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24D-059 (9) BP-2023-1732 177 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-059-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1732 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 30200 ROOFING Const.Class: Exp.Date: Use Group: Owner: LLC PIONEER ENTERPRISES, 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: 12/13/2023 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: " ft, 6 V ,C:t lv Fees Paid: $211.40 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DEC 1 2 2023 - T e Common h} 'Ma sachusetts 1af�tyand Inspections ,+ rl Massachusetts State uIIut ding Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit NumbemZ3' /73,� Date Applied: Building Official: SECTION 1:LOCATION I�1�1•-471.j c 5 K t\iN r i t f PAR o W000 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 lc Repair le Alteration 0 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 (El" Is an Independent Structural Engineering Peer Review required? Yes 0 No El' Brief Description of Proposed Work cr.c,i c? C:k t t I t.i Cat`c;S,(kti4 Lf\C� i �CiT F c f^cA CA�(�, ,1 ti1�-t .LL \ 'Ci. , Wfc c� aa24t��c tL, S. +:�;. sr-�►C, l.lk e fi L &iI 1‘ r;IfkU 1 \��S l m F ,{�C'�j�t i�r�r t. l 5-ikt��t�1 s S 1 t S fa LL e%£. 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) El FYisting 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❑ Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-S 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 be R-3❑ R-4 0 S: Storage S-1 0 S-2 0 U: Utility❑ Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) �/ IA 0 IB ❑ IIA ❑ MI El IIIA ❑ IIIBC IV C VAc VBC SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal Trench Peanut Debris Removal: Public I7' Check if outside Flood Zone Indicate municipal 13" A trench w'j.not be Licensed Disposal Site Ge required ETor trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: I:\Historic Commission Review Process: Not Applicable Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No C� 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 /� Ptt�N `<AL. Etv 4 a 9-AS f, L ,C. I As- CCt Si- km.tF,-]ZS , (k0 /0007 Name(Print) No.and Street City/Town Zip Property Owner Contact Information gN VEAk.7V1,k t.e6c- ii13 g7a3 — - plc ZRP5L.LC. CiMt1L.C.Ir>1 Title 0 W ts£A .. Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property own x hereby authorizes: �yul , -X: G (Z tk CiiiSi ►7l1�a 4� Camp p L t Criii I'Y��rtic�1m1 O[ Z) 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 tn°. Otherwise provide cunttruc tion 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 s cv I R F ,,,1 6---, p1 �1 7i `t Company Name i L F � 1��� / �L t14\ LOi Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip 113534 101.3q il13 -5;34- /, 3q ,5Ex~ctm2,mc,►cvc-,ocFlc 6_00►01-/x►i.-Gaut, Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COntPENsrvrt0N IN5U4ANCE Al l•lunVi t (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? YestrNo C SECTION 12 CONSTRUCTION COSTS AND PERM-IT FEE Item Estimated Costs:(Labor /� and Materials) Total Construction Cost(hum Item 6)=$J(, 03- et.) 1.Building $ V`"/ 1'�.( Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$19((.4 D. 