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06-022 BUILDING 1-2 BP-2023-1110 46 EVERGREEN RD COMMONWEALTH OF MASSACHUSETTS BUILD#1 &2 Map:Block:Lot: CITY OF NORTHAMPTON 06-022-018 Permit: Agricultural All Bldgs PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1110 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 48000 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 HAMPSHIRE PROPERTY MANAGEMENT GROUP Use Group: Owner: C/O EMERSON WAY LLC Lot Size (sq.ft.) Zoning: URA Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 08/17/2023 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: � TIT A A . Fees Paid: $340.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 1 � � na 400 ;17 The Commonwealth oTf Mas - •tts Uqbl, �� Office of Public Safety and Insp ic��r'/N.� Massachusetts State Building Code(780 CM ��'44,4 oF0 rioN Building Permit Application for any Building other than a One-or Tw ily II elling ?� f (This Section For Official Use Only) Building Permit Number.".T ia/6 Date Applied: Building Official: SECTION 1:LOCATION yko Cve , rv-41 'Rd _ 41c11v,tp4 p13s3 \ila..c)cee 44tll Crmlo 'Z,;;1c),►o 1 2- No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 151 Repair IR Alteration ❑ Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work: repkaeZ asri).1l- Snt1G'YiIL cc on eftktrt ird,i:-6 JJ SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ❑ A-4 0 A-5 0 B: Business 0 E: Educational ❑ F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 1-4 0 M: Mercantile 0 R: Residential R-10 R-2® R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: A trench will riot be Licensed Disposal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required❑or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 1-kco'N Aul T)ev-Mt 4 Po ()'iL .:' tvl :'l1vii11pAs).l t.)`i(LC 1 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 'TC010c.'fhi NAtA 1{c,Q,Y '-113-kkS0-(ci3t6 - - S xJwel(0 hpo'ty0 oho.c(Ali Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor {� _ {� \iJ i‘c�tit, W.E. 1.-L-5- ---iv.) A Sc t '3'c-�7�, ' j1[�c1S2r Company Name 1 CLrc, W ikli-i.. ( S 1_ - I ct CItP Name of Person Responsible for Construction License No. and Type if Applicable yS amIt iex�(- /•[.,CtV .t„1*cy fr(A Ol,3e c Street Address City/Town State Zip 316-... 1--j l to I - - -jnsv c' 6). a-‘W,ray \v- . us rt-.. Telephone No.(business) Telephone No.(cell) e-mail addreg SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes RI No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ L3? ) Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ _(contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ -16,`),)O (contact municipality)and write check number here 1 0 7 i SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. .k4;1'`YA W kWic & & — L 3.P,t L . Aa- ---11(o( 'A(15fr,'13 Please print and signAame Title Tele hone No. Date y5 71At ev 'Dr NIOrVinoo,0on I-1A C.)inu( eXPcilC.t^r\ Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /�. / B/ 7 ZO Z Name Date City of Northampton Massachusetts v,?r - 6 A W * v cX DEPARTMENT OF BUILDING INSPECTIONS 9�, 212 Main Street • Municipal Building ��. Ca Northampton, MA 01060 �� ' j'$' 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: NA6(N L , e, (0.344, Not j:4 L HA 0040 The debris will be transported by: Name of Hauler: Assc..04e& '12-) tc, ireckIr� Signature of Applicant: ra— (_A Date: 0'11S( /z)2..3 The Commonwealth of Massachusetts _ Department of Industrial Accidents • Eei_ 1 Congress Street,Suite 100 '- a Bolton, Al 021/4-01' www mass gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER\i1TTiNC U THOR1TY. Applicant information Please Print Leeibiy Name(Business/Organization/Individual):\Pt\ icks , Lam. Sexton ateAvn S►d-t� Address: 45 Ota,.16,4e"Dr City/State/Zip:ilriemwkek.at Mv+ stow Phone#: 3ig YScoci --OLD/ , 1 :ire rou aft employer'. Cherk the appropriate box: Type of project(required): 1.0 lam a employer with employees(full and/or part-tithe).