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70 WASHINGTON ST - BUILDING INSPECTION (3) — � � . What is the current use of the Building? eac Material of Building? 3 (2-,G K If dwelling,how many units? Wig the Building Conform to Law? e S Asbestos? p rehitoas Name r 2 Address and Phone ) Mechanic's Name C 2 /k� M n 2A- Y s ( kr,m r 2� M.a a 5 G- l� F'� o /I c- Address and ptor►e 1 -3 -�-. 6 G -7 Construes+ Supervisors License 0 13 �G q-HIC Registration* G G. Oo permN Fee Cal hdon Estimated Cost of Project 3�'.Y— Permit Fee i �l - S 0 Estimated Cost =7K1000 Residential _ Estimated Cost X$41/:1000 Commorcia�--- -.. _._. . . An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building permit to build to the above stated specifications. Signed under penalty of perjury Date �' o 2 N� 1 o S ks ° m il-, a � a Z�k CITY-OF 1111 _. PUBLIC PROPERTY DEPARTMENTJ, 6 W%aWIS"oRuuxt - NaroR 33o WA9UNcnw SnU=*SAU1K wNA0& has 01970 APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION DR OLTTION,OR CHANGE OF USE OR GCCUFANCY FOR ANY EXISTING STRUCTURZ OR BUILDING: 1.0 SITE INFORMATION Location Name: -70 GaAswry tiJ Building: Property le located in s;Conservation Area YIN NO Historic Dbtrict YIN t 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land U, &tj ( o T n"fyq- ` Name: Address: S � < Telephone: G �- 3.0 COMPLETE THIS SECTION FOR WORK IN E7(ISIINp BUILDINGS ONLY Addition Existing Renovation Ro�� Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Bdef Description of Proposed Work: c s Z � l J �n�2s -- Mail Permit to; CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT I2C W.\912W::\k S:9EET•$.\L,M.W.MMC.it .L•1-1 S i9/C T'EI:VM745-IM •FAX'.97474C.9844 Construction Debris Disposal Affidavit (required for all demolition atul renovation work) in accordance with the sixth edition of dw State Building Code, 730 CbtA section 111.5 Debris,and the provisions of M. GL c 40,S 54; Building Permit k _ _ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined b MGL c po Y Po . tY Y 111. S 130A. The debris will be transported by: (name of hauler) fu Jcbriswtll be disposed of (n:une�t(aciGty) t�ddfC%� .11 Ya.i( l'q . ♦i_L.fYiJ a ,:Cltl-dt..(7 i7.1U.)f _ CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT wtUar RIF.Y URI-AX)" M]Yoft 1Y WA%HI.IGTOHSTREhT 4 SAIEN,MAs5ACn1.81cT1s0197^. 'rt.L:978-743.9595 •FAx:9M74tb9946 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anfilitant Information Please Print Le ibl t 2 c� NameaNameBusitxsstOr izatioNlndinchwp: p _S u Address: ��� BUK `i 1 1 b CitylStarciZip: �2z bob y ' YYn UI9 ?,o Phone #: 5 3 a- - 6 3 GG g A rc 'on an employer?Check the appropriate box: 'Type of project(required): 1.�I ant a employer with/& 4. 0 1 am a general contractor and 1 6. 0 New construction empioyees(full and/or part-time).• have hired the sub-contractors k .❑ 1 am a sole proprietor or partner- listed on the attached sheet. r ?• ❑ Remodeling I _ ship and have no employt:c:s These subcontractors have S. 0 Demolition working for me in any capacity, workers' comp. insurance. 9, 0 Building addition INo workers'comp. insurance 5. 0 We are a corporation and its required.] officers have exercised thew 10.❑ Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself. No workers comp. C. 152,§1(4),and we have no Ay / y ( p• 12.�Ruofra'peirs— de:� insurance required.] t employees.[No workers' 13.❑ Other comp. insurancemquirctl.] -Ally applicwd dtst chucks box el must ats0 All out the mclian below showing limit workers'cumpantadion policy infiamwiun '1 tontcowrwn who submit this affidavit indicating Ihay arc doing WI work and then hire pttsuk cttnrmnon muan.uhmft a new amdavil indicding arch. �C'ontrxwn than check this boo mttst attached an additional Abort Aowing the name of tho sub•contrwtm and their workers'comp.policy information. /mn an enployer that is providing wtorkers'compensation insurance for uny employees. Below is the policy and job site infannurion � I Insurance Company.Name:�{{//�1�iA" tl r L __IJ 1/5u/Z4-,_V_Ce_ CO . Policy q or Self-ins. Lie. 00 (' QSDate:E irrtion a3 0 Job Site Address: () W fie-/ [nv y/7i 1 City/Statelzip: 579 u, r 14- of f pd Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sccurc coverage as required under Section 25A of Y[GL c. 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the O13ice of Iu.c,ngatiuns ul'dtc DIA for insurance coverage verification. I do hereby certify under use pains mad penalliejs of perjury that the information provided above is true and correct i S a- OU OJrcial use mdy. Do not write its this urea,to be coniple/ed by city or town ojjfe iml City or'rown: Permit/License Y____ Issuing Authority (circle one): I. Itoard of health 2. Building Dcprrtntent 3.Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Cunlact Person: __ Phone p: Information and Instructions Nlassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An emplojwr is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver of trustee of an Individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152.§25C(6)also states thug"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, bLGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any coniraa for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)narne(s),address(es)and phone number(s)along with their certificatc(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,arc not required to carry workers' compensation insurance. If an LLC or LLP does have employees,_a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Offlelals Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bur leaves etc.)said person is NOT required to complete this affidavit. I'he Otlicc of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Dcparnnent's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents O®ee of Investlgatlems 600 Washington Street Boston, MA 02111 Tel. N 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised i-26-05 www.ma3s.gov/dia Axe Board of Building Regulat'ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 137667 Type: Private Corporation Expiration: 12/17/2008 Tr# 124338 BUILDING MAINTENANCE CORP. PETER ALLARD P.O. BOX 3118 PEABODY, MA 01961 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 Ca 60M-04/05-PC8699 xe lJrnrunzo?zu�eaCC�z a1-4& zdl ells Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration:`137667 One Ashburton Place Ron 1301 Expiration:'-1017/2008 Tr# 124338 Boston,Ma.02108 Type:-Private Corporation BUILDING MAINTENANCE CORPi PETER ALLARD 58R PULASKI ST. p ,..+CLa.�•�. PEABODY,MA 01960 Administrator Not valid without signature k • BUILMAI-01 MENA GATE(MMIDDIYYYY) ACORDTR CERTIFICATE OF LIABILITY INSURANCE 6113/2007 PRODUCER (508)852-8500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Protector Group HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 100 Front Street, Suite 800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01608-1435 INSURERS AFFORDING COVERAGE NAIC# INSURED Building Maintenance Corp dba US Roofing INSURER A:Acadia Insurance BMC Development LLC INSURERS:Commerce &Industry 58 R Pulaski Street INSURER C: Peabody, MA 01961 INSURER D. INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY E PI p TION LIMITS LTR S POLICYNUMBER IDD EACH OCCURRENCE $ 1,000,00 ` GENERAL LIABILITY 300,00 CPA00 A X COMMERCIAL GENERAL 85685-14 12/23/2006 12/23/2007 PREMISES Ea oe LIABILITY $ LIED EXP(Any onene person) n) $ S,OO CLAIMS MADE OCCUR 1,000,00 PERSONAL BADV INJURY E GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMP/OP AGO S 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: E __1 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO MAA0085652-14 12/23/2006 12/23/2007 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ (Per person) X SCHEDULED AUTOS X HIREDAUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS III PROPERTY DAMAGE $ (Per accident) fGARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: ASS $ EACH OCCURRENCE $ 5,000,00 EXCESSIUMBRELLA LIABILITY 5,000,00 A X OCCUR CLAIMS MADE CUA0085698-14 12123/2006 12123/2007 AGGREGATE S !V $ d $ DEDUCTIBLE $ RETENTION $ WC STATU- X OTH- WORKERS COMPENSATION AND TOR V LIMITS ER EMPLOYERS'LIABILITY 12/23/2006 12123/2007 E.L.EACH ACCIDENT $ 500,00 g WC531-15-84 500,00 ANY PROPRIMB R/PXCLUDE/EXECUTIVE E.L.DISEASE-EA EMPLOYEE $ Oyes,de/MEMBER EXCLUDED? 500,00 If yes,describe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER $50,000 A Installation Floater CPA0085685-14 12123/2006 12I2312007 Job Site Limit A Special Form CPA0085685-14 12/23/2006 12/23/2007 Transit/Storage $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EYf.I IreInNS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS F CERTIFICATE HOLDER CANCELLATION SHO ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Salem DATE THEREOF,THE ISS UING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Purchasing Deept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 120 Washington St,3rd floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Salem, MA 01970- REPRESENTATIVES. ORIZED REPRESENT VE ©ACORD CORPORATION 1988 ACORD 25(2001/08) ti .JUN-Ub-2007 14:28 CURNS, VERNET & RSSOC. INC P.01i02 ICI U.S. Roofing a division of Building Maintenance Corp. �l 11!!