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18C-151
BP-2023-1075 22 WARBURTON WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-151-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1075 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 7900 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: HERSHIPS DAVID Lot Size (sq.ft.) Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUB0W551 13923 NORTHAMPTON, MA 01060 ISSUED ON: 08/10/2023 TO PERFORM THE FOLL O WING 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: av ' 10 ' I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner �i The Commonwealth of Massachusettsr\c, ��'0 �"' FO r0 Board of Building Regulations and Stand rds7n ' �IICIP LITY I Massachusetts State Building Code, 780 r R ,°2- U Building Permit Application To Construct,Repair,Renovate Or -f Revised ar 2 lI One-or Two-Family Dwelling T0,v.,,/(hFrTh� This Section For Official Use Only oso NS Building Permit Number:Nu 3o ? 3--fD 7,S Date Applied: f�C 0 0 J )s.) 1/ 8--o-zaz-3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers Welibuicesa Wm t4srtthnYntArn 1`10'WW1 1.la 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 ves❑ Municipal❑ On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: bow& Irkexs.h. s t•kerk lv,9}x 1 IAA MC1.00 Name(Print) City,State,ZIP 22- VSlo.rbur{ese. W "WI-Sao-Q1-191 6.e.v+clinu-5IN12-. "ctrnaaa.cam No.and Street Telephone Email Ad�re. SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Ek Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': roof r9lp,c Lt d - oA eVtc rc. 1Mrne, SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1. Building $ 1 tqb:Zi 1. Building Permit Fee: $ Indicate how fee is detci alined: 2. Electrical S ElStandard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Feesii,4j� Check No.1O5 Check Amount: 0 Cash Amount: 6. Total Project Cost: $ -711c), 0 Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES ^.i Construction Supervisor License(CSL) 10(90VS S(%Iair} w de, / License Number Expiration Date Name of CSi /�List CSL.Type/see'beim) R . L e J OluArker rpc Type Description No.and Street s U Unrestricted(Buildinus up to 35.000 cu.ft.)lY6('ahawitk� MA O1 Ot,rp O R ' Restricted 1&2 Family Dwelling City l own,State,ZiP fI M Masonr y RC Rooting Covering WS , window and Sitting SF } Solid Fuel Burning Appliances Svi.--114--- --5c.s u szy.6Arwsis j•co LY1 _------- I insulation Telephone 1..mail add D Demolition 5.1 Registered Home improvement Contractor iHIC) et t Wte, uS rr��nn 20 '10 44 I ( V �, lson Cp(11l RnoCvS f A5 HIC Registration Number Expiration Date TUC Company Name or HIC Registrant Name 45 Olo+Mcr 1 /►06660nroaiFi scat" No.and Street Email addregS /46 CAA OODO 311s•soq-inwl City'Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 15C(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 .❑ 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 kith3. k15,, , 'D$A Segken'Rain,06 to act on my behalf,in all matters relative to work authorized by this building permit application. avvx \lc rqs $191_24.23 Print 0-,- ,!nature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION B!.entering rtuy name below,I hereby attest under the pains and penalties of perjury that all of the inforntalto; contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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(NK.:)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 m; > tzo‘ pica information on the Construction Supervisor License can be found at w 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basementiattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "TotaI Project Square Footage"may be substituted for"Total Project Cost" City of Northampton ' ny' Massachusetts �{ w * c DEPARTMENT OF BUILDING INSPECTIONS y ` 212 Main Street • Municipal Building Jy a Northampton, MA 01060 31'D�ti`� 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: (Au:, Min 9 Vtaky6ce NLA, c ouo The debris will be transported by: Name of Hauler: Aoc:‘aAecJ, 'p,,;aaAns tnJ .6 Signature of Applicant: Or,Q,.), Date: gl911_013 • The Commonwealth of Massachusetts ' g Department of Industrial Accidents iiril-_ - 1 Congress Street, Suite 100 Boston,M i 02114-2017 WwK:massgov/dia iN+rikers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TORE FILED WITH THE P€.RMITTPNfi Ai'THORITV. Applicant Information Please Print i.evihit Name(Business Urgani7ation.fndividuat):W t\de, LL'L . A 4le Sta,A3 Address: c.IS Oates �r City/State/Zip: Niboon&A.0104 MA CANDO Phone#: 3is-suit-'1"1(pl Are yea an etttattpleyer?Chtek the a ppropriate box: Type of project(required): 101 am a employer with employees(full and orpart-tiros?