18 TURNER ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards SALEM
,.
WMassachusetts State Building Code,Igo CMR t9{b SEP A�M 11
ev A}`aFj,?��
Building Permit Application To Construct,Repair,Renovate Or Demolish a
(� One-or Two-Family Dwelling
� ;'This Semon For oia1(ke .
Building Pemsh N ber . .:: Dare A ®rl:.
2d _
I
.�.laeilding ..cial(Prim t48oie) Signature
CIT(#V 1;S1TIC IO�IATI�N
1.1 Property Address:
ST 1.2 Assessors Map&Parcel Numbers
/SrT�R,vFr
l.la Is this an accepted street?yes_ no Map Number Parcel Npmber
13 Zoning Information: 1.4 Property Dimensions:
Zonvpg District Proposed Use Lot Area(sq it) 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:
Zone: _ Outside Flood Zone? Municipal❑ On site sal stem ❑
Public❑ Private❑ Check if es❑ P disposal sy
SECTION 2: PROPUTY.OWNERS.IiIPt
2.1 Ownerr of Record:
�[� 1Ei�rrN1 L) vim_ _��«/'?
Nam City,State,ZIP CW"Et
Ir I �rN�_c aMar� � c£wds , cep
No.and Street Telephone Emafl Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(eheck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ rOther ❑ Specify:
Brief Description Wc F F)xl Tf- 4
jw
wod P
eyFN F. d,-Y4 - B;Tf C 'g47 S/:o FJ
SECTION 4:ESTBf7ATED CONSTRUCTION COSTS
Item Estimated Costs: OfSeia]Use Only
(Labor and Materials
1.Building $ 1 Buikilng Permit Fee.$ Indicate how fee is determinech
Standard City/fown Application Fee
2.Electrical $ O Total Project Cost'(item 6)x multiplier x
3.Plumbing $ 2: Other Fees:
4.Mechanical (HVAC) $ '
5.Mechanical (Fire $ TOW Ali Fees:$
Su ression
Check No. Check Amount Cash Amount.
6.Total Project Cost: $�j ❑Paid in Full. ❑Outstanding Balance Due:
G4>� FO(Z- p u
a` 1013 �' } r�stc� _ rmaLX . oto.
SW MN 5: CONSTRUCTION 0MVICIsS
5. Construction supervisor License(CSL) o q q�7t —7 7 7.
T/r/ 1914r'? License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
Z Cf 6h l0-JK'-y S '� rj Description
No.and fivd
t c G U Unrei
strcted dm to000 w.R
J R Restricted l&2 Family Dwelling
City/rown,State,ZIP
Roofing Coverin
WS Window and Siding
Solid Fuel Busing Appliances
97d' F/.i/I3C (tyiN3i-9r -/3S'`J (dG^tA.�(e I
Insulation
Telephone Email I D Demolition
5.2 Registered Home�hnprovement Contractor(HIC) iii gj 1S 2 l
o'r a.5 O.J /C(Srt P.N /' HIC Registration Number Expiration Date
HIC ComOy4Name or HIC Regisgant Name
Ym ,.> c IJJ��
No.agd_s I ,✓U-- WiF `/'7r'r-/ Email address
Ci /rows State ZIP Tel hone
Sy&-noN&VV0RKXw4 cobIpENS TION EJSURANCE AFFIDAVIT @LGJ-e.152.4 25C(0)
Workers Compensation insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........0 No...........0
7a OWNRR AUTHORIZA .40N TO RIE COWI:ETRA WHEN
WNEIi'S AGgW QRCONTR AfTOR... 7?AR ' IN6PURMr
I,as Owner of the subject property,hereby authorize _
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SEMON 7b:OWNEW OR AUTHORIZI$D AGENT DECLARATION
By entering my name below,I hereby attest and the pains and penalties of perjury that all of the information
contained in this application is true and acc to the of my knowledge and understanding.
