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69 MARIAN ST 69 MARIAN ST BP-2018-0124 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot 13-084-001 CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2018-0124 Project# 69 MARIAN ST Est. Cost: 7800.00 Fee:40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Lot Size(sq. ft.): Owner: JUSTIN PIZZOFERRATO Zoning: Applicant: SEXTON ROOFING CO AT: 69 MARIAN ST Applicant Address: rnWur. Insurance: P 0 BOX 6327 (413) 534-1234 NPP8236461 HOLYOKE, MA 01041 ISSUED ON: TO PERFORM THE FOLLOWING WORK: 69 MARIAN ST:: ROOF - S TRIP &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: Check Number: Building Fee 40 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 69 MARIAN ST 69 MARIAN ST BP-2018-0124 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot 13-084-001 CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2018-0124 Project# 69 MARIAN ST Est.Cost: 7800.00 Fee:40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Lot Size(sq. ft.): Owner: JUSTIN PIZZOFERRATO Zoning: Applicant: SEXTON ROOFING CO AT:: 69 MARIAN SI Applicant Address: Phone: Insurance: P 0 BOX 6327 (413) 534-1234 NPP8236461 HOLYOKE,MA 01041 ISSUED ON: TO PERFORM THE FOLLOWING WORK: 69 MARIAN ST:: ROOF - 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: FeeTvpe: Date Paid: Amount: Check Number: Building Fee 40 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only \ `\> City of Northampton Status of Permit: / / ,11°;;,,. - ,7 Building Department Curb Cut/Driveway Permit / ./ 212 Main Street Sewer/Septic Availability • VA( / Room 100 Water/Well Availability \ 4$9k.,:l! Northampton, MA 01060 Two Sets of Structural Plans .:7Vir','1C-4**5. phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 619-14 — p/-/ This section to be completed by office 1.1 Property Address: & C pi1414,9(/141^-1 Map I )7 Lot 0 Unit Ag"ttelv c4/44 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JVS4- j1V P122C., cefraTo 601 414,4,ei or,-) No.tiffutopoibAJ, “44. Name(Print) Current Mailing Address: 9, 3 ci? fi e::01,4ver.4-t- 61 40 1$2 A Telephone Signature 2.2 Authorized Agent: & C) fle b 0 cu-1-1 g 1 "U 2144.-+ 163:4).° g CA?-7 liatio 4, s•fe4 dew , Name(Print) Current Mailing Address: 6-6(1 Z—UY Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit 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 6. Total=(1 +2+3+4+5) g0-() Check Number tiko 4c(0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: (--410,-Itrzfret-L 7 1-7 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) Roofing Or Doors ID Accessory Bldg. E Demolition New Signs [0] Decks ID Siding[0] Other[0] Brief Description of Proposed"-, Work: oititrt ,4• V( gef 6,1 hc..iy e,041 teed 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 addition to existing housing.collate - e following: a. Use of b ing :One Family Two Family er b. Number of rooms' each family unit: Nu •.er of Bathrooms c. Is there a garage attach'e d. Proposed Square footage of neik-Tconstructio Dimensions e. Number of stories? f, Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Com ance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction ' in 100 ft.of wetlands? Yesqo. tsonstniction within 100 yr. floodplain Yes No j. Depth of b-.ement or cellar floor below finished grade k. Will b 'ding 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, JU4 t 9122_0 'er(cd ) ,as Owner of the subject property hereby authorize a 4_401- rzGOC-tvisi .4. etc to act on my behalf, in all matters relative to work authorized by this building permit application. 4'14=4 ilbe-11,-e-41A g-b 4 7 Signature of Owner Date , clawgccsict--f a 04 Pt" ekla--- ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed un r the pains and penalties of perjury. eti-{rt:6€ C.1 Print ff Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Ulf cite S S. &10c1 License Number QJ. S. 3 a -7 1n.o kink, (NV\ OLIO y f (4� — ( ? Address Expiration Date r/ ` `` Signature Telephone 9.Realstered Home Improvement Contractor Not Applicable 0 &i ,u 12 v4ge .e � .c . irk )- 3q Com an Name Registration Number . k. ODC s - < <f Address Expiration Date I`t � . cA.A4 d( 0 Y ( Telephone 5.3(i- / V 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 building permit. Signed Affidavit Attached Yes LY No 0 City of Northampton )" " Massachusetts w %{ ,' - DEPARTMENT OF BUILDING INSPECTIONS • N�; , 212 Main Street •Municipal Building Northampton, MA 01060 Sst jy V- Debris 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. The debris from construction work being performed at: (0 C1 W1.40/2 N 5 r (Please print house number and street name) Is to be disposed of at: et)' 1 1. 'Di stool Coo 141#41 � s r k(Ito k‘ (ANA. (Please print flame and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: eov>k � rrGk s pot (Company Name andAddress) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. SEXTON ROOFING AND SIDING INC. (413) 534-1234 . Pa©. Box 6327 FAX (413) 539-9906 Holyoke, MA 01041 00 ININ 11111411111111,11111-%. sextonroofing@hotmail.com air amARA eh. CT HIC#0605383 MA HIC#118239 www.sextonroofing.com -_------7Z.--=--=---- _____ ____ Since 19885 SUBMITTED TO 'Ts yiI _ ZZ.,'re.e./:c-4'C' PHONE /)�-- l7 / DATE ...374-71/ 7 -_-- STREET .7 i Ael A t v a JOB NAME —_ CITY /I 21PCODE J�t'C'lhir t) 1.1/0- JOB LOCATION Proposal to furnish and Install the follo ing EMAIL J Re-Roof tJ Tear-Off Main House :/•Garage J Shed Complete Roof Preparation • r Home exterior to be protected by tarps and plywood f Shrubs,landscaping,trees to be protected y (Entire existing roofing material to be removed to existing decking,Including flashing,etc. " 'I Site to be cleaned everyday with roll magnet debris removed at project completion ;:r01.4,44 '^� Deteriorated existing decking replaced at$2.50 per sq.tt .*7 44-J._ ,-4 Install all new decking/type: �'� Jr-New raw 'metal drip edge installed at eaves and rakes 'S P-8 J F-5 J Rake Edge r-New flashing will be installed where necessary(see Special Requirements) . Install new pipe boot flashing J Bathroom Exhaust Vent J Reflash chimney with new lead e'We shall acquire all appropriate permits etc.for all roofing work Complete Rooting System !,I/ c.../,.... ,.../72.4 1 Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) J 3' ...r6c ..e-Leak Barrier installed at valleys,around penetrations and chimneys to protect critical areas �k ,ci►K�1 rinstall Roof Deck Underlayment on remainder of roof J #15 Felt Synthetic Felt Sgles t IKO J GAF J CertainTeed -1 Tamko / :� 30 ear J 50 year rfetime Color. stall Attic ventilation system -i Cap over Rid s= ':nt J Roof Louvers Warranty Options / A ,We guaranteed our workmanship for 25 full yea - * v n. / 9 i!e opo#e hh reby to furnish material and labor-complete in accordance with the above specifications,for the sum of: ,14(let (`1,:c-S4'l,0 ,4"-;,„ii.. —0,-=‘,47 dollars($_ 2, r ), .,uENTro 9EMAGE as FOLLows eJ ,ey ) ' / I`. All Matatyl is guaranteed to be as apeaoad At work lo be completed in a workmanlike manner - 1 according to mown oeoea. Any Member, pe or dahebon ham above seiheaeo a nmolmg Authorized tti *aka oasts toll be executed only upon written orders.and me become an arra chelge mar and Signature - _ above the*Ornate.At agreements omapsnt upon sworn,accidents or slays baymd our control. Nhisl This pi, aI may be Not reaponvble,!,or welt damage during conemxbon..Owrw to pay napanetis legal teas roc np"wont ansndmcatih rKarWsl t Fti txrttemtb Wilhdntwrt by us d not accepted within days. 11 (ffilraep oar of i)9rspa#al-The above prices,specifications and conditions ��1) are satisfactory and are hereby accepted.You are authorized to do the Signature I`work as specified,Payment will be made as outlined above. t\Dom of Acceptance Signature 1I 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 Rooting and Siding will not be responsible for debris or dust in the attic or storage areas _ . • ., — .. .. . . . . . . . ' . ' . : . • . . , • • . • .. i . . • . . . . . 4.\. • •• . .."..!. .\ - . The ComrnorrWealth of Mass achus eit . - • -- Depan`rnent of Industrial_Accidents • . • n. , . . . . n Office of Inv estigatio-hs . ' 1*Congress Stred., Suite ID O . . . . . 3 gston,3/14.0.2_Z14-2 017 • • - . Worker s' C a-mp'ens 2,tiOr 1.11313_17 an ee AffiE2.viL: B—ril clers/C oritr a ctors/Ele c-bdci PTI /P1-amb ers . . AD-oli -f.-Imforma-hon_ : . . • Please Print Le zibly- • . . . . . . . •Na-me pi cfness/Organizatiouadi-richial.): Sexton Roofing & Siding Inc . . •' • . - • . . , . . . . . . . Address: P . 0 .. Box 6327 . . ' • : • City/State/Zip: H o 1 y o k e , 1A 01041 - Ph:one,#: 413-534-1234. Are you an employer? Check the appropriate box: ' ' - Type.of project(ricruired.): • ' 1.[11 I am a eMplo-yer Ydih. . • 4. N;za ageneral•OMAractor ara I . . . 6. DNew cons-4710.cm ' • ha-re hired the•smb-contractors .' * • caiiiloyees (full and/or pdit-tinie).* 1 . listed on the attached sheet • 7. 7 RrmodeTing - 2:0 I am a s ale propetor or parba. .-. - ' deL ' ' . ' ship nhaye Thse sub6o # torshare [ Demoliion . . . • working for me in any capacdtd.. . employees and. aye workers' • comp;-insmance. . 9: [1 E,u4d.Mg ad.d,ition No:workers' comp.insurance . required]. 5. El We are a corporaLon.audits 10.E ElecticalrepaLrs or acatdonk . . 3.11 I arri a homeowner doing all-wcir.k • officer haire,exercdsed.their 11.[j Plutobiug repairs or arlaitians • mystit Rio wonois, ,ccap. . . , right of exemption per I\,ft, ' . 12.1thofrepairs . . -i nsurance required.]t • • c, 12,-§1(4)., and we have no ' employees. [No Workers' ' . 13.E Other . comp.Msurance required.] • • • ' • • . . .. *.A..iiy arpplicanttlit chock3 box1-1.lutist alsol oat-the section below showing-their Tio-ncrrs'ononio ens OionPolin information- . . . t Home.owaers Who siibmit-Ebis affulcrit•intiicating-therm doing all-w irk•andifiken.hire outside coniractcors mnst Tairmit anew,aEdivit indicating-Fitch . 1-Cantractzia that ch.eoL-tais box musi alhed.an ariaiii mai sheet showing the name oftie sub,c oithacton an.d.siatz wether or not-those eniiiies)aavC . euTloyees...If the s-ub-ccintracturebaye ramPlo-yees,they mostiscryisle their tvozkers'camp_policy nianbcor.: . . . I forL col employer thcri is providing}Pork-erei com_p a n s etinn.tnsva-mace for Try employees, Below is fte policy wdjob sta. nformrptio7-L ' . • . - . . - --. Insurance Company Name: - , . Policy#or S eH-+n R.Lic.4-1 - . ELTLrationDate: ' • . " . . , . . . i _ A job Site.A_dch-ess: (0 •ei PM b 49/ • cit-y/S-b±e/Trit i/62.44 .-0.44-4 -Wife. Attach a copy Of the workers' conan ens adon p olicy del:1;ration p age (O-I...owing the policy n-piber and erpirrhon date): Failure to sectze coverage as requited under Section 25A of.MG-L c.152 can leadto tie irapodtion ofczhainal penalties of A - free Up tb$1,500.90 md/cir orie-ye 'imprisonment as well as ciyilpenalie.s.io.ihe form"of a STOP WOlq ORDER.and.afire . . of-up to$250.00 a.day aD-ailist the violator. Be ad-vised.tizt a copy of thisstament May be forwarded to the Office of. . Et . vestgaiions ofte DIA for insural_?_cc coverage ver'r5cation_ 0 - • , . . ., Ida her ebY.ce2-11351 er the 2 cdns ccnd per.alde.s.gip er-j-r.gy facd the e inforryrjo.71proliided lib a-ye is true crui corr .ect -- . • Sizaafur .e: . • • • Date: lritir7 . . . . • • . Phone#., 41341Z34 0 . • .. - . . . . • • ' .. . . . . , . . . . • Official i.r.‘e only. I_D o no't-wrtie tn this. &ea,to be completer!by city or Lown offici .al • . • . • ' • .• . .. . • . • . . . . ' • City or To7n: . • . • • • • Termit/Licens-e# - • . . . . • . Issuing Authority(circle one): . . . . • - • . . • 1.130 ard of Health' 2.B-u..qa-i-n g D ep ar#ent 3. -.LI.y/T own Clerk 4.Electrical Inspector. 5.Pip mlnin.g Inspector 6, Other . . . . . • 'Contact 1 erson: ,-, • ' Phone#: • • 0 . . . . . . - . . . • . . . . ' • . •-• tie\_.A...._ TIII,:eiCioortil:II 17 ez:1,:f•eis II:1;„off;i1.1lit :::;.1:::.;sits ....:-•-:,-,•::::-.7 l'i I Congress Street,Suite 100 4.......; .i. Bovion,Mi (/2114-2017 ..*--4.z.,::,F-7eV . www.mass.sayfilia IA orkeIN' Cimipensation Insurance Affidavit Bulklers.ContliclorilEhtriciansilltimbers, TO RI'i'1711.ED WITI1 WE:PLRMIT1ING AUTHORITY. . . .. A.E.!r)I icrini'InformationPle-i$e Print 1 eoitilv ! 'lb ... , ,,'.` . •' NaMe 5MD n _ . __ _....... __..,.. ,.. . ,...7 . Address: II. E • 1-40an-hli n 3f- .... . . City/Stale/Zip:C00(teattr, l'ritalta)(0 Phone#: 547—&/3—(p95c3. . ....___.........,,......„.._......__....____.....,:...„....„.....:-..:...:_,,...,,,,,,,,_.. ..-...„..,........_,........___.......,„._7177.7.-_.-7_:::'i.:.:...---.::.;-_-_=_.' -..:_...7::::::-'Z.:::;,.:: :::•,.:,:.=.17.::— Art,1 col IstA ciliplef tr?Clirck I A Illt illy rripry ir him: i Type of project(required): ; I.ELK i).z e,n1001 t with,,, q _ _c ,,,,„,(:,,fttl..-ikw r.i,'litrei* ) 7. (ii Nal.'COOSITteti011 1 2.01 ilm g 5r0e Rits5rtelor of pArtinrstip and kaNT T.,,1:e,41,1oc.e.'s ValrTE! for z.;.•ii i S. 0 Remodeling 41-11e c Isxic 14' iNo%',1tii.•-els'morno z3- r. - re:piled I , '• I I, 1 9 0 DeinChAili()I1 • !-Adit)t.,-.wr,x 3.....,e1 all w..16,tny:4-zil (No l'odrketv"cootp In- a:cc rt-zr.mo.1 1' i • 1 t . I I(I 0 13 uiiding arkition ! 1 D i,..,n e toinc-43m.rv!-40.e..'A i Ij he NsT,11.g 1:;r.":“1C101-$K1 4.t/01,11.1it 411‘t--.-:f.X,011 711,-prrii-4-r,l, 1 w lit 1 A CI li 0:t Ii4A1 2-1)...'ant r414/i eithzr ....,.:x;A:aters•zdrriptits3i1,di1 1n0riniC CT.alr sole i I LO Elearrcal;epairi or widnions I t I prort4yn's 0.1t-:ttc,,,,Ilit,ye,t-t t i i 17. n phrrobinp repair ,r wid,[ions . 0 1 ocilz 6.2..encza2 coil,.,-OCIO4 11:I'le.i 112.n.11:r.t.-d the sLiG-zontr:c,P'i InSird in tfi.c.rt .il.threi 1! 13[afio-of tcpaim Dog,slaievs 9etril,G-0Y4:iti.and IIR‘T ‘,',i -t;'C,11t1P ii,siitarg!:' 1 I; 14 0 Oer th 1)0 Vic arz,,i c4-3;ion...e.:-L4 iis kt."1"..:e..--;hal c CNv-co,...K.1 the:,.1,iili of,-.xcliw.r.:,-.1 per mc,t,L •I ft 1.).7.,..:'.11:14"nr,to rriNeyets cNo‘K,f'n e r 3.(017.1 le.7-..amc•tegron;:i"! 'AO) Ipplicr.a,dm eivcks bo x gi lizes7 also ftl out the si:,,,Lj.je;troow 511.0,:vmg tI-4 4-worke:I.ron,..isar..-5311,-T,policy vi,",..hivrit'a:,, . f tiot,-,mr,!.,04,svorn:tb:x•aniciaof.thdicAmiit the)ev?(.167:12J1 4,06.and hien ht:tec-414t4.17 cry:Iracw-5:1-nIzi.51.)?,..,.”11:1vi';rntko-4 itilli,-*.%e?[ch 1Contuctors.ilfAt ch::..t Ili.east 0..L11P e.,..ti.,.heLl an all:fa:34W Ii1w;stin% Iry Ulf 110,1,4"or EX Wtlt..:urtila.clui:,.And attic.,.mtlii.71-.r.,,-go;ilarNPe V0•11:POr: eiriknrrl if me ib.:annczols hastenplu:vtr.s_Orr n'sl p-c.vvg..Ic he sort n' .i.riop polio'witIK.1 , I am on.employer MU(i s providing worker.i'CoMprirSeilMir 10'14rernce for my empioree3, ildow iN iliePolic.r and PO 3110 infortf Iallim, . Inst Complqy Nfilliarn . -r1501-1111r10-e C--om pan _ .._ . 110r s,H4.„t,,i.,, ...i'. ,...., 70i up I er—,301741:Npirgo.Dzt, rikl 1 .... ....._ , ,.. Job sill:.Atli:In:5S. e, 1 /,,,,,„_,, , , City,'Slfne/Zip.1,./.te--- 44.6.-$09 fcS41 1 4111111 . - —..-......-. . .:._. -.. . . Attach 8 copy niche workers' coin FICIISil tion [Whey declaration page(showing,the policy number and expiration date), failorr to sec me coverays as rcqui!ed under Ni GI c 152, 2 A is a el iminal viol...11nm punkhakile by o fine up in SI.,51.)0.01,/ and-or one-year imprisonment.as well;Ls cix il penaitics in the form ofa STOP WORK ORDER and a fine of up tu S250,&O a day mainst 111c v101ator A cop) ul this NIalCinCrit 1113Y In 10INVIIItlei1 le.thc OiIitc of 1.11,,vitigittions ii the DIA for insurome - • cr..werafte vcrilicanon. ... , . . I da hereby cerii, • „. .• , naiejet of per boy(11.i11 nee IV ormal jog pre.l'elderl abirfre IS I i and correct • ... - - Date- Phcree ii.. . . Officiol ase rmly. Do nig write in II 1 iY area, in be completed by lily or town offida . . city or Town: ' . Permit/1 icense# Issuing Authority(circle one): 1. Board oillea 1th 2. Ouiltling,Department 3.CO flown Clerk J. Eleeti,leaf Ini'pector 5. Plumbing Inspector ii.. 0 llivr • • Con i4e1 10 ercotr __ . Phone 4; -- . , • J T ® • AWREP DATE(MMIDDIYYYY)CERTIFICATE OF LIABILITY INSURANCE 07/07/2017 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 Leandro Guimaraes Universal Insurance Agency,Inc. PHONE 374 Belmont Street (wc.No..Ext): (508)752-9333 (NC,No):(508)752-9303 Worcester,MA 01604 ADDRESS: leandro@universalinsagency.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: WESTERN WORLD INS CO INC 13196 INSURED SRM CONSTRUCTION INC INSURER B: AIM INSURANCE COMPANY 18929 18 E MOUNTAIN ST INSURER C: Worcester,MA 01606 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LIMITS LTR / INSD WVD POLICY NUMBER (MMIOD/YYYY) (MMIDOIYYYY) A V COMMERCIAL GENERAL UABIUTY Y NPP8236461 -07/07/2017 07/07/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAMS-MADE V l OCCUR PREMISES Ea occuE ence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GE/NL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 / POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ 1,000,000, OTFER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) • ANY AUTO BODILY INJURY(Per person) $ OWNED SCFEDULED BODILY INJURY(Per accident) $ ALTOS ONLY AUTOS • FIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AWC-400-7030818-2017A 07/04/2017 07/04/2018 '1 PER OTFF AND EMPLOYERS'LIABILITYSTATUTE ER Y ANPROPRIY 6ERPARTNERE: CIJTIVE N NIA EL.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) EL DISEASE-EAEMPLOYEE $ 1,000,000 Eyes,describe under 1,000,000 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) SEXTON ROOFING IS LISTED AS ADDITIONAL INSURED ON THE ABOVE GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SEXTON ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. 102 PINE ST PO BOX 6327 AUTHORIZED REPRESENTATIVE okixt;h0 .01 Holyoke,MA 01041 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ' CERTIFICATE OF LIABILITY INSURANCE DATE 612812017 ACORft 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 be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require on endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME:Kathl Hutchinson Ormsby Insurance Agency,Inc. PHONE(A!C,No,Ext):(413)737-0300 )FAX(A)C,No): PO Box 718 • E-MAIL ADDRESS:khutchlnsonI ormsbyins.com West Springfield,MA 01089 INSURERS AFFORDING COVERAGE NAIL* INSURED INSURER A:Colony Insurance Company 39993 Sexton Roofing and Siding Inc INSURER B: PO Box 6327 INSURER C: Holyoke,MA 01041-6327 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: • REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFF POLICY EXP INST ADM SUBR DATE DATE LTR TYPE OF INSURANCE • NSRD WVO. POLICY NUMBER (MMIDDIYY) (MM!DOKY) LIMITS A _ 101PKG002159902 6/252017 6/25/2018 EACH OCCURRENCE 51,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE XO OCCURPREMISES(Ea Occurrence) 5100'000 MED EXP(Any one person) 55.000 PERSONAL d AOV INJURY 51,000.000 _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2.000,000 y POLICY708+. D LOC PRODUCTS-COMP/OP AGG 52,000,000 OTHER: ' COMBINED SIGNED LIMIT 5 (Ea accident) AUTOMOBILE LIABILITY _ ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED —SCHEDULED BODILY INJURY(Per S _ AUTOS — AUTOS accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE 5 _ AUTOS (Per accident) — S . _UMBRELLA LIAB _OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS MADE AGGREGATE S DED 1 RETENTION 5 S WORKERS COMPENSATION AND PPER0TH TVTE EMPLOYERS'LIABILITY Y/N ANYPROPRIETORRPARTNER/EXECUTIVE EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA S IF yes.describe under EMPLOYEE DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION Town of Amherst SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE -- I THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED(�� REPRESENTATIVE��jj p.1 ACORD 25(2014101) ®1988-2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD • nC� �fIJae e oii2))W2ue( r � J / J Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration • Type: Corporation • Registration: 118239 SEXTON ROOFING & Siding Inc Expiration: 02/14/2019 P.O. Box 6327 • • Holyoke,MA 01041 • • Update Address and return card. Mark reason for change. SCA 1 20M-0511 n o,..,.,,.,-4 r.1 Fmn!nvmen. n Lc.**r;?-a Massachusetts Department of Public Safety �- Board of Building Regulations and Standards License: CSSL-099689 Construction Supervisor Specialty ' EVERETT J SEXTON _. r -' - • PO BOX 6327 44,1-- HOLYOKE MA 01041'4;4 •• • • Expiration: Commissioner 10/05/2017 •