Per I UMBRELLA LIAS OCCUR _EALqH_9Cgy_RRENCE EXCESS LLAB CLAIMS-LADE I DED RETENTIONS E PEft V pp COMPENSATION OTH- EMLO � TM ER - - ANY PROPRIETOR/PARTNERIEXECUTiVE YINTO BE SENT SEPERATELY E� _- If EXCLUDED? [ J NIA' "---( ---` — Mandatory In NH) EL DISEASE-EJ1--- }- —— If yes.describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY � I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett Sexton ACCORDANCE WITH THE POLICY PROVISIONS" AUTHORIZED REPRESENTATIVE ACORD 25(2016103) O 1988-2015 ACORD CORPORATION_ All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachuseus Department of Industrial Accidents I Congress Street.Suite 100 Boston,AAA 02114-2017 www.mass gov/dia Workers'Compensation Insurance AtBdmit:General Businesses. TO BE FILED►►ITH THE PERMIrrI\C-►t`THORITI. Aanticant Information Please Print Le:Ttbh Business/Organization Name:MNP CONSTRUCTION INC wto.-- .Address:45 EXCAHNGE ST City-State/Zip:MILFORD, MA.01757 508-498 8870 Phone#: Are you an employer?Check the appropriate box: Business Type(required): -- 1.[✓� 1 am a employer with 5employees(full and [7. • ❑Retail _'.❑ orpatt-time).* . F1Restaurant Bar.Eating Establishment I am a sole proprietor or partnership and have no Office and'or Saes(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] S. ❑Non-profit 3.❑ ►1'e are a corporation and its officers have exercised 9. []Entertainment their right of exemption per c. 152,$10),and we have no employees.[No workers'camp.insurance required)* 10'0 Manufacturing 4.f:] We are a non-profit organization,staffed by volunteers, 11•❑Health Care with nc>employees.[No workers'camp.insurance req.) 12.Q Other CONTRACTOR •:gym applkatu that checks tis 41 must also Citi out the srctton beiou shooing their ttorkers'comprnyatton poltct'tnformauon �' •*It the amwate officers have exempted themsett es,but the cortxwatton hs,othtr cmplovees•a workers'compensation palkti tb rtrquued and such an mpntrauon shtntld check box;1 i am an emptny er that is prorrding workers compensation rasurance or mg,e f mp/oj ees. Bir/ow is the po/ica•ittfortnation. Insurance Company Name:HARTFORD UNDERWRITERS INS. CO. TRAVELERS-RMD Insurer's Addres :R.O. BOX 5600 Cit State Zip: HARTFORD, CT. 06102 Policy 4 or Self-ins.I.ic.y"I K709706r q policy declaration 11/16/2r�tt� —` Attach a copy of the w•orlters'compensation F'x iration Date:_ration Page(show=ing the policy number and expiration date). Failure to secure coverage as required under Section 25A of%,IGL.c. 152 can lead to the imposition of criminal penalties of fine up to S 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 da} against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DW for insurance coverage verification. l do herek certif u t �plties of perjury that the information./' provided above is true and correc7. Si ature: f Jr Date• ` /!� � Phone»:978-403-5942 [I.Board use ori/r. Do not w rite in this area,to be completed hr cit} or town oJrcial Town: PermitiLicense# 4uthortiR(circle one): _ of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office Person: .._ Phone#: ttiu�t m-am not dta ACpRp�' �r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 11/27/R. T ERTTFICATE 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 B REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the BETWEEN THE ISSUING INSURER(S), AUTHORIZED the terms and conditions of thepolicy, policy(ies}must be endorsed- If SUBROGATION IS WAIVED,subject to certificate holder in lieu of such dorsement(sIlcies may require an endorsement A statement on this certificate does not confer rights to the PRODUCER ONE FAMILY INSURANCE AGENCY LLC X10 Elf ol-tok-(978)403-5942 FAX ac�hhrilb12 J 1 Main St Suite 15 —_ WC,No):_ Lnnenburg _ --- AFFOM MG OOWMtAGE - -- INSURED - - _. _ —__ MA 014.62 019tNt6tA: HARTFORD UNDERy S NM.S CO - -_ _. NAtrs MNP CONSTRUCTION INC Asn _ —~ �`--- - a Vic:45 —— -__.. EXCHANGE ST APT 3E INSURER D:_ — MILFORD INSURER E: '------ MA 01757INSURER COVERAGES CERTIFICATE NUMBER: 478475 INSURERF THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO........ INSURED NAMED Agp� FOR THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTREVISION(N UMBER: EXCLULICY PERIOD SIONS AND O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLOTHE TERMS, EXCLUSIONS ANp CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. H RESPECT TO WHICH THIS TYPEOFINSURANCE ADUL`9j R _.. '.— - _ COMMERCIAL GENE I NUMBER --. POLICY EFF i POLICYpIP - --- — - RAL LIABILITY MIMIO - LOIRTg CIAIMS-MADE OCCUR I f EACHOCCURRENCE E!_e-e—rerus� : t - GFJYLAGGRE 'ATELSTAppLIESpet PERSONAL8ADVINJ(AtY $ - (-1.� (-1 LOC AGGaa OTHER AUTOMOBRELUIBIUTY PRODUCTS-COMP00PAGG s s _ _ ANY AUTO D SINGLE LpN : ALL OWNED —_ — AUTOS SCHEDULED BODILY INJURY - AUTOS WA __._ _ HIRED AUTOS NON-OWNED AUTOS BOOILYIFLNIRY(Per sad" s PROPEBTYD/Wgl _.- ----_ - UMBRELLA LIAB LPoraoodentl -'�- EXCESS LWB OCCUR CLAIMSMADE N/A EACH OCCURRENCE s DED RETENTION$ AGGREGATE _ '-"- ERSCOMPENSATION AND EMPLOYERS LIABILITY s ANYPROPRIETOR/PARTNER/EXECUTTVE Y/N 1 t PER OTH- A OFFICER/MEMBEREXCLUDEDT Xi (Mandatory in NH) t'&A ILIA , WA 6S60UB 1 K70970619 � H ACCIDENT Iryes,desaibeunder 11/1612019 11/16IZ000 E.L.EL EA ~_ t 1.000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE'EA - j 1,000,000 ` EL DISEASE POLICY LIMIT $ 1,000,000 - - ? N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 701,Additional Workers'Com Ren' Schedwe.may be attached it nom�e is requite pensabon benefits will be paid to Massachusetts em claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. employees ort1y.Pursuant to Endorsement WC 20 03 06 t3,no authorization is given to pay This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy Issue date of this Certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof Of Coverage-Coverage Verification Search tool at www-mass. ov/lwd/workers-com po cY precedes the g pensatiorYnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SEXTON ROOFING SIDING INC TME EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ACCORDANCE WITH THE POLICY PROVISIONS. IN 102 PINE ST AUTNORi;ED REPRFSENTATNE HOLYOKE MA 01041 Dan ie!M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE c 11!/2277!19119 YY, 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,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 endorsement(s). PRODUCER CONTACT - NAME Art Calvillo One Family Insurance PnHONE 978-403-5942 Fi4r�c No: 978-403-5943 1 Main St Suite 15 E-MAIL Lunenburg,MA 01462 ADDRESS: arti@1familyinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURED INSURER A,-Evanston Insurance Company -- - - INSURERS: MNP CONSTRUCTION,INC. INSURERC. 45 EXCHANGE ST APT 3E — — MILFORD,MA 01757 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 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, FXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR WRIT - LTR TYPE OF INSURANCE _ _L_ WVD POLICY NUMBER YNYYY) ��Y EXP - LIMITS - x COMMERCULL GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE OCCUR PREMISES Eaooaurenge S 100,000 MED EXP An oneperson) $ 5,000 A Y Y 3ET9385 11/03/19 11/03/20 PERSONAL a ADv INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY❑JECOT- F1LOC .. PRODUCTS-COMP/OP AGG t 2,00 00,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO Ea acadent BODILY INJURY(Per person) $ OWNED tCLAMAS-LIADE AUTOS ONLY BODILY INJURY(Per acddent) S HIRED PROPERTY DAMAGE $ - --- AUTOS ONLY (Peramdent UMBRELLA UAB EACH OCCURRENCE j EXCESS LIAB AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTT.- AND EMPLOYERS'LIABILnY Y/N I STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/NEMBFR EXCLUDED ElN/A EL EACH ACCIDENT $ (Mandatory in NH) EL DISEASE-EA EMPLOYEES ff yes.describe urWer DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sctudule,may be attached r<more space K required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN SEXTON ROOFING&SIDING INC ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST P.O.BOX 6327 AUTHORIZED REPRESENTATIVE HOLYOKE,MA 01040 ART CALVILLO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD v ProposaC _ SEXTON ROOFING AND SIDING INC www.sextonroofin .com P.O. Box 6327 Setting the Standard Holyoke, MA 01041 . 413.534.1234 f. 413.539.9906 MA HIC# 118239 _ ._sextonroofing(crhotmail.com SUBMITTED TO Naomi Rodriguez PHONE 858-395-6612 DATE 11/26/19 STREET 288 Riverside Dr _ JOB NA�titE CITY,STATE,ZIP Northampton,Ma. _ JOB LOCATION SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR. 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed(it $75.00 per sheet. 3) Install new metal edging to rakes and eaves of roof. (811) 4) Install ice and water shield on eaves(6'), vent stacks, in valleys, chimney, Skylights. 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. 8) Install IKO Architectural style roofing shingles as per manufacturers'specifications. 9) Cut siding at intersecting roof where porch meets house and install 1"X4" pre primed wood with Z metal. 10) Install new cap over ridge vent. 11) Supply manufactures Lifetime warranty and SRC 5 vr. workmanship warranty. UPPER BACK ROOF$2,800.00 PORCH ROOF FLASHING$1,200.00 MIDDLE BACK ROOF$3,800.00 SEE ABOVE PRICING All Material is guaranteed to be as specified. All work to be completed in a Authorized _ workmanlike manner according to standard practices. Any alteration or Signature deviation from above specifications involving extra costs will be executed only -- upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond Note:This proposal may be withdrawn by us if not accepted our control. Not responsible for water damage during construction. Owner within(14)days. to pay responsible legal fees for non-payment,and applicable interest. 9icceytance of Proyosaf The above prices,specifications _ and conditions are satisfactory and are hereby accepted. You Signatu - �- are authorized to the work as specified. Payment will be z made as outlined above. Signature Date of Acceptance.