Loading...
23A-113 53 MAPLE ST BP-2020-1101 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 23A- 113 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-2020-1101 Proiect# JS-2020-001850 Est.Cost: $5400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sg. ft.): 10018.80 Owner: GIDEON FISCHER E Zoning:URB(100)/ Applicant: SEXTON ROOFING CO AT: 53 MAPLE ST Applicant Address: Phone: Insurance: P O BOX 6327 (413) 534-1234 WC HOLYOKEMA01041 ISSUED ON:5/4/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF PORCH ROOF ONLY 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 5/4/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only f ti_ City of Northampton Status of Pe I Building Department Curb Cut/Drl ermit 212 Main Street Sewer/SeptigAvailability { tr As Room 100 WaterNVell ANailabilit.y Northampton, MA 01060 Two Sets of Structural Plans T' " phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans ,J Other Specify . CF-null P!Nr,INPPECTiONS k ___ Ap 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 A— /� Map 25 )f/� Lot 113 Unit 5'J Zone Overlay District Eim St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �/• t f fie/ COO FA S� Q� � Z/ ���pljf 57— C'. Name(Print) Current Mailing Address: %`� I`r- " Telephone ature 2.2Authorized Agent: / Land- Name(Pri t) 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 U (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) j Check Number 272-(, n �n /This Section For Official Use Only Building Permit Number" I/ X'zo " I/D Date Issued: Signature: 5- q-Zd Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) (• r -L'�`t�iz id �. . f'Y",y-., t! �.f*i�..f.ai`r ...f��' l if�':. .�:�ai�•`'MI.�i7YC 7'wa��r7.F�.�. Fi,3..4r���,j.�:`,+� t r -.:.,....,.rry:..,.. .r.n,....r:...r....w..a...w..L.u. �.rr,.,,..a........:....•.-..4.,,.,.a,.,y,.,,,,,.r►Aar+n.r!•rr+,.. _...:mx�...-a.w.-.:�arwry:. .r•_v w.. .. .•+•ar r.+r.••v:r.. -.. :s a.twsy. :.. ..,.�,.....+,. ,.wa .+++.•.o-.r+c!!aa+r.r..re.�y,r ..-.., ....,...o ..s+�++ai. .kr .-.+.a..,.,pws..._e ,� tt i 1 ' _ .. .. ..-... +- Y •-..�. . .:'tet..,w:} ' 1 ,.,. f� -4:1+ c_ t ,:.'- ,i•�.. t ».r°F':'?ifG"�,d. .� `� I ( � -., � •.. a �. ... ..,_ . . •��• ='.f'1+•,)L* ��,.1t#i.; ..F^� '".r '•,. ::i �'!'r-r�ld�•�4�,�i}:. „ay Ft. 1,E.tw. F><'d i'�+i•/�..•��"t� ,�� 4't�attr «.. .. . ..... . ,,.... _.... .,,... „.. _;,....,.�..,.--_-_.. .�.,_-..y- } , ... tory.• r atv- ,.Y-...,: ... ...._ .. sy°R t;}i.'at,�.. J ��� d i <� s.tq{�. 1�! . '•.', St Rc !m ,�s „+`�A ..�. it � �. i. C I _ y , 7 l � : rir':'i i• lir j':. t 3 , 1 J '";fit t•' l ' �i^d';t::•�.: c'• . - iy;�: �`�l .i7•.=�r�� � ,,.e C :,".e�,i. "* �7s' a" r - `t it .. ' r ;• Pif:9��i. .^l.d ' }r ';'�y„'�t�.S.`-;, *�µy ` al. �` i. i Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ^ Frontage ' Setbacks Front Side L: R: \L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding a been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Regi of Deeds? NO Q DONT KNOW YES O IF YES: enter Book Page T_ and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0-----DON7 KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO (D-- - IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excav on, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing [j;j— Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[p] Other[Q Brief Description of Proposed /f Work: i- �c,� v�Cal 106 L 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 Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Complia Masscheck Energy Compliance form attached? h. Type of construction i. Is construction w6in 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, C>A S4: as Owner of the subject property I hereby authorize to t on my behalf, in all mattrs relative to work authorized by this building permit a ication. L 12- Signature of Owner ate I, •' ACL �� 'rfl , as Owner/Authorized Ageht hereby declare th the statements and i formation on the foregoing app lic tion are true and accurate, to the best of my knowledge and belief. Sigrwd under the pains and pe lties of perjury. f 1, !cr 4L-X' L`- Pn'ni Name 29 Signature of Owner/Agent , 4 l , i f r !.