Loading...
31A-162 (5) BP-2023-1152 105 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-162-001 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-2023-1152 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 23450 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: ANDREWS NASON KATIE SUE &CHRISTINE Lot Size (sq.ft.) Zoning: URB Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 08/25/2023 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: I ! )2 (pi • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED l WIWI a AUG 2 4 2023 NORTH he Commonwealth of Massachusetts Board of Building Regulations and Standard' bE T OF Sn�TN UNLIT Massachusetts State Building Code, 780 CMR ° '. Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building P it Number: gP' 3 - l 1 '? Date Ap lied: ,,.,K"? 8-2S-Zo23 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers (OS C1nArG (Zc) 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: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner'of Record: kovtie. %Jcs( n ,N(m 4I pl 5,-1 Mil Ol Zkoo Name(Print) City,State,ZIP 10 5 Mai r`ckciA cza (A nag() kp.#,eyv,Sor12S G email No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s).19 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: ii++ C2�l�r)Csi� it�1\�(`C [�,c�nc.�-4 C11\ 19- c Qi- Yntrt SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 0,3y 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No.in IV Check Amount: tit.' Cash Amount: 6.Total Project Cost: $ ac3'\sr3 ❑Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES i wiser action Supervisor License((SL) toto?lvS AI RI2/12} Sadoc% \t4 kat License Number Expiration Date List CSC. type t c e b dowj 5 01tlY No.and Street Type - Description �,vai i icted(iruiidinus unto 35.000 cu.it.) t\let` atmphsr► t`&A 0tOL.ek I R Rstricted i&2 Family Dwelling City.,Town,State,ZIP M Masonry RC f Roofing Covering WS Window and Siding SF a Solid Fuel Burning Appliances 16-Ste9 1110` _seA dretviet' .c.o M I Insulation T�lcpltonc Email address D ; Demolition 5.2 Registered Home Improvement Contractor(HIC) `�� ,,�A�^ 208y-io y 1 pas V`�1 1 sAst, fr hen Reav9 4 6445 HIC Registration Number Expiration Date Hie Cisr+ipasiy Name or MC Rc-gktr iru Name 44S OksiAtiar . rocht'a @S ez4ahcb t04{.Coati No.and Street Email addreK hloT�l ►+ J A owoO its- -„tnl City/ own,State.ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes . No 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 \[i[t _15IL , 't)$q ' y l to act on my behalf,in all matters relative to work authorized by this building permit application. V PrintOuner'sName(Electronic Signature) 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. Ste► \ICA& 612 I 20Sb Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do hislier 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.niass to\ t, a Information on the Construction Supervisor License can be found at w mass.,,ov it i 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 halt='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 Massachusetts * r DEPARTMENT OF BUILDING INSPECTIONS y; 212 Main Street • Municipal Building J' Northampton, MA 01060 1�4C 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: (` Se\c, vvC , 1.p%lo 110-IA C N,ay P-AA C0'40 The debris will be transported by: Name of Hauler: AcsocAce\ LA e�Aikck-i+rkoj t S Signature of Applicant: &A, fiat Date: (1�510%3 • _ The Commonwealth of Massachusetts it, ,° Department of industrial Accidents ;=11ems I Congress Street,Suite 100 Boston. t1 I ii2114-30I- ` www.mass.gov/dia 'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Leeibly Name(Business/Organization/Individual): p(M , 1r1S' L.\1. --NiSA Seaclkoe.` .0eAvn kl, s►c).--m- Address: 4 S ()t„,,,,x4,,-Dr _] City/State/Zip:t jar y„ke}an i NIA Blot/0 Phone#: St 4Scoq --,- ,l N.r,s+"u at!eatltk{r?,i.`1 hscis nce rpprr.priate hr„; Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 1 am a sole privricttr or partnership and base no employees working for me in $. [3 Remodeling an apa:irs 'tie 4r14e< owayr rn;urarzee required 9. ❑Demolition 3.121 I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 10 Q Building addition -1.Ct an,a homeowner and*ill be hiring contractors to conduct ail work on my property. I will that ali..untra.uus either hatic uy.xkers :-anrfirn'unm ntauamc itr arc sole !1.