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$/lU (contact municipality) 3.Mechanical (Other) $ Enclose check payable to C Ill) b'r faz"j�f-mhpr(Ski 6.Total Cost $L527 ,t (contact municipality)and write chellk number here SECTION 11 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. (Si V/4 41/_pe, ‘ ,2,4,44.a/4/Z diviLLE,c ' /_,/,5<f -_ha/ /Wfile.7 Please print and sign name � Title Telephone No. Date �I�IT�/'tj0��/ ad_ aiDl� ��s>CIc ti RCLJ i I.Z.Z-�.rC1Cf_66/4Vi• Street Address City/Town State Zip Email Address Cal Municipal Inspector to fill out this section upon application approval: (4106,. • C \a/3/9-3 I Name Date City of Northampton le'7t:14 Massachusetts ��5h. wf DEPARTMENT OF BUILDING INSPECTIONS64 T 212 Main Street • Municipal Building :3444,000)L1:"Northampton, MA 01060 X1.W10\' C. 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 in7Di ,rl 57-i Location of Facility: 3 5,� -�l ��� St.�t��F l�-C , D)/Q,S The debris will be transported by: Name of Hauler: A5-drixri7n Szawiir, 7,eizf-r y _c) Air. l f Signature of Applicant: �, /"., , ,, Date:,e'.2//�il�7 12/11/23,12:39 PM ECA WC Affidavitjpg The Commonwealth of Massachusetts _' Department of Indnstrlal Accidents "LETAlt_ 1 Congress Street,Suite 100 R 1i' Boston,MA 02114-2017 www mass.gov/dia 14 wirers°(ompeasatiae Insurance Affidavit Banders/Coatrset hers TO HE FILED WITH THE PERMITTING AUTHORITY. Aoolicaat l.fora alias r n Please hist Led&r tk n Name tBusiness' gamtion'individual): e C.-A C-re.nc�[� Ccr16k-ItLC.4t•ty "TAP, Address: 8 (Ate )t- ,Av} t City/State/Zip: Hitiord 4 Ni-4 01154 Phone#: Art atria car taspMytrf Cleric the appraprta a has: Type of project(rmpltiredk I am a employ wtah employs:es(full and/or part-time)• 7_ Q New construction ICI 1 am a sok proprietor or panoaship and have no employees working forme in g_©Remodeling airy capseiry-[No workers'camp.inhuman:nquiredl 3�1 a a latmatu»cr doing all aurk myself.[No wretch'rump.insurance requiem.]' 9. Q Demolition m a,Qr 1 am a howsoever and will be tiring aoeracto sw conduct all work on my pmperry_I will 10 Q Building addition ensure that all contractors either have worlds'compensation insurance or are sok I in Electrical repairs or additions proprietors with all CIIVICUCCS. 12.D Phunbies repairs or additions SO I am a gametal custrartor cad I hair hired the sob-c ntracton bawd m the aaacbni sheet. 13 ROOf Thine midi-COdmcwma have anployrca and have workers'cants!.Ott.' 6.0 We ate a oa sad as offbeat have taeictldd their of'sm inoa per)lull.c. rquirs 14.0 Other 132.;1(s).and wr have no employees[No workers'comp.iscauauce i !Any applied that cheers box n1 mutt also fill out die simian below showing their workers'cataptiltatiom ply dim. *flanmwamr who aahou this affidavit mdmtigt they are daioa a9 weer and duo bar amide ctmaeran aura submit a sew affidavit indicating such. tcomac'eoadtIdsedtthishotammamebaseaddioiomdshettshooiaadhcameeraesabeonaaerorsandseatwhf ercramtboneentioiesha►e aap♦uycm It the have m olayeek they mawProvidet6er workers'comp pommy nambtr I rill as employer b provilsis writers'eaahpessitlar l arc ter far my euiplayeec 6dasr Is gee piney sal jai site fisforsisdan. Insurance Company Name: A M t-to a cQQ �j.ti5wicwv�4R1 C Policy tt or Self-ins.Lie.#: vW C.,oo loOgV $1,a0R34 Expiration Date: to f 111aaaq lob Site Address: j Tl f R { ""'Sip 31- Cww/Stale/4x 0161I l f1 fd h Q/( 11 Attach a copy of tie workers'cospeosatias policy deeisratior page(sho,ulig the policy Number sad Failure to secure coverage as required under MGL c.152.§25A is a criminal violation punishable by arise up to SI.500.00 and/or one-yesr imprisonment,as well as civil penalties in the fort of a STOP WORK ORDER and a foe 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 MA for insurance coverage verification. I L.hereby egret milts the pairs sad mishits ofp►jawy hid fie It fermstisat predici first sad emswt signacure: rL ' .l Daft: u Phone#: (ljkfaf ass only. De ism mks la this arm,as he eaarata.d by etlry"tom m sjpidat City or Tows: PeraWLkeese N lrauissg Authority(their oser I.Board of Health 2.ituldiag Department 3.City/Twos Clerk 4.Electrical Impeder S.Plumblog Inspector 6.Other Contact Person: Piave d: https://dnve.google.com/drive/folders/l pm3pppCCrODWSTTKBLc7ETLnmT183_bX 1/1 ACc tflR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MINIDD/YYYY) 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 PHONE Ezth (617)783-1160 FAX E-NAIL (A/C,NO): ADDRESS: bran@pointinsure.com 1103 COMMONWEALTH AVE INsuRER(s)AFFORDINccovERAGE NAIL* BOSTON MA 022151111 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER 8: E C A GENERAL CONSTRUCTION INC INSURER Cc _ INSURER D 8 OTIS ST APT 1 INSURER E: MILFORD MA 01757 INSURER r: COVERAGES CERTIFICATE NUMBER: 897535 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. iLLTTRR ADOL TYPE OF INSURANCE SUER WVD POUCY NUMBER JM POUCY Y IWUCM/DD/Y EXP ---- LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S CLAIMS-MADE J OCCUR PREFACES(Es occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 3 ADV INJURY $ GEM.AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGO $ OTHER $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea eccidenry ANY AUTO BODLY INJURY(Per person] $ AUTOS ONLY ANED UTOS N/A N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per acodent) $ $ UMBRELLA LIAO _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION V PER OTH- AND EMPLOYERS'LIABILITY n,/N /� STATUTE ER FERBEXD?ECUTIVE EL EACH ACCIDENT $ ,000,000A OFIC //MEMERC EXCLUDED? WA WA VWC10060260282023A 02/11/2023 02/11/2024 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OP OPERATIONS boa+ EL.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is minim') 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.govilwd/workers-compensationhnvestigations/. 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 POUCY PROVISIONS. 45 Olander Dr AUTHORIZED REPRESENTATIVE Northampton MA 01060 , I C( Daniel M. roWl ,CPCU,Vice President—Residual Market—VUCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 12/11/23,12:38 PM LP Baruch WC Affidavit.jpg "�__ The Commonwealth of Massachusetts 1,.. '�.'� Department of Industrial Accidents :Tit •a —;�'_— I Congress Street,Stolle 100 Vii, Boston,MA 02114-2017 -,,, wwwtlslass.golt�dla Brokers'Compensation lasannce Affidavit BaHAen/C l*hers. TO BE FILED WITH THE PERMITTING AUTHORITY. AnnliCaM Information Mom him Lodi& Name(Busuxss•OrgntuzatiotuIndividual): L c Yw'CtAch 'MICA Address: 6? 1 120.-+ntun 6N a City/State/Zip:3\,.,„0I.skonct t bk. 01-1 Phone#: Are yam an employer^check the apprapriatn team: TyPe d Ferny(required): 1fil I am a employer nisi, 7- enrpkwou Mill amUo.part-time.• 7. 0 New construction 2.01 am a,ok prupraetar or putocnhip and have nu employee:working for me m S.0 Remodeling am Capacity.[No workers'cop.inngrmCe ieq _) 30 I am a hamoswtas doing all wad[myself.(No wonere camp.i..mm>ADe reamed.]' 9 ❑Demolition I 0[l Building addition 4.01 as a homeowner and MU be hang contactors to conduct al work/nag peapeny_I will auurc that all vvaanetura either Invc workers'eampeasaun issuance or ase sole 11.0 Electrical repairs or additions proprietors with no employees_ 12.0 Plumbing repairs or additions 301 ass a saran!atmactor and I have ltircd the tub-astracton listed on the Mathes'sleet 13.1:4RoofPelfiirs These have employees and hive workers'crop.usaraoet: 6.0 We arc a corporation and its offces%have taaaned elicit tight of cxrmption per kAGL e. 14.0 Other 132.f 1(4).and we have no empkryees.