17 ANDREW ST - BPA-2008-330 RELINE CHIMNEY & ROOFING �Ur✓c
What is the curteM use of the Building? /
Material of Building? L✓ tf dwelling.how many units?
Will the Building Conform to L
Asbestos?
Amhit Wo Name
Address and Phone ( )
Medmuws Name
Address and Phone HIC �^Its 1 9
Construction supervisors Ucw"
Estimated Cost of Projed s CY0 _ o PermU Fee Calculation
Permit Fee: �v Estim W
atedCostX:71S7000Resident
Estimated Cost X$411$1000Commardat ---------An Additional t3.00 In added as an
Administrable charge. j
Make sure that all fields are properly and legibly written to avoid delays in procs"Ing.
The undersigned does hereby apply for a Building Permit to build to the a e stated
specifications. Signed under penalty of perjury
Date 9-1 J 07
Cal
N
s
y p VM
1
PUBLIC PROPERTY
DEPARTMENT x
%"Von 130 WADUH M STIEW•SMiW M. &UAQ4S4'M 01970
Tm-9. ?4&tM•FA=M74S.9e4e
APPLICATION FOR THE REPAIR RENOVATtoN_ c NSTRUC nON
DEMOLPPION.OR MANGLE OF USL OR OCCUP NCy, FOR ANy EXISTING
STRUCTURE OR HU LDWG
1.0 SITE INFORMATION
Location Name: Budding:
---- Property gddresx--- --- -- -.. - -- - — -- -- -- - _
17 *"i r S—
Property is located in a;Conservation Area YM Historic District YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN E7CI8ZIdQ BUILDINGa ONLY
Addition VNew
Renovation Number of Stories
Change in Use
Demolition
Approximate year of Area per floor (sf)
construction or renovation
of existing building
add Description of Proposed Work: � E rT�✓S of C��E�-T
sot rSlcJ /IE �fao J
——--- ---Mail Permit to: / 9,jw f w Jr; - - -
Aj.ilson Roofmg, Inc.
49 Denton Drive
Methuen,Massachusetts 01844
(978)975-4500 Fax:(978)975-0987
Pro osal
ff
ed to: Dore:
it woti 9795 16c3
� C 617-719-02016 8/30/2007
Job Nmne Com.operson Streetode Job Location
01970 17 Andrews Street,Sslem„MA 01970
We hereby propose to furnish labor and materials to install new shingle roof to manufactures
specifications by the following:
• This estimate covers the following shingle roof areas:
All roofs and flat roof. -
• Remove the existing(2)layers of shingles and felt down to the wood deck.
* The building will betarped during the removal process.
• Inspect for and replace any loose or rotted wood.
Any wood deck replacement would be an additional$6.00 per linear foot after first 16 linear feet.
We would match the existing decking as close possible.
• Our proposal is based on removal of two(2)layers.o€,shingles.Iffiire iiian additional
layer of shingles this would he an additional cost to the contract.
• Install ice and water shield 3 feet along the edge of roof and in valleys.
• Cover remainder of roof with 151b felt paper.
• All valleys to be weaved.
• The shingles will be installed by using roofing nails.
• The shingles that will be used are OAF Timberline. W
Your choice of color.
• Install new vent pipe flashing.
• Reuse and seal the existing sidewall and chimney flashing.Any new would be additional cost.
• Reuse and seal the existing hatch flashing.Any new would be additional cost.
* 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 on main house
and addition would be an additional$545.00 to the contract price.
* Clean and remove all outside job-related debris.
• Provide standard 30 year shingle manufacturer's guarantee.
* Provide standard Aulson Roofing,Inc.2 year workmanship guarantee.
• Carry all necessary worker's compensation and liability insurance.
• Any fees or permits will be an additional cost to the customer.
• The customer is responsible for preparation of interior of building(attic).
Contract Notes:
pe— To install new vented(Velux 101)skylight where hatch is would be an additional$675.00 to
the contract price. �W01(./I�f%lice• y ViC.r��w.�' �^et +eG u` -tgfi t�.w �S•',d@ �.a
Flashing on chimneys(3)has been tarred over. We will have to toter over if we use existing lead U
as
pdt flashing. To install new lead flashing would be$475.00 per chimney. ADO (3) @ /fro0• G�
Estimated By:Bruce Tinkham
We propose hereby to furnish manria&and tabor,mntprae in acenrdaepewith aboveepeditopdon,for rhesatn of
Seven Thousand Two Hundred Eighty dollars and no cent $7,280.00
Payment terns are to be as follows:
* 1/3 deposit,1/3 when half done,balance at completion
All material Is guaranteed to be as specified.All work to be completed in a substantial worKmanlike manner according
to speclficatlons submitted,per standard practices.Any alteration or deviation from above specifications involving extra costs
will be executed only upon written orders,and will become an extra charge over and above the estimate.
All agreements contingent upon strikes,accidents or delays beyond our control.Owner to tarty fire,tomado and other
necessary Insurance.Our workers are fully covered by Workmen's Compensation Insurance.
