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23A-306 (3) BP-2024-0219 104 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-306-001 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-2024-0219 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: WILDE HSE LLC DBA SEXTON Est. Cost: 8600 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 GORMAN CHRISTOPHER TENNANT &MARJORIE Use Group: Owner: L POSTAL 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: 03/01/2024 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: Xsase. 4AtfrOtA44 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Ils The Commonwealth of Massa usett Fg c8 W Board of Building Regulations an Stanza � ���� FOR Massachusetts State Building Code, 780 6.mro„ U ,USE LITY ,,, ,, / ,USE Building Permit Application To Construct,Repair, Renovate Or Derf 9'0 .a 1 Reviled Mar 2011 One-or Two-Family Dwelling ��%n�'otis , LA/J This Section For Official Use Only Building Permit Number: A V .j q Date Applied: 1,-0 tll l b f l b-s b ro u,.Ec t- fi4 31112%{ Building Official(Print Name) Signature Da e SECTION 1:SITE INFORMATION 1.1 Property Address: j O tJ D Nli,I,ek, S f 1.2 Assessors Map& Parcel Numbers Q0Ck- li>oM i15 t MA hio(Q.b 1.1 a Ts this an accepted street?yes V. 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: I3 Zone: _ Outside Flood Zone?Public V Private 0 Municipal �On site disposal system 0 Check if yesE� SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ^`11 r Zne {Zp-a(Z,�.� S3o 'rL 1 V 0�i. N 01 O Print) City,State,ZIP —r 1014 0 MVLA,CAC --1-- ( )s-3q-Iq C rE ni n1 clorzm e_eul kiLcon,\ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building l Owner-Occupied El Repairs(s) Er Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work':(gg,,,,,,,oyf, •AU. EXl yri06,5+N i,JCl LE 51 R 131A 1u FF() t7 e,0.,k 11)Clti i t.I 51-0.u (cc_ i w ( 1 to s-ria u. Sy -1411-l ( nl &2,I ANA m2 lij i t�.s-f.K Lk. (.,,.F c---i iv-.z {,ta c,i,->►`rt�u.& 1 va G,L I Si t 4 9i Q ,p c.„FJ vCANY _r T. lamas%\ r_kt t.� --3 S 7,A,spt\J (_.rV\ G,,04Z of __ SECTION 4:ESTBUTED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ C.. /_0000 1. Building Permit Fee: $ Indicate how fee is determined: /LQ ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: li Check No. Check Amount: Li° Cash Amount: 6.Total Project Cost: $ C000- 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) }�N �'�{Z j L E License umber Expiration Dat Name of CSL Holder OLyi List CSL Type(see below) D r R' Type Description No.and Street yP P KDtLR� f '/�^ O ) map O U Unrestricted(Buildings up to 35,000 Cu.ft.) iYvti,�Ys6 t R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / SF Solid Fuel Burning Appliances t 113S5"3 ij'1Z3 q Snt`1'a.J kb oc 14l7-I t ci•)Gf,C I Insulation Telephone Email address Ayny1/411 C.bw D Demolition 5.2 Registered aa HPmeQImprovemeent Contractor(m D�V 1 . 1\V�'. l 1��,� HIC Registration gq7NumberExpiration Date HIC Compan ]Name or HIC Registr Name �-1 s` t Olk ' �Sf.' arJ{ .0041*4 (W* I Cam,���Mom)l-Cinik o.and Street Email address City/Town,State, IP 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 Pc— 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 authorizes �`"C'01t 1 &OCR t,k)�1 LI r� . 1 11\1 �•1 to act on my behalf,in all matters relative to work authorized by this building permit application. 02k/342V Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information conta' in this application is true and accurate to the best of my knowledge and understanding. /wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov'dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton py " �t Massachusetts i. �. ye, r * e ka � t• i DEPARTMENT OF BUILDING INSPECTIONS y a? :' r 212 Main Street • Municipal Building vA a —.Ai Northampton, MA 01060 fstl.• ‘1C 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: ,1�. L , vv 5-1-EA Location of Facility: S -A S`-\--„ Oil The debris will be transported by: Name of Hauler: P\,5 5a c-,t k—i—T. \r-- L.t,t L_`- t 4\1 6 IAi 2. g 6K E Signature of Applicant: _yam `.j/ty Date: The Commonwealth of Massachusetts l!=* 1g 1 irf Department of Industrial Accidents t .,._ r; 1 Congress Street,Suite 100 +1 t�.y Boston,MA 02114-2017 www..mass.gov/dia nutters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO HE FILED WITH THE PIERMITIV G AU'THORII%. Anolicant Information Please Printh `Lrrib Name lHusincss Orp ani anon lndanidu .? _al):�e J I(c, $� {s\`t It. le v 10 3 a______ - Address: q 0L. o 4__`1� City/State/Zip: t Phone# itt_g....)-74,-M\y‘ni5-1114 :___(q 145 7'1 au V Art ynu an tmplatrV.I.-bird.toy appropriate.tea: Ty prof project(rryuirrd): ICI lam a employer with aanployers[lull and o part-tune I.• 7. CI New construction 0 l ytn a sok plulwldlr or pusus rsblpandhate no t-mplutors working for nic an 8. 0 Remodeling area CapCli5.(Na.)wurkery't:tnp.insurance. roosted.) 9. ❑ Demolition .3.1:1 I am a hurnontnor doing all work myself.(No workers'comp.insurance nynsrotl.J° I U Q Building addition4.0 I a a homeowner and wilt be.hiring tin aclurs to conduct all work on nitproperly. I will m m ensure that all contractor.either late wokers'cingicnsatnut insurance of air suk 11.Q Electrical repairs or additions pit gins w ith no enspk+yrca. 12.0 Plumbing repairs or additions S I am a general cunua.tor and I lute hued the.sidi�wrtractun listed on the attached sheet. 13 oof repairs Thew sub-contractors lute ctitplutces and lute workers'comp.insuranr_: Th 6.�w'r air a co u tpcnaun and its officers hate eilt:mo d thou right of exemption per NH:l.c. 14. (�� 132.41(4).and we hate.no utpluyre%.[No*oriels'comp.insurance r.yicuaal •:ltn4 aprlicall that chicks boa#I runt also fill out the section Mutt showing thcu wickets's,+rnpcnsata.n policy rolotltuOmL ' I k•irso•w rners who submu this atrial%nt ut.hcating diet are sting all work and then hire k.ut.ide.o+ntricttrs saint sYblllif a strait affidavit iimdiL'sAos suck -(.,otr...t.,r.that:heck this OA mu,®atiachcd an aildiuunat shed siiuwtng the nano.4 the sub-coNta.turs and dale w11 ih eOr ma Aare amain'how cnrrlo_..r, It t . cols-.ontra.t.rs lac.err 'J's.".s.ther roust pmtt&their wurktis comp puly.:y ausi tlr. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance(company Name: Policy~r or Self-its. Lie. _: Expiration Date: Job Site Address:I 01/ 100 rJ O1i,L Ck 3r- C it) State:Zip: D M. 1 IA) �A Attach a copy of the workers'compensation lies declaration (showingthe • her and e pirdtion date). ,\ Failure to secure coverage as required under M(L c_ 152.§25A is a criminal violation punishable by a tine up to S1.500.00 and or one-year imprisonment.as well as civic penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the y iolator_A copy of this statement may be forwarded to the Office of Investigations of the DIA tar insurance coverage verification. I do hereby certify under the pa-inss nd penalties of perjury that the information provided a ve' true and cornea �:C;L1tUle: • AP / �e��l Dee: 7 ! arne';t: /13 l 577 1o?f,/'J Official use only. Do not write in this area.to be completed by city or town official ( icy or I own: Permit/License# Issuing authority (circle onrl: I. Board of Ilealth 2. Building Department 3.( it -limn Clerk 4.Electrical Inspector S.Plumbing Inspector (i.Other ( ontacl Person: Phone#: 2/23/24,3:45 PM LP Baruch WC Affidavit.jpg _ The Commonwealth of Massachusetts 0 Department of Industrial Accidents _',.ffl.._ ,t I Congress Street,Suite 100 —:}i:= Boston,MA 02114-2017 - www macs.gor/din � 1l Ill kers'Compensation Insurance Affidavit:Builders/ContractorstEkctriclanslPlumhers. TO DE FILED WITH THE PERMITTING Alit 11OKIl Y. Annlicant Information Mast Print Leaihly Name tHusrncss'ih1aniration'Individual): L. Inn bsyS set o 4� Address:_ (��"� fZo,�ht�ten s City/State/Zip: :,s�� : - Phone#: Are yam an employer?Check the apptnpr•tate bos: Type of project(required): Itly1 mr a cnipkser with cmplo ses(full muter part-timed.• 7. [a New construction 21:1 1 am a wile prupnctor of partnership and have nu employee.working fur me in 8. Ej Remodeling m a calncity.[Nu workers'comp.insrm ucc nquned_j 9_ D Demolition 31:3 1 am a humuowncr doing all work myself.[No worksns'comp.anomie.:it-ownd.)• i O 0 Building addition 4.0 I am a Iwmuuwn.r and will be hiring contractors to conduct all work on un•property- I will c-nsun:that all conuaactun either hake workers'compensation insurance ur are sole I I.❑Electrical repairs or additions Prupnetors a ith no employees- I2.D iumbing repairs or additions SO 1 ant a cr.renal contractor and I have hired the soh-contractors listed un the attacied sheet ]3(']Roof repairs These sub-cuntnctun have employee.and have workers'comp.insurance.: �J 14.0Other 6.0 W.:are a corporation and its officers haw exercised their right of exemption per MGL c. 15''_t I(4t.and we have no employees.[No workers'comp.inswaance required[ *Any applicant that cheeks box aI must also till out the section below showing their workers'compensation policy urformatim. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors nose aubsnit a new affidavit indicating ow--h. :Contractor that check this lux!Mist attached an adartionai sheet shun ing the name of the sob-cwaracton and state**ether or nut those entities bane ernpkn res. If the sulrconiricturs have nnplovees.they mist provide their workers'comp.policy number- . L. I am as employer that is providing workers'compensation iasarance for my employees Below is the policy omit jab she information. // _�� Insurance Company Name: Arne/dui t.mi J-. L-{3 _ --- i Policy it or Self-ins.Lie.#: LoS lv QU'C-'�Ka�6 `1 kaa 5 Expiration Date: 01/ IA( 2y Job Site Address: ip q 1 V a(0 C7-(A.-C . 51-- City/State/Zip:l)d Cj}k{s pira1 f\ 0110 • Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex lion Ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500_OO andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S230.00 a day against the violator A copy of this statement may be forwarded to the Office of investigations of the DNA for insurance coverage verification. ` I do hereby certify,fader the pains and penalties ofpeigary that the taformatma provided above is true and correct Signature: 77'- r... Date: l I, �--1 7OZ ] Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: PermiUl.icenae h Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other _ Contact Person: Phone a: https://drive.google.com/drive/folders/1EJlauznxk442ABFg7A82m8pToYeiOXwe 1;1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ACCORD 09/12/2023 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 Kathi Hutchinson NAME: ORMSBY INSURANCE AGENCY : (413)737-0300 FAX No): E-MAIL khutchinsortCijormsbyins.com P 0 BOX 718 NSURER(S)AFFORDWGCOVERAGE NAIL/ WEST SPRINGFIELD MA 01090 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURER C: INSURER D: 45 OLANDER DRIVE INSURER E: NORTHAMPTON MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: 929774 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 PouCY EXP LTR TYPE OF INSURANCE Y SWIIVBR POLICY NUMBER (MMIDOIYYPOUcY ri 1 (MWDOIYYYY) I.T5 COMMERCIAL GENERALLUABILITY EACH OCCURRENCE S RENTED CLAIMS-MADE OCCUR - PPREMISES AGE T(Ea occurrence) $ MED EXP(My one person) S N/A PERSONAL a ADv INJURY $ GENL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATEPRO- $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER S AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED N/A BODILY INJURY(Peracddsnt) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER _. A OOFFFICERIMEM ERREJ(CLUDED?ECUTIVE WA NA NA 6HUBOW55113923 06/01/2023 06/01/2024 E.L EACH ACCIDENT $ 1,000,000 (Mandatory In NH) I EL DISEASE-EA EMPLOYEE S 1.000.E If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY UMIT S 1.000,000 N/A i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers- compensationhinvestigations/. Continuation of above Named Insured:DBA SEXTON ROOFING&SIDING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel ieI M.C y,CPCU,Vice President—Residual Market—WCRIBMA 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WILDE-1 OP ID: KH ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/12/2023 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 Ormsby Insurance Agency Inc. PHONE 413-737-0300 FAx 413-737-0617 698 Westfield St PO Box 18 WC,No,Ext): (NC,No): West Springfield,MA 01090 Eric Dembinske Bass: INSURER(S)AFFORDING COVERAGE_ NAIC S INSURER A:Northfield Insurance Company I .&URED INSURER S:The Travelers of MA 10647 Waldo HRo fin dba Commerce Insurance Co. 34754 Sexton Roofing&Siding INSURERC: 48 Olander Drive Northampton,MA 01060 INSURERD: _ 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP UMRB LTR MSG WVD IMM/DD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ($_ 1,000,000 CLAIMS-MADE X OCCUR WS556514 05/30/2023 05/30/2024 DAMAGETORENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMB APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: $ C AUTOMOBILE LIABILITY - ccide BINEDntSINGLE LIMIT $ 1,000,000 ANY AUTO L11219 06/30/2023 06/30/2024 BODILY INJURY(Per person) $ AUTOSOWNED RE ONLY X AUTOOSS ULED BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLYY (Pa P tD)AMAGE $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION X OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/ ISSUED