BAKERS ISLAND - BUILDING INSPECTION (26) L16ioq
7 I lie C ommo1111e.111I1 of INLIssachusclls
1: ,� —BuarJ ul Building Regulations and Standards CI'I'1'OF
\lassa IR'selts SMIC Building Code. 7SO C NIR SALEM
Krri.,eJ Ibrr_'nll
Building Permit r\pplic;ttiun To Construct, Repair, Renovate Or Dumulish a
Oite-or Tn u-kanulr 1)u rllin,\r
This Section Fur Otlicial Use Onl
Building Permit Number: Date plied:
r IIuilJiny l)Ilicial(Print Muriel Sigrtaturc p
RSECTION 1:SITE INFORMATION
Z
Prop Address: 1.1 Assessor 6lap h Parcel Numbers
� K�� �Lgrrr)
Is this an acre led street?yes n Map Numher Purcel Nunsher
oning Information; 1.4 Property Dimensions:
y District Proposed lire 1Lo(Ar;:a(s4ii1—) — Frontage(Itl
uilding Setbacks(R)
Front Yurd Side Yards Rear MYod
quired Provided Required Provided Rrqufrcd
ater Supply:IM.G.I.c.Jo.§Ja) 1.7 Flood Zone Information: 1.3 Sewage Disposa❑ Pris ate❑ Zone: Outside Flood'Lone? Municipd O On sits d Check if cs❑
SECTION ]; PROPERTY OWNERSHIP'
nerl of Record:
X syWV6,rs! f it/7�9j �n!/°�` S.9Grri'� r"f� O/5 7 G
rlN) r-- �Cuy.Sluta.l.IP
SSFx TT C?7�Steel relrphune Email Address
SECTION Js DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction ❑ Existing Building❑ towner•Occupied ❑ Repairsls) O Alteratlonls) O Addition ❑
Demolition O FAccessory Bldg. ❑ 1Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work : ,* -F,,7 f-may cy,F ' wd' ee
Kcs=os� S Hd�r s
L v9 rSi cTq.yT Fss or NI"/✓l
SECTION J: ESTI,\IATED CONSTRUCTION COSTS
Runs Estimated Costs: '
Labor and Materials) Oft NI Use Only
I. Building S I. Building Permit Fee: f Indicate how lee is determined:
2. hlvetrical S ❑Standard City ty,Tossn Applicasion Fee
O Total Project C'Ostr t Item O x multiplier
t I'Iunlh1°g S =. UlhcrFecs: S_ — /
J. \Iech.Inic.d III\ ul 5 List: _. �5700
\IedLwiad JOT,
(((���
S r,rtal .\II Fees: S
FI��ressiunr '
n Pohl Project Cunt: S ri, ( hcd \u. — __( IlecA .\nun M: . _. ;._..C',Ish \,nomil:
4sU ��l/ 0 P.Iid in Full ❑Unlsl;mding I1.ILulce Due:
N f: CONS I'RI C'rlON .SEmu hS
4.1 C'unstrucIlull Supenieur License(C'SI.) _
// I Icon>c \unlh.r I\pirdion D.nc
.\',wle ot'CSI Ihddcr list C St. I'�N 1•ec
PQ—
Nu .md Street ._._.---- t1 I�nreslridcJ tlLulJin s li to 11,UIItl w. IL1
IC Ne,tricled LCi ICund IAtcllin
RC• it,lotinit Coterillit
µ'S µ'indow,au Will
SF Solid Fucl Burning Appliances
1 Insulation
10, hone
f mail uJJrcas U Demolition
411 Registered Ilume Impruvement Cuntnlctor(IIIC) _
C 4� IIIC 1(cgisintwo N..oNr f.cpindiun DuW
111 'C'onlpau) Nana or I IIC Itcgislmnt Name
Email uJdreas
No, and SInM
City/Town, State ZIP ftme
fcl
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152. 1 25C(6))
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 AMdavit Attached? Yes ..........C! No ...........O
SECTION J OWNER AUTHORIZATION TO BE C0111PLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property,hereby authorize
to act on my behplf,in all matters relative to work authorized by this building permit application.
