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31B-134 (7) BP-2024-0761 122 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 B-134-001 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-2024-0761 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: WILDE HSE LLC DBA SEXTON Est.Cost: 17525 ROOFING 106265 Const.Class: Exp.Date:03/08/2027 Use Group: Owner: VIKRAM BUDHRAJA Lot Size (sq.ft.) Zoning: URC Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113923 NORTHAMPTON, MA 01060 ISSUED ON: 06✓12/2024 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: Foodngs: 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: 7sP Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner REC VET.) J U N 1 2 2024 : , The Commonwealth Of Ma achusetts Board of Building Regulation, :a `'.. ---- ! MUNICIPALITY' INSP,=CTIOV$ Massachusetts State Buildin Code, vi _MA Ot0RO 1 ��� USE Building Permit Application To Construct,Repair,Renovate Or Demolish a j Revised Mar 2011 One-or Two Family Dwelling This Section For Official Use Only Building P 't Number:437�'., y" 7(i/ Date Applied: `u,N � Ss /�'/7 - 4 IZ-ZOGq Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 14 Property Address: I a a 514 rt. S-. 1.2 Assessors Map&Parcel Numbers t O k-1/44..xw.P c o t,N 1 YYA 1 C)lob 1.1 a Is 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: utsPublic 0 Private 0 Zone:._ O Check if yes❑Flood Zone? Municipal 0 On site disposal system El SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: is e-N u- k KOS-1 b T -k 1 MI\ b lacaa N (Print) City,State,ZIP ST-N. �—-- (311? 3'-a. 3? r . niA 1L .Ge11,1 o.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Er Owner-Occupied 1d Repairs(s) Er---Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proceed Work':Ckt rnoV (U, F.iC t S ft iJ R "5 4.I t Y l I K 9 f ACE ail rRrc rr as `1�( , 1 t 'S-T Li 1 Ci h/ r' , `�5 At 9.1 ,i.�5 ifi 1-4. Sy 4 71.44 eriC. lVekiDEAL1 Ai4 n4 t I w\SIU_ Ag.ciirrt C uiLA I i-‘ltl S, l al-EN U SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /7 J co 1. Building Permit Fee:$ Indicate how fee is determined: I 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ A Suppression) Total All F i Check No. I I ICheck Amount: Cash.Amount: 6.Total Project Cost: $/7 j 5 P 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Superviso License(CSL) lei,& r t ��(� Licensese Number Expir n ate Name of CSL Holder T List CSL Type(see below) RC_,, 1.1,�0 L-N .f�� . Type Description and Street O�;:� J4_ \ , f As 0 1 _T U Unrestricted ed 1 2 upel 35,000 cu.R) l �V 1 Y\ V lW� R Restricted 18c2 Family Dwelling City/Town,State,ZIP A I M Masonry RC Roofing Covering WS Window and Siding G� \,, SF Solid Fuel Burning Appliances )5. 7Li .SXc �c lrwG►{fi�Ca✓P 1C. - I insulation • , . elep one Email address C nAl L.exyit4 D Demolition 5.2 Registered Homem Improvement Contractor(MC) ?°e Ill`yi1 O CC"01J 1`b `C I t el. 4 L 1 t\ G HTCoRegistratiion/Number .xpira on Date I IC Company Name or I lIC Registrant Name DL-i\t c ` cZ . ,��Cco.Ar> tt,ICa n4 1 C£ 4}ayA)l,.col .and Street (ji3 /-J23'/ Email address City/Town,State,' lP Te ephone 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 No .0 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 authorize 'C'b \�� to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) e SECTION 713: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 contained in this application is tru dacccuratee to thebest of my knowledge and understanding. Silsym ti/ e / asp Print Owner's or Authorized Agent's Name(Electronic Signature) to 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.govIota 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 half7baths Type of heating system Number of decks/porches _______ Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for`Total Project Cost" City of Northampton �gµii�.M• SAS :' SAC.,.. v• Massachusetts ��� .