[No waken'coop. •—••r requcedl •Any applicant that checks boa 01 amu also fill not the nation below showing their workas'c mpen nine policy information. • t Homeowner,.who submit shim affidavit indicants they are eking all work red then hire milli&mm m mt aeters ail tsb a races odar feg aodirmr=erth leontrsuarm that chuck dais box anon ameba ao addition/sheer Aiming the now of the and state whether or not those entities haste cmployc int=,ulravrarkseas have eaaployrxs.dwy taut piu.'isle weir workers'comp.policy number. t art so employer that ft providing workers'compeasatioa lasso-owe for ay employees. Below is the policy sod job she information. Insurance Company Name: , flrnec caeA '�.tllawltt.,iC3.. Ct1 Policy#or Self-ins.Lic.#: {n5 la au t3 aid%qv9 4cia$ Expiration Date: oil I1(asca.,y lob site Address.,7 7-��__( Y_li as City/Staadaip' /A OiCO2) Attacks copy or the workers'compensation policy deelaratiaa page(showing the policy er and espi "dui date). Failure to secure coverage as required under MGL c.152,RSA is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisoomnent,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. 1 As i+ d enin and"►Our pdre anip✓rmWea atjpm iy at ther istga usLa p .I4.J Al...... .w. A..1.*woo Silptature: Ito ///Ied 70Z3 Phone#; Wield use may. Do oat weiw L this area,as he caa[plomi by thy or an*kW City or Town: PermWUrease tt Issuing Authority(eir'cle est): - I.Hoard at Health 2.Rolldirg Deportment 3.Cky/To son Clerk 4.Electrical la specter 5.rhashing Inspector 6.Other Contact Terms: rime 1: https://drive.google.com/drive/folders/1 EJfauznxk442ABFg7A82m8pToYeiOXwe );1 ,acoRL) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/15/2023 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(les)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 PHONE 617 763-1160 FAX IIAA�rC.No.Ertl: ( ) bye,Nol: �p'I'I bruno@pointtnsure.com 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE _ NAICC BOSTON MA 02215 INSURER A: ACE AMERICAN INSURANCE CO 22887 INSURED INSURER B: L P BARUCH INC INSURER C: _ INSURER D: 637 RATHBUN ST APT 2 INSURERS_ BLACKSTONE MA 01504 INSURER F: COVERAGES CERTIFICATE NUMBER; 921636 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIES.WAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE INSD WVO POLICY NUMBER ,(MMM/OD!YYYYI POLICY MITTS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ j CLAIMS-MADE LA OCCUR PRBASES M (Ea occurrence) $ MED EXP(Any one person) I — N/A PERSONAL.&ADV WJURY $ GEM AGGREGATE MST APPLES PER; GENERAL AGGREGATE $ LOC PRODUCTS-COMP/OP AOC& $ Pam' ��cT II OTHER: AUTOMOBILE LIABILITY _Ma COMBINED SINGLE LIMIT s ANY AUTO BODILY INJURY(Per person) $ - OWNED —SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY (Per eeoddent) UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR cLAIMg.MAoE N/A AGGREGATE S DEEXD 1 I RETENTION S WORKERS COMPENSATION X SPTA UTE ( _ER 1 AND EMPLOYERS'LIABILITY oFIC �EXUDoi� / El-EACH ACCIDENT $ 1,000,000 FFiRrM RCL WA WA WA 6S8UB0W59692023 07/11/2023 0711/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1 1,000,000 If yes.descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Addldonal Remarks Schedule.may be attachad H men seen.I.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-compensationfinvestigations/. 