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5E1 I am a general contractor and i have hired the sib-contractors listed on the attached sheet. 13.®Roof repairs These sub•contracrors hase etpplosecs and has ssorkers'comp insurance. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152.6l(4),and we have no employees.[No workers'comp.insurance required.] 'Arty app', a .-iiut aid:.. of i ,,11,.:also fill Ott!:SC es'tion belts showing shear worker.:c< sarson pohcs intir!n.a.tirst. t Homeowners Who submit this affidavit indicating they are doing all wont 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 jot my employees. Below is the policy and job site information. Insurance Company Name: _:"Xeititostkikil- Pa!'1t.Celta. Policy#or Self-ins. Lie.#: U YUSCN\1145 1\3\23 Expiration Date: ow j01 I 2A25-k Job Site Address: OS ccmrd t _City/State/Zip: f Aci(k1/11*1 t Rik Attach a copy of the workers' ompeasation policy declaration page(showing 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$1,500.00 andlor one-year imprison,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: ,---(A) Date: BSI 3 Phone 4: 36-- gee --I 7 lD k 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 S.Plumbing inspector ts.Other Contact Person: Phone#: AC Ro D 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 Dembinske ORMSBY INSURANCE AGENCY PHONE Fa,No): E-MAIL. o. x1): (413)737-0300 DDss: edembinske@ormsbyins.com P 0 BOX 718 INSURERf8)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 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 TYPE OFINSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DO/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEr DAMAGE TO RENTED $ _ CLAIMS-MADE I OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL F.ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY _J PROT _L_ J LOC PRODUCTS-COMP/OP AGG $ JEC 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 der accident)__ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6HU80W55113923 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/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-compensationtinvestigations/. 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 • C (- Holyoke MA 01040 Daniel M.Cro(it�hy,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 07/25/Z023 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 NGMF PHONE 978 726-9830 I-INSURANCE GROUP INC (A/c,No.Ext). EMAIL gcamossatoei-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 (MMIDDIYYYY) (MMIODPRYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocorrence) $ 100,000.00 CLAIMS-MADE IX I OCCUR MED EXP(Any one person) $ 5,000.00 IMA395923A 8/25/2022 8/25/2023 PERSONAL B ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER ProdoctS Completed OP.Appregate $ 2,000,000.00 7 POLICY ri PROJECT M ILOG B COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ 100,000.00 ANY AUTO BODILY INJURY(Per person) 5 20,000.00 —A OWNED SCHEDULED 1020096012 4/13/2023 4/13/2024 BODILY INJURYIPer accident) AUTOS WTOS AUTOS S 40,000.00 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Pet accdent) $ 100,000.00 C' UMBRELLA LIAR OCCUR EACH OCCURRENCE www— EXCESS LIAR e CLAIMS-MADE AGGREGATE DED I RETENTION$ D WORKERS COMPENSATION WC STATUTORY OTH YIN AND EMPLOYERS'LIABILITY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? n/a $ 1,000,000.00 6HU B4N86974323 3/26/2023 3/26/2024 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ 1,000,000.00 It yes,describe undo' DESCRIPTION OF OPERATIONS below E.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 gov/lwd/workers-compensationfinvestigations! CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE IT IS THE CUSTOMERS RESPONSABILITY TO INFORME ANY SEXTON ROOFING CHANGES OR CANCELATIONS. 45 Olander Dr., Northampton, MA GUILHERME CAMOSSATO 1/1 0 1988-2010 ACORD CORPORATION.All rights reserved. Ace CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDONYYY) 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 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; BRUNO ROZEMBARQUE POINT INSURANCE INC exti (617)7831160 WC,No): E-MAIL ADDRESS bruncepointinsure.corn 1103 COMMONWEALTH AVE INSURER(S)AFFORDINGCOVERAGE MAW A BOSTON MA 022151111 MM3URERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: E C A GENERAL CONSTRUCTION INC INSURER C: INSURER D 8 OT1S ST APT 1 INSURER E: MILFORD MA 01757 INSURER P: COVERAGES CERTIFICATE NUMBER: 897535 REVISION NUMBER: THIS IS 10 CERI1FY 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. I►1sR 'ADOL"SUBR POUCYEFF POUCYEXP ITR TYPE OF INSURANCE t/SD WVD POUCY NUMBER IMWDDIYYYY) LIMOIDDIYYYY) UMRS COMMERCIAL GENERAL.UABIt.RY EACH OCCURRENCEDAMAGE10 RENTED $ CLAIMS-MADE OCCUR PREMISES occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY r 1 Ezei L J WC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per parson) $ OWNED SCHEDULED AUTOS ONLY N/A BODILY INJURY(Per accident) $ u AUTOS AUTOS HIRED NOrPOviiiNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per tlsadent) UMBRELLA USE OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y!N AYPROPRIETOR'PARTrEVEXECUflVE F E.L.EACH ACCIDENT $ 1,000,000 A OFacER/MEMBEREXCLUDED? N/A NIA NIA VWC10060260282023A 02/11/2023 02/11/2024 4MandaIovy In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTiON OF OPERATIONS below EL DISEASE-POUCY 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.n 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.gowtwdlworkers•compensation;investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wilde HSE LLC ACCORDANCE WITH THE POtJCY PROVISIONS. 45 Olande Dr AUTHOMZEDREIRESE NTATIVE Northampton MA 01080 lO I Denid M.Croty,CPCU,Vice President—Residual Market—.VGRIBMA Q 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 WILDS 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 4 M0 Washington Street-Suite 710 Boston,Massachusetts 02146 Home Improvement Contractor Registration Type I.I.G V�s.Cf Rogtstrabar 201347G 5$..t C 0 S'e SEXTON ROOF$P G r1513411443 Explrat 0134'91l25 <S 0t.ASJari1 L;t ht'01701 .YPTO!: $/A D3104 uoaate Addrea and Metal Care- THE C 4#MVOVIALT*r OP MASIACNVI1ETTS OPPLA of Cansumar*'5re 6 ivatrwu Ropuranon Reaiittotion vs(d for MdivWuet use only Wore t* MCitEIMP1tOYEMENTCONTRAc os •ottreksndal*. NfgMd relate I0, TYPE.L,,1.0 O ets et Conaunrr Affairs and Buse...MOOutanon ' sear waauwr, Wanda I aw Wun Paton Street butts 710 en '.4,767025 Baamer.MA 02114 011 A SEA'TON WA.NO•B G45 .-- 5A.tril.40.0E 4sS CIUt!#'3ER Dn / % .."+..d LS+ k.�_ �" T `M otr'MA t lt61 Urldenec,r tarn Not valid without signature WILDE HSE,LLC SEXTON ROOFING AND SIDING www.sextonroofing.com p.413.534.1234 +� info@sextonroofing.com "- —tea.: lIMO ��� �► 45 Olander Dr. Northampton, MA 01060 Setting the Standard MA HIIC 2208470 SUBMnTEO TO !CK t 1 v Q-S0"t PHONE Q�02d d 3 yO/ DATE —3/;3 STREET /C16 U4 Ay li,Qc'YJ • e6)0 EMAIL CITY,STATE,ZIP ,( ! wi 11-6 N Special Requirements: S SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: f It 1-c trip and remove existing shingles and dispose of In proper landfill. fR, m Jn cis cape c1 t t/- ( -inspect roofing deck and replace as needed @$ .100 per sheet. Cniistali new metal edging to rakes and eaves of roof. Color: 4,j4 r T - ❑5 in 0 8 in IA-Install ice and water shield on eaves(6'),vent stacks,In valleys chimney,at intersecting roofs. ill on So/4r TAOSfl •ersii444t /6 C3'Gstall synthetic roofing underlayment on remainder of roof. de. /V A i��_�- Dv vc� 42'install new flanges over existing vent stacks. gi-thstall starter shingles on eaves and rakes of roof. "Pli -11' Crn1 install IKO Architectural style roofing shingles as per manufacturers' OI'� �� specifications. -------------- lnstall new ridge vent cap over ridge vent. 'Reflash chimney 0-Supply manufactures warranty. .Supply SRC 5-year workmanship warranty. (-Sexton Roofing shall apply for all permits. VJe c&A-Phe,r uJood Shingle: G� i-l � Color: We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of Total Due$ 023 S—d 1/3 Down Payment S 78O r Balance due upon completion$ Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above.Unpaid balances ccrue interest at 18%per annum.Purchaser(s)will pay for ail costs, expenses and reasonable attomey's fees Incurred by Wilde HSE,LLC NA R fing&Siding to recover any sums due under this contract. Customer Signature: ` Date: —� Authorized Signature: Date: / "-iv"'' ATTENTION HOMEOWNERS:Please cover all personadnegi attic,garage,or storage areas due to possible roofing debris or dust coming through cracks of wood decking.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 will be executed only upon written orders,and will become an extra 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 during construction.