• 7. ❑New construction II1 am a...oh:proprietor or pannncrship and hare no employee,working for me in K. l._.I Remodeling mr!xcapscit% "sooworker=-e;er ' cn,urar,ee regruire0 9. Demolition 3.01 am a homeowner doing all work myself.(No workers'comp.insurance required.]t ❑ 10 Q Building addition 4.31 am a b.Kr:eow her and aill be hiring cuntractors to eondtat all u.Irtt uu my property. I will x:.Vittei 2.nt w.rrti er>'.eir)/0tn.,stnm irstieersn:c m arc ate I in Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-ccvmtrx�tcx3•hal.e et o)ces and hase wothers'comp.Mutt-au,'' 13.®Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Dyer I52 §1(4),and we have no employees.[No workers'comp.insurance required.] *Any appi:..dnc that checks box 1st mug.also fill out The',row bclnw,Ilowfn:i their workers::.41-ptuNatssou policy infurmtiion. t Homeowners who submit this affidavit indicating they are doing all work and then litre outside co trac u rs must submit anew aHutavit 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. am an employer Mat is providing workers'compensation insurance for my employees. Below is the polity and job site information. n Insurance Company Name: Tcci - -Zrx,t�trAlflt tic ,gyp Policy#or Self-ins.Lie.#: Lt 1 tPjr Ey 45 \\V\23 Expiration Date: ow I01 (202..M Job Site Address: Lit0 bietavten Pek eiel \-2- City/State/Zip:NtioAlleteriAm 1MA dtn(06 Attach a copy of the ssorkers'lompensation polio declaration page(shoµing the policy number and 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 and/or 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 certifr under the pains and penalties of perjury that the information provided above is true and correct Signature: £ C_.LJJ4t Date. ( 'V `2323 Phone#: &S-- Sag Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Otter Contact Person: Phone#: ActaRri CERTIFICATE OF LABILITY INSURANCE E 0503Iritri3 THIS CBLTiFH..*TE IS MINED AS A WAT1ER OF INFORRIATICIV ONLY ,dam CON FIRS NO RIG iTS WON THE CERTIFICATE MOLDER.TRW CERTIFICATE DOES NOT AFFWefillATIVELY OR MEGNEGATIVELY AREND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. TITS CERTiEICATE OF INSURANCE DOES MOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUINGINSURERS). AUTHORIZED REPRESENSCRIEDRIRMODLCal,AND THE ATE MOLDER. !IMPORTANT: 1f the oarlflieaie holder is an ADDITIONAL NSURfD,the po icp(ies)must hare ADDITIONAL FISSURED previsions or be endorsed. If SUDROGATIORIMUMINEGLesirocr tie Bar s set ranstilhaer of dui pulley,certain paces may re'4utre an A setternient on the certificate dtosEstltsmilwiiiGlart ripe Vie•tEttairiarfirEfiwr(af such.e irfMCewMaA CONrACT i BRUNO MOZEINEAROLE - -- - ------PONT 1114.SUIRANCE @ifoLFY &-1'i — — ; crairL 1 as commDDnee LT•-r AVEcnvesc macs r ,I 93758 MealitEC arittlmak E C A GENERAL CO*4.STR#lCTiQN fisiC usimee= s CMS ST APT 1 tom: COVERAGES CERTIFICATE Mlii n- 897535 WARM NUMBER:. mil$.IS it aERT F? "F*!4:"-1fiE..POLICIES 3-Hu.M:RANCE.LI EG SE_LOw.-tokE.8EIBIABS lF1,T•:to. MISUSED tom.ASCTIE FCR Tom. . C.`F PERIM INDICATE rr@I11111.1STANCO4G ANY REGRJ1itE 1ENel, TaWA OR COINOMOR OF MST COITRACC I OTAER DOCUMENT VviTH RESPECT WHICH THIS CERIATI.CATE VW SE IMR9E.V Cii RAA>^PER TAN, Ti-E INSURANCE AFFORDED Ehr i14E Pri_lr ., :'E d". D N:tE Slate: TO A.L./ifIE TERMS, E.1cu..iJIBONS4AaCONIDI1it;SNS tlF SICH POLICIES.UNITS SHCriNN.MAY Ht Vl EE ;iiE LICED, t C CLAMS. i19[f. T /AMdtf�3W6E PIQGLSNMtlr9Efr lit' .'_'.,._L- __- �^' 7 FAQ ix..t:L':IRRENC:E: t 1 ra�1 oat TO'-l'vf-.i�iTa, r^'.bH JE.f, I �' `MIMESES F-rt__H:caarkeme; i � iqi 1 1 W.4 �i� e 4.RDVOLIF 4.4_ i WINILMAIMINIMEnharasoonshes 1 Wit.A ' _ ralligliga""2".k jljra ue • 1 w—, 1 (Ea sa loner 4,10 41.,11`.••. 1 i ROM_,'INJURY,r.$7'p $ t i Y E Aram PIWA 4 ➢BQ7iLY Wr;ll RI(Pie i 11 It i i f r $ I i IDIC SLIMS i i CfAISS- ADE ( MA 61 i AGGREGATE fI c# ':S0e9er 1 !ISCIVEICILCIAIPBRWROIRX rr� orrtr ,s rAOC 1 , I STATUTE I I Eli , AR;.