Note:This proposal.me be withdrawn B not axe ted within 30 it
Aulson Roofing,Inc.Aulhori Zed'Signatw
Acceptance of Proposal-The ebovapriow,specifications and conditions are satisfactory and are hereby accepted _
You ere authorized to do the work AS specified.Paymentwlll be made as outlined above.
Signature
Date of Acceptance 9' q • }
Signature
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\L�1,•a l�Vr.ltllt�Y::Ji�53E[T��.\Li'!1,k.\�Y\l.�/l�!11f�i4�
Ta:~45.4591 •FAX:9TW404M
Construction Debris Disposs( Aft1davit
(required fix all demolition and renovation work)
In accordance with the sixth edition of the State Building Code,7S0 CNIR section i 11.5
Debris,and the provisions of MOL a 40.S 54.
Building Permit N _ _ is issued with the condition that the debris resulting$oes
this work shall be disposed of in a properly licensed waste disposal facility as deRnod by%AGL c
tIL.4U0A.
The debris will be transported by:
- -- Iname of haula��—
fhe debris will be disposed of in
PeA�bc —f-���C�rE4` S�✓Jj� on,
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05/08/2007 15:31 9789750987 AULSON PAGE 01
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
:.utat R[F.Y uasaxl-L
M.vvtatt I=WAsh11%G10hiS7 EET4SAlas,MA$ACIIt1'*. IN019n
Tht:978-74195" s FAX:9M740-9846
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Annlicaut Information (� Please Print Leeibly
/O NjMe iauaiiwssrpnizuiorvindivulual): AtCL, e,,� / A lJ 14-6,/ .
Addrews: !� I LA V111a al 31 Q �—
city/Starcizip: $ Phone 0: 2b 97d-
Are yo an employer?Check the appropriate box: 'type of project(required):
1 I am a employer with 4. ❑ 1 am a general contractor and[
A 6, 0 New construction
employees(full and/or_part-time).• have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet
7. ❑ Remodeling - --
ship and have no employees. _ These sub-eoavactors have S. ❑ Demolition-
working for me in any capacity. workem'comp. insurance. 9. ❑ Building addition
(too workers'comp. insurance 5. ❑ We are a corporation and its
!0.❑Electrical repairs or additions
rcquirctL) officers have cxcrcixetl their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(No workers'comp. c. 152,f 1(4),and we have no 12.PNRtlof repairs
insurance required.) t employees. [T'o workers' 13.❑Other
comp. insurance required.]
'Ally UVlicaw that thetas boa NI must also lilt tam the well"Wow slaaiaa then workees cumpanswioe puliry infunnation.
'I I.mtoolsa a who submit this affidavit indicmina tAq am doiaa all work and thin hW omside canaacima mwt submit a new amdavil Wisaaing suck.
!C rxturs that eheslt this bole must attached tin additional Jaen showing the name artho suiYeomraclon and their wartime,amp.policy ine amatiue.
I um an employer that Is providing workers'compensation hsurance for any employees. Below is the pulley and jab site
iuiaratatioa r,/�� --�// � (
Imsurancr Company.Name: s'1�t�f
Policy q or Self-its. Lie.0: a 'U�A C�, d ._ Expiration Date:
Job site Address: 17 /- d8i"2.f s./ S'T CityistatUzip: 5;4L f.✓/
Artach 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.1GL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,560.00 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. Ile advised that a copy of this siateuant may be forwarded to the Of ice of
Inr.angmiutts of*the DIA for insurance coverage verification.
I do hereby tertW under the pains penalties afperjury that the in/brmallon provided above is true and correct
ed
Pluaw 7sV ? r,5'- 6 LC rlJ
OJjlcial use only. Do not wrire in dies area,to be cutoplded by e4 or town aJJleAd
City or'rown: Permiti11.1cense p
Issuing Authority(circle one):
I. hoard of Ilealth 2. Building Department J. City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: _ Phone q:
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,
esptess or implied,oral or written"
An errployrr is defined as-an individual,partnership.anochatiM corporation or other legal entity,or any two or more
of the ruregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
association or other legal entity,employing employees. However the
receiver or trustee of am individual.of mo partnership.' and who resides therein,or the occupant of the
owner of a dwelling hrntse having not roots than damapartments
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."
SILL chapter 152.¢25C(6)also states that"every state or local licensing agency than withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any
appllesat who has not produced acceptable evidence of compliance with the insurance coverage required."Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth not 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 ank if
necessary,supply sub,contacror(s)name(s)'adrkess(cs)and Phone number(a)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,are 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
,elf-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 u 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.
111ease be sure to till in the permitllicense number which will be used as a reference number. In addition,an applicant
that must subunit multiple permitilicense applications in any given year,need only subunit 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 rule for future permits or licenses. A new affidavit must be filled out each
year. When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. it slog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
1'ho 0f6ce 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 Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of lnvestiptlons
600 Washington Street
Boston MA 02111
Tel. # 617-72749M ext 406 or 1-977-MASSAFE
Fax#617-727-7749
Rcvi>ed 5-26-05 www.mass.gov/dia