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30B-042 (3) BP-2023-0970 303 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-042-001 CITY OF NORTHAMPTON Permit:Exterior Res PERSONS CONTRACTING WITH UNREG TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUA NTY FUND (MGL c.142A) BUILDING P .RMIT Permit# BP-2023-0970 PERMISSION IS HEREBY GRANTED TO: Project# roof 2023 Contractor: License: WILDE HSE LLC D1 A SEXTON Est.Cost: 13950 ROOFING 106265 Const.Class: Exp.Date:03/08/2027 Use Group: Owner: HARDENDORFF ERIC D TRUSTEE Lot Size(sq.ft.) Zoning: URB Applicant: WILD> HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON,MA 01060 ISSUED ON: 07/26/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: >2 . D ,,r Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fa).:(413)587-1272 Office of the Building Commiss oner ' t� C ./ The Commonwealth of Massach,setts J 4,,‘ .0 Board of Building Regulations and .land rds U� FOR Massachusetts State Building Cod•. 78 c t, 4.....„............,I ?, (FO LITY U of Building Permit Application To Construct, Repair,Reni . ftow "sh a ised ar 2011 r, One-or Two-Family Dwelling ,04,��Sp, This Section For Official Use Only ! I t''°so`J'�'S Building Permit Number: 3�- y,?j-?'70 Date Applied: i� �5 /� 7-Z6.-zoz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 3 "Rvra cs at bc. Nloc}-1N+,,+,r6r,1 Mix 014a 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: — Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) . 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public 0 Private 0 Check if yes Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Er c., k-30rdRn6,13s r AInNwl infleio•.. t 1-6A 61610a Name(Print) City,State,ZIP ?103 R,.ve..16a0 bar '}13-1to1-V2.2- eciscn►c 2_ 1 `Vine el No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 51 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': 'C"911o.c a- t•t•snk ar, e.c k . Vvsyvui. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ \P °1SO 1. Building Permit Fee: $y Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 1 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire S Suppression) Total All F Check N U Check?Amount: l OC 'ash Amount: 6.Total Project Cost: $ 13 C\6 0 0 Paid in Full\\\\ El Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) touat.5 3181 az--I SoegNt tt te, License Number Expiration Date Name of CSL Holder List CSL Type(see below) 'RC 41S Otonder Dr No.and Street Type Description l3 t.Tnrestricted(Buildings up to 35,000 cu.ft.) 11(31rlhtM I\P Mott0 R Restricted 1&2 Family Dwelling City/Town,Stale,ZIP t M Masonry. RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 3t5-�o4-1..1101 4.04IV- 440_2(ka,ntenhC nc4.cam 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 20%14 i 70 `3 2oZ$ t Stet}4r► efan 4 Cd,; HIC Itegistration Number Expira ion Date HIC Company Na or HIC Registrant Name 13‘an444 C• -- sash, G ita66140,4N caws No.and Street Email address (UtttrtltAtl" M# ateitao 3IS %Oct-111 1 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.g 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 SECTION la:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize�r(;�5 1� �t� T _ sS ken ►wt i� to act on my behalf,in all matters relative to work authorized by this building permit application. .f e.n2ys 1 a 312-02.t Print Owner's Name(Electronic Signature) Datc SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. (Such (JAIL) -11i 2Aa3 Print s or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will go have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at \ WW.mass. m-oca Information on the Construction Supervisor License cart be found at www.mass.gov!dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths • Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts 1!`: !l Department of Industrial Accidents • -i=rat' 3 1 Congress Street,Suite 100 `:�'•1-r- 4? Boston,MA 02114-2017 ':..�--,cor. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contr ctorrs/Electrlcians/Piumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leelbly Name(Business/OrganizatioMndiv;dual): ire, \-1, U.S._ S2je,on 94,c,V'ts k.c.,,Mrs Address: y5j 0tw�t,r 'b J City/State/Zip: t( s', MA At)IaO Phone#: 3t5- 9--1-7 to i Are you as employer?Check the appropriate box: Type of project(required): t am a employer with employees(full andlor part-time)* 7. New construction 2 I am a sole proprietor or partnership and have no employees working for me in B. ~Remodeling any capacity.[No workers'comp,insurance required.] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. �Demolition 4 u am a homeowner and will be hiring contractors to conduct all work on myproperty. I will 10 Building addition etsire that all contractors either haze workers'compensation insurance or are sole I I.aElectrical repairs or additions proprietor with no employees. 12.0Plumbing repairs or additions 5EI am a general contractor and I have hired the sub-contractors listed on the attached sheet gh of emptioa per MGL c. 13. Roof repairs These sub-contractors have employees end have workers'comp.insurance.: 60 We are a co ration and its officers have exercised their 'n t ex 14. Other 152,101(4),and we have no employees.[No workers'romp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'cotioo policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit anew affidavit indicating such. :Contractors that check this box must attached an additional'beet showing the name of the sub-contractors and sate whether or not those entities have employees. lithe subcontractor have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ti'twelea -rnaihenoni Cam{- Amer sta.,. Policy#or Self-ins.Lic.#: (p yvi7s\455kkactl Expiration Date: to(1 j 26 214 _ Job Site Address: 3o3 kZiQQ-ce:Cdo.. 7...)c- City/State/Zip: M.P.61OA Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct. Signature: &L1Z— b3/419__ Date: -112-312s.323 Phone#: 31 S-S(oA—71to1 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone City of Northampton 6 •' ^a Massachusettstari ei • .Q DEPARTMENT OF BUILDING INSPECTIONS St.rr a 212 Main Street • Municipal Buildings 1a! Northampton, MA 01060 j'bh, - \ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: lflato IAul,ARce, A ate The debris will be transported by: Name of Hauler: essa_ , e.r _ ax____(..DakkAa'S Signature of Applicant: Date: 1 1 /2,w23 Ac p DATE(MM/DD/YYYY) 1�...� CERTIFICATE OF LIABILITY INSURANCE 06/09/2023 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(ss. PRODUCER CONTACT NAME: Eric Derribinske ORMSBY INSURANCE AGENCY (A//co"vo.Eri1: (413) 7-0300 FAX Ho)_. E-MAIL ADDRESS: edembinske@ormsbyins.com P 0 BOX 718 INBURER(S),AFFORDING COVERAGE NAIL• WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 _- INSURED ---- INSURER B: WILDE HSE LLC INSURER C: DBA SEXTON ROOFING &SIDING INSURERD: 45 OLANDER DRIVE INSURERE: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 901203 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR r, ,INSD MVO POLICY NUMBER (MM/DD/YYYY)((#AMIDD/YYYY! COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RE—WED CLAIMS-MADE J OCCUR PREMISES(Ea occurrence $ _ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY'----- PRO- Li LOC PRODUCTS-COMP/OP AGG $ 1 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ee accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accidentL_ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB 1 CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ �/ $ WORKERS COMPENSATION X PEATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/M E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA N/A N/A 6HUB0W55113923 06/01/2023, 06/01/2024 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 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.gov/Iwd/workers-compensation/investigations/. 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. Sexton Roofing and Siding Inc PO Box 6327 AUTHORIZED REPRESENTATIVE 1�4 <<. 