<W;AAA6ii TM Aft"IE .,(TIRE iii , Et..tEA+cw,AT er 1s t,a A . Fx-.EiT =:r rrT-; WA1:;tillE ' f T mow. 1.t 2Gi ELCrSME-EA EMPLOYEE I 1,000,000 DE iRrlIOR.Or Sits wok., A .' Ft. F--Fti)L-tC7''LJwTf z Ti,Q i1T t b tilde DOPIROPROIReszAwanas '',MA'!M: O RN:LE9t+ACR IRI IIMAINIIIIkmaRoznim Stritiklk mortis AdblamtChnortvgraluriwtrwirein VANINWOhogrensattan-benefits sail is pats al MassaciluSe s einp ayes Cilltr..Fur cart to EndEndOiCarrerit`.NC 2C as 06 a,no authonzettort LE given to pat daiiNA[irasau4ts to errTiCyeeS.'n.states afher then Massactmetts if the resared ham,a has hired,7 a etrpleifees outside of Massacflurelts.. TElibpiteata of tessarice,staves Msa milky uti tote ce Tte dare rat 'mas sued todess the exprTatera date ce re andre EYE prec des the ihswedilmillbiseseekebrOlimiarical. The stets ef"ihis:x:be+a!e can he turaniftned Rai(*Dy ar..MitiSirtq Eele'R ZIef al COVIfage ?fie Venfic tictrr CEITTIMOME BOLDER CAifIL:L3.IJir7RN SHOULD AM'OF OE ASCRIE DESCRIBE..POLiCIES BE C ARCELL ED BEFORE THE EXRRATtON DATE THEREOF. NOTICE WR..L BE DOWERED IN Wilde LLB .. ACCORDARCE aT IINEPOLICY VISIORS. 45 Otander Dr morresetirsatiesamtree Northampton MA WED &isAfti4.C �°yr CF4-L 'Aim EEC-Ram Merles.-WCRIDSIA aimai S Acacia:,CORPORKNON. AR eights.rimed *Coma 2S(21141113,1 The ACORammeamil Nu.aiec muNiondmais of-A CORD 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 Gudherme Camossato NAME PHONE 978 726-9830 I-INSURANCE GROUP INC (A/C.No.Ext).. EMAIL vamossatoei-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 MILFORD, MA 01757 INSURER E: � ^ INSURER F: COVERAGES CERTIFICATE NUMBER:000015 KEVISION 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. 1NSRL ADDLI SUER POLICY EFF POLICY EXF TR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DDYVVV) (MM/DD/YYY LIMITS A GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocurrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR '11ED EXP,Any one person) $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGRF.( TE y 2,000,000.00 GEN'L-AGGREGATE LIMIT APPLIES PER'. Products Completed Ops Aggregate $ 2,000,000.00 7 POLICY ri PROJECT 170G B COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) S 100,000.00 ANY AUTO BODILY INJURY(Pb,person) $ 20,000.00 ALL OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURY(Per accident) AUTOS AUTOS $ 40,000.00 -- �r NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ 100,000.00 re- C UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIRE CLAIMS-MADE AGGREGATE DED RETENTIONS D WORKERS COMPENSATION WC STATUTORY OTH AND EMPLOYERS'LIABILITY YIN LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED, n/a E.L.EACH ACCIDENT $ 1,000,000.00 Mandatory BNN) 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 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.gov/lwd/workers-compensationAnvestigations/ 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 m 1988-2010 ACORD CORPORATION.All rights reserved. AC QDATE(MM(DDIYYYY) 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). CONT PRODUCER NAMEACT Eric Dembinske ORMSBY INSURANCE AGENCY LAIC No.Exs)_.(413)737-0300 FAX (A/C, ADDRESS: edembinske@ormsbyins.com P O BOX 718 INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: DBA SEXTON ROOFING & SIDING INSURER D: 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. INSR SI:TYPE OF INSURANCE ADDL. BR POLICY EFF POLICY EXP LIMITS LTR INSD WV!) POLICY NUMBER IMM/DDIYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ — N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY Li jE a L_J 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 LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE I W- AND EMPLOYERS'LIABILITY A OFFICER/MEMBER .L.EACH ACCIDENT $ 1,000,000 EXCLUDED?ECUTIVE N/A 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 , I DESCRIPTION OF OPERATIONS I LOCATIONS I 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 r (. Holyoke MA 01040 Daniel M.Crowley,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 WILDE-1 OP ID:KH AcoRu CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) 08/07/2023 