SEPARATELY ANY PROPRIETOR/PARTNER/EXECUTIVE l E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? J NIA (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCIR DATE(MM/DD/YYYY) El CERTIFICATE OF LIABILITY INSURANCE 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(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 BRUNO ROZEMBARQUE _ NAME: POINT INSURANCE INC (n/cc.No. ): (61ONE7)783-1160 (FAX No): nooRESS: bruno@pointinsure.com 1103 COMMONWEALTH AVE INSURER(S)AFFORDING COVERAGE NAIL* BOSTON MA 02215 INsuRERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: L P BARUCH INC INSURER C: INSURER D: 637 RATHBUN ST APT 2 INSURER E: 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 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. ILICY EXP NSR ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER (�DY/YYYY) (EFF A MIDD/YYYY) ITS LTR INSD WVD COMMERCIAL GENERALLIAB1UTY EACH OCCURRENCE S _ -_i DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) S N/A PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY a LOC PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILEUABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED N/A BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LAB CLAIMS-MADE N/A AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION �( AND EMPLOYERS'LIABILITYY „ STATUTE ER A OFFICER/MEMBERN EXCLU EXCLUDED? CUTIVE N/A N/A N/A 6S62UB0W59692023 07/11/2023 07/11/2024 EL.EACH ACCIDENT 1,000,000 S (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.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 Sexton Roofing Siding ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE STREET AUTHORIZED REPRESENTATIVE 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 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, Massachusetts 02118 Home Improvement Contractor Registration f Type LLC Replstradon 2 473 WILDE SEE.LLC f. Eovation 0430r1025 !MIA SEXTON ROOFING s SONS -„ 4S()LAN DER DR N RTMAMPTON VA 03104 VMS Addnrp end Return Caro. THE CO'MMC WEALT►r OF MASSACHUSETTS Mee or Consumer moorsi SwlnSSS 111441000600 ReglMrwon valid For bdMblol vas only betoo Wm HONE IMPROVEMENT CONTRACTOR otplrMNn WM• N SHAM Mum a: TYPE:LLC OMlos et Conway AI ,cmd auMeese R.MrlcScn tOM W.s1$nelen$bos •Suet,710 MA Will WADE HSE.LLC 034.SEXTON R0004NO t a O N3 SASHA WILDE ,�lJ 43 OLANOCR OR al «Mott NORTHAMPTON,MA Wile uneer..d+ seriatim,valid without seriatim, 2/9/24,3:09 PM 104 Nonotuck St Signed Contract.jpg c1 6b 1 WILDE HSE, LLC SEXTON ROOFING AND SIDING www.sextonroofing.com 6r'r1' cab p. 413.534.1234 j117 iirim=i info@sextonroofing.com Vire) >i► _ i101111. 45 Olander Dr. MA HIC#208470 Northampton, MA 01060 Setting the Standard SUBMITTED TO 4"lf/'G qL c� �`,i ,,,.et /• PHONE 4--/ 7 l3Ty DATE /_j) _� V STREET 'Kf / / 44 r / ;11- 1 d ( �/l/e)tia 1 Ue- -- t_' r EMAIL C- t fr1 ii Cr,,I,.,( ,• CITY,STATE,ZIP e_e'v^e el C ,C_ WI tr_ Special Requirements: . 4'fe___.- SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: 0 Strip and remove existing shingles and dispose of in proper landfill. 3 feks o - ''4>'-- Z Inspect roofing deck and replace as needed @$/lc per sheet. .. CMG i1. 'l0 stall new metal edging to rakes and eaves of roof. Color: 4,,>"!i'r?r E ❑8 in t Install ice and water shield on eaves(6'),vent stacks,in valleys, chimney,at intersecting roofs. +'fnstall synthetic roofing underlayment on remainder of roof. :stall new flanges over existing vent stacks. ! 1lnstall starter shingles on eaves and rakes of roof. -!1 stall IKO Architectural style roofing shingles as per manufacturers' specifications. r_21Tnstall new ridge vent cap over ridge vent. E-Reflash chimney _(.ec.,a( 'Supply manufactures warranty. Eply SRC 10-year workmanship warranty. -48'r on Roofing shall apply for all permits. k / Shingle: '---�-'t JV."?C IC Color: v i We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of 9400 2�// Total Due$ i�ILii'J/ 1/3 Down Payment$ vg t7 ( .7 Balance due upon completion$ /-3-3 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 shall accrue interest at 18%per annum.Purchaser(s)will pay for all costs, expenses and reasonable attorney's fees incurred "de HSE,LLC DBA Sexton Roofing&Siding to recover any sums due under this contract. Customer Signature: / Date: (/?Lii/ Authorized Signature: Date:_,/ — d - f 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.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.