� r'.- �!•. '�i. ....} '' ( f-:.. �' �.=T �;.?.,5.�. .. p.1:.ip _.tli r i\ ^. ,,eb .!�i":,,1� x:_;�• _. . .. 7:~ nF '�. �:•i( •f� +; Jt,��•�'<. .Fi t1 ''�, i;• a at.;..,�""'�.- 1.•��'z�►. � t... - �1 f�, 14 77 v . p f.i`t.;F,.: `. ...`., E•f'i,.Ifr+t; 'r • ,. Psg 1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction u ervisor: Not Applicable ❑ Name of License Holder: -C A I — _ / ) License N ber )IXdd Expiration Date��,_ S gnature Telephone 9riRtmistered Home Improvement Contractor: N Not Applicable ❑ ComxkanName Registration Number A r ss p ation Date ` CJ Vim' 1t C, / Telephone S_�1 Z 3 Li` 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 0,51. t � DEPARMNT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yJt cD� Northampton, MA 01060 rsN 1�0 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, 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 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 PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I here ly apply for a bui ng permit as the agent of the owner: - (kvd I 6aie 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 .. .. _n..,►...-. .,�,ry�.,.......y..,«_,. ...—...,.-. ..,s, .._.� ...�.�.... , ..e _ ......•...,...w.....y.. ..w.rr.,-+..iiri...tu...:,,wq,iw.,.,...i.•.....�.. ...«..•... - :�, �• ."',i' r. i. '! 'i 'i: tt a '.,, Zvi„, i .. moi.l:��' � 1,r:f, .� � }• a J�7f.'�a 1s r h 'ro .. .. I . i. 7. {',r.+ $ 7 s,r i«” iirr.tR'!¢¢tiii +�'�v�' Lwd"c-c• .{'„ ,rrf t � tf.n q! }r .).. '!. 3 •1a`. iti �k .t. .rA-S �,�. t ,.i1• c 3'T,�T. i'�. 5��:. �'t' �t!,S:{+�r yr 7. #� 4 'i •..Y r. , t,�.�F� gt;� {J .+k> +. -i Itit' � aJ 'i .+yy �1•� ,*, ;a f •°t _c �. V�, >w : ' a..V ���+.: 6' Y�.{..• < ;',4 r. 'rxt�a.�� � •ft y°� t�`sk��t,,.F »:�.y/i+x r s t•}aL..., �.�kyrtt"L f' t''L�"-i �jQ `v ". ys,..s":..A •;.►"r �.? •.ZAi`[ - .a,'}'I`3'ed4r'i .• -Oct. /`.��II s.°., r'.,:} �,b'a ?. ,r1 d.:,P;r x' i.7/1' r s ik:J i.i. 5.. I�2 ... T'�L.r�i.i ,s'.�'.i`,S R{1`_A..;j� r� :0.r !.s-. ii��j�•:;Ei l.t t ."1+r'.p . X13 1+':i�P: p �I..Y i:: . l tt", • 7W li •.40%!:� 9k� r.+'t:Ssy.t4;• '7a . •a a�• 'sof; :,t �: +.•nc:, ..1� �. -l. _r.,4. �z 5. .+t-` �;. ti wLli:.x� '.il' . - s� ., _ , : •j,`' t`�`ti, ,(',+t',YIY..� - _ .. ' ].. s•. ::1,diY.Y � 1L-.r '!+.�.. .Jy ..,:«r• c.! �-. . ,. . ��rr���.r.. �+ \, :.i . �� .. t..n �.t°- v / - ��;;,r r�. .r. easr�l• �;,� c' fy1.. ,�'i`�la ,_ -a- ;,fi.1 ..y�{y/:.S- r'�1=.:. , .' ,t 'YJ�.s' .i}_r. :{ 7.L.._. .. '.� ,`:•S+ ��� . ..;t 'v'p,t 1: 'uri.ri'. •�'3 '�. J�:S_ . ;S, SfE'1t t•. iJ - �!! '1 U- ti'rj. F•t� _ 1,i .7. '1' �. rT ;77�yj, 1 '•�j l t3,� .f x• + iY...?`.� S.ryi 4 a f= }li t` .� _�.' :. ._.. . ..... .,.. .. % � -`a•4��Tr7y !d'%:fi? .. ` Ff"��k�lsf,�.rf'-'} _ - _ .. . �' �•.f: 'oJil City of Northampton Massachusetts A r_ DEPARTMENT OF BUILDING INSPECTIONS z i 212 Main Street •Municipal Building D� �{ Northampton, MA 01060 J !-iy. T',^�Q 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: 6_3 91 uk S (Please print house number and street n me) Is to be disposed of at: �osd_,q_ (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ZB Signat a of Permit Applicant or Owner e 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. r l • y J Roy c if M � '3 1, A Tin Wit. Yt'iy. dr'.