• '<< Ff ,�, 4 ` DEPARTMENT OF BUILDING INSPECTIONS F, r 212 Main Street • Municipal Building �V' � Northampton, MA 01060 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:D jr p 5� � Location of Facility:( pa kt.L J r I� biiO The debris will be transported by: Name of Hauler: Zz,t II 7j/4r"��", 4/C_ Signature of Applicant; i,d,L Date: 44/2/-2-e/ _ . The Commonwealth of Massachusetts =`"` Department of Industrial Accidents ?i. 1 Congress Street,Suite 100 ��_J�.� Boston, afA 02114-2017 t'Ces'' oil►H.mass.go /dia %%r»kers'Compensation Insurance.Affidavit:.Buildrrsl('ontraetorsi Elect rich'ns/Plumber.. 1'O BE FILED WITH THE PERaII1-1'1MG At THORi Ii. Annhcant Information Please Print Legibl' Name glumness'Organzatranlna dual):_cfi V --J. Ers_ 1`.F 4_ SI 1k Address: 1-1.5"--A, ()1...*.11L&& ,(e • City/StateiZip: O ,1 kittk 1 b J CA Qj O Phone 4: L3)s31J ' Are you as cmpkner?Cheek the appropriate box: Type of project(required): 1.a 1.nrl a irtiplo)o.with employees dull and ar,part-thane).• '. a New construction 2C:I i am a sole proprietor or partnership and hase no employ ix,working foerr>rr m N. Q Remodeling ani aapactty.(No wtakers'eoatp.insuranar m Lula :; •.e 30 I am a lwavwn rirez rla+mtg all work myself.(1u wurka-rs'comp, imurr x reputed.ted.1' 9. a Demolition 4.ant1 a a homeowner and will be hots avntraa'lurs to conduct all work on my property. I well I O Building addition apt that all contractors either hrac workers'compensation rnsurarwe or are sole 1 I.a Elcxtri al repairs or additions ptor�+neturs with nu employees 12.0 Plumbing repairs or addition.. S IIaam a general contractor and 1 has c hued the uhtaxuractut listed on the attached sheet. 13 'iwf repairs These wt+-contractors hate employees and has workers'crimp.insurance.' 6.0 we•ate a corporation and its Aker.hoar Clue 14.a(thC( oRair oat al then night of exemption per�4(;L a 152.+114).and we has,:no employees.(No workers'comp-insurancerequired.l *Any applicant that chocks boa n I must also fill out the section below showing their workers'compensation puliay information *limns-ow elate who subunit this atli.laait indicating they arc doing all work and then hire axrt.ide auntra.tor must submit a new attidaa it itxlicating.twli. :Contractor that check this box must a ttachCd an additional sheet showing the name of the sub-Contiaa'tors and state w he-thcr or not thou:o tltic.has c ctnplu)Cc, It tie suh,-euntractoas 11,.+.cnc,to ces.they must pros talc their ...orlon'cc'nip.poliea number. t am an employer that is proyvding►s•orAers'compensation insurance for my employees. Below is the policy and job site information. Insurance Compan'. NameJ.13461-1.,42., ---- — Policy#or Sell-ins.Lie.#: i4 ttv Q L f5 T/I3 9&L/ Expiration Date:C O i 1/073-7 - Job Site Addres.:JJ2( SfTt i a J City.state.'Zip: k\o e�f Athpro Ai, MADI ZI) Attach a copy of the workers'compensation polky 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 51.500.00 antor one-year irnpnsonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri licat ion. • 1 do hereby certify under he pains and penalties of perjury that the information provided abo •e is tr e and correct. Si njttire: Date. i/Q / eg Phurc ,) j,'/ Official use only. Do not write in this area.to be completed by city or town oificiaL Cite or Coon: Perni(1License is Issuing authority(circk one): 1. Board of Health 2.Building Department 3.