` 7. New construction 201am a sole proprietor or partnership and have no e mplo yees working,for me in 5. ❑Remodeling any capacity.[No workers'romp.insurance required.] 9. ❑Demolition 3.01 am a homeownerdoingall work myself.[No workers'comp.insurance required.]` 4.01 a a homeowner and be hiring to conduct all work on properly. I will 10 0 Building addition m Crrwur:t that all C.:0,1MB either have.a-in-kers'eintipmsa r i^,-stets or arc sole 1 1.0 Electrical repairs or additions proprietors with no employees. 12.0 Numbing repairs or additions am a general contractor and i have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.( 13.®Roof repairs h,0 We are a corporation and its officers have exercised their right of exemption per MUL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.; "`Any applicant that cheeks tsar=; mast also fill out The section below showingTheir corners en ersalienpoliex information. Hen:WO r.ns who submit this affidavit indicating they are doingall work and then hire outside contractors must submit a new affidavit indicatingsuch. !Contractors that cheek this box must attached an additional sheet showing the name of the sub-cootractors and state whether or not those entities have employees. If the sub-cuntractorshave 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. r� ��, (�_ (� p_Y__ Insurance Company Name: L rw.aii trs � esy `moo K pout IGO► Policy #or Self-ins. Lie.#: lh Nuepw6t5113a1 Expiration Date: Ma till 12.0114 Job Site Address: hYa \isfaibustan Wai Citv1State'Zip:AdAltircital MA GAO Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGT.c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 and,`orone-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 ce rtifj-under the pains and penalties of perjury that the information provided above is true and correct. Signature: C� ' �' Date: 8Ir111023 Phone#: 315- Official use only. Do nit write in this area,to be completed by city or town official. City or Town: J'ermiULicense# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5. Plumbing inspector tl 6.Other 1 Contact Person: Phone#: ACORD Client# DATE TM 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 Guilherme Camossato NCMF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C,No,EXtp. EMAIL gcamossato@i-insurancegroup.net 799 GORHAM ST ADDRESS LOWELL, MA 01852 INSURER(S)AFFORDING COVERAGE NAIC 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 SUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DO(fYYY) (MM/DDIYYYY) LIMITS A GENERAL LIABILITY 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 8/25/2023 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEENN'LI AGGREGATE LIMIT APPLIES PERM Products Completed Ors Aggregate $ 2,000,000.00 POLICY ri PROJECT I `.,OC B 1 COMBINED SINGLE LIMIT AUTOMOBILE UABILITY (Ea accident) $ 100,000.00 BODILY INJURY(Per person) ANY AUTO $ 20,000.00 A OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per adent) AUTOS AUTOS ectoderm $ 40,000.00 —� NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ 100,000.00 C UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DEO[ RETENTION E D WORKERS COMPENSATION YINWC STATUTORY OTH AND EMPLOYERS'UASILITY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, n/a E.L.EACH ACCIDENT $ 1,000,000.00 Mandatory lnNYl( 6HUB4N86974323 3/26/2023 3/26/2024 E L DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below £L DISEASE-POLICY LIMIT $ 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 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.govAwd/workers-compensationnnvestigations/ 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 1/1 ID 1988-2010 ACORD CORPORATION.All rights reserved. -----1 „ Accomii CERTIFICATE OF LIABILITY INSURANCE , amonrowym , kie.....