7 SUMMER ST - BPA THE SALEM INN Sep 28 07 08: 48a Richard/Diane Pabich 1 -978-745-7220 p. 1
COO/ 19.00 31 a JI jvJ.,---- Aulson Roofing, Inc. Oy� 1 CD O
49 Dmsoa Drive
Mmwobazm01544 —
' . 9754M -70=(978)975-W$7
Pro sal
.ue.aafau �-
Satam R mewal 979-745-7220 9/2712007
$"a - N•"0• �0"
141 WaWngton Sheet JDsve>'al
80,smarzoca* rabLOGMAM
Salmb MA 01970 `rM Saltm be,7 Summ Swat MA 01970
wekwayp►apmaaJarwtsb Maw adasshwis rtvbuse8aswsmglermfmomomfem►e
epedyleada s by AefeMoWfap:
• This aamna oovdts the fMowmg ebmgic rm darose:
Emdre Main Run!'
• p.ayae the esashag(1)layer of shmgia roof to hags the new roof apphed dually over it.
• All vdlaya an be waavad.
• Tim-Ng] w01 bs inetdted by usinW raoflaft mail.
• The ehmgln dna wt71 be and am GAF 7"imbe dimm
Yameboioe docim.Sxa�mt
• bawl now vast plpm flashing rep to 4 inches.Any larger will be proParly sealed
• Rom and seat the cdedmg ddmwdl and dunmey flarhng.Any new world be addi4mmsl anal.
* Rouse and sat the edWsi 9ky4M flaeldmg Any mm would be eddffioml anal
• LWall mill f niabd ala®immm drip dga along all awx and takes.
• Clem Wnmrs.
• Clam and mm a all outside job ruffed debris. ;.
• Provide stmdlhd 30 yew ddmk manofaclmes's pw max
• Pmvlde samdatd Ambmm Rooffag Inc.2 yam wadmmahist gusrmt m
* Gory an acoasmery wodcer a compeassfim and liability im mwm.
* Any Inn;or permits will be an addmomal cost to the wamrm•.
Cmasm NOW
ifAubm bas to!mall a wa3mmy(Rom ofbuitdhW not of soaflbld and plywood and pat a
f o dorm n m on Wound cound fie ydce OmM be$700.00 c om.to the rnmtract price_
Esd mmd Br Bruce Tmthma
Attyarpaa itchy aJYwdel eeWmia6 Watdlalar,cvei'�-'Jm will a6ore�adJ&dYrsew qF.
Ten Tbomamd Nbte Hundred NbmW dollaea and no cmb S10 00
Payment moremmbeaddb ..
• 1/3de l/lrtlrl4baWimu mapledm
Aa a,swis%,atwaeedb M a eptlael Atl rusk m be amprra m twewritlsalmedat ssa.wneaea
m w•�etiee,�a•4 t! d rummies Atr elgaimeetlnieliea EaWe iw.epadfiaeuae/awlayy a►e tab
wai b®sal adypoe oH�udwe.d Ma 6eem w me d�ew:sdJ,teedw im
Aa y®au s.tYyem�4m�il�.e/ddauY ardcYP b•�accsa[d.Owaar bot+7 aR,trrdo oe0 aartr
6.sac or.oAm..vadq.o.sad b wada.tti aoMwaaaa ratraoa
7AY be wabdm ffr d sompudwOft JO
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Ym w amOtind to do am vrynta Wn be Waft a eatWoaUeea
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
4unUAtt1Y lattat:ull
M srsta 12C WAsrrv:TaeS ItWr a S LIK hLULW a.'STtx01970
Tkt:M745.9M a FAX:9W40.9646
Workers' Compensation Insurance Affidavit: guilders/Contractors/Electriclans/PMmben
.applicant Information Please Print Legibly
Nome A -,i c -testa
Address: 44 T�t4t••r7cx,.4 -hQ
City/Statedzip:.. tag- .ffn/ M a18—L4y--- Phone H: 271- 97,5— �a'a 6
Are yen an employer?Cheek the appropriate box
Type of Prefect(ro9ulred):
l,,"a cmploya,with 4. ❑ 1 am a gencral contractor and 1 6. ❑NOW construction
employees(full and/or part-tine)• have hired the sub-comracton a
2.❑ 1 am a sole proprietor or partner. listed on the attached shed. : 7_,Et^"_�^��,-
Ilog
ship and have no employees These sub-contactors have a. ❑Demolition
working for me in any capacity. workers'comp,insurance, 9. ❑ Buddingaddition,
n
req workers'camp. insurance S. ❑ We are a caqwrahave
exercis and its 10.❑Electrical repairs or additions
tequircti) otTita:rs have cxerciwxl their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself.(No workers'comp. C. 152,41(4),and we have no I41;kItuofrnpairs
insurance requited.) t employees (No workers' 13.❑Other
comp. insurance required.]
