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Salem Historical Commission
f2o WASHINOMN STREET SALLEM ns 01970 For Office Use On1v
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APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
Pursuant to the Historic District's Act(M.G.L. Chapter 40C)and the Salem Historical Commission Ordinance,
application is hereby made for issuance of a Certificate of Appropriateness for.
❑ New Construction O Moving ❑ Reconstruction Alteration,c� �l/�}�
❑ Demolition ❑Painting Sign
Other Nfi
District: ❑Derby Street ❑Lafayette Street Wclntire ❑Washington Square
Address of Property: ST• LOIL776
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
Please t)y)e or print clearli AItaclt arklWom lslJerts,asneces,r'O,' 4jY#
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KName of Applican Ownerontracto ena t❑0ther:
Signature: Date: I
TeI.#: E-mail Address-
Certtftcare will be mailed to the owner unless alherx e indicated h c:
Certificate should be mailed to; Name
Mailing address.§.L �k City. $ta Zip: ��
ROOFING Re- Measure & PIL
Customers Name and Town: v Aid, 3 C - - Tech: '
Diagram-(bird's eye view) Pitch- X 112 (ex. 612 is 6 pitch)
aQ�� 4�4t. ��G 3 = �►t
I 1311
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Don't forget pitch multiplied! unit$ Total$
Low Pitch Roof Layers Total:
Steep Pitch Roof Layers Total:
Total Roofing Area
Additional demo Surcharge SQ. Type
Rafter Vents (Baffles) Qty.
Ridge Vent. Ft ��j� Skylight Size Qty
Color of new drip edge Skylight Size Qty.
Caps Soffit vents size Qty.
Chimney Re-leading 33
Sidewall step flasing
Gutters: Qty. unit$ Total$ Box Vent Size Qty.
Gutters. Box Vent Size Qty.
Dows out: Permiting $
Miters: Dumpster $
Gutter uards $
Gutter Total $
Other $
Total is
Leak-Proof Rorsirm System Scope of Work(Asphalt Shin le)
Project Name&Address.
Area for work to be performed. Pk RJ— L- NOT included areas- Lr#{
Resklenua Commercial Not
Comprehensive Limited Lifetime Warrant Coverage: (5,-years: t2,yaarsi Eugiele
' Labor Ql ❑ ❑
' Workmanship ❑ ❑
` Materials ❑
• Incidentals [Y ❑ [
• 1-time Transferable lid ❑ ❑
NOT
Surface Preparation &Details: Included Included
' Building Permit(as needed) ✓"
' Removal,of up to 2 existing layers of roofing !/
' Dumpsler if needed)&Rubbish Removal Locabon ?
' Inspection of sheathing&penetration flashing_._Re•nat loose boards as needed)
' Sheathing rat replacement priced at S 9 1. per 4x8 it sect on f S. per board It
' Protect house and bushes Clean and remove all debns when finished l�
Protective Products:
1 Premium Ica and Water Shield:Granulated.6 ft from lower edges,in va'eys,around roof penetrations&on
low-slope areas
2 Non-Absorbing lfnderlayment: Prem um Synthetic Undarlayment to all surfaces not receiving Ice&Water
shield.
3 Drip Edge;Superior 8"Aluminum Drip Edge to all roof edges including lower edges and rake edges.
Cobr ❑white ❑ brown Elsilver metal ?
4 Pipe Vent Boots:Install new Adjustable Pipe Vent Boots to all existing tpe vents.
5 High Wind Starter Strip,H' h Performance Starter Slri
Shin les:
6 Manufacturer;
Product:
Color: Slatestone Gray
NOT Priced
Ventilation: Included Included separate
T Ridge Vent: High Performance Rg d External Baffle Vent
S Soffit Vents: type and size-
9 Rafter Vents(Baffles):(Only where eaves are accessible from attic Interior access will be needed
10 Roof Top Vents:(Static# (So!ar# } v
NOT Priced
Optional: NOT
Included Separate
11 Aluminum Sidewall Step Flashing+Ice&Water Shield: Ar tK
12 Chimne Re-Leading Replace lead counter noshing on chimney
13 Replace Sk i' hts.(Type- Model-. Quantity } fnteror coor.white L/
Leave existing skylights and install new counter flashing.
14 Gutters:Seamless Aluminum Color. Size: Downspout Size:
Gutter Guards: Gutter Guards Color
O er Notes and O lions:
F Tr c N r'
Customer elgrees I&this roof scope bs specified o*fbardjez 00 08 1 2020
Specific Areas NOT Included:We understand the following surfaces are to receive no work:
• Chimney repair work and re-leading(unless specified above) • AO other permss required by the sly not mentioned above
0 All areas and surfaces not merittoned above 0 Ventlrg on hip rid 'See warranty for details
Clarifications: Basic cleanup will be observed at the end of each working day thorough at proiect completion We understand that if needed,landscaping will be cut hack
away from the house by the homeowner or others p.ior to starting the work See Definitions and Conditions en the back of this page for explanations of terms
WHITE OFF CE YELLOW CUSTOMER Doc ID:8402M1VF=97e0cb342c9958b31d041 aa01[70