� r� ._�. .�Ne!6 •cal :e t'4�;. '8i- ?•�' w� .eY '�r '�a..� ,Y�`.d".n w' �`:,'. zw a Proposal SEXTON ROOFING AND SIDING INC www.sextonroofing.com P.O. Box 6327 Holyoke, MA 0'104'1 Sc:�:issg ztu:Standard 1 . 41.:.534.1234 f 413_39.9906 MA HIC# 118239 sexton roofin hotmail.com SUBOTTED TO Gideon Fischer PHONE 522-5970 DATE 313120 STREET 53 Made St IJOBNAME Lower Wrap around porch CITY,STATEAP Florence:Ma. JOS LOCATION SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 1) Strip and remove existing shingles and dispose of in proper landfill. 2) install neve 1/2" plywood. 3) Install new metal edging to rakes and eaves of roof. (8") 4) Install#15 synthetic roofing felt. 5) Install starter shingles on eaves and rakes of roof. 6) Install IKO Archibmtural style roofing shingles as per manufacturers' specifications. z 71 Supply manuftetume Lifetime warranty and SRC 5 yr. workmanship warranty. i "Shingles tray no subed for.060 EPDM at same price 3 . Ws P Ir ro fur*ii ^ tel tatx�r--corr fete in accordance with the above specifications, for the amount Frye end Four Hundred Dollars($5,400.00)Payments to be made as follows:. Due in full upon !anon " r ;M t aiw s�rq ed.!tit aro to i PVA*ed in a AUthorbwd t' rilMW?+ryK 0000N&V td AW4"P1%00c**. Any s6mawn or t a 1014 314 " g Vitra cotta*0 be executed Signature r r �r s+eswn AMiO*Nato.sort wo bownv Sn sr*a durp oar arks above +Mb rtM11c fir+ed ,s�or delays " '`"�� �1®tllpiaa4t`4prvw ,rrrra �"` Note:This proposal may be withdrawn by us if not accepted s t3 tis k A►f0rH*r-n nl,and within(14)days Th*above �,C*Vftftaw 609SWory unci are Signatu e< ,, .-. 0i . Ydt IM9t atm I vrt�ris as � 10 �� I ro signature t' �I.''. T r +: � .+� ,l7�, d ry ra, �� ,;�' ` .� ,t• ,, �`r .j i -h Ile.I I ,+-c y.ST ,w dr �>t•Q` t"�''7 >c� ., ,. .'� �-, � r ria; i :.f� y.� .0 •.�, a�'A w'�,y = �. N, r+ � v i � Y d : t Br; y.x•rv" .•XN, f,.Y„,� r y �p,' t -:�� � '>:. ti .ks � �> -. �F A r .A � 't, ',tc -,g M may.., ;44 Yo t; r x $ a .;yw y.v bra�'t•' ' '�$_ � ...A...as=:S.er •,. � 1 k �}.d ..rr p4�, _- r � ,,�}Iaw �, � � �rs hn� y,.''r' T. ' r .'� � T� �,fit' f a +6n � rP! '' r � � •�f�e A t '�f� i r � d '..I �J,' F � x ��I �� ':k t � a'.�•W'' •,� � Y�-� : "� .,�,;;� ,na+��w+�#�' 'moi.�•,� L•� rr a ..�.^d�z,� '.ir yam: ,�y .., �Y'.�,cf< aF' s�. ! r .rw .• Y',?,w� � .� {.- a ,d• f �i ! t`^4 �; tl.tib,. �" #r �Ty >, 3 C�+a%i�"- r �f�'ir���,vi.Y�'f tk�' r �;..�s aaM 1 ♦ g _. X 1 ..� x rJl� � J• 4 .; !1"+ �; �'rY ^.�"`�,� ,= � "tC' �T* rM,` r �t'* ,rs' •..''�rfr�'w„�^,r1! � �-.!• s,� 4,77 ,r r yt ¢$ m� �� t i7a v .¢►4°» i+' '1 Y. a r } 9•". i 4" ' !y "+"";r ;ayb ���Xa aha. i�t� tM:R � ., A^y+�! � ,. t•" 18�+.73� � ? +rs4 :�, +,•W'„ - ��. N�-.. -.-.� � r�� r �..""t wr3;. ,�'vts�o. R �^� t 1 ��,;ii:t ,1¢ s,'f' �• M� bfi '• `�•'"S � ��5, * .� v t -#,a k�n �. 4 " ._1Y�.. '�� ,n�. :d'Y k v,' !`., •r �i �,S,d .•'f•� yrt, +' A 7 `'.� s �a%�' 1 �,' �i �+•�}�'^� M iF:.'.8 y *4�R"�Y�{� ,°d�i 'i.�. t�a F��`L � 5.fyte,'� �xt;•p'��,h.j� �' r i �• rs e of i. alr4s.�''. +5,..�:. fP" 1 ^"r , �t.L ,i. •� - I'f# ,•�,r�.. f '� t':„ .s'' ` ".#'�a ',i�� ',, ":S. '�R'b" .,�,,.a•T4ii ��' YY^� T��` �� ; � �� ��� -�t fir. �.�. � s � 4 u�•� r � r " r"k"+..� Ta, .'k�! � � _�4�:d���° �` :q' e�1�fr� °\'ra T["Sr 3,�'�'r�C�y,r �l°C�a>t�. Y ; ♦ _,e�'s, 'r }� f �� ti'�� f Ty '4 "'�, .�._.>,e�.4 � e 54i� t<s �'�t;t 3 s., w., !p,.`'�f��t%Uw.'��,.L r:y:06� P'° :q`. 3' .,•„J.�'s`t ,.`:3:7.F',�e�R;r��,#+Ye''•R#1 �a4 i_ '' . i .n I , wi�sryt{ .r !. - i...i�'”�; c. "rF� +. +,','�':�i Ca. :«, + �f, '" 'e.- !�,. •t k{�'. s ,:: r„ir ,. '-, -1+ " "�'-• u 1 �".t": E � ".;fir �,�a �..,� ��1 y,� �' "� ° ,�� � '4�'':� y T4s z = yRk ,,,d �r-•. r '.X,•, +, f r is f,t .{y •x R- ' yy ij,..,i - �'��. � �e�.• Mfr:-,+i t '`:..�+ � i z� Tf': i•�ttitzil�—t', ��x SK r ,r. , �" 4 `� ..+J f � iC 4 b•4.��' x r {`' ;��r irk� ,� ` � ,�) � R � .an !- '- rte' W`s'� ,� -', k 1"rr-�i r rfi"•�'fR " ,i !a p i ..�,at �T M� �$ �"�" _ .» -aYt.... - ,.w �n !� ,Ia Ta •-dr.•:�r , -33n rc..� 4 fr a.: 344 io , SPY.' G� .F � r .�.; �� +{ Pyr• 7 .x.L' Jg`ll ..a. .w "4 -` The Commonwealth of Massachmselts r _ - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mas& 02111 www.massgov/dia Workers" Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(B„sines org-mizafiondndividtml):Sexton Roofing & Siding Inc Address_P.O. Box 5327 citylstat :Holyoke, Ma. 01041 Phone#:413-534-1234 Are you 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.J New construction employees(full and/or part time).* have hired the sub-contractors 7.L Remodeling 2. 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. G Demolition working for me in any capacity_ employees and have workers' 9.Cl Building addition [No workers'comp.insurance comp_insurance. required] 5-7' We are a corporation and its 10.U Electrical repairs or additions 3. i. I am a homeowner doing all work officers have exercised their 11. C'Plumbing-repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c_ 152, § 1(4),and we have no 12-X Roof repairs employees.[no workers' 13. F Other comp.insurance required.] *Any applicant that check box rl must also fill out the section below showing their workers'compensation policy information- i Homeowners who submit this affidavit indicating they are doing all wort:and then hire outside contractors must submit s new affidavitindicaAng such .;Contactors that check this box must attach an additional sheet showing the name of the subcontractors and state whether or not those entities have employees If the subcontractors have employees,they mast provide their workers'comp.policy number. I am an employe-that is providing workers'compenrsation insurance for my employees.BeLnw is the polity and job site i nf°rmafiam Travelers Property Casualty Company of America Insurance Company Name: Policy#or Self-ins-Lic.#:UB-00078982-19 E 06/04/2020 Expiration Date_ Job Site Address: y) City/State/Zip: (1f Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required tinder Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine -- up to$1;500.00-ani/or one year imprisonment as well as civlilpenabies lC the f6rm 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 ofthe DIA for coverage verification- I do herby certify der thepains andpenahies ofperjuq that the information provided above is true and correct- si�M ft,,.- / Date. Print Name: Phone#_ L' Of use only Do not write in this area to be completed by city or town official City or Town- Permit/licease#: Issuing Authority(circle one): I-Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical hispector 5.Plumbing Inspector 6.Other Contact person: Phone#: e �1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDD1YYY'n TMLSri=3-wicATE 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 713 (A/C,No,Ext): (A/C,No): E-MAIL WEST SPRINGFIELD,MA 01090 ADDRESS: 286TF INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SEXTON ROOFING&SIDING INC INSURER B_ INSURER C-- INSURER :INSURER D: PO BOX 6327 INSURER E HOLYOKE,MA 01041 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE UISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUREMENT,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.LIWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR DD BR POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE NSR D POLICY NUMBER (MTd1OMYYYY) (UMWL IYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE ,$ COMMERCIAL GENERAL LIABILITYCLAIMS MADE OCCUR_ PREMISES ( RENTED '$ ME (Ea occurrence) i ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER ENERALAGGREGATE is POLICY 0 PROJECT LOC PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE +$ i ANY AUTO LIMIT(Ea accident) I ALL OWNED AUTOS BODILY INJURY is SCHEDULE AUTOS Per person) 1 HIRED AUTOS BODILY INJURY ;5 Per accident) � NON-OWNED AUTOS PROPERTY DAMAGE !$ (Peracddent) UMBRELLA LIAB e OCCUR EACH OCCURRENCE ;5 EXCESS LJAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE 'S RETENTION $ -777 �$ A WORKER'S COMPENSATION AND X I WC STATUTORY OTHER; EMPLOYER'S LIABILITY YIN U"G078982-19 06/0412019 06104!1020 LIMITS ANY PROPERFTORIPARTNERIEXECUTIVE E] MA E_L EACH ACCIDENT j5 1,000,000 OFFICERWEMBER EXCLUDED? (Mandatory in NH) E_LDISEASE-EAEMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPFRATIONSILOCATIONSIVEHICLES/RESTRKTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUFD TO THE CERTIFICATE HOLDER AFFECTING WORRIRS COMP COVERAGE. TBE INSUREDS ALA WOR10=R.S CONIPENSATION POLICY,ANMD ITS LR-ffrM OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE TNSL='S tiiA EMPLOYEES IN SMATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLALNIS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HRZES:OR TLS HIRED EMPLOYERS 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 W ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPRESENT r ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION- All rights reserved_ f �1 SEXTO-2 OP ID-, ER ACORO' Da TE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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: ff the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WANED,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 De mbinske Ormsby Insurance Box Inc. PHONE 413-737-0300 FAC 413-737-0617 698 Westfield St PO Box 718 (AIC,No,E)d)_ _ (plc Nol West Springfield,MA 01090 L _eeern skew rens y1rIs.COm — Eric Dembinske INSUR, AFFORDING COVERAGE MAIC# INSURERA:Colony Insurance CO. sNSURED ,Quincy Mutual Fre Insurance 15067 INSURER sexton Roofing&Siding,Inc. PO Box 6327 INSURER c= -- Holyoke,MA 01041 INSURER D INSURER E- INSURER 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. ILTR NSR TYPE OF INSURANCE ADM SUER POLICY EFF POLICY ERP POLICY NUMBER )DnLIMITS A X COMMERCIAL GENERAL LIABILITY I( I( EACH OCCURRENCE $ 1'000'006 CLAIM -MADE OCCUR IOIGLOO2159903 06/25/2019!06120/2020 RprOTO RENTED m y 100,000 { 5,000 MED EXP JAny ane erson S --- -- I I PERSONAL&ADVINJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER_ I GENERAL AGGREGATE S 2,000,000 POLICY D PRO- D LOC Z,000,OOO JECT ((I PRODUCTS-COMP/OP AGG 5 _ OTHER: I S B AUTOMOBILE LIABILITY COMBINED SINGLE LGAr 1,060,600 I -acdden(I $_ ANY AUTO 06561 05115/201910511512020 BODILY INJURY(Per person) $ OWNED SCHEDULED — AUTOS ONLY X AUTOS BODILY INJURY(Per amidentS I- HIR HIRED �( NON- WNED PROPERTY DAMAGE – -- _.. AUTOS ONLY AUTOS ONLY ! LperacdderY�_ S. $ UMBRELLA LIABOCCUR I EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE c I AGGREGATE S —_-- DED ' RNT ETEIONS I WORKERS COMPENSATION ' I MUTE EMPLOYERS'LIABRJry ER YIN N A _-- ANY PROPRIETORIPARTNERIEXECUTIVE O BE SENT SEPERATELY EL_EACH ACCIDENT 5 OFFICER/MEMSER EXCLUDED? N/A i 1 —._-- (Mandatory In NH) i EL.DISEASE-EA EMPLOYE S If yes.describe under I DESCRIPTION OF OPERATIONS beim I EL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ir more spare 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 REPRF_SENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C l The Commonwealth of Massachusetts -- Department of IndustrialAccidents I Confess Street,Suite 100 Boston,MA 02114-2017 wwK:mass.-vv/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHOWTI". Applicant Information Please Print Legibly Business/Organization Name:MNP CONSTRUCTION INC Address:45 EXCAHNGE ST City/State/Zip:MILFORD, MA, 01757 Phone#:508-498-8870 Are you an employer?Check the appropriate box: Business Type(required): 1.Q 1 am a employer with 5 employees(full and/ 5• [3 Retail or part-time).* 6. E]RestaurantBar/Eating Establishment 2.0 1 am a sole proprietor or partnership and have no TE]Office and'or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8- 0 Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing no employees. [No workers'comp.insurance required]* 4.❑ We area non-profit organization,staffed by volunteers, ]1.❑Health Care with no employees.[Ivo workers'comp.insurance req.] 12•(D Other CONTRACTOR *,1ny applicant that checks boa Yl must.also F11 out the section below showing their workers'compensation policy information, *.If the corporate officers have exempted themselves.but the corporation has other employees,a workers'compensation policy is required and such an organization should check box"i_ I am an emplgyer that is providing workers''compensation insurance far my employees. Below is the policy information. Insurance Company Name:HARTFORD UNDERWRITERS INS, CO. TRAVELERS-RMD Insurer's Address:P.O. BOX 5600 City/Statelzip: HARTFORD, CT, 06102 Policy#or Self-ins.Lic.41 K709706 19 Expiration Date:11/16/2gip 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 c. 152 can lead to the imposition of criminal penalties of fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine _ of_up_to_S?50=00-at day-against the-violator-Beadvised-that a copy o"t i_s statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u 01des of perjury that the information provided above iv true and correct Si-nature: /' Date: < �� I l 7 Phone#:978-403-5942 Official use only. Do not write in this area,to be completed by city or town official Citv or Town: Permitt.License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone# oww,mass.eov(dia CERTIFICATE OF LIABILITY INSURANCE DATE(MMOD/yy" FLunenbura CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-iTHIS IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER RTANT_ If the certificate holder is an ADDfnQNAL INSURED,the pDlicy(iPs)must be endorsed. If SUBROGATION IS WANED,subject to rms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the cate holder in lieu of such endorsement(, RCONTACT AMILY INSURANCE AGENCY LLC "AME ArtCalviuo PONEFAX MAIL3-5942 t Suite 15 ADoREss: acaivillo128@yahoo.com urg INSURER 3I AFFORpING COVERAGENAIC# ED — -- MA 01462 INSURER HARTFORD UNDERWRITERS INS CO 30104 MNP CONSTRUCTION INC L R6=--- INSiJRER c: --- 45 EXCHANGE ST APT 3E INSURER 0: MILFORD INSURER E: COVERAGESINsuRER MA 01757 F: CE — RTIFICATE NUMBER_ 478475 THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDD REVISION NAMED ABOVE FOR THE POLICY—PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITON 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 M INSR AY HAVE BEEN REDUCED BY PAID CLAIMS- .— ADOL'SUB ._. LTR TYPE OF INSURANCE IN D i EAPOUCYNUI POLICY EFF POLICY EXP MBER COMMERCIAL LIABILITY MM10 I D UMTS --- I CLAIMS-MADE D OCCUR I EACH OCCURRENCE S DAMA E TO RENTED .._ I PREMISES occunenre $ N/A f MED EXP(Any one person) GENL AGGREGATE LIMIT APPLIES PER: I j PERSONAL B ADV INJURY s POLICY ]PRO-JECT 1. 