•AnryapphU awi rhite'ha boa el mm also fill"the section ttrloty thowittg their woetme eutnpuwYim pwity ierutoatiw►
'Itumwtwran who submit this atrldavn indisuk l awry an doiq as wont tad tam biro mtt"evntmmaa~submit a rtetr aflUbvh indiatins such.
:Co msun that chink this box mm stitched aft additional Am.bowing the natm orgy sub-cotmaeton,Mid their wutkess'comp.Pettey wrhnnatMat.
1 amp on employer that is providing workers'cumpensodoa!issuance jot fay employers Below Is the policy and Job slime
iaforwat"
Insurance Company Vamr. �S/a r 1 CT_ SN S V'�av rt• 1� ..0
Policy N for Scif-its. Lic.0:W f S310S!L-3-__... . .__._ Expiration Date: /O
Jub Site Address: 3S6✓1,�T5ft ZS1-4WA P v CitylstataZip: S-v9L T/"/
Artach a copy of the workers'compensation plan cy declaration page(showing the policy number and cxpirativa hate)L
Failure to wcure coverage as required under Section 25A uf.1GL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1.500.00 and/or one-yea impristmincnt,is well as civil penalties in the form*(a STOP WORK ORDER and a rind
of up in S250.00 a Jay rguiast the violator. lie advised that a copy of this slawincrit may be forwarded to the Office of
lu,sugmuuis of the DIA for inwnrcc cover • t •rificatiun.
1 do hereby certify oP, r the pains IM110 of per/ary that the in/orwarlow provided above is true(orld enures
c-F-
O/Jra•191 artoalp. Do cot write is this area,to be rexep/ettnfby dry of town o/JlrQ
City or Town: _. PermidLicense N___.
Iuuing Authority(circle one):
1. Iluard of Health I. Building Department 3.Citylrown Clerk 4. Electrical Impector S. Plumbing Inspector
6.Other
Contact Person: _ _ Phone p•
Information and Instructions
tilyvsachuscua General Laws chapter 132 requires all employers to provide workers' compensation for dx'f..empioyeea
pursuant to this statute,an rotAOiyoe is defimeed as"-"every person in the service of another under any contract of hits,
express of implied,Oral a written."
An oopfoyar is detiaed as"an individual,pormetship'ansocia°°n.corporation or other legal entity,or any two or atone
of the foregoing engaged in a joint enterprise.and including the legal repasmnavtx of a deceased employs,or the
Adam or other legal entity.emptying employees. However the
receiver of d dwelling
g o se having
of net
tsht a and who resides therein.or the occupant of dw
ostler of a dweltimg Kraus having net mote than three apartments
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds at building appu
rtenant therein shall not because of such employment be deemed to be an employer."
AlGL chapter I32.42SC(6)also scats that"every store or teal licensing agency stall withhold the isswna or
reaewd of a Seeass or permit to operate a business or to construct buildings in the commonwealth for any
appllennt who has tat produced acceptable evidence of compliance with the lusuranee coverage requIrW
Additionally.MGL chapter 152.$23CM states Mc her the
until coo��ktb our any Of
of its Political
liti a with subdivisions
ns *41
enter into any contract for the performance of publicacceptable
rance
requirements of this chapt
er have been presented to the contracting authority."
Applicants
please fill out the workers'compensation affidavit completely,by checking the boas that apply to your situation and,if
necessary.supply sttb.conttractor(s)oarruKs),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees otter than the
members or paters.are not required to carry waken'compensation insurance. If an LLC or LLP does have
employes,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Alto 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
lndustrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
at the number lured below. Self-insured companies should enter their
compensation policy,please nil the Department
,elf insurance license number on the appropriate line•
City or Town Offleiab
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 fill out in the event the Office of Investigations has to contact you regarding the applicant•
Please be sure to till in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permiViicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"fob 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 now affidavit must be filled 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 dug license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
l'hu 001,:o of lovcstigatiuns would like to thank you in advance for your cooperation and should you have any questions,
plcuse du nut hesitate to give us •a call.
The Department's address,telephone and fax number.