('ityrTowu('krk 4.Electrical Inspector S. Plumbing Inspector 6.Other _______ ('ontact.Person: Phone#: Ac Ro o® CERTIFICATE OF LIABILITY INSURANCE DATE(MaMiDDIYYYY) 06/05/2024 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 endorsementisl. PRODUCER _ACOONTACT Kathi Hutchinson ORMSBY INSURANCE AGENCY ,PHONEeitu (413)737-0300 rax ING.No): Alma khutchlnson©ormebylns.ODm P O BOX 718 INSURER(S)AFFORD/K1COVERAOE NAM/� WEST SPRINGFIELD MA 01090 Ramat A; TRAVELERS INDEMNITY CO OF AMERICA 258613 UNLIKE INSURERS: WILDE HSE LLC INSURER - INSURER D 45 OLANDER DRIVE INSURER E; NORTHAMPTON MA 01060 _INSURER F COVERAGES CERTIFICATE NUMBER: 1014749 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 CONDRIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _..__ ... A DDL SUER �'.—. POLICY EFF POLICY EXP r ---'------ ---- TYPE OFINSURANCE INSD WVD POLICY NUMBER MWDDIYYYY) (MWDD/YYYY) LMBTB COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGE TO RENTED CLANS-MADE j OCCUR PREMISES(Ea oowr R Se) : LIED EXP(My ono person) $ — — WA PERSONAL aADVw-RY $ OENL A-GGREGATE LIMIT APPLES PER GENERAL AGGREGATE $ POLICY r 1 LOC PRODUCTS.COMP/OP AGO $ OTHER >i COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea eceldent) s _ ANY AUTO BODILY INJURY(Per prreon) $ OWNED SCHEDULED N/A BODILY INJURY(Peraocfdert) $ AUTOS ONLY AUTOS NiR ED NON-OWNED PROPERTY DAMAGE : ----- 4 AUTOS ONLY AUTOS ONLY LlcoideL+t1— $ UMBRELLA LIAR OCCUR EACH OCCURREJ4CE ti _ EXCESS LIAR —. CLARIS-MADE N/A AGGREGATE $ PED RETENTION; �/ $ — WOR1(ERaCOMPENSATION X STATUTE 007`' LI AND EMPLOYERS' ABlr1Y A ER AwYPROP(OFFTCER/MEMISER T RlDXECurivE fl WA WA 6HUBOW55113924 06/01/2024 06/01/2025 EL EACH ACCIDENT. $ 1,000,000 (Mandatory In NH)EXCLUDED? I I El.DISEASE-EAEMPLOYEE $ 1.000.000 If syeoee dIPTION oealbe under _-- - DESCR OF OPERATIONS below El..DISEASE-POUCYuser $ 1,000.000 N/A DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES(ACORD 101,Adtllonal Remarks Schedule,may be attached R 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.govftwd/workers- compensatioNlnvestigations/. 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 PROVIS1ONS. 212 Main Street AUTHORIZED REPRESENTATIVE I . Northampton MA 01060 Daniel M.Growl y,CPCU,Vice President-Residual Market-WCRIBMA i 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marls of ACORD ACt?i / CERTIFICATE OF LIABILITY INSURANCE DATE(YYIDDlYTVY) 4111u.re-` 06/03/2024 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 Amanda Cordelrc NAME: Clayton Insurance Agency,Ina (PpH(ONE (413)538-0804 FAX(AIC,No): (413)534-7874 E No. ctL 6 1649 Northampton Street Ito.E B�rMlrr�dstyrnntrunrrwnrvr nA1 INSURER(S)AFFORDING COVERAGE NAIC a Holyoke MA 01040 MEURFRA: Submissions INSURED to5uRiFt B; Safety Insurance Company 0014 Wide HSE LLC,DBA:Sexton Roofing&Sidinc INSURER C: 45 Olender Drive INSURER D: INSURER E Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: CL246306545 REVISION NUMBER: THIS IS TO CERTFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOE 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 APOLICY EFF POLICY EXP LTR TYPE OF NNst1RANCE ROD DL WVDLIM POLICY NUMBER MIDD/YYYY) INWDOMYYY) LETS INSD MD (M X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f 1.000,000 DAMAGE TO RENTED CLAIMS-MADE (X1 OCCUR PREMISES Ea occurrence). $ 100.000 MED EXP(Any one person) $ 10.000 A — BND0016953 05/30/2024 05/30/2025 PERSONAL dACV INJURY $ 1,000.000 GENt AGGREGATE LNIT APPLIES PER. GENERAL AGGREGATE $ 2'000,000 POLICY ElTrei LOC Ei PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER. $ AUTOMOSILE LIABILITY COMBINED SINGLE UMW $ 1.000,000 (Ea eccitlpnt) ANY AUTO BODLY INJURY(Per pawn) $ B OWNED ScHEAIRED 5935264 05/30/2024 05/30/2025 BODLY INJURY(Per=MIR) $ AUTOS ONLY X AUTOS PROPERTY DAMAGE X HIRE X AUTOS VYN� AUTOS ONLY AUTO ONLY (Per patents $ 5,000 _ UMBRELLA LIMB OCCUR EACH OCCURRENCE f EXCESS OMB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION OTH- A EMPLOYERS*UASLRY YIN ND STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA El.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED9 (4ndasory M NH) EL.DISEASE-EA EMPLOYEE $ If yas,desabe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY UMW $ DEMOTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 1St.Additional Remarks aclradid,aisy be a4acbd N more space Is required) - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN THE CITY OF NORTHAMPTON ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET AUTHORIZED REPRESERTATNVE • NORTHAMPTON MA 01060 ®1888-2015 ACORD CORPORATION. All tights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 5/10/24,8:19 AM IMG20240510065637.jpg The Commonwealth of Massachusetts ,.g r �.!I Department of IndusMal Accidents _:-m= 1 congress Street,Suite 100 Boston,MA 02114-2017 wwntltrassgoWdta Warioere Compensation Iasaraace Amdavtt Bafden/Col xciorsiElectricbWPiambers. TO BE FIIZD WITH THE PERMITTING AUTHORITY. AnnitantInfognation PldhaePrint Legibly Name ividual): M�k CilltNONIA Catyaktu4.04, "T Address: ti Ohs No} a- City/StateZip: Itt‘£arA RA A(1S1 Phone#: 1 410 3 1,1 4 9 ire as rt:g ce ieyset ect fie appropriate hem Type of Waled(required): 1.Iaam a employer with S employees(dill asNalrart-time).* 7. 0 New construction 2.Qtama sole pmprie$orapt.cWashi0 end ban no employees working dxmein 8. RemodelMg soy spy.[No waken'comp,insurance requital] 3.QI am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.Qlmahoreeo nerandwilbetinesooatracroo tocoed=al mode onmypropaty.IwtU 1oQ13I11dtIIga itlOri eass=that all eentraetora abet here vodkas'motion ina ne=or aro solo 11.0 Fiectrical repairs or additions prapeidm with no employees. 12.0 Plumbing repairs or additions S.0 lam agataaimatoctor=dI have hired the sub-000ttaclmsliMedontbe attached:beet 13.631af=pairs These actors have aeployeea and lave waken'comp.Imvaoeei 6.0 We as a corporation sad its officers have oxen iced their right of gumption pm MGL a 14.Q Other 152,$1(4),tad we have noe ployea.(No ' Rio: >o l • applicant that docks boa nut also flit oat thy soaks below'booth%Pair policy infommdem. t k workers' wee who hm& iayarc&, Await 1 a must submit affidavit indicating such. icamnacaos that dtsetttdaboammtattatiedsn additional= eeber*thenemoofthewhmatracmr:aidstatewheherornotthosemitiesbave employees.Vibe enlamnaaclotshnsaapbteer„day mat panicle their wadtat'comp.policy timber. I are as awpdoPwt at is Forfar,s ar*ers'cespaardos fssausxce for soy employees. Below is the policy and Jab site Insurance Company Name: 1 namettan ThcCedeg Cris Ca Of -AM Policy#or Self-ins.Lic.#: IVVIS%4 Expiration Date: 30 1243.5 Job Site Address: )aa. 5fii I City/sta./zip:,K o 01 vtca) Attach a copy of the workers'compensation policy declaration page(showing the policy ntn and ampbrillon 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-yeah imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ea*smiler the pries and penalties ofl y that the friforesetlen pied chose is true sxd correct $i®agae: seas. 4see Date:0 5'/O K / 20 2*' MOW#: tfQJ q fo Official xss owlp Do Hot write he this ossm to be co pleeant r cite or tome official w City or Town: Permit/License# • Issuing Authority(circle one): L.Board of Health 2.Bantling Departmest 3.City/Tmra aerlc 4.Electrical Impeder 5.Plumbing Inspector 6.Other Contact Perna: Phone ilk s • https://mail.google.coo/mail/u/0/?taboo&ogbt#tnbox!FMfcgzGxTFZVkRgKLjJvWVThdsMWzdWV?projector=l&messagePartid=0.2 1 i 1 A IJ CERTIFICATE OF LIABILITY INSURANCE DATE 05/09/2024 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 poticy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require en endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT GUILHERME CAMOSSATO NAME; I-INSURANCE GROUP INC ,,, (978)645 6996 FAX No). 799 GORHAM ST-UNIT A irfo@Hnsuancegroup.net LOWELL,MA 01852 INSURER(S)AFFORDING COVERAGE NAIL INSURERA: ATLANTIC CASUALTY INS CO INSURED ) B: TRAVELERS PROPERTY CAS CO OF AM MJA GENERAL CONSTRUCTION CORP INSURER C: 6 OTIS STREET INSURER D: APT 2 INSURER E. MILFORD MA 01757 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ells ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IIIR WVD POLICY NUMBER (Molpo/YYYY) IMMlOD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL I le9n ITV DAMAGE TO RENTED 100,000.00 X CO X PREAUSES(Fa oca,menoe) _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000.00 • A 1261008542-0 05/03/2024 05/03/2025 pERaQ AAL&AD,/ipuuRy $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GENL AGGREGATE UNIT APPLIES PER PRODUCTS-CONPrOP AGO $ 2,000,000.00 PQucY n JPEG n LOC $ AUTOMOBILE UABkny CFOs eBINENEDISINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS .— AUT �E DAMAGE $ UMBRELLA UM! OAP EACH OCCURRENCE S MUCBieLJAB • CLAILISALADE AGGREGATE S DEO RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LNBIl1TY Y I N TORY LAWS ER B ANY PROPRETORIPA AC? N/A ASSIGN#1397554 04/30/2024 04130/2025 EL EACH A lT $ 1,000,000.00 OFflCERAE06ER EXOLUDOCCLUDED? (MMISMory M NH) EL.DISEASE-EA EMPLOYE!;$ 1,000,000.00 tr.°ie/Di O D�'acRlPnoN OFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Addttloaal Remarks Sebedule,N more specs Ie required) General Uabilty:for regular and usual jobs.Worker's Compensation:MA employees only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Wide HSE,LLC DBA Sexton Roofing and Siding Co THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 45 Olander Dr Northampton 01000 AUTHORIZED REPRESENTATIVE MAGUILHERME CAMOSSATO ) ACORD 25(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I/G eMXO1eAold8WZ8VLbd9Vzisto er3 t/sia PIoitaNP/uco-aiOs'eNP/fsdn4 zP amnia atosaaa».y aa4WO'9 1401#6111111IPPOWS aelsodsui Patqui81't 4$11.1iumwAra•c IS•+•s$•ba koraZlawnJ•Pas 3 xA)L1IMr Snots' was NNW JO 4t)p Aiipossisisso a!es taw my oil asps les+so ass ia'pJllky :#a•ugd WANPa"WNW al r +dili is r +im'WV NW ognis £val.PI mogingpa+softamoo axtssMw ao3 via 24030 suo d w eul30=IWO a97 01 Maim%a9 Ago wwtuaitls s!ql jo Ado*y'Joygo!A aqi 3suPtge tep. s arms as ai l io asg s Pus ligailo 7I110A1.OILS'Jo=J I ail of=WNW PAP ss R logagoosPckig ara6-a•o ao 00'00VIS el an se9 u Ai a ft •a vszi 7Si'a Ian in=P se afism03 anaas of=Psi *( pus.Aagsas�Lifted a+a )a>hd� *o. 7 1•idea•gamy CY99/9 Al ri h"Go ht )LO a 3 ;tsAL•vrib9Mg8nealso) '3!'I'611JpSJe#1°Wd 47 "17Uvrtreltar , Went D ADO i isossnsuojiq asp-Wpmpm gsrm apsyst A ielanimus slossmosisssa.aIS1+►MSrypta* iingabierk.••tsm r *Ng aRaad woo Loy VoLotekonA1e4*+ 4wmp3l *mi vow 4 wow px. =pox+sow pow amos000 sagipaer.e mom=goo pagans7*sou xogs!4*rap soy oaaxsoo- 'q,es SWARM A*spgllsnaas'mgosnwotaotaaleaaapesnoamimoppas4pwrpefeiopasAaipfowayw*ono*!pRmpsapesuaroomeg{ moongIggdmw+.ssIWm"PP>aNw°9sewp4ro9gmsgs Urn pg Est"9"MP a4sma!iddsruov. tP + »1049. oti)' 1 oasnmlar Pen VIS W o�'tI ''1ottadtwtoi rono103 P iARMOW pow uopwodwasysaytag n‘Ps limo*.ss�potA awl poismioptowa�eq asocl, ssIadas3 £! P **apeg skeautroales op rum aWI pee•enemocapuz+ose use IOs )i Pp aJ dou Smgonjd •saaboldma on toy*s+osa!*do*d io sifigku 18t1.110013 �Q-}.j j vex aw,e.o.s+m.od nM es. 000_save**Aug amp utawrwo o us pop mow p81.J0i lerI'AtmiMlfososparrnapsooaaseoFs#ao3euga4il!aPaxorwmogstOPISPIP lU.f ilk iv-... ..-dolma.ssnpor*oNI 1tala=Napa ao Sum)oueoamo4 a me I DCIMOUlaa 0'6 jpvptloa*mow!•doPoo aNsmo.°N)*Fisk*As Sugapainag 0-g s ems)Ileppa*t Kukesissa no aaq poi dm:moodr ioiaudwdaloe a tam t O acIptumeco' NQ-L itoggfwad,otpww )+oaioldwa 44 WAPAgldo.srae=I *WON)MOW pad vee.eerieei+de re/PHDirtaisl/m-w IBMaay :#auogd holS Q ` -4 '.a rrot8:dr, ue1s/4D r {5 " kk?1 Lyn :sstuppv r3 rA. qv/km/4 a 1 ti*4 !wl.Alociatiustresc281Fenel=KW ew01 Alva andir •epleue•i Y 'AIMOIwlr MILLUw113id MU FILM 43113 36 UL 10011.1141/1.111310043/11.11011.111Nopealieieg*$A+•PWV aieleteetelli••n suadossa.ualteem grAwilvsearamm Bet alpIS 1S xo,?l ` 0V Plasisimile sw$HL D U _ stiasa aatrismfo ypa/xattamo3 Bd(-}t p! v OM 4ag8 dl Wd L0:8'VZ/6 N£ ACCPREP DATE(YMIDWYYYY) 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT BRUNO ROZEMBARQUE NAME: POINT INSURANCE INC PHONE F (617)783-1180 FAX,No): — t-MAIL bnnoOpointinsure.com _9)ZR : 1103 COMMONWEALTH AVE Me (s)AFFORDING COVERAGE POW* BOSTON MA 02215 INSURER A: ACE AMERICAN INSURANCE CO 22687 III UM --- --- ------ INSURERS: L P BARUCH INC INSURERC: INSURER D: 637 RATHBUN ST APT 2 INSURER E: BLACKSTONE MA 01504 INSURER F: COVERAGES CERTIFICATE NUMBER: 921638 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 AU..THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. EXP LTR TYPE OF INSURANCE INBD SUBR WYD POLICY NURSER (M OAA)DO/YYYY) (N WICY EFFLDDIYYYYI UNITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S AMAGE TO RENTED CLAIYIS MADE OCCUR PREMIISES(Ea°O NI:MMel $ MED EXP(Any one person) $ WA PERSONAL a ADv INJURY $ COWL AGGREGATE UNIT APPLES PER: GENERAL AGGREGATE S POUCY PRCO- LOC PRODUCTS-COMP/OP AGG $ OTHER. $ AUTOMOBILE LUIBtLITY COMBINED SINGLE LIMB f (Ea aoci anD ANY AUTO BODILY INJURY(Per person) $ OWNED — SCHEDULED N/A BODILY INJURY(Per akxWell) $ AUTOS ONLY AUTOS PER NONAUTOS ONLY AUTOS ONLY Jf I) GE I UMBRELLA LMB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPBIMAT1DN X PER TUTS 0T AND EMPLOYERS'LNBUTY • ANYPROPRIETORPA of ERRAEMBEREi a�Jo� WA WA NIA 6S82UB0W59692023 07/11/2023 07/11/2024 EL EACH ACCIDENT $ 1,000,000 (leandstory M NH) EL DISEASE-EA EMPLOYEE $ 1.000.000 II yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LMT $ 1,00%000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I V6eC1.ES(ACORD 101,Additional Remarks Schedule,may be unsolved M more Space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 08 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/Iwct/workers-compensation/investigations/. CERTIFICATE HOLDER . . CANCELLATION SHOULD ANY OF THE ABOVE DESCRRMED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WS.L BE DELIVERED IN Sexton Roofing&Siding ACCORDANCE WTTH THE POLICY PROVISIONS. 102 PINE STREET AUTHORIZED REPRESENTATIVE HOLYOKE MA 01040 ( ( Daniel M.Croy,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 Licensee Details Demographic Information ull ame: SASHA MARI ENILDE r 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 HE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1 000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Typo LLC :.DE 0-SE. Rogislrabon 2 t7Cr 0 8-A SEXTON ROOFING&SR}N G F.xplratids Ol 3�+Z�25 45 0.ANDER DR !.:)RTMAMPTOP MA 03104 tlad.»Addr.s.and Return Cant. THE CcUMOMMYALTN OF MASSACHUSETTS Qrfi L.of Cannon*,Affair.&*uolnoss Raqulation R.pla1ratkm v.tM rod indNidu.t taw**Dolor.the HOME IMPROVEMENT CONTRACTOR eraireatei date. If hand return 1e: TYPE.<i C O5 s.or Cooney*,Altars sod business Rayuletion 8221.1.I f F•Wr+'I00 1000 rra.11l tors ay..l •$uq.Ito nun 94:3C12025 Radon,MA 02114 '0: 0E KSE.U.S OS A SEXTON ROMFrt+G$11.1) SASPIA Ors Gllt"tDER OR sue,.-.++, .tom �`l��j�'-�-.-_, NQsT ANI'TOli,MA O33G Undorara»tnry Not valid without signature SEXTON ROOFGUARD Description Line total Sexton RoofGuard 1.Strip and remove existing shingles and dispose of in proper landfill. $14,285.00 2.Inspect roofing deck and re-nail any loose decking.if replacement is needed due to rot, de-lamination,or damage,the following prices will be charged: @$100 per sheet for 1/2"CDX @$125 per sheet for 3/4"CDX 3.Install new metal edging to rakes and eaves of roof.(white/brown). 4.Install leak barrier protection 6 feet up on eaves,around vent stacks,in valleys,around chimney and at all places where roof intersects with walls or other roof facets. 5.Install roof deck protection on remainder of roof. 6.Install new flashing over existing vent stacks. 7.Install starter shingles on eaves and rakes of roof. 8.Install IKO Cambridge Architectural roofing shingles as per manufacturers'specifications. 9.Install new cap over ridge vent. Warranties to be provided after final payment: IKO Lifetime warranty including 10 years IronClad SRC 10 yr.workmanship warranty Reflash Chimney(Included) Quote subtotal $14,285.00 Total $14,285.00 SEXTON ROOFGUARD PREMIUM Includes everything from Sexton RoofGuard $14,285.00 Description Line total Sexton RoofGuard Premium 1.In place of Cambridge shingles,install Dynasty Performance. $1,760.00 For those seeking a more premium option,the Dyansty shingle is available as an upgrade over the Cambridge.In addition to a class 3 impact rating for hail damage,Dynasty can also withstand winds up to 130MPH.This performance,combined with high definition colors,enhances your home's protection, curb appeal and resale value. Warranties to be provided after final payment IKO Lifetime warranty including 15 years IronClad SRC 10 yr.workmanship warranty Quote subtotal $16,045.00 Total $16,045.00 AUTHORIZATION PAGE ❑Sexton RoofGuard $1.4,285.00 Name; Vikram Budhraja Sexton RoofGuard Premium $16,045.00 Address:122 State St.,Northampton,MA ❑ Sexton RoofGuard Elite $20,200.00 NOTE:Quote valid for 30 days from date of estimate.1/3 deposit due at signing via cash,check,or ACH deposit. Description Line total ❑ Gutter Replacement Removal of existing gutters and installation of new gutter system.(Can reuse $2,540.00 existing gutter guards) Q Install proper ventilation via rooftop intakes under shingle $1,480.00 Quote $16,045.00 Options $1,480.00 Final Price $17,525.00 Customer Comments / Notes i want the premium roof replacement,venting,and soffit and fascia repairs as needed without full replacement with PVC.does the venting Include a whirlybird? Vikram Budhraja: l/clv�unvlrudh.�.aja, Date:6/10/2024 Timothy Wilde: iiiw ]W Date:6/11/2024