� P.O. Box 3118 gi)40FINQ Peabody, MA01961-3118 Telephone: (978) 532.-6300 Fax: (978) 877-0803 CONTRACT The Owner(s) of the premises described below("Job Address"), hereby contract with and authorize U.S. Roofing, a division of Building Maintenance Corp. ("Contractor-),to furnish all necessary materials, supplies, labor and workmanship,and to install, construct and place improvements at said Job Address, according to the following specifications,terms and conditions: 1. Owner's Name: Vernco Trust 70 Washington St. Suite 310 Salem, MA 01970 2. 7ob Address: (2 Roofs) 70 Washington St. Salem, MA 01970 ' 3. Specifications: Contractor agrees to perform the following services in a good and workmanlike manner: 1. Rear Roof: approximately 70' x 15' in area; abutting parking lot i 2. Lower Entry Roof: approximately 40' x 15' in area; open on 2 ends - Remove excess stone ballast from both roof levels Prepare the existing roofing systems for the new roof in according to Duro-Last Ii manufacturer's specifications - Overlay the existing roof systems, installing new 3/8" Fan-Fold insulation board per Duro-Last roofing manufacturers specifications - Install new non-corrosive nailers as needed Install complete 40-mil (nom.) Duro-Last Roofing System according to the Manufacturer's published specifications. Includes prefabricated roof membrane, prefabricated wall flashings, fasteners, accessories and edge materials. Employ 90 pound fastener and system configuration Furnish and install prefabricated parapet wall membrane on each side of newly installed roofing systems - Install pre-manufactured flashings on all roof penetrations as specified by Duro-Last - Install new grey perimeter termination system over all non parapet perimeters ensuring that the building aesthetics are preserved as designed or improved. - Provide for a safe, non-disruptive job-site ensuring appropriate access and disposal lanes. - Work environment to be clean and safe for roof mechanics, building employees and public .,'UN—Ub-2007 14:28 CUKNS, VLKNtI & HSSUC. INU r.vje/uc - Dispose of all debris in an approved facility in accordance with all local, state and federal regulations - U.S. Roofing will acquire all permits and schedule inspections Cost of Work: $ 8,400.22 4. Extra : I� In the event that the Contractor discovers rotten sheathing, It shall be replaced per order of the Owner and, if performed, the Owner shall pay an additional$3.50 per square foot for labor and materials. 5. warranties: The above work comes with Duro-Laws L9-Year Roof Warranty (furnished to Owner from Ouro-Last directly)for materials and a two-year warranty (furnished by Contractor)for labor. 6. payment Terms: The total cost of the contract is$ 8,400.00 Payment shall be rendered in the following manner: Balance (100%of the total project cost)shall be paid upon successful completion of all roof work * Now Available: Visa 8 Mastercard Credit Cards are accepted as payment. •Credit card payments are subject to a nominal service charge 7. Attorney's Fees: in the event of default, the Owner shall pay costs for collecting amounts owing including, without limitation,court costs,expenses and reasonable attorney's fees, in addition to any sum that the member may be called on to pay. S. Entire Acreemenlo This contract constitutes the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement.The Owner agrees that Contractor has made no statements, promises, commitments or representations not contained herein. 9. Modification Other than that required as a result of paragraph 4 above, any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding Y onl If evidenced in writing signed by each party or an authorized representative of each party. 10. Unforseen Circumstances: Contractor is not liable for delays due to weather,strikes, accidents, ads of God or other circumstances arising out of causes beyond its reasonable control and without Its fault or negligence. 11. Governing Law: It is agreed that this agreement shall be governed by, construed, and enforced in accordance with the laws of the Commonwealth of Massachusetts. IN WITNESS WHEREOF, the parties have signed their names hereto: Date: 6-6-2007 Date: .S. Roofing, by its agent nt for Vem o Trust Willard H. Murray 2 TOTAL P.02