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23A-237
• BP-2023-1035 171 NONOTUCK ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 23A-237-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1035 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DB SEXTON Est.Cost: 9930 ROOFING 106265 Const.Class: Exp.Date: 03/08/202 HAGE STEIN EDWARD L/E ERIC HADELSTEIN Use Group: Owner: TRUST:E Lot Size (sq.ft.) HAGE STEIN EDWARD L/E ERIC HADELSTEIN Zoning: URB Applicant: TRUST:E Applicant Address Phone: Insurance: 19 EASTWOOD DR SOUTHAMPTON, MA 01073 ISSUED ON: 08/03/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF ON HOME EXCEPT FRONT PORCH 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: I if i' • i ' , Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner RECEiV."=C The Commonwealth of MassachtrOtts AUG - 2 2023 'l Board of Building Regulations and Standards F Massachusetts State Building Code, 780 CMR_ ran NICI ALITY DEPT.OF BUILDIN(;1NSPEl,T ON$ U Building Permit Application To Construct, Repair,R.enovattfOrlDetirtalisirtsaolt ised _at-2011 One-or Two-Family Dwelling This Section For Official Use Only �7"" Building Permit Number: -Y.3 'CC �� Date Applied: ./y (3_3.10z.3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1-11 IJoiciktt.It, ,A- 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.t.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Eris dory Ck ci n l\l a tUnc..w park t t- 6t CL 0 Name(Print) City.State,Z P 1"11 Nom61wy S} L.3 13oo I e_Jet1M,Jt @ Irma.am 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) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work'-: rood rep 1p,rcn rri. yt hmkt, <,/ct - •crook e6 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ q q 30 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. Mechanical (Fire Suppression) Total All Fees: $ �/ Q Check No. 1051 Check Amount:"lb Cash Amount: 6. Total Project Cost: S "! Q& ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I0(62tDS 31 2-7) SCANA License Number Expiration Date Name of CSL Holder List CSL Type 0.ee below) g.0 45 U ex- fl� No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.tt.) JCSY-\hur^91ac► t-AA n\Ov 0 R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 15 91ponlnl So.C.yo,@ CO-+Glenrag',t{�s�CL I Insulation Telephone Email address b D Demolition 5.2 Registered Home Improvement Contractor(HIC) klG ► tea. Q�t 4 S:aw.e� 2 y'lo (�nLn Date t � HIC Registration Number Expiration HIC Company Name or HIC Registrant Name `-AS Gk,naear bc- €4Alr n«stg No.and Street Email addreis tV isvklr a tc)r r. NM aSp n �ttS 4i i xp1 City/Town,State,2IP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted witl6 this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes $ No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize VIA .,�,� �, NSA ScA€gt 4'C .•ea, to act on my behalf,in all matters relative to work authorized by this building permit application. \-keotAck.ei n 81 112323 Print Owner's Name(Ele tropic Signature) Date 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. Xso 10t e'Ij2023 Print Owner'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 not 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 www.mass.gov/oca Information on the Construction Supervisor License can 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 ro?m 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" City of Northampton "" " .'s...:"....s.lc Massachusetts �' L '`'.t. DEPARTMENT OF BUILDING INSPECTIONS Z. , 212 Main Street • Municipal Building �ti s L . Northampton, MA 01060 ('S„ 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: LAR c-ta.�n Sk Hthiesta.. C'v. 0v040 The debris will be transported by: Name of Hauler: ASCor_1a4-c0 1 1 Ln-c-r-u-S Signature of Applicant: _ -- W Date: 8 1 i( �023 The Commonwealth of Massachusetts Department of Industrial Accidents _:nn'= 1 Congress Street,Suite 100 • =1 � Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMUTING AUTHORITY. Applicant Information Please Print Leeibly Name (Bu>sines/Organization/Individual): Address: y 5 City/State/Zip: Ma,rk++...ttpl,n MA o YJ1oo Phone#: 3tS- q--11 to Are you al employer?Clink the appropriate boa: Type of project(required): t O am a employer with employees(flail andlor part-time)! 7. New construction 21:11 am*sole proprietor or paitnetahip and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 31:1 am a homeowner doingall work myself. 9. Demolition yse [No workers'comp.inatnusce required.] 10 Building addition 401 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contactors either have workers'compensation insurance or are sole 11.aElectrical repairs or additions proprietors with no employees. I2.0Piumbing repairs or additions 5N1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. Roof its These sub-contractors have employees and have workers'comp.insurance i ® t 6aWe are■corporation and its officers have exercised their right of exemption14.QOther 152, 1 4 haveno � per MG[.c. !t () employees.[No workers'comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors 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: Teuvek is d mi4t jC AYvtericca .- Policy#or Self ins.Lic.#: (o l zki\AL55%kacit3 Expiration Date: is( 2c)214 Job Site Address: 11 I Itlat64uck- S1- City/State/Zip:AfotrAhc r,.�}� MA Cm 40 0 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$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 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 cemfy under the pains and penalties of perjury that the information provided above is true and correct. Signature: cr-- Od e/9—_ Date: SI 1/2 23 Phone#: 31S-Slog—'17to1 __ Official use only. Do not write hi 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/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone r: ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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(s). PRODUCER CONTACT NAME; Eric Dernbinske ORMSBY INSURANCE AGENCY (A/C,NO.Egl: (413)/37-0300 FAX UVC,Na): E-MAIL ADDRESS: edembinske@ormsbyins.com P 0 BOX 718 __- INSURER(S)AFFORDING COVERAGE -_ NAIC I WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: DBA SEXTON ROOFING& SIDING INSURERD: 45 OLANDER DRIVE INSURER E 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 ADDL SUER POLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (IMMJDOtYYYY) IMMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ _ DAMAG TO RENTED CLAIMS-MADE li- - OCCUR PREMISES1Ea occurrenceL $ MED EXP(Any one person) $ _-_-- N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ -- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident?--_---- ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED I AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ _-- HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE _$_ EXCESS UAB CLAIMS-MADE N/A AGGREGATE I DED RETENTION$ $ WORKERS COMPENSATION Na, PER µ STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR,'PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A 'OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6HUBOW55113923 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 I 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 L. Holyoke MA 01040 `— t Daniel M.Croy,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 T,A CERTIFICATE OF LIABILITY INSURANCE 07/25/2023 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 Guiiherme Camossato NAMF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C.No.Ext). EMAIL gcamossatoZi-insurancegroup.net 799 GORHAM ST ADDRESS: LOWELL, MA 01852 INSURER(S)AFFORDING COVERAGE NAIL INSURED INSURER Al 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/DDIYYW) (MANDD/YYYYZI LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMEROAL GENERAL LIABILITY PREMISES(Ea ocurrence1 $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(My one person) $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONAL a ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,060,000.00 GEN'L AGGREGATE LIMIT APPLIES PER Products Completed Ops Agprepete $ 2,000,000.00 POUCY I 1 PROJECT 1 M ILOC COMBINED B AUTOMOBILE UABIUTY (Ea aco SINGLE LIMIT adent $ 100,000.00 BODILY INJURY(Per person) ANY AUTO $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accidentl AUTOS AUTOS $ 40,000.00 NON.OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per acotlent) S 100,000.00 C UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DOD RETENTION$ D 'WORKERS COMPENSATION WC STATUTORY OTH AND EMPLOYERS'UABIUTY UMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, n/a E.L.EACH ACCIDENT $ 1,000,000.00 (Nanaabryln NH) 6HUB4N86974323 3/26/2023 3/28/2024 EL DISEASE•EA EMPLOYEE $ 1,000,000.00 It yes,describe under E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS bet., $ 1,000,000.00 GENERAL LIABILITY:for regular and usual jobs and the certificate holder is an additional insured. Workers Compensation:benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authonzation 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.govilwd/workerscompensation/investigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY SEXTON ROOFING CHANGES OR CANCELATIONS. 45 Olander Dr., Northampton, MA GUILHERME CAMOSSATO 11 1 El 1988-2010 ACORD CORPORATION.All rights reserved. ACORIJDATE(AlworYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF NFORMATION 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(3), AUTHORIZED REPRESENTATIVE OR PRODDER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pdicy(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 Neu of such endorsement(s} PRODUCES CONTACT Reim BRIRNNO ROZEMBAROUE POINT INSURANCE INC FillellEeticuz_ (817)783 1160 FAX LAM. moms& bn111o/4poirtIe e.cone - 1103 COMMONWEALTH AVE INSUREI(S)AFFORDING COVERAGE NM• BOSTON NIA 02,2151111 eitsatota: NM MUTUAL INS CO 33758 INSURED INSURER : E C A GENERAL CONSTRUCTION INC INANERC INSURER D: 8 OTIS ST APT 1 INSURER E MILFORD MA 01757 INSURER F COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: DAIS IS TO CERTIFY THAT THE PEES 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 WAY BE ISSUED OR WAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES ASCRIBED INN IS SUBJECT'TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IILTRR I TYPE OF INSURANCE IY P jCY swam II � t f YI LAM NAB�CTALGENERAL UAeR,/TY EACI4 00CLIFIRENCEs CIMHSMADE 4 I OCCUR +FFRB S occurrence) $ i d DIP(My one person) $ N/A PERSONAL&AOVINJURY $ GE ML AGGREGATE UNIT APPLIES PER GENERAL AGCI ELGATE S _-- PgUGV LI LOG PRODUCTS-CLWPTOP AGO --- 1 art* ! r AUTOMOBILE LIABUTY C06BNED SICGLE LIMIT (Ea acdderN; $ AAL.TCC BOULY INJURY Ter person $ MIMED SCIIExnLD:J AUTO*ONLY 11 AUTO N/A BOCILY INJURY(Per accident) $ AUTOS UN.," Auras ONLY (Per wisteirin HIRED NJOICWINEO PROPERTY 3PANIGE Y EXCESS(AB CLss .MADE N/A AGGREGATE S DAM RETENTIONS p WORKERS COMPENSATION X STATUTE E AND EMPLOYERS'LIABILITY YIN R TORFARTNEVEXEC,RItE fit.EACH ACC109rr $ 1,000.000 A ;C.=gCERW_.3TBEREXMLIDELYr n NIA ;IINA VWC10060260282023A 02/1120231 02f11/1024 (Mandatory in NH) i EL.DISEASE-EA EMPLOYEE $ 1,000,000 11 1e describe*ter _ -DESCXFITLIR:O OPERA. *foie E.L -POLICYL>r/T $ 1,000.003 WA I f. DESCRIPTION OF OPERATIONS t LOCATIONS:VEHICLES LACORD let.AddiBonL fiewatia SeMdata.Mr be attached if were apace*welled; Workers'Corttpeasakon benefits veA be paid to Massachusetts employees arty.Pursuant to Endorsement WC 20 03 0613,no authorization is given to pay claims for benefits to employees n states other than Massachusetts if the insured hires,or has heed 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 too(at waver.atass.govk . in gatio rst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde HSE LLC ACCORDANCE WITH THE POLICY PROVISIONS. 45 Dander Dr Mn1gpZEDBEPRENDITAIVE Northampton MA 01060 V ) Daniel el ttL�• r CPCU, Jtce President—Residual Market—':+t(',RIBMA 01988-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Licensee Details Demographic Information [Full Name: SASHA MARIE WILDE Owner Name: License Address information rr: NORTHAMPTON State: MA Zipcode: 01060 Country: United States License Information [License No: CSSL-106265 License Type: Construction Supervisor Specialty 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 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs find BustnOse Regulation 1000 Washington Street -Sulu 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type t.LC J�..C.E*SE._�G Racitsuation 206476 Dill,*5EX ON ROOFING 6 SIabVGi EtL+ir�btfl► G�70i71aQ5 416.0t.ASER DR NCMT►WPTOP; MA 63104 VP s1P Ad4r1Ea.n4*Mum Cut THE CCwY4ti'.I AL tt MASSACHUSETTS OmIsoorCanoum•A•'rr.6['worms'R►vuuuan 11.b1.U.110ntiMtb►MNoalUSf ass ally Wore H0QE INPR;7YEV/ENT CCtiTRACTOR RMw Ir%woeNllW TYPE :t OII{ee of Conouomf Affairs yid Maims*R.qul,Dor Rsauuaism Euiltmitta ne WoNt^iiutci Stet bulb 710 nivi>•:: IM:1:.2.54 Sarum t11A OM .rw:0 __ O EJ AartCS*cofl4Obti Ci sikSriak' iI rNeytttlAffrrOti,MA 01106 Unde a Ty Not valid without signature WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.cam p. 413.534.1234 info@sextonroofing.com Vir0 • 45 Olander Dr. Northampton, MA 0106 Setting the Standard MA HIC#208470 SUBMITTED TO Eric1lagelstem PHONE 113.433-3091 DATE 7/18/2023 STREET 171 \onotuck St EMAIL ephagei(i gmail coin CITY,STATE,ZIP Northampton.A-1\01060 molt SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR:Main house,does not include front porch 1) Strip and remove existing shingles and dispose of in proper landfill. 2) Inspect roofing deck and replace as needed @ S105.00 per sheet. 3) Install new metal edging to rakes and eaves of roof.(white) 4) Install ice and water shield on eaves(6'),vent stacks,in valleys,chimney.at intersecting roofs. 5) Install synthetic rooting unclerlayment 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. Color: Charcoal Grey 9) Install new cap over ridge vent. 10) Reflash chimney as needed(°$400.00 11) Supply manufactures Lifetime warranty and SRC 5 yr.workmanship warranty. ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage,or storage areas due to possible rooting 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 Nine thousand nine hundred thirty dollars($9,930) Payment due in full upon completion All Material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra cost. Authorized a will be executed only upon written orders,and will become an extra Signature GfA'Vh'ti Wait, charge over and above the estimate.DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS ON HOUSE MAY BE UNAVOIDABLE Note:This proposal maybe withdrawn byus if not accepted within AND WE ARE HELD HARMLESS. Not re ponsible for water damage P during construction. Owner to pay responsible legal fees for (14)days. non-payment.and applicable interest. Acceptance of Proposal The above prices,specifications jj and conditions are satisfactory and are hereby accepted. You Signature (.7 are authorized to do the work as specified. Payment will be --7 l ,?0D-3 made as outlined above. Date