1 LOC ' I GENERAL AGGREGATE s — OTHER PRODUCTS_COMP/OPAGG S AUTOMOBILE LIABILITY I I $COMBINED ------- -- ANY AUTO I S1 LE LIMB s AUTOS EO ASC�HEDULED + N/A { BODILY INJURY(Per person) sALL OW — NON-OWNED BODILY INJURY(Per accident) s HIRED AUTOS I AUTOS -— PROPE er UMBRELLA UAB I s -- OCCUR i EXCESS LIAB CLAIMS MADE N/A 1 EACH OCCURRENCE s DED I RETENTIONS I { AGGREGATE s WORKERS COMPENSATIONAND EMPLOYERS UA6rLrrY 1PER OTH- AFIC OPRIETORIPARTNERAD(ECLn1VE YIN i X, STATUTE ER A OFMEMBER EXCLUDED? NIA WA NIA I — — (Manda 6S6OUB1K70970619 11/16/201911116/2020 EL EACH ACCIDENT $ 1,000,000 If yes.descnbe under EL DISEASE EA EMPLO s 1,000,000 DESCRIPTION OF OPERATIONS below I _ I EL DISEASE POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEFUCLES(ACORD 101,Additional Remark¢Sctledule,may be���fit�ne space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 3 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. 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 precedes the 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.govAvd/workers-compensatiorYnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULDt ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXTE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING & SIDING INC ACCORDHE POLICY PROVISIONS. 102 PINE ST AUTHORIZEDIVE HOLYOKL 1 MA 01041 ` " Daniel M. U,Vice President—Residual Market—WCRIBMA 1988-2014 ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CORPORATION_ All rights reserved. ot DATE(MWDDlYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/27119 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 endomement(s). CONTACT PRODUCER NAME Art Calvillo One Family insurance PHONE E� 978-403-5942 ;UC No_ 978-1035943 1 Main SL Suite 15 E-MAIL Lunenburg,MA 01462 ADDRESS: art�alfamilyirlsurance.com INSURER(S)AFFORDING COVERAGE NAIC A INSURERA: Evanston Insurance Company INSURED INSURERS: MNP CONSTRUCTION,INC. INSURER C: 45 EXCHANGE ST APT 3E INSURER D: MILFORD,MA 01757 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_ INSR TYPE OF INSURANCE POLICY EFF POLICY EXP L1MfT5 LTR INSD WVD POLICY NUMBER UM MWD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAM` -M iU CLAIMSADE X OCCUR PREMISES oavrrence Ea S 100,000 MED EXP one n) $ 5,000 A Y Y 3ET9385 11/03/19 11/03120 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑TEE T) F—]LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER_ $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT S Ea a dent ANY AUTO BODILY INJURY(Perpe ) S OWNED SCHEDULED BODILY INJURY(Peracodent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident $ UMBRELLA LABOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMSMADE AGGREGATE $ DED I I RETENTIONS S WORKERS COMPENSATION PEROTH- AND EMPLOYERS LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTNE❑ NIA EL EACH ACCIDENT S OFFICEWMEMBF_R EXCLUDED'? (Mandatory in NH) E.L.DISEASE-FNA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AdMonal Remark¢SchedLde,may be attached it more space is 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 AUTHORRED REPRESENTATIVE HOLYOKE,MA 01040 ART CALVILLO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD � r �a fs Id 13uS�r�ess Iia &��_ StrE�pt-Sine 7-10 HOS�npraver Cords 78 S"IOit ZiOLYO FWG R S®JNC,I111C Corpolzidim, PO-B 6327. H01yIE IMPROV i $£3Iy0 � f31t1ENT CON gE ,J SE TA T TACTOSIZR � HOL�Q S 0304—24u EYTON ROp Rc_js;Zon J FI1VG&SIDING CO nIC-0605383112 Eff«ri�•e SfG_ 1/20I EXPrion ` __tL 11/30/2020 i Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Canstructioni; r Specialty CSSL-099689 EVERETTJSF(TOM xpires:X0105/2021 PO BOX 6327' HOIYO �ry1L1:.Ot041 y'r - i. It ... �` }fSS z�t7" Commissioner