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&Siding 102 PINE STREET AUTHORIZED REPRESENTATNE HOLYOKE MA 01040 Darnel M.Crovrl8y,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 Demogr phic Information Full Name: SASI-IA MARE WILDE Owner Name: License Address Information iity.VT NORTHAMPTON tate: MA __ ''code: 01060 untry: United States License Information Tc-ense No: CSSL-106265 License Type: Construction Supervisor Specialty rofession: 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 HE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1 coo Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ?rpi :C �'+ .DE*.SE. LC Rol,istrabor 21Ua7:: 0 B-A SEXTON ROOFIN G i SONG E 1Ditstr�r ^v4 31 i:15 45 O.A",DER DR NORT•IAMPTOh.MA 03104 updw•.Add,..-,ono Rsw-r Ca-a THE CDMMOttIVEALTN Of MASSACHUSETTS OrrAA of Consumer Affairs it ffustnass Rraulat'oi Aosest{Mioo vsfid Iw Individual vas ant),Wen t`.s HOME IMPROVEMENT CONTRACTOR •apttat en dam. ff found trtunn M rot;;.0 CKlas at Consume Affairs send Business Rsoulal>on Rs14attlttst! taaffi.lfttl 1044 WsaRarotoet Strom Suits T14 Z 44T; 04.3f—2S Boston.IAA 07114 A*De.=St C 0'S'A SEXTON tir3:4 INC t 5 O"JO SASMA Yn f?E ',4,,✓ .,. � /s1 ,, 4S OLANDER DR ,, , . ,,, c A 5 /'--1 ✓I[�'� NORTHAMPTON MA OVA ... Unea'seveturr Not valid without signature 12/11/23,11:41 AM 177-179 Prospect St Signed Contract.jpg 1.-&-k ' r-7VZ-.4 WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com .' p.413.534.1234 "° ,pro s.�""-"�� info@sextonroofing.com S 45 Olander Dr. N.orthampton., MA 01060 Setting the Standard MA HIC#208470 .t Ir.?/ /. eep✓!44 SUBMfTfED TO 7 e' j_(`rph pi �G PMOIYE tIS/ �2� DATE ---6 T �� STREET /75 O1r y S`7-f-� EMAIL GTY,STATE,ZIP A o M `)—Pk-f ?--- Special Requirements: y� SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: (-, ^ �- y yD �_ Oi Strip and remove existing shingles and dispose of in pro r la dfill. re--. ? w Inspect roofing deck and replace as needed @ r$?O2/'` sheet. r- // ha-,/b9'/'r�, i -Install new metal edging to rakes and eaves of roof. 1 1 ��I�Ty / '' AA /Y _cofor: t d/ i-f- in ❑8 in FL.A'r--.( -/--• . install ice and water shield on eaves(6'),vent stacks,in valleys, G 7l e /n'� l b�f chimney,at intersecting roofs. . /) 6 U L f Il synthetic roofing underlayment on remainder of roof. v I�"P"Inaii new flanges over existing vent stacks, L'�Install starter shingles on eaves and rakes of roof. �` �-f Erfnstail 1K0 Architectural style roofing shingles as per manufacturers' �- eel() l specifications. E iinstall new ridge vent cap over ridge vent �' /T--'� G iv- Yd fzeflash chimney c,r�h/w4l)e-y radSupply manufactcll�warranty. V j upply SRC 10-year workmanship warranty. lb Sexton Roofing shall apply for ail permits. ' 7'y//f r 7 7 /-e__ 67 E/ Shingle: �! �(/� -- Color: ��� /t We propose hereby to furnish material and labor-complete in accordanceac� with the above specifications,for the sum of Total Due$ 0oR 0 v 1/3 Down Payment$ /a)S1 d 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 o tli"ed above.Unpaid ba ances shall accrue interest at 18%per annum.Purchaser(s)will pay for all costs, expenses and reasonable actor x fees Inc re by Wilde USE,LLC DBA Sexton Roofing&Siding to recover any sums due under this contract. /1 %/iii, �/''— i 7 Customer Signature: I Date: ) 1 /./ Z 3 Authorized Signature: Date: l Z—Z ,).-? ii; ATTENTION HOMEOWNERS:Please cover all pers nal belongings In the 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. — r A doi_ y ,_:). iiirlf (1,-,," ,---.(ff-) \..c..c10:12-R-----.. CA-)Cr -or- / 7 - /%9 64( -C.'-f- rT. ./— https://drive.google.com/drivelfolders/1 uZSdAHBSIXSEns81cZrC5y95DBm37Gvu 1/1