---- 05f312023 THIS ATE IS ISSUED AS A NATTER OF INFORMATION OM'? ANTI CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CEITTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE:AFFORDED BY THE POIJCIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT coNsTrn.rm A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPREeorAilve.OR-PIIODIXER,AND THE CISITFICATE ROWEL IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the pries)must have ADDITIONAL INSURED provisions or be endorsed. *SUBROGATION IS aktven, stitoct tat ow terms aid cundittuns cd the frailty,certain putties may require an endorsement. A statement on this certificate does riot calks rights tie the certificate Mader in firm 0*such andeirsetnends). 1 CONTAcT Pfle411X3Eft t.V.VW: BRUNO ROZEMEAPOLE POW PI4SURAACE INC ,4 l"'"31,L14*.Attn-rta-tvez eig-• . F-xx it.ieek. „Augersa_lauriciapeinitesure.con _ III.)3 CONNOIONAIEALTI-i AVE IIRRINSFRESi AFrORONISCOVERFOGE 111111/CO BOSTON VA V21541"fl, Luc: ANNAWAVALOBSCO, ,. WS , IMINSIWID. PASURRIES= _ ECAGEMERAL CONSTRUCTION RC 'Asumuse: _ 1111111111011V 8 OTIS ST APT 7 ININIIMeer. ' fALMREI MA Qtrs.,' `11111111.1111111W: COIRERAGES CERTIFICATE NUMBER: 997535 REVISION NO1111381z. ThiS is !t CERIIP? '1,2,- THE POLICES OF INSURANCE LEFED EanvirtivimE-SEIMMINJED TO THEINSURED NAMED ABOVE FOR THE POLICY PERM INDICATED. NOTWITHSTANONG AFIY REQUIREMENT,Taal OR CONDITION OF AMY CO1TRACT OR OTHER DOCIANENT WITH RESPECT TO WHICH THIS CERTIFICATE IIINf BE ISSUED OR WAN.-PER-TABIL ME INSUFBINCE AFFOKI8:1 a",'THE PtLIOE ZESC,RIBED HEREIN!IS SUBJECT TO ALL THE TERMS, Exr usiatis,vti:i couciTIONs O'F SUCH.RIMER,UNIIIS.SHOINN INV!HAVESEElt REDUCED_TII,FIND CLAM& TiO3-R-1 --rileT11-- /NEW- iT--- --R 1 ETIF, taireoseestattece IAE4sLA pilisuivilleillIMEA6 EaRRINIENNINT $111111M MRS I 441111MOKALMSFeREPUFAMIMITT li qEACHAMIENERENC.F_ li 7----7, ; DARREL'FORESTED / i aiNEstfAOE ' ' "•'-'„...LST 11 i i PRIRMIES/Es occurrence), I ri. 11111€4DEP'4Aut one.testosV '!I i [kg& I il it i PERSONAE 44 A tt,A!BMW $ t 117-1 t i BIEWILUAMAISSIIIEGNIMIPPIRM 1. ; 1 1 il ABEKat.430;*-GATE ,i I 1 srucv 4.__i FRII' E fi LaC 1 , 1 PRCCUCES-COMM..Aaa I 1 i s , awsicrs* I i FOIPME'UNIBITAT I UT ) ii CCIIIIIWASVOLGtEE1111 1 lassedifeitt $ 1 !I WY atatV3 I I I, i; SONSWINURVI eirrposairit 1 ,,:o+ismisre ,41,07)INEY n Atri5tUVE ji"'1W i Palk r" f NeWkIluitiEL., , I . P DOIXIX AWRY'(Rer mcitaindl$ li Vtietlafardt37410105E IIi .Atj'ist.M111-'4" l' tKORE4-atiLl' ,1 Jr : i ( ,tassimeccrates ' It ii ncrun i i ISWIFFOOPARRENCE s LE Ell,SES"Al5 i i,CLAIRSANBEi il WA i AGGREGME $ tiet ItETESOIAV, , tl 1 imimaima 211111MIEIMI r, I :,PEN t,': ,,,NTH- WM li 0-% STATUME I I ER ;'AIEFFINICMIRTYSEFAITTNERIFREMATUE- nip t'' ' '' , , I 'SEILENCRACCIDENT s T,C)00,000 A -rantratierrassuiz=,...emot :WA Mk 'NfWCVAEXQfi32MZPi23A WRI/V2IMEORRIVEINc'; Illaildatory in Piti) I I I EL LISeAse-EA EMPLOYEE(t 1,000,000 Pow rtrsitto Ante , i I 45ex,parTmo.o..7-m.Fiio loke:aft, ' Ez,DISEASE,-POIXTUNIR '$ 'LILT Opel 1'1 . : lig, sii, i 1 i i 1 inenr,113WW-aPERAIICIMI'LaranEYOMPUSMOSEN EAMST iSCINISIONFIRNEssamrSoledlulek norNIARINSNOhNINFRONNINWimq- %Noreen:Coupe-mason benefits teill LIR part ta IttaisactemiNthemploymet only.%nutlet MEr4intamnienelir 21:1 MOS S,no-authonzation is given to pal claims for beterits to emptayees'n states otter than Massedrusegs##le OMR-at tines,or hem hired 87Cee errgadayees outside of litassachisetts_ Ths ceattlebta-• a insurance st ova des rirdiey in force on ass de*that tee calibrate.t..k issued(Unless SOEF "JEptratOCT darn.on the atom policy precedes the ,i,stga gate,,,)f this atnalcate of insurance!. The status&this caretaige ran be 77t.:AnttOr.'ed daiTY t,i.arZL9WIT:ffiePrrA0 of Coverage-CoveraWVetificatIOn Sear,t;inei-m ovvoev.,fnas&r...Wiwcemorkels-camemilitr,rinvesiqat=Fa. CERTIFICATE HOLDER CAMELIA110111 ; Si 12 NI L 11 lite CIF THE ARCM Claw-BIDED POLICIES FliE.CAPIcELLED EEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NegORIDARCEINITWINEPOLICT