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 413-737-0300 CONTACT MEJ Ormsby Insurance Agency,Inc. PHONE 413-737-0300 FAX 413-737-0617 698 Westfield St PO Box 718 IA/C,No,Ext): (A/C,No): West Springfield,MA 01090 MAIL Eric DembinskePRR 35:._ _________. • -_. INSURER(S)AFFORDING COVERAGE NAIC M INSURER A:Northfield Insurance Company R INSURER S:The Travelers of MA 10647 I�to� Ro fin dba Sexton Roofing&Siding MSURERC:Commence Insurance Co. 34754 48 Olander Drive Northampton,MA 01060 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ IN$R TYPE OF INSURANCE ADDL.SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD IMM/DDIYYYY) IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X I OCCUR WS556514 05/30/2023 05/30/2024 DAMAGE TO RENTED 100,000 PREMISES(Ea NTErence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 21a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY (Ea aaMacci COMBINED SINGLE LIMIT s 1,000,000 dent) ANY AUTO L11219 06/30/2023 06/30/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY X AUTOS BODILYBOODILY INJURY(Per accident) $ X AUTOS ONLY X 2UTO1 ONLY (Per dent)AMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSUAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X STATUTE ERµ AND EMPLOYERS'LIABILITY Y/N ISSUED SEPARATELY ANY PROPRIETgOERIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ �IAind t IM E In NH)EXCLUDED? N I A E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Roofing &Siding Contractor CERTIFICATE HOLDER CANCELLATION NONE-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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 Sheet-Suite 710 Boston,Massachusetts 0211 a Home Improvement Contractor Registration Typo LLC `V ^SE -LC Ras strabar. 2' L7G b A SEvrcN ROOFING&SIDING ExWrabar O4r34+1 [5 Cii.ASDER DR ►t'AT•tAieRTCti 1.th 0104 WPM,Addrsss salt*Mutts Cod- THE COVaIONVAtAITaa OI MA;$ACHUeETT$ O01E4 Cr Cansumsr Mhos Reputaaaa IIspiaAeet00n wad toe**Attu*,uss only 7Ncre r . M C+VE IMPROVEMENT COKTRAGTMR emArMagm drb. IrlsyeNd moo ro TYPE..t C Me*at Cmnunw Affairs And Sum naa+ReuuIMIer roweMAapt.aSbset •swr.71^ � „I'� 04 Daabeam,aka 02t11 W::+E h-sti.LLC Q 3'A SEXTON i INC a ii ECG SA.O 45 t/�,t�RLP-44 NR } � OR F,+-*Y'�,:i; ..tea [�/ — lyQRTiiWL'APfOti.MA WeIC4 i Jna rm:wary P Net valid rr1N1MA iiignaturs WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com p.413.534.1234 .�,�� info@sextonroofing.com $11t0 �� 45 Olander Dr. Northampton, MA 01060 Setting.the Standard MA HIC# 208470 SUBM1rriD TO HPMG PHONE 413-650-6010 DATE 8/2/2023 STREET PO BOx 686 EMAIL sbardwell@hpmgnoho.com CITY,STATE,ZIP Northampton,MA 01060 Jobsite:46 Evergreen BLDG 1-2 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 @$95.00 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 roofing underlayment on remainder of roof. 6) Install new flanges over existing vent stacks. 7) Install starter shingles on eaves and rakes of roof. 8) Install IKO Architectural style roofing shingles as per manufacturers'specifications. 9) Install new cap over ridge vent. 10) Supply manufactures Lifetime warranty and SRC 10 yr.workmanship warranty. Al 1 bNTION 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 Forty eight thousand dollars($48,000) 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 costs Authorized / A)� e/] will be executed only upon written orders,and will become an extra Signature (�('/ charge over and above the estimate.DAMAGES TO BUSHES AND OTHER VEGETATION'MARKS 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 construction. Owner to pay responsible legal fees for (14)days. non-payment,and applicable interest. Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You Signatur are authorized to do the work as specified. Payment will be made as outlined above. Date From: \,1`(1\\de. NS cc � S AGl�v4-- q=.tc- —. fait?(- -GAANNrtcs-1 IAA O(Di a c� To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at yC� Exar dv i^at-Y14 MA 0tc53 because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully,