07-009 (6) 422 NORTH FARMS RD BP-2019-1158
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mia :Block:07-009 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:ROOF BUILDING PERMIT
Permit# BP-2019-1158
Project# JS-2019-001878
Est Cost:$13800.00
Fee:S40.o0 PERMISSION IS HEREBY GRANTED TO.
Const Class Contractor: License:
Use Groum SEXTON ROOFING CO 99689
Lot Size(sa. ft.): 1032372.00 Owner: WADE ROBERT N&AUDREY S
Zoning' WSP(100)/RR(90)!WP(17VSR(IO)! Applicant. SEXTON ROOFING CO
AT: 422 NORTH FARMS RD
Applicant Address: Phone: Insurance.,
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON:4/19/2019 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 Skmature.
FeeTvt)e: Date Paid: Amount:
Building 4/19/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department Curb CuUOnveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaWMell AvailabilAy
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloNSda Plans
Otlrer
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOL H ATWO FAMILY LLI G
SECTION T -SITE INFORMATIONAPR R 2019
1.1 Procell Atltlreo: // Thi on to be completed ce
a ` -O DEM OF BUILDING INSPECTIONS
y�J- A)V114M r'O2vi Gd Map YAY AMPTON,an—Aroea
Zone Overlay District
Ekn SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
R0 ho -f aoL S/22A/aG ��4ens (�D. Chc f�
Name(Prim) pp Current Mailing AAdddress:
Telephone �O 3,19-;,-
Signature
2.2 Authorized Agent:
/'J P a r� z a 11 I y�lE, flVUl
Name(Frio rreiC� M MaiFng Address:
yi32a / 7S
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
I. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) �D vQ
5. Fire Protection
6. Total=(1 +2+3+4+5) / D Check Number
This Section For Official Use Only
Building Permit Number Date
Issued:
Signature: �l- �q- ZQ)9
Building Commissiawrnnspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information
Existing Proposed Required by Zoning
This column W be filled in by
Budding lkpurtmenr
Lot Sim
Frommise
Setbacks Front
Side U R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lor area in.bldg&in ed
parkmio
k of Parking Spam
Fill:
volume&Lo sr
A. Has a Special Permit/Variance/Finding er been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the�/Registry of Deeds?
NO O DONT KNOW V YES O
IF YES: enter Bode Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (D- DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO (D
IF YES, describe size,type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO ®—
IF YES, describe size, type and location:
E_ Will the construction activity disturb(dearing,grading,exca tion,or filling)over 1 acre a is B part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK fcheck all applicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) [—] Roofing0�
0,Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks IQ SidinglO] Other[CQ
Brief Description of Proposed.,�lH7,4fG.44A1leo%aeC si -9lr
Alteration of existing bedr m_Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
5a. ff New house and or ition to existing housing.conrle a following
a. Use of building. One Family Two Family er
b. Number of rooms in each family un'. Nu r of Bathrooms
c. Is there a garage attached?+
d. Proposed Square footage of new constructi Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compl' ce. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction will100 ft,of wetlands? Yes No. construction within 100 yr. floodplain_Yes No
1. Depm of base ant or cellar floor below finished grade
k. Will builtli conform to the Building and Zoning regulations? _Yes No
I. Septic ank City Sewer Privatewell City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,2 'r L"A 04 ,as Owner of the subject
property ((�� pp
hereby authorize �3.�L+v nJ rx,c��l'-+Pi
toacton my behalf in all matters relative to work uthonzed by this wilding permit application.
Signature of Owner A� Date
1, r �i �"SI R r ✓ q � as OwnedAuthonzed
Agent hereby deGare that the statements and infonnahan on the foregoing ap ;talion are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of per]ury.
ue,
J-
Print Name
SgnaNre5F`Owrier/Agent Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of license Hdder.- ✓P/c' V .�4 k T� S2 99G �' /
License Num r
Address 6yiration Date
OV 11-7
Signa um Telephone
S.Realistarad Home Ins ravemem Contractor: Not Applicable ❑
Cornu'Name Registration Number
Address I �� �/� ,,/ Expiration Date
`
Yin k (ll 4 r)(c7 / Telephomnizz23
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 afftlav2 will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes - W' No_.... ❑
City of Northampton
•
Massachusetts
C e
1 pEenul}ffivS or BUILDING rnsPECrims
�\ zlz Main street • Nunicipal suiltl nq
NorNampton, eco 01060 Yrr yj\0
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'be
done by registered contractors.
Note:Lf the homeowner hos contracted with a corporation or LLC,that entity must he registered
Type of Work: ')�dRR07 , o " / Est.Cost: )3
Address of Work: yOC' NAt-A J P'h S jam`
Date of Permit Application: 44-E (co /17
1 hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
—Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not ownerbccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PACE FOR MORE INFORMATION.
Signed under the penalties of perjury:
1 hereby apply for a building permit as the agent of th owner:
Date Contractor gime HIC Registration No.
OR:
Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
_ City of Northampton
- Massachusetts
w _
1 1 ffiPM� OF aOZLDZMG ZHSPSCTZOSS 2 �,
212 Main Sheat .M iciw auilai Cn
Nc[Nhaep ' MA 01060
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:
/ rf
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
✓{SSGuA "-Ile t 5
(Company Name and Addres )
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.
�ro�nga[ �d
SEXTON ROOFING AND SIDING INC.
(413) 534-1234 P.O. Box 6327
FAX (413) 539-9906 Holyoke, MA 01041
sextonroofing@hotmail.com fft CT HIC#0605383
MA HIC #118239 www.sextonroofing.corn
Since 1985
suernlTTEoro l— D vttoNE onTE 9 /
STREET �J •LY S JOa NM1E
Litt
srnrE �tG vt�` ��. ,roe tocnnoN
zlPcooE
Proposal to tumish antl natal[the following EMAIL
❑ Re-Roof )pr-O# IY(ain House Cl Shed
Complete Root Preparation
/'Home exterior to be protected by tarps and plywood
C! Shrubs,landscaping,trees to be protected 3/
Entire existing roofing material to be removed to existing decking,Including flashing,etc.
ip-"ane to be cleaned everyday with roll magnet debds removed at project completion wr1� a
%"'Deteriorated existing decking replaced at$2.50 per sq.ft
❑ Install all new decking/type:
Whit rows metal drip edge installed at eaves and rakes O 'rW ❑ F-5 L) Bake Edge
Flashing will be installed where necessary(see Special Requirements) -
Ipsmll new pipe boot flashing ❑ Bathroom Exhaust Vent
Refiash chimney with new lead
qao We shall acquire all appropriate permits etc.for all roofing work
fete Roofing System
Leak Barrier installed at all eaves to protect from ice dams(and meet codes in the north) ❑ 3' Wer—
> Bale Barrier installed at valleys,wound penetrations and chimneys to protect critical areas
,X Install Roof Deck Undedayment on remainder of roof ❑ #15 Felt ❑ Synthetic Felt
Shingles `'
lif IKO O GAF ❑ CertainTeed - ❑ Tamko / ❑ 30 year ❑ 50 year ifetime Color �1"����
natal[Aflic wmfilaflon r1 C
system ap over Ridge Vent o Roof Louvers C
WpaOptions
ruarantead
our workmanship for 25 full years
hereby to fur material and lace, mplete in cordae a with the above specifications,for the sum of:
iv L*� L.— doll. 7
sjno'
M wbrelam®�an�ealromasmaHie].PO,wMbte p,�.,n.wYnunlYe mw., Authenzod
aoAarn n mub.rd w*o+% Art/m..mo oa..®m�aao mob bmrs:iwrwg
dma cmuweo®w.d w+r„�nnTwwdas.Nbll,accniesmb e,.,w a...00e
Signature
.Wbmeesnmab.Ngwnenumndgeenw�sesesemx m>aeivna�dwrmmm. Nate:This VrWnsal^wY Ee � .
xd rmpue4leMxbr EumSo ening mruo-icuan.OwmmpaY��nyL9I[�Ibss mr wextra nbyus Jrpt.puxlw in days.
A
Orrrpmnn at yreppaal-The above prices,specifications and conditions signature
are satisfadlory antl are hereby accepted.You are authorized to do the
HAtISA agm*ed.Payment win be made as outlined above. siynaiure -.---
s
com a crac s o e woo exmo a aria not a s. a mr a ns or asi h e atuo or s:oia_a yeas:
�\ The Commonwealth ofMassaehusetts
Department oflndustrialAccidems
I Congress Street,Suite
Boston,MA 02114-2017
w ..massgov/dia
VAuckers'Compensation Insurance Affidavit:Bonders/Coubr ctors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant InfH PleasePrint Legibly
Natne (Business/Orgaui?nrion/Individual):Sexton Roofing&Siding Inc
Address:P.O. Box 6327
City/Stst,yZip:Holyoke, Me, 07040 Phone 4:413-534-1234
Are Yoo sa employer?Check Ne appropriate boz:
Type of project(required):
I.Q[arn aemploym wah_employees(fWlaM/m pan-ume)• 7. ❑New construction
3❑Ian a sole seviesa or partrierstip and have no employees working For mein $ ❑Remodeling
any capacity [No workers com,in mance required]
9. [1 Demolition
3❑ mmomeowner ad
I a hdoing all work myself[No workers'comp on '^^•ralwral.]t
4.❑I am a homeowner and will be bung conhaetors to eordmx alt work on my property. I will 10 0 Building addition
ensure Naz au cnaserors eaher have workers compmsafiou macusace m are sole Il.❑Electrical repairs or additions
propue.with no employees.
12.❑Plumbing repairs or additions
5.Q I am a general conhader and I have hoed the subconhxtoes listed on rhe attached sheet
hese subronhadors havecaployees and have wo&.'comp.umuancef 13.E:]Roofrepairs
6.❑We are a eoryomtion and in otbeers have exercises Nearigbs ofe rnption per MGLa 14.E]Other
152,§1(4),and we have no employees.[No workers'comp,iosomeec required]
'Any applies^[dant checks box#1 must also fill out the section below showing their worse'compec cosou poke,iNormaeoa
1 Ho.woers who soi vn Abis a(iblr a indicting they are doing At work and Na.hue worde cwacmrs mu#submo anew affidavit iadiaeng such
tContrzdars that check fins box alar anzch on eddieoal sheet showing the name of Ne subwnnadors and sure whetM or at Nose entities have
employees. If rhe sub-eoueacbrs have employes,the,mart provide Ncir workers'comp.peluw number.
lam an eng/oyer that is pmWdingworken'compensation insurance for my employees. Below is the policyandjob site
information
Insurance Company N. TravelersProperty Cas Co of Am
Policy#or Self-ms.Lic.#:7PJUU1BGo7898212 Q - Expiration Dau-6/4/19
Job Site Address: 124 /f/p��7 S 'T^ City/State/Zi
P�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date}
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,m well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
I do hereby<erlifyu the pains and penalties ofperjury that the informationprmdde''d//ab
Is true and correr2
Scan tae' Date-
Pho #: �4 3 - S3v- /23I/
OfjWal use only. Do not write in this area,to be completed by city or fawn official.
City or To": 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#:
The Commonwealth ofMossaehresetts
Depwhnent oflndustrialAccidents
1 Congress She4 Suite 100
BostoP4 MA 02114-2017
www.massgry/din
Vw.oh..'Compenuartion Insurance Affidavit:Builders/ContraetoNElecbiciaus/Plombem
TO BE FILED WITH THEPE.RMITTWG AUTHORITY.
Annlicautla ermatian Please Print Legibly
Name Bas;oars/Organvatiodlndiw;dmt):LOG Homes Improvement Inc
Address:18 Spring SL 1st floor
City/State/Zip:Milford,Ma.01757 Phone#:(774)214-6239
Artyoa av wpbyer!CMca arc aPPrapriah box:
Type of pmject(required):
I.Qlam aemployuwims emplay�(tu6 ad/mP -eine).• 7. ❑New construction
2.01..solepmptlumr mpsrmsah,mdhavemmployeaw 66,Emma a E" ❑Remodeling
oar-P-* paowatw'coma.umumm-poet)
3.QI®slmmeoxardoisg aU oink myself IN. s'somP.msunmce mgwred_I* 9. ❑Dumong ad
4❑lamalwmmxMssadwdl}.chumg[cob owmM all�wd[mmypmpc,. 1w 16❑&llldtnj addlh0n
eosmemnaa c000acrosamchmewodas'compwsm vamavmmare sole 11.❑Elecuicaln:pairsmadditions
pmpndms xiih m mploysa.
12.❑Plumbing repairs madditions
5.�I am a�sral mntrxmrmd I navehvrd the sub ca�lncross tisim ooticannul+dsuer.
he cob-msaraaoa have®Pbyao mlhavewvkers'comp umammt 13.❑! RoofRpaus
6.❑Wemea wpoiatim and in o�mshave uaaxE@e"vright ofmmopam pa M(:Lc 14.❑Other
I52,41(9),mdx have m cmPtayae:.INa vad:vs'coma.bu�ammscquirM]
•Any apphmottlmrLcJ¢Lox#1 mart elm fill ma(hexmmbelowsboraiog tlx'a awtlrms'mmpm�mrpplay_. .�
tHammwmswbo mbm¢thisa�davi[iNrasay spry amdohg all amkaad thin�eowsidemmacmmmm[submi[avew affidavrtadimri�suA
tContrslors lbaab Jcthisboxmut mgrbMavaddiemW slim[shox%gtMmme o[tbe subaooharm¢aod aatembedse-ormsaare mliria have
emplaym. tfttiesubcom brshart�ry�,tbrymunpovide tlev xod:m'oomp.Polity aumW.
Icon an emplalei Wotisprorrdrngrrorke+r'rvmg'enroLian inurrmirefor my amp/nyea. Blow is tbepoAtcy mrdjob site
informafion.
brscrance Company Name:Travelers Indemnity Company of America
Policy#or Self-ins.Lic.#.UB-1)(196202-18 Expiration Date:0201119
Job Site Address: CitylskoerMp:
Attach a copy of the workers'compensation polity declaration page(showing the policy numberand expiration date).
Failure to secure coverage as required under MGL c.154§25A is a criminal violationpuoishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine ofup to$250"00 a
day against the viol r.A copy ofthis staters d may be forwarded to the Office of Investigations ofthe DIA for insurance
coverage verifi,
I do hereby. the pains mWpenalfies ofperjury that the nformofionprosidrdabgve trbueandrorrecG
i
" atuue: ZLNDate: / 1
Phone#: 1 239 -
0%7"we oNp Do notwrim in dd,area,0 be rompldedby ch,or townofficiat
City or Towa: PermittLicense#
Issuing Authority(circle one):
1.Hoard of Health 2.Building Departeat 3.6tyffowa Clerk 4.Electrical inspector S.Plunbing Inspector
6.Other
Contact Person: Phone#:
CERTIFICATE OF LIABILITY INSURANCE DATE 07=0IY9YY)
18
TWILCEAMrATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERRFUCATE DOES NOT AFFMMILTWELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIMCATE OF INSURANCE DOES NOT CONSRTVTE A CONTRACT BETWEEN THE ISSUING INSURER(S),JIUTHORQED REPRESENTATIVE
ORPRODUCER.AND EC FICATE HOLDER
IMPORTANP.If fhe cadiTiote hOMar La an ADDITIONAL INSURED,Ute policy(ias)m161 be entl0rsed. N SUBROGARON IS WAIVED,wbj NA w
Ne corms and contli0ons aFMe pofiry,celhal poNdes maF inquire and endor nent AGYaMnent on fh-s m10Ta:ab does nlH confer dgll�b
oNNficate bolder N lieu of sudl
PRODUCER CONTACT
RAMS
A COSTAINSURANCE AGENCY PHONE FAz
2 FRANKLIN COMMONS OUG,NR,Ed):
EJINL
FRAMINGTIAM,MA 01702 ADDRESS
783BY INSURER(S7AKORDWG COVERAGE NAIC0
INSURED MSURER A: TRAVELERS DNpAMiYCOMPANY OFAbffIfICA
LOG HOMES 1MPROVEMENT WC RISIIREN S
INSURER C:
xsuRmo:
18 SPRING ST 15TFL MSUREa E:
ME,FORD,MA 01717 wsuRER F:
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GENERAL LAMIJIY CH OCCURRENCE S
COMM1ERCVH GENERAL LABILITY
CLAIMS MADE 0OccuR AMAGE ( RENTED S
REMISES Eaomn�vlrE)
E>9(A�rymepveon) s
ERSONALAADVINJURY is
GEMLAGGREGATEIJMUAPPUESPER: 3ENERAL AGGREGATE js
POLICY OPROJECT 0 LOCPRODUCTS-COMPIOPAGG s
AUNMOBlEL4TBRltt COMBINED SINGLE s
ANYAUTO UW(Eaa¢Jdan)
AIL OWNED AUTOSBODILY INJURY S
SCHEDULEAUTOS ONR cep)
HIRED AUTOS BODILY INJURY $
NONUWNCa NITQS PROPERTYDAMq(,E $
(Paamtlm)
UNBREIIALWB OCCUR EACH OCCURRENCE S
EXCESS LAB CVJM6MVIE GREGATE IS
DEDUCnBLE $
RETENTION $ $
A WORISRS COMPENSROON MDA MSTAMORY OTHHt
EMPLOYERS LIAMMIY YM UB-IKU&=-18 0=1mia =2019 UMI15
ANY PROPERTORNARU mYE O WA ELEACHACCIDENT Is 100,000
CfF1l;ERnn¢MMBEA IXCAIAFDt
alaMmryMraq EL DISEPBE-E0.ENPLOYEEIS 100,000
n r+s.n:amei.Mer E.LmSEASE-POUCYUINT $ 500,000
CESCBIPIION CF DFEMTIOW Mo/
DEBCRIPIKIN OF OPERATN]NSILQATNNIGNEHICLESME51 W CTIONy'9ECUU,ffEMS
THIS REPIACFS gNYPRIOR CFYTDIGTE 6SUm TO THE CEATtrIG]E flMDE1tAFfEC[WG WDRIC;R.S C04fl•COVIXAGE
CERTIFICATE HOLDER CANCELLATION
SEKTONROOFING&SIDINGINC sLIDULD AxrTstHEABDVEDEscxmEn PalesBE CnuDIa1ED
BEFOftETHE EIIPaunON DATETNEREOF,HDIICE WBJ.BE DEWERED
102 PINE ST IN ACCOImANCE WRH Tf�POLWY PROVLRXINS.
PO BOX 6327 AUTHORRED REPRESENT
HOLYOKE,MA 01040
ACORD 25(201M05) The ACORD Rams and logo are mjMmRl matin:of A ORD 1988-2010 ACORO CORPOiuuIm. Ag rights reserved.
A " CERTIFICATE OF LIABILITY INSURANCE UAMWMOIB
CEROFTCATE IS ISSUED AS A NATTEI{ OF INFORlCA Oli_Y ANO CONFEILS NO RIOIRB UPONTIE�TE HOLOER.THI
CATSDOESNOTAPFNBOIT YORNEWT YANEfID,ESIETBIORALTERTNECOVETAGEAFFOROEOOYTNEPOIIGESBELOW
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