PROWS/ON& Wide HSE.tiii.C, 45 Olander Dr MIN11111111110111•111MIIIME 'D j tham arii(514, Norpton NA 01060 amid It -CPCU,Vire Pet...in-Residual,Markt-WCRIEMA 1: e2e15 ACORD CORPORATION. AN rigits.reserved. ACORID 25 prifinin The AC131113.PERfnir avat ItsysivossmitiNeNdmivisvtACORD Ap,cc R fil.o1i DATE(MM/DO/YYYY)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(s). PRODUCER CONTACT NAME: Eric Dembinske ORMSBY INSURANCE AGENCY tPAtHOc No.Ext): (413)737-0300 FAX ,No): ADDDRESS: edembinske@ormsbyins.com P O BOX 718 INSURER(S)AFFORDING COVERAGE NAM* 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 INSURERF: 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. ILTR TYPE OF INSURANCE _.. NSO'SUBR.__. .. ............ . _.___._ - --- T POLICY EFF POLICY EXP WVDLIMITS POLICY NUMBER I(MMlODlYYYY) (MMlDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ N/A PERSONAL ii ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY jECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea 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 accident'_ _ _ 'UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I RETENTION$ �/ $ WORKERS COMPENSATION PPEERTUTE OT ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6HUBOW55113923 06/01/2023 06/01/2024 (Mandatory in NH) EL.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!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 Holyoke MA 01040 a .. 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 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 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 and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachixsat1e 02118 Home Improvement Contractor Registration Type uLC Jr..t:fS1p..LC ftogtatratwe 21164?G 0 91•A SEXTON PtOOFIN3 ii 5.I3 d Ee�lraflon 4u 7045 45 MAMMA I DR ivDirr(AMPTON MA D3104 vac**Addrn4 sod'Wen Card. Toot CCWM,OtrWIAIJW OF 16A61ACNVIETTS O*'ir.s of COMIUMN mown 6 Imam Rsyulanon MWsir.Mort K.bd for tn4Mdu&use ontr bstufe emi, move IMPstoYE'eENT coormActov e,*lration date. i,feud tataret 10 TrPE.t:1,C Dews of Ceimuwar ARak's a+d itueinsse Repulstwrt essuivaitOP Eaairansas TKO NhM'rotor tltteat Sults Tt? /soo !I gaalon,MX 02%11 Y�tOE 0412.ltw p'B'A SE:rtfSS te4.s NO 5,044 ) 4sotiN4Akli1J R �� 49 GlA1'JER De f�,.',rdeC. �."��r++l C 5P�'' — µ+,GtrHi!AI9rDN,MA 411ti4 unaorsoo ury Net Wild without tionituri WILDE HSE. LLC SEXTON ROOFING AND SIDINC www.sextonroofing.com 41,1(0 t • 45 Olander Dr I Cat.f._.► Northampton, MA 01060 Setting the Standard -aiiMUI ;;- MA I IIC#208470 p. 413.534.1234 info@sextonroofing.com SUBMITTED TO David Herships 1 PHONE 14113-321)-F- 79'' 1 DATE 1612112023 I STREET Prospect Ave&Warburton Way EMAIL davidhersh22@gmail.com CITY,STATE,ZIP Northampton,MA 01060 j roofr/field 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 0$70.00 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 m derlayment 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 OR Manufacturer Match as per manufacturers'specifications. 9) Install new cap over ridge vent. 10) Rehash abutting chimneys. ll) 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 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.broken out on the page below Payment due in full upon completion - r _ All Material is guaranteed to be as specified. All work to be completed Authorized } l in a workmanlike manner according to standard practices. Any Signature , alteration or deviation from above specifications involving extra costs will ix executed only upon written orders.and will become an extra Note:This proposal maybe withdrawn by us if not accepted within charge over and above the estimate.DAMAGES TO BL.STIES ASPom it ('A days. VEGETA ION'MARKS ON HOUSE MAY BE UNAVOIDABLE AND WE ARE.HELD HARMLESS. Not responsible for water damage during construction. Owner to pay responsible legal tees for non-payment,and applicable interest. /iii+.‘i Acceptance ofProposal The above prices,specifications ir and conditions are satisfactory and are hereby accepted. You Signature t are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: t a 90,2-3