The Coninlonwealth of Massachusetts
Depattatent of Industrial Accidents
Oma of Iavesttptlona
600 Washington Street
Bostov%MA sal 11
Tel. k 617-7274900 ext 406 of 1-977-MASSAFE
Fax 0 617-727-7749
Reviscd 5-26-US www.mm.gov/dia
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
13G
TS:wwrw)!t! F.�c 9riJ�6ri/s
T
Construction Debris Disposal Affidavit
(required fix all demolition and renovation work)
In accordance with the sixtb edition of the Stars Building Codsi, 7SO CHIA section 111.3
Debris.aid the provisions of M. GL a 40.9 34
Building Permit A _ . _ is issued with the condition diet the debris resulting Reek
this wort shall be disposed of in a properly licensed waste disposal &cility as defined by %4GL e
I l 1. S 130A.
The debris will be transported by:
tnaiee or fouler)
fhedcbris will be disposed or in
t nacre ter•r�;,t,ry)
.11;4.11 - -
.air'
,Sep 28 07 08: 46a Richard/Diane Pabich 1 -978-745-7220 p. l
--
Aulson Roofing, Inc. O� 1
49 Damim Drive
Metlaur,Massachumms 01544
--- (978)97545W F=(978)9754987 - -
,PrQ OSd
,.yped..E.dmdmr toga
Salem Renewal 978-745-7220 MW2007
80e0 o6Nara Penon
141 w Sheet nave Babmt
Nr:smaaadzipcmh Ab6zleldrAm
$aunt,MA 01970 "The.Satan Ian",7 Srantner Stlett, MA 01970
we herby propene sofarmish labor and to to iesasAnow shbrgla roof to aanwJactnes
WadJleadoas by t ef*NO *ff:
• This eaCmate O"m tic following shingle roof arm:
Foie Main Rod
v pmpam the md5nng(1)layer of shingle roofto Lave the near roof applied directly over it
* All valleys to be weaved.
• The shingles will be installed by using tooling nails.
• Tm shingles do will be need are GAF Timberline
Your dwoe ofb01M.C=hg�y1
• bagall now van pipe flashing up to 4 inches.Any larger will be properly wadod.
• Rem and seat the eaiaang aidewell and chimney flashmg.Any new world be additional cast.
• Rom and seal tic existing s>ryH&8as<dag•Any new would be additional cost.
• %%all mill fished alamiaom drip edge along all eaves and raps.
• Clean garters.
• Cimo and rmove all omW&job rclmvd dabrio.
• Provide standard 30 yew shbngie suanufacturca's guataotec.
• Pmvidc standard Aulam Roofing,Inc.2 year warionat"guarantee.
* Carry afi nommy worker's compensaboo and liability masuramx.
• Any flma or permits will be rm additional cost to the cask nor.
Contact Nome
if Aubun has to mnmD a wa rway(Gant of baildho oat of scaflbM and plywood and pot a
Gill dme man an grmmd control the price sha11 be$700.00 e.><tra to the contract price. -
Esdmam i By Brune TW&M
rvrp etpasa howl tolovid aainwiab aadbdar,amapiek is nowdl am r with above @%Jbr drsrm ae
Tell Tbomand Nine Hundred Ninety dollars sad Be cents SAP"
Pa nmer terror on to be as ddl mr.
• 1f3 doped;1/3 at MK,balm e upoe completion
Anmmmir08ammveedme8mtpm+a.a.Au.mkmmamvpirmdle..Mwahr vmrkmangme�er.mmdla,
a rpmMaai mbmsft4 pr aandad paNIOM Ass aaomAm acda.imnoa trove seem gwMerwm oval"OW&
via ne emam•da•14•Jm•minim rod.•.rd vie bmam.m mm..lrg miv.rddamd.md®m
nopmuy
Aa.B®man'mrR♦u�m rprm atil®..widme addnnb�7Oed wr.med.Oror mmury Bay.dodo and min
ivmwwm.cw.mrav airy amend ey arodamn►oaopm.dm raaswm.
ran to ria.hmm Hand wahia 30
AUL"ROOFMO,M.AUTHORMM SIGNATURE
Ac�ae,P[Arnrior+psAposArl lee abxro pajsrR ereoi6rtiar sad aaadlrierean axed.army aaa�md•
. Ym w mnatAmto do am rrpeo Payreal Wm to made r eaamae aaa.a.
(�tE Ol.r..M.w.uo ��rt—�
i
tSD I To 130s!1J UN--t)L
Sep 28 07 08: 46a Richard/Diane Pabich 1 -978-745-7220 p. 2
04/24/2MI/ 11:W VI00 rower .,w.,.... . ..__
Aulson Roofing, Inc.