Date
Print Ut.ner's Nane(Elcewnic.Signature)
SECTION 7b:OWNI I OR AUTIIORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest ultder the painLpeZties of perjury that all of the inlurmntiun
contained itt this application is true and Decorate teba viedge and understandiltg,
i 6- 2e
Prim Uttncr'sur:\uthorircJ,\can's Nanw lGlcctrunic 5i rmuel
Dale
VOTES:
I. .\n Owner ho obtains a building permit to do his.her own nark,or an owner who hires an unregistered contractor
w
(not registered in the Hume Improvement Contractor I HICI Program),will no have access to the nrbitretiun
program or guarani) fund under\I.G.L. c. IJ?.A. Other imponant information on the HIC Program can be Ihund at
tt st+t mn. ;,'+ •s I Information on the Construction Supenisor License can be found at++,t.+ Iu.1•° 'd't 'll+`
\\hen substantial twrk is planned,prus idc the ioturmatiun below
total flour area I+y. Il.l . _--_.._1 ineluding garage, finished basement iltics,decks or porch)
Ilabilable rout"count ._ _, ... .
Grois I"olg area 1$4. ll ) .._ Number ol'bedruoms
i
\umberoflialt'halhs I
Numherothathwomi - \lm+herol'dccki porches
I pc of I1co11llg ;)`letu tt wo
I�pc„I aa`Gng .�.tem
I'nclo,cd I
1 "I' LII Pr+yeCl $Ilu;lre l'on6lgc n1.111`e .11h,titutpl l'or "lolal I'rujed("Ill"
`t. C['CY OF 5.\I.E.1,[, NWSACHUSETTS
' s UL'ILOING DEP.IICf>I�NT
120 %V,%SHLN(;TON $TitEET, ) FLUUZ
-EL (978) 745-9595
FAA(978) 710.9846
<l�lOk tl�Y DR)SCOLL
L1Y0 Z T)IOSL\3 ST.P1EQR8
DIAEli OF Punic.PROPERTY/OCrMi 00}LtiIISSMNER
Worker' Curnpensation Insurance,w7davit: 13uilders/Contructurr/ElectrlcfansJPlumbl
li I alleant Inrormatlno (ease Print Legibly
NainC tlhui'rs.oUrg,amralium Individual):
�tJdlc'Sa:
City/Srale/Zipt Phune i
I'lil An vmploye6r Check the appropriate boat
ll of project(required):
I. un a employer with J, ❑ I an a general contractor and 1
employees(W and/or part-time).• have hirad the subcontractors 6• ❑New cunvructian
2.0 1 am a sole proprietor or partner• lived on the attached sheet t r• ❑ Remodeling
.,hip and have no employees These sub-eontracton have tl, Demolition
working for me in any capacity workers'camp,insurtiall ,
INo worker'callinsurance 5. 0 We area corporation and its y ❑Building addition
nquil l oftli have etterti Chair 11i Electrical repairs or additions
J.❑ 1 in a homeuwner doing all work right of uaetnptiun per MGL I I.0 Plumbing replan or additions
myself.(No workers'camp, C. I52. 4I(4),and we have no 12.0 Roof rupain insurance required.l t ompluyeex(No warkers'
comp, insurance nyuirad.l 13,C]Other
•.%-ty:,pplh:ue nuW ehmYd bad It"I eleo fill uul the lecliva but uw.hawing'h p
eir waken'Comfit" 'fun pulicy "All—ill'I h.muuwra�n when l l'hid U}Ir4vi1 indli they ud doing cll,wrk and'Arn Ain Wields rdnllaefpd intuit n,hmll d n aITlJaril in ch
dlaing,u
'r,ntrxWn'ha1 cAvik'hie boa mudl a'tacAud an adduiurud.heel,hawing the nwnd of the rul.eunamturd rnd their wndgrd'comp.policy Inrarnuadae.
/urn un ruWpluyn/hut 6 pruvlJ/nX worker'eumprurmlun lnsnraner�or my rmp/uyrrx Bduw l die po/lay and/u6 rJJe
in�unuuJlnn.
In.,ur.Inee Company Name• /
L
Policy J or SCIi i'U. Lie. d:
---�A7
Eapiruaian Data:
Job Site Address: City/Stutil 1p:
.\/rash a copy of the workers'compenit policy declaraHalt page(allowing the policy number and expiration data).
"lilura to seaua cuvenge as required under.4eetion?JA arStGL c. 152 can lead to the imposition orcriminal penalties era
nnc up w S I,SCU.01)und/ur one-year irttpri..1alI, is Weil as civil penahies in this form of a STOP WORK ORDER and a lino
•:f tqr ro 5?SO.UO J Jay against the violator. Ile adv that A copy of this nrily rent may bo furwardad to the Dllice of
I,n rstig�'iun.+,ti div f11.A Ibr insurance cover, vc lie�liun.