5-i Holyoke MA 01040 Daniel M.Cry,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD Client# DATE TM CERTIFICATE OF LIABILITY INSURANCE 05/01/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT 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 an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Guilherme Camossatm hiAMF- PHONE 978 726-9830 I-INSURANCE GROUP INC {Arc.No.Exi). EMAIL gcamossatopi-insurancegroup.net 799 GORHAM ST ADDRESS LOWELL, MA 01852 INSURER(S)AFFORDING COVERAGE NAIL INSURED INSURER A:GENERAL STAR INDEMNITY COM INSURER B:ARBELLA PROTECTION INSURANCE LDG HOME IMPROVEMENT INC INSURER C: 18 SPRING ST FL1 INSURER D TRAVELERS PROPERTY CAS CO OF AM MILFORD, MA 01757 INSURER E. INSURER F COVERAGES CERTIFICATE NUMBER:000015 REVISION NUMBER: 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 TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL ADDLI SUER POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DD,YYYY) {MM/DD/YYYY)• LIMITS A GENERAL UASIUTY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP!Any one person) $ 5,000.00 IMA395923A 8/25/2022 6/25/2023 PERSONAL S ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GENL AGGREGATE LIMIT(APPLIES PER Products Completed OP)Aggregate $ 2,000,000.00 POLICY I I PROJECTFloc B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EaecadAU) $ 100,000.00 BODILY INJURY(Per person) ANY AUTO $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/1 3/2023 4/13/2024 BODILY INJURY(Per acswdent) AUTOS AUTOS S 40,000.00 NON-OWNED ' PROPERTY DAMAGE HIRED AUTOS AUTOS IPer acadent) $ 100,000.00 C UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION S D WORKERS COMPENSATION WC STATUTORY OTH AND EMPLOYERS'UATY VM SIU LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED' n/a $ 1,OOo,0o0.00 6HU64N86974323 3/26/2023 3/26/2024 Mandatory M NH) E L DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,descnbe under DESCRIPTION OF OPERATIONS blow E L DISEASE-POLICY LIMIT $ 1,000,000,00 GENERAL LIABILITY-for regular and usual jobs and the certificate holders an additional insured. Workers'Compensation:benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 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 toot at www mass.gov/!wd/workerscompensahorviinvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WILDE HSE,LLC EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY 45 OLANDER DR. CHANGES OR CANCELATIONS NORTHAMPTON,MA 01060 GU/LHERME CAMOSSATO 1/1 ©1988-2010 ACORD CORPORATION.All rights reserved. A C OR/ DATE(M4BU/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/31/2023 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 POUCHES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(S), AUTHORIZED REPRESStTATIVE 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 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 Neu of such endorsements). PRODUCE* raser"riACTBRUJO ROZE BARQUE POINT INSURANCE INC mar mitt. (817)783-1160 FAX ADDI�fi bFULTDOaillfir UIN.COra 1103 COMMONWEALTH AVE NIBUIRERMAFFORDINGCcVERAGE RAW* BOSTON MA 022151111 ilWRERA; NM MUTUAL INS CO 33758 INSURED s1BURER B: E C A GENERAL CONSTRUCTION INC roc: INSURER D 8 OTIS ST APT I mum E: MILFORD MA 01757 INSURER f: COVERAGES CERTWICATE NUMBER: 897535 REVISION NUMBER: TH8 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 A FOR013)BY THE POLICIES DESCRIBED HEREIN IS RLFLIFCT TO ALL THE TERMS, t7CCLUSIO S MAD CONDITIONS OF SUCH POLICES.LIMITS SHOGMN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR ADDL 6i POUYi1MMC EH: POLICY EXP LTR TYPE OF INSURANCE HilD a MUM,NUMBER NOPDONYTH AMYDOrTTTY) LIMITS CLINNINICML6ENINIU.W1MJIY EACH OCCURRENCEDAMAGE 0 f 1 C MAOE ❑OCCUR o�.M� ceNrence) $ LEDLWfMlonepree9 $ N/A PERSONAL AADV INJURY $ GEHLAGGREGATE DIRT APPLES PHt GE2.151NL AGGREGATE $ POLICY JECT ( LOG PRODUCTS-COIIPA7P AGG B MEP AUTOMOBILEUABILmr COLEINED SINGLE LIMIT $ I ANY NOD ;BDQLY NARY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Peraccident) $ — AIr10BONLY AUTOS ONLY iPeraaoduai f , 1 UNINIELLALIAR ru"t-1R EACH OOSSiRReNcE $ MESS LIAR CL AUS MADE N/A AGGREGATE $ p DEC RETE".TIONj $ JIORIERSCOMrBBARON XPet E I ANOLWLOYdtt'LIABILM YJM ER A Mei+WA VWC10060260282023A 02/11/2023 02/11/2024 EL-EACHAHxlOB(r $ 1,000.000 Ste deiory In NM) EL DISEASE-EA EMPLOYEE $ 1,000,000 Hyyreaa d_el®ie'Or ar % TwJIX OrrOPERATIONSDelon _ 9 EL DISEASE-POlCYurn $ 1,000,000 WA Dr CRE'ilON of OPERAUON$r LOCATIONS S%UNCL.ES(ACORD ISt f-isd Mssds tdsarq mq be allsheii a aNee awe le wgniwd) Workers'Compensation benefits wet be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees rz 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 ef this certificate of insurance)- The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search lrioi at rww.ntass.gov =Investigations). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde NSE LLC ACCORDANCE METH THE POLICYPROVISONS. 45 Otancier Dr NUTNCIRm NVE C Northampton MA 01060 Danidta / CPCU,Vice President—Residual Market—WCRIBMA 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered!narks of ACORD • THE COMMONWEALTH OF MASSAC USETTS Office of Consumer Affairs and Busfne s Regulation 1o00 Washirt ton Street-Suite 10 Boston,Massachusetts 0211; Home Improvement Contractor Reg=tratlon Typo .L4 V�ri 6E!.SE.:LC Roo bon 25&LT3 o�tl�A SEXTON I�Oilh3 A S1OktG 800P 04�3Y21i25 45 OLAti3ER DR MORTMAMPTO, MA C31C4 Updeu Addna end Return Cent. THE CCYMONNVEALTH Of MASSACHUSETTS On.c1 or consumer Atoms S auelMn R.sulelle l R.Ofelr„ion Heed for Indivtdu.l moo only Won 4M HOPE IMPROVEMENT CONTRACTOR elyNgtlen OHM.If found r11um 1e. TYPE i• Moe el Commoner er Affairs and auiMMa R.gulalmr USAMat e1 LAAUElon 1000 WeaAMgton Street SWIG 710 !'.4eT5 '44'34/415 Swan,MA 03114 OSA SE+<1 V.4.Cirt4G S SO N3 $ASMA'N=.pE P'14'4-41Ueil/'--- yOR7ruAewTOh,NIA 01+G4 UnGe^1SCrelary Not valid without signature Licensee Details Demographic Information Full Name: SASHA MARIE WILDE Owner Name: license Address Information City: NORTHAMPTON State: MA Zipcode: 01060 Country: United States License Information License No: CSSL-106265 License Type: Construction Supervisor Sped Profession: Building Licenses Date of Last Renewal: Issue Date: 7/6/2023 Expiration Date: 3/8/2027 License Status: Active Today's Date: 7/7/2023 Secondary License Type: Doing Business As: Status Change Reason: License Issuance Prerequisite Information No Prerequisite Information No Available Documents WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com _ p.4t3.5341234 Arir �r.�a Ilnfoo@sealonmoo .aoltla VINO 45 Olander Dr. air Northampton, MA 01060 ` '"'° Standard MA I-'IIC#208470 SMARTtmro Eric Hardendortf 1 PHONE 1413-%l-9L DATE S1312o23 Stit> i - 303 Riverside Dr EMAIL I erictwicup101@gmalcom Crr STALE,ZIP Northampton.MA 01062 roofr SEXTON ROOFING HEREBY SUBMrfS SPECIFICATIONS AND ESTIMATES FOIL House Roof P 1 1) Strip and remove existing shingles and dispose of in proper landfill. 2) tispect roofing deck aaad replace as needed @$90 00 per sl-,eeL 3) Install new metal edging to rakes and eaves of roof(white) 4) lnsta$l ice and ware shield on eaves((a vert stacks.in rays,chimney,.int intersecting roofs. 5) Install synthetic roofing underlayment on remainder of roof. 6) li Mt new flanges over existing vent stacks 7) Irsll stater shingles on eaves and rakes of roof 8) Install IKO Architectural style roofing shingles as per manufacturers'specifications. 9) lascall new cap over ridge vent.Install»c strip on north side of ridge 10) install solar powered attic vent fan provided by owner. II) Refith chimney as needed 0$400_00 12) Supply manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. n ezkoc ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage,or storage areas due to possible roofing debris or dust coming through cracks of wood decking. Sexton Roofing shall apply for all permits. We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Thirteen thousand nine bundled fifty&Dm((I3.950) Payment due in full upon completion AU Ma°erui ss guaraMeed aa be as specified. A8 stork re he completed . in a worlm anbke manner according to standard practices. Any alteration ordesiation firma abase specifiritims inwairwygextra costs AlithOOhld will be executed only upon written orders,and will become an extra sputum aitett. charge cower anrb above the estiamer_tiliMAGES 1D Ma tES AND OTHER i bLit 1 A71O MAJB6 ON HOUSE MAY BE UNAVOIDABLE AND WE ARE HELD HARMLESS.Not responsible for water damage Note:This proposal may be withdrawn by us if not accepted within during c an.. Owner wpaT resipereablie legal fetesitu -s non-payment,and applicable interest. Acceptance of Pigpen' The above prices`specifications and conditions are satisfactory and are hereby accepted. You Signature "i-14✓L are authorized to do the work as specified. Payment will be )j made as outlined above. Date /// /2-3