Print Owner's or Authorized Agent's Noffe(Electronic Signature) Dale
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
mm mass. op v/oca Information on the Construction Supervisor License can be found at wwnvntass. ov/d s
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 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
a 1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
�
Business/Organization Name: a /���l�G n// s`QCf
Address: ®o/�✓✓ � p >
City/State/Zip: `GT�t/FeV /0—
sPhone#: l ?� y�Cl
Are you an employer?Check the appropriate box: Business Type(required):
I:RTam a employer with employees(full and/ 5. ❑Retail
or part-time).* 6. ❑Restaurant/Bar/EatingEstablishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] 8. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing
no employees. [No workers' comp. insurance required]* 11.❑ Health Care
4.E] We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp.insurance req.] , 1213 Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#l.
I am an employer that is providing workers'compensation insurance�forr/my employees. Below is the policy information.
Insurance Company Name:
Insurer's Address:
City/State/Zip:
Policy#or Self-ins.Lic.# Expiration Date:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 agai t the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D "for insurance coverage verification.
I do hereby cer ' nder the pain enaltles ofperj th he information provided above is true and correct.
Sign p p.. /p Date:/ -se Z �C
Phone#• ! ?4 �l� 113. (FJRVC£ TirV_k49M
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. Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
Information and Instructions
Massachusetts 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 employer 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 or 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 that"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,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract 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 your insurance company's name,address and phone number along with a certificate of insurance.
Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members
or partners,are not required to cavy 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 Officials
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 fill in the permiUlicense number which will be used as a reference number.In addition,an applicant that
must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary). 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 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 dog license or permit to burn leaves etc.)said person is NOT required to complete this
affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
www.mass.gov/dia
Form Revised 02-23-15
ChYOFSALEAMASMASETT,
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lh 745-9993.
%Il�ERILYDI,
Fills 740.986
MA170it 7} issSZP
DHmcwa a PFLI c /oumn=
Construction Debris Disposo/Affidavit
(required forall demolition and.renovatibn work)•
In a=r&nw with the sbM edition of the State BuRAw Code, M CMR, Section 111.5 Debris,
and the provisim of MGL o10,S S4; BuildhW Permit fi is issued with the
condition that the debris resultbt from this work shah be disposed of in a properly licensed
waste deposit fadlity as defined by MGL c 111, S 150A.
The debris will be transported by.
(name of hauler)
The debris will be disposed of in:
(name of facility)
lei EJ 7- 57— A414C.,
(address of facility)
Signature of applicant
91-2 ?-_a
Date
Aulson Roofing, Inc.
49 Danton Drive
Methuen,MA 01844 , P� .
(978)9754500 Fax: (978)685-0753
Proposal BY EMAIL ONLY
cadeyo2608@gMgil.com
Proposal Submitted to: Phone: Date:
Catherine Deyo (978)979-9918 May 5, 2016
Street: Job Name Contact Person
18 Turner Street
City,State,Zip Code:. Job Locatlom
Salem,MA 01970 18 Turner St., Salem
We hereby purpose to furnish labor and materials to install new shingle roof to manufacturers
specifications by the following:
* This estimate covers the following shingle roof areas: front,left& right of main house(approx.
1500 sq.ft.).
* Remove the existing(2)layers of shingles and felt down to the wood deck.
s The building will be tarped during the removal process.
* Inspect for an replace any loose or rotted wood.
Any wood deck replacement would be an additional$5.00 per linear foot or$3.00 per square foot.
We would match the existing decking as close as possible.
* Our proposal is based on removal of two layer(s)of shingles. If there is additional
layer of shingles this would be an additional cost to the contract.
* Install ice and water shield 6 feet up on all eaves(heated areas only).
* Cover remainder of roof with synthetic underla ent.
Yr! Ym
* The shingles that will be used are G.A.F./ELK Timberline architectural;50 year limited lifetirne
guarantee.
* Your choice:of color: charcoal
* Install new vent pipe flashing up to 4 inches. Any larger will be properly sealed.
* Reuse and seal the existing sidewall and chimney flashing.
* Install 8 inch white aluminum drip edge along all eaves and rakes.
* To install a new concealed ridge vent to be covered with asphalt;shingles.
* Clean and remove all outside job-related debris.
* Provide standard shingle manufacturer's guarantee.,
* Provide standard Aulson Roofing,Inc. 2 year workmanship guarantee.
* Carryall necessary workers'compensation and liability insurance.
• Any fees or permits will be an additional cost to the customer.
* Contract Note: If entire roof area needs to have%" CDX plywood installed,it would
be an additional$2,600 to contract price.
Option No. 1: To remove dormer window and refurbish it off-site, prime,paint and
reinstall,would be$600.
Option No.2: To remove all wood trim on face of dormer, including rake and window and
install pre-primed wood to match as close as possible would be$900.
Please initial if electing any of the above options.
1
We propose hereby to furnish materials and labor,complete in accordance with above spedJlcation,for the sum of-, $6,338.00
Sia Thousand Three Hundred Thirty Eight Dollars and no cents.
Terms and Conditions:
1. Payment-Payment terms are as follows:
*Deposit of 1/3 down, 1/3,half done, balance upon substantial completion.
2. All monies due and payable shall accrue interest from the date such payment may be due
at a rate equal to 1 1/2%per month.
3. Permits,Fees,and Notices-Aulson will secure building permits and other permits. The
customer is responsible for the cost of said building permits and other permits, as well
as governmental fees,licenses and inspections.
4. Preparation-The customer shall be responsible for preparation and cleaning of interior
of the building, specifically the attic as small particles may fall into the attic from the roof.
5. Delay-If there is a delay at any time in progress of the work by an act or neglect of the
customer or contractor, change order, casualties,fire,weather or by other unavoidable
delays,the completion time shall be extended for a period equal to the time lost by
reason of such delay.
6. Changes-Changes in the work may be accomplished after execution of the contract,
and without invalidating the contract. Any alteration or deviation from the above
specifications involving extra costs will be executed only upon written orders, and
will become an extra charge over and above estimate.
7. Insurance-Customer to carry fire, tornado, and other liability/homeowner's insurance.
8. Disputes -Should any dispute arise between the parties arising out of this contract the
dispute shall be submitted by one parry to the other in writing and parties shall make a
good faith attempt to settle such dispute. If such dispute cannot be settled the venue to
resolve any disputes shall be in Lawrence,Essex County, Massachusetts.This
agreement shall be interpreted and enforced according to the laws of the Commonwealth
of Massachusetts. In the event Aulson is a party to any legal proceeding on account
of any acts or conduct of the Customer, Customer agrees to pay Aulson all reasonable
expenses including attorney's fees incurred in connection with the legal proceeding.
9. Claims and Back charges-Customer shall notify Aulson within seven(7)days, in writing,
of any circumstances arising from the performance of the work herein described,which
reasonably may be anticipated to result in a claim or back charge to Aulson.Aulson
shall not be liable for any claim or back charge where Aulson has not been notified in
the manner as set forth above.
10. Waiver of Claims-the making of final payment shall constitute a waiver of claims
(except as to the workmanship guarantee)by the customer.
11. Indemnification-Customer indemnifies Aulson from any damage or delay that is not
caused by Aulson or their negligence.
2
12. All contractors and subcontractors must be registered by the administrator.The name,
social security number,address and registration number of the contractor is:
Aulson Roofing,Inc.
Tax ID#04-2549953
49 Damon Drive,Methuen,MA 01844
Registration# 111969
13. Customer represents that he/she is the true owner of the job location.
14. Customer has a three(3)day cancellation right as stated under M.G.L.Chapter 142A,
Section 2, Subsection(8)as may be applicable.
15. In case one or more provisions of this proposal or any application thereof shall be
invalid,unenforceable,or illegal,the validity,enforceability and legality of the
remaining provisions and any other application thereof shall not be in any way be
impaired.
Estimated by:Bruce Tinkham
Aulson Roofing,Inc.authorized signature
Above specifications and terms and conditions are satisfactory and hereby accepted.
Payments will be made as outlined above:
Do not sign this contract if there are any blank spaces.
1I44
Signature Date acceptance
sn r
Note:This proposal may be withdrawn if not accepted within thirty(30)days.
3