49 Denton Drive
--- Methuen.Massachusetts 01,844 - -- --- -
-- -- - (978)975-45W Fax:(979)975-0987
Proposal
Prvpwsst sabsnared ro: Phtnar
Salem Renewal 978-745-7220 9/20/2007
som odrNmm CaWactPermw
141 Washingtort Street Dave Pabich
City,Sfote and7ip Cock idbLoeafton
Salem,MA 01970 35 Winter Island Road, Salem,MA 01970
We propene to f rn"and lmdall a new LAAM.. snaJiTnB system to RPI mainwfadao+ers
spenfimfiomr in rlae fotlmping manner
• This estimate rovers the following areas:
Upper Fiat Roof
• Remove the existing double coverage roof(leaving 3.3"Iso board).
• Mechanically fasten 1/2"Polisgyaouxate Insulation with 3"insulation plates and coated screws.
• The.060 EPDM membrane will be Hilly adhered to the insulation.
• All seems will be primed and seam tape applied
• The roof edges will have installed new.032 white aluminum edge metal and 5"EPDM cover
strip.
• Old hatch curb to be removed and boarded up.
' Fan curbs to be flashed with EPDM flashing membrane,
■ Wal l to be vertically flashed and properly terminated(where it meet house).
Provide 20 year EPDM maaubuotureas materials guararebea.
Provide standard Aulson roofing two year workmartship guarantee.
" Carry all necessary insurance,workman's compensation and liability.
Remove all outsidejob related debris.
Any fees or permits will be charged as an additional cost to the coauack
Estimated By: Bruce Tinkharn
Weprcymr kareby falwortaa msdatds wdrabr,eanpLarw aroudmm with abaveapeefiearasn./�tUe roof
Five Thousand Two jt;dt d Eighty dollars and no teats SS,Z80.00
trues ate to to as
trt deposit, 113 at start,babnm at conoerim
All tnatmial is guacmnlesd to be as specified.All work to be a pleW in a substuAW wodnnanlik,mameraodordmg
to�iaations sotantaed,per sttu>detd praetias.Ally alkratian or deviation fo�rr alleve
apoeifieatiorrs inwhytg extra strata
71 be executed only upon writab orders,and will beromc an®dra charge mw and above the estimate.
All agrocuvmta conmtgent erg m strikes,eomdauts or delays bcytmd aq controI.owner to carry fire,tmnado and other,
nPurizary iasaremcc.Our wmkdta ale belly covered by Walkinan's compensation dusdrrintx.
Note:71ror proposal may be vn%dmwa if not accepted within 30 days
U ROOFING, A t ONA
ACCEFrANCE OF PROPCLW-The above Pelee;vperiac door and wadmon ace satitrmtory and an
You me nudwnwd to d"the wq0k as spedfifi Payment will be node as mrdlmd aI
2� -Z_ ss're
Date of AeceptAnoe 4-/o —
si8wmaae
_" .• EI'I'�tOFr
PUBLIC PROPERTY
DEPARTMENT
SntjK YAMAu"Lsr„s 01970
APPLICATION FOR THR REPAIR RENOVATION. CONSTRUCTION
DuMOLITION OR CHANGE OF USR OR OCCUPANCY FOR ANY EXIS wG
STRUCTURE OR BUILDING
1.0 317E INFORMATION
Location Narrw Building:
Property Addross:------- - -- --- -_. _ .
- ---- -----—
ScJrl e2 Xvfo
Pmpwty i•located in a;Cormewation Ares YIN Hlslorle DIskk*YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: S £W w 4 ;,N i s
Address:
Telephone: 7 F 7 S' 72 Z o
&0 COMPLETE THIS SECTION FOR WORK IN EYl821W0 BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
&d Description of Proposed Work: Go
, n owe c47lc/-L
----- ---Mail Permit to: ;:` ----
What is the current use of the Building? O(d 7-1 L
Material of Building? Vol,!> /�✓l� ^t< If dwelling.how many units?
Wits the Building Conform to law? Asbestos?
Architects Name
Address and Photo l 1
Medtanie's Name
Address and Photo
CAXN&Ucdm Supervisors License HlC Registration S
Estimated Cost of Project S dd-6 Permit Fee Caladadon
Permit Fes S g2
Estimated Cost X$71S1000 Residential
-- _ Estimated Cost S41/411000 Ccn""WcW-----
An Additional $5.00 Is added as an
Administrative dwg&
Male sure that all fields ars properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit tabulid to the a s stated
specftatlons. Signed under penalty of perjury
Date /a" 3°-07
�I
r
s