36-054 (4) -3proponl
SEXTON ROOFING
A division of Sexton Home Improvement Co.
13) 534-1234
FAX (413) 539-9906 • Holyoke, MA 01041
MA HIC #118239 ow CT HIC #0605383
www.s exto n roof i n g.co m
Since 1985 tL _
SUBMITTED TO (. PHONE 30 — 17 7 t0 DATE —.®2 3"I S
STREET 5 !7 FeD444-3 �4 JOB NAME
CITY �p�
STATE ZIPCODE N G V �Q JOB LOCATION
Proposal to furnish and install the following
❑ Re-Roof 4--fear-Off &'Main House ❑ Garage ❑ Shed
Complete Roof Preparation
Zr-Home exterior to be protected by tarps and plywood
7a—Shrubs, landscaping,trees to be protected
Entire existing roofing material to be removed to existing decking, Including flashing,etc.
W'Site to be cleaned everyday with roll magnet debris removed at project completion
❑ Deteriorated existing decking replaced at$2.50 per sq.ft
A-Thstall all new decking/type: t/d-, p iF P I%(W U o A Y P l y
tl— hite rown metal drip edge installed at eaves and rakes 3"F-8 ❑ F-5 ❑ Rake Edge
New flashing will be installed where necessary(see Special Requirements)
W-Install new pipe boot flashing ❑ Bathroom Exhaust Vent
❑ Reflash chimney with new lead
J,'We shall acquire all appropriate permits etc.for all roofing work
Complete Roofing System
Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' a-V
1"'Leak Barrier installed at valleys, around penetrations and chimneys to protect critical areas
install Roof Deck Underlayment on remainder of roof ❑ #15 Felt Synthetic Felt
Shingles
&' IKO ❑ GAF ❑ CertainTeed / ❑ 50 year or'Lifetime Color
❑ Install Attic ventilation system ❑ Cap over Ridge Vent ❑ Roof Louvers
Warranty Options
❑ We guaranteed our workmanship for 25 full years
Ut o hereb tq furnish material and labor-complete in accordance with the above specifications,for the sum of:
S&IJeAl TH00,5.4*0 ApuG 14uy11QzQ dollars($ `7i4140 '� )•
PAYMENT TO BE MADE AS FOLLOWS
All Material is guaranteed to be as specified. All work to be completed in a workmanlike manner Authorized
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 Signature
above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Note:This proposal may be
Not responsible for water damage during construction.Owner to pay responsible legal fees for Withdrawn by us if not accepted within / days.
L—agn-2ayment and applicable interest of 11/2%per month.
S of VVr posdl-The above prices,specifications and conditions Signature actory and are hereby accepted.You are authorized to do the
as specified.Payment will be made as outlined above.
f Acceptance Signature
ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust
coming in through the cracks of the wood. Sexton Roofing and Siding will not be responsible for debris or dust in the attic or storage areas.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 5 '7 RE�-0(o' 2 D� t
The debris will be transported by: s
S�o 114
The debris will be received by: &C,4,,Ple-�
Building permit number:
Name of Permit Applicant )
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors(Electricians/Plumbers
Applicant Information Please Print Legibly
(1 _
Name (Business/OrganizatiorAndividual)
n � I
Address:
4
City/State/Zip: p hP 11'(,ti 1t1I 1 I?LA P ())1o1 I Phone#: L12- �j-t�,z,-( q
Are you an employer?Check the appropriate box: Type of project(required):
I. _l I am an employer with 4. C I am a general contractor and I b. New construction
employees (full and/or part time).* have hired the sub-contractors 7. Remodeling
2. C I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8: Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance. t 4. , Building addition
required] 5.'-J We are a corporation and its 10. Electrical repairs or additions
I C I am a homeowner doing all work officers have exercised their I L 1 Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required]i c. 152,§ 1(4),and we have no 12. Roof repairs
employees. [no workers'
comp.insurance required.] 13. - Other
Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;.Contactors that check this box must attach 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'Icofmpensation insurance for my employees.Below is the policy and job site
infor
Insuranc e Insurance Company Name: 4 ) _ m 1�-'I u rl i ci u nu o
Policy#or Setf-ins. Lic.#:���1/�� )o- (n c)�q o�q`r_�(3)VI k Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number,and expiration(date).
Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine
up to$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
$250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify under thepains andpenalties ofperjury that the information provided above is true and correct.
Signature: " , / ^_ Date: 1 5
Print Name: { ; 1 G i 1,01 ),i Phone#:
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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact person: Phone#:
( The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
_ o l Congress Street, Suite 100
Boston,MA 02114-2017
;.w SJev. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organizationaclividual):
Sexton Roofing Co.
Address: P.O. Box 627
City/State/Zip. Holyoke, Ma. 01041 Phone #:413-534-1234
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees , These sub-contractors have g_ ❑Demolition
working or me in an capacity. employees and have workers'
g y P t3'� 9. ❑Building addition
[No workers' comp.insurance comp:insurance.t
required.l
5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions
3.F-1 I am a homeowner doing all work officers have exercised their 1.1.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
q ] employees. [No workers' 13F] Other
comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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:
Iam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name: —
Policy#or Self-ins.Lic.#_ Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of.the DIA fo � ance coverage verification.
I do hereby certify un r e pains and penalties of perjury that the information provided above is true and correct.
Sign afore: Date: `f r L
Phone#: 4135341234
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 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[p]
Brief Work:Description of Proposed ��e O re- S r A_ U
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and.or atldition to existing hou"sing, conp[ete the following:
a. Use of building : One Family_ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, (— as Owner of the subject
property ,`
hereby authorize 3.,P— ly")
to act my behalf, in all matters jelative to work authorized by thib building permit application.
Signature of Owner Date
I eke as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing applic ion are true and accurate,to the best of my knowledge
and belief.
Signed under the pai sand penalties of perjury.
t
Print Name
cf '�S
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: }�— Not Applicable £
Name of License Holder: -,� X+_0/1J w1w, 177
License
U Number
� e /�—
-)n -5
Address Expiration Date
06Ll-aV-7 sr
Signature Telephone
9.Re' red Home!Im rovement Contractor Not Applicable £
Company Name Registration Number)e- 5 -1 f 0 ,e, H
Address f Expiration Date
Telephone!;3 r� /d-3
SECTION 10-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 b 'ding permit.
Signed Affidavit Attached Yes....1.. £ No...... £
11.'-:Home`Own r Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780 Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-Year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the building permit-
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature,
'
Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This coltarm to be filled in by
Building Department
Setbacks Front
Building Height
Bldg.Square Footage O/C
Open Space Footage %
#of Parking Spaces
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
x�� x~�
NO �_v~�/ DON7KNO\� �_/ YES �~�
|FYES, dateiouedj �
IF YES: Was the permit recorded at the Registry nfDeeds?
NO K ] D
�� �� 0
IF YES: enter Book Page and/or Document#
B. Does the site contain abrook, body of water orwetlands? NO 0 DON7KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobenbtained v~� Obtained x—� Date v�/ ' �
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ~�«-� NO y~x���
�
IF YES, describe size, type and location: | |
.
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre oriait part ofa common plan
'
that will disturb over 1acre? YEG ���) NO ����
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
-`'
3-r
�,�� ' A Department use only �
City of Northampton A
t, f/ Building Department Gtrrb Cut/Drlve�vay Permtt }
00 212 Main Street Sepver/septicAvaira61llty `
Room 100 Water/l/�tei[Avallabillty
4
Northampton, MA 01060 TwvlSefs oi'StructuralPlarrs
phone 413-587-1240 Fax 413-587-1272 _PIo�/Slte'Plans � f
I ,
OtherzSpec�fy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Property Address: This section to be completed by office
�� ��® eJ 2 Q IZ Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
T40L 66m,
Na (Print) /� /' Current-yla6,7 Address
�1 r,cf A �q� f��F, Telephone �a
Signature
2.2 authorized Agent:
SEX--T?") ,g L- t1-0 ry(j r-C, OA4
Name(Print) Current Mailing Address:
ILS3 (I1d-3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection a ,
6. Total=(1 +2+3+4+5) () Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
57 REDFORD DR BP-2015-1049
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-054 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-1049
Project# JS-2015-001997
Est.Cost: $7400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sa. ft.): 12501.72 Owner: BARRY PAUL
zoning: Applicant: SEXTON ROOFING CO
AT. 57 REDFORD DR
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.514120I5 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/4/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner