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32A-033 (2)
BP-2024-1288 64 CHERRY ST UNIT I COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-033-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTIN(; WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2024-1288 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: WILDE HSE LLC DBA SEXTON Est.Cost: 18003 ROOFING 106265 Const.Class: Exp.Date: 03/08/2027 Use Group: Owner: JESSICA STARK Lot Size(sq.ft.) Zoning: URC Applicant: WILDE HSE LLC DBA SEXTON ROOFING Applicant Address Phone: Insurance: 45 OLANDER DR 315-569-7761 6HUBOW55113924 NORTHAMPTON, MA 01060 ISSUED ON: 10/03/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: !�/ Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner cC C The Commonwealth of Massach eats OCT 2 I Isti i Board of Building Regulations and taw. ds/ Massachusetts State Building Code 78O ( i209 UNIPALITY 4 SE Building Permit Application To Construct,Repair, t° 1? i,: ' , a i'evis d Mar2011 One-or Two-Family Dwelling �"'70A i�a�Fcrro„� QQ This Secti For Official Use Only �" Building Permit Number: 4W- 7 r h, Date Applied: Building Official(Pnnt Name) gnature Date SECTION 1:SITE INFORMATION 1.1 Property Address: (pN GAkU e.t.tk s- . 1.2 Assessors Map& Parcel Numbers 130(t'"T NvA,tvvre4, NI* OlNot) - 1.1 a Is this an accepted street?yes ,/. 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: Public l>� Private❑ Zone: _ Outside Flood Zoye? Check if yesC� Municipal I;�On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 3 c Gi. SiA g qkrsi t Y $ Ol& a. t J/.5 STf TIok1 kb 6113y08h—IS/ Sf S'OC�(a.ou.O.COM No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Cl Existing Building Or, Owner-Occupied 0 Repairs(s) l Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Cl Number of Units Other 0 Specify: Brief Description of Proposed Work2:0..En41,ve Eat%rrAV St t 6L ES,l st-P BAN Rp' 7 'DE',C'tl j, INSTAU. I es 4 Wtt erALi�1£i t 1.4 a.ratL Sil crtc Lux'wit, # I tzssAl.'- Mctkr'rc4lanvt` i+ 1FS,ti sc4►1- QMete uciirr ( t.- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ if t3 09 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ J 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) �Total All Few: /� Check No. ,11t/Check Amount:IA v Cash Amount: 6.Total Project Cost: S r g � 6 b 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor' `r License(CSL) /O/ j�*�+ Name V�/ 1 W Licensee Number /CJ piration Date o CSL I older List CSL Type(see below) (� No.and Street Type Description A�l� V O f U Unrestricted(Buildings up to 35,000 cu.ft.) {v OUS) R Restricted I&2 Family Dwelling City/Town,State,ZIP i M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ,SetV otJ,wct 113Q1I)FcC 1 I Insulation el one Email address c� 1►tL,cs M. D Demolition 5.2 Registered Home Improvement Contractortr (MC) 0?OQ D &i c O4J (�i G�I 1 HIC Registration Number xpirat on Date HIC Company Name or HIC Registrant Name s l+iq\itt �R • Se o to LMRIO �of F I re � at• J L. GDyr and Street Email address , . • q City/Town,State, ' 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 PERMMI'I' I,as Owner of the subject property,hereby authorize '�O J �(' F�is y 17�1 -11 to act on my behalf,in all matters relative to work authorized by this building permit application. /o1a/ Print Owner's Name(Electronic Signature) ate SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. • /o 1 nt Owner's or Authorized Agent's Name(Electronic Signature Da 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(INC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for`Total Project Cost" City of Northampton QtY, Massachusetts ''•.c� N l ( DEPARTMENT OF BUILDING INSPECTIONS ? �° t{ 212 Main Street • Municipal Building O�ti f�C' -1---4 Northampton, MA 01060 .%:: `'�0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: `1.---) i,g i Location of Facility: 15.57) /L1miii// ( Ly F2 7 A 011, The debris will be transported by: Name of Hauler: cys- 6/4 / ✓ eetizpiA d'Af;cAes /4/C., Signature of Applicant: ` fd�e/ Date: /()4/ _ The Commonwealth of Massachusetts ►►�= . 1, Department of Industrial Accidents ;FIRI q 1 Congress Street,Suite 100 ;;ug Boston,MA 02114-2017 ,. 41 www.mass.gov/dia Jai Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Sexton Roofing&Siding Address: 45 Olander Dr. City/State/Zip: Northampton, Ma 01060 Phone #: 413-534-1234 Are you an employer?Check the appropriate box: Type of project(required): LID Q I am a employer with employees(full and/or part-time).* 7. ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.111 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We arc a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins.Lic.#: UB-0W551139-24 Expiration Date: 6/1/25 Job Site Address:64 Cherry St. City/State/Zip:Northampton,Ma 01060 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,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and pe ties of perjury that the information provided above is true and correct. Signature: , ` Date;/" /21/ Phone#: 413-534 1234 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#: A!'�� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kathi Hutchinson NAME: ORMSBY INSURANCE AGENCY PHONE 413 737-0300 FAX INLC.N0.ExI): ( ) ,-(A/C,No): n'"'DREss: khutchinson@ormsbyins.com P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIC WEST SPRINGFIELD MA 01090 INsuRERA; TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: WILDE HSE LLC INSURERC: INSURER D 45 OLANDER DRIVE INSURERE: 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ADDL S1)R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD INVD POLICY NUMBER (MM/DD/YYYY) (MM/DO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEOAMAGE TO $ CLAIMS-MADE I I OCCUR PR M S a ES(EENTED oocurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $PRO- POLICY I ECT L I LOC PRODUCTS-C OMP/OP AGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea acddent) _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident)_ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTERA ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6HUB0W55113924 06/01/2024 06/01/2025 (Mandatory in NH) E.LDISEASE-EAEMPLOYEE $ 1+ +BDB If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers- compensation/investigations/. Continuation of above Named Insured:DBA SEXTON ROOFING&SIDING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 ( L Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORDx CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 Cordeirc NAME: Clayton Insurance Agency,Inc. PHONE (413)536-0804 FAX (413)534-7874 (A/C,No,Est): (A/C,No): 1649 Northampton Street E-MAIL acnrdeiro@daytnnineuranre net ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC U Holyoke MA 01040 INSURERA: Submissions INSURED INSURER B: Safety Insurance Company 0014 Wilde HSE LLC,DBA:Sexton Roofing&Sidinc INSURER C: 45 Olander Drive INSURER D INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: CL246306545 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC 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 ADM SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A BND0016953 05/30/2024 05/30/2025 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY n ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 5935264 05/30/2024 05130/2025 BODILY INJURY(Per accident)^ $ AUTOS ONLY AUTOS X HAIRED UTOS ONLY X AUT NONOS-OWNEONLD PROPERTY DAMAGE (Per accident) $ Y Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY /N STATUTE ER ,, ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 REPRESENTATIVE NORTHAMPTON MA 01060 I 7 4‘7.ee.r !' ~.'1tr+ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 10/2/24, 10:10 AM IMG20240510065637.jpg The Commonwealth of Massachusetts ►` —I►l, Department of Industrial Accidents 4.�_'=7Bi I Congress Street,Suite 100 � ,_s v g Boston,MA 02II4-20I7».,,� wwmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaulicant Information +Please Print Legibly Name(Business/Organization/lndividuaq: A j A G Cca conekkoNcet Col Address: to Ohs Alps a-- City/State/Zip: Mdc'aa M-1 61751 Phone#: 11(21 410 3t 49 Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 5— employees(full and/or part-time).' 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doingall work myself. 9. 0 Demolition ys [No workers'camp,insurance required.]1 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will I 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees, 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'corm.insurance required.] 'Any applicant that checks box#1 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name: Tflo�v4_lt�f$ P C ck& Cn QF_AM loor Policy#or Self-ins.Lic.#: 111155 L Expiration Date: 1-1-I XO 12015 Job Site Address: 62 q c mo sf. City/State/Zip: I t lA O 1/yo Attach a copy of the workers'comp n on policy declaration page(showing the policy number and expi 'on date /`'mil) 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,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance •.. coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above iss true and correct. Signature: %era, iase _Date:05/O l{ / `LO 2*' • Phone#: Cie 1—q w'—3NI/g 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: iss ' https://drive.google.com/drive/folders/1 ZyXGHtu68J3njf9-oHbp9M-yfWgOXr9u 1/1 A�® CERTIFICATE OF LIABILITY INSURANCE °ATE`MM,D°�YYY) 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 policy(ies)must 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 GUILHERME CAMOSSATO NAME: I-INSURANCE GROUP INC PHONE (978)645 6996 FAX C.No.Extl: (A/C,No): 799 GORHAM ST-UNIT A ADD E4ARIESS: info@i-insurancegroup.net LOWELL,MA 01852 INSURER(S)AFFORDING COVERAGE NAIC U INSURER A: ATLANTIC CASUALTY INS CO INSURED INSURER 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 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB) POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS POUCY EFF POLICY EXP LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 GE TO X COMMERCIAL GENERAL LIABILITY PREMISES(EaENTED occurrence) $ 100,000.00 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000.00 A L261008542-0 05/03/2024 05/03/2025 PERSONAL&AOV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 —I POLICY n JPERC n LOC - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'UABILrrY TORY LIMITS ER B ANY OFFICER/MEMBER EXLUDED?PROPRIETOR/PARTNER/EXECUTIVE YI�I N/A ASSIGN#1397554 04/30/2024 04/30/2025 E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory in NH) I ' E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes.describe under 1,000,000.00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) General Liability:for regular and usual jobs.Worker's Compensation:MA employees only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wilde HSE,LLC DBA Sexton Roofing and Siding Co THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 45 Olander Dr Northampton MA 01060 AUTHORIZED REPRESENTATIVE GUILHERME CAMOSSATO ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Licensee Details Demographic Information Full Name: SASHA MARIE WILDE owner Name: License Address Information City: NORTHAMPTON State: MA Zlpcode: 01060 Country: United States License Information Picense No: CSSL-106265 License Type: Construction Supervisor Specialty rofession: Building Licenses Date of Last Renewal: Issue Date: 7/6/2023 Expiration Date: 3/8/2027 License Status: Active Today's Date: 7/7/2023 Secondary License Type: Doing Business As: Status Change Reason: License Issuance Prerequisite Information No Prerequisite Information No Available Documents THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Typo LLC wiLDE r+SE.PLC Rsgtstrason 206470 CA OulG�202S CSA SEXTON ROOFING S SIDING 45 OLANDER CR AfORTr4AMP'TON MA 03104 r N.i VONA.Adds and Pieter,Caro. TNt COOIIOOMWSKTN O/MA10ACMlS11TI Oak*M Ceniminser AOttis t atww..IMpi-Mlaa lbelsllaHsu vMd OM MNNdmN woo ony adore tra HOME �C TOR 4100. NOMaMtNwdto Tin OAN M Ceaaawar Minks Ma Swims*Ilqulauon 1im wooklen Mr$S.s •Stilts 710 2201 .esommiso � iaalnti MA 02110 te.�DE•St ..0 D S A SEX1 Ow ROOFING•It b SASHA wADE ) �-44'�' 41 O �dA IANDEp OR w. A.�A(rA' aORTwMPTON,MA 03104 %Jndsse+mslary Not valid without signature SEXTON ROOFGUARD: WHOLE HOUSE Description Line total Sexton RoofGuard:Whole House For the entire house: $15,649.00 Set up heavy fabric tarps to direct debris away from house. Set up plywood barriers or other systems to protect delicate vegetation Laydown plywood on decks or other sensitive areas to limit damage from falling debris. 1. Strip and remove existing shingles and dispose of in proper landfill. 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: @$80 per sheet for 1/2"CDX @ $105 per sheet for 3/4"CDX 3. Install new 8"Aluminum edging(F8)to rakes and eaves of roof.(white/brown). 4. Install leak barrier protection(Ice and Water)on entire rear and front porch roofs. 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(Synthetic barrier)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 ridge vent and mathcing shingle cap over ridge. Warranties to be provided after final payment: IKO Lifetime warranty including 10 years Ironclad SRC 10 yr.workmanship warranty Ventilation $2,354.00 Attic Ventilation System: Many older homes struggle with regulating temperature in the attic space. During a roof replacement, proper attic intake ventilation can be installed and paired with a ridge vent to optimize airflow.This can reduce your energy bills by up to 17%and protect your roof from ice dams by ensuring your attic can breathe! Add shingle-over ventilation to the eaves of the main house to ensure airflow through the entire attic space Estimate subtotal S18,003.00 Total $18,003.00 AUTHORIZATION PAGE Sexton RoofGuard:Whole House $18,003.00 Name: Jessica Stark Address: 64 Cherry St., Northampton, MA NOTE:Quote valid for 30 days from date of estimate.1/3 deposit due at signing via cash,check,or ACH deposit. Final Price $18,003.00 Customer Comments / Notes Jessica Stark: Date:9/27/2024 Timothy Wilde: Tuna- j 141tiL Date:9/27/2024 . r