/,lu/rrrrby rrrri r rJrr drs point wrJ rnul r.r•:/perjury Jrul r/rr Lrfunrrurlmr pruviJaJ about it oar urJ rurrrrc
. , 177f
r7/jicivl r..e only. /7.r,roJ nrilrin!/rir.arru, N.Sr rmup/NrJ by City ur lutcn of/Jrr�[
I•,ui u'�,\u'harily icirele uaa): .—._. - . -._
I. hoard ill Iloahh ocp.lr tilt,,,, 1,
9. tLher _. . __._. . ._._ Iilp'futut Clark 1, i•aeetrical h'q'ccrnr i. I'luot bin4 L'rp,'c Wr
l:a„1.1.1 i'rr I•to:
Ihone l:
^� CITY OF S.u.E.ai, AkSS.1CFiL'SETTS
JULWLNG DEPAMLLVT
I '0 WASHLVGTON STRESr, J`FLOOR
Itl. i97� 7�S-9S9S
KJAME t -SY ORLSCOLii. F.Vt(97� 714984d
.MAYOR I}iOSLLf SLP[Elu
DIU TOE OP pL Bt tC nopritTY/St Q,DLNG co.wasstON EA
Conitruction Debris D13pos31 At'tidavit
(required for all demolition and renovation work)
In accordance with the sixth edition Oahe State Building Code, 730 CMR section I 11.1
Debris, and the previsions of MGL a 40, S 54;
Building Permit b is issued with the condition that the debris resulting from
this work shall be disposed of in a property licemed waste disposal facility as defined by hIGL c
I I I. S 150A.
The debris will be transported by:
The debris will be disposed of in :
(name or fac+lily)
(Jddretf orficdily)
+�ln�r+rro of permit ipplicint
:ua
Memorandum of Agreement
Between The Aulson Company LLC and the Essex National Heritage Commission
Bakers Island Roofing
Exhibit A
The
Cotnnaz3v. , LLC
May 31,2012
Essex National Heritage Commission
221 Essex Street
Salem,MA 01970
Attn,: Ms.Annie C.Harris
Re:Baker's Island Roofing
Dear Ms.Harris:
The Aulson Company, LLC (Aulson)is pleased to offer our proposal for the above
referenced project.Aulson is an environmental specialty,roofing and paint contractor and
is SSPC QP-1,QP-2 certified contractor.
We are pleased to offer this proposal based on the scope of work supplied by you.
Scope of Work:
Remove and dispose of existing roof shingle system from both houses. Install new
roof shingle system(Architectural 50 Year Shingle).Re-lead chimneys if needed.
Scope of Supply: Aulson will supply the following.
Trained and experienced supervision.
Trained and experienced workers.
Equipment and materials for our scope of work.
Aulson's Standard Insurance.
PRICE:
Roof Removal and Installation Lump Sum: $19,975.00
Waste Disposal Lump Sum: $ 1,200.00
Re-Lead Chimneys Per Chimney: $ 525.00
Terms: 1/3 at contract signing, 1/3 at 50°A completed and 1/3 at substantial completion.
Conditions& Oualifications: We expect EN.H.C.to provide:
Permanent lay down area next to the building, storage,permits,security.
Inspect and sign-off sections of approved work as it is completed.
Aulson will not be held responsible for additional work required within areas that
have been completed and approved as per this contract.
Our proposal specifically excludes liquidated damages and is based on a mutually
agreed upon schedule.
All change order work performed shall be billed and paid in the current requisition
period.
All work will be performed during regular hours as specified unless otherwise noted.
Layout,engineering and third party monitoring,sampling and inspections.
We expect any special requirements for the government, City of Salem,or any
other agency work to be arranged by you and it is not included in this contract.
We anticipate the following:
We have not made any assumptions towards the existence of unidentified hazardous
materials.
All materials, equipment,waste will be transported on and off the island by others.
Aulson's work to be from 8 to 12 hour days per Aulson's project manager daily
decision depending on atmospheric conditions.
We have not included the repair of any deficient existing conditions or created during
our work.
Unless directly specified on this proposal,our price excludes bonds,winter conditions,
overtime,police details and dumpster(s).
We have not included the replacement of any materials but as per our SOW.
We took forward to working with you on this project.
Sincerely,
ftetB me
Chris V.Pocoli,Chief Engineer
The Aulson Company,LLC
1.99 Pond Street,Georgetown,MA 01833
Tel: (978)500-0248 Fax: (978)585-0753
Preflight Parking Pass https://www.preflightparking.com/Reservation/ResReceipt.aspx?Recei...
1 of 2 6/24/2012 10:01 PM
E Sex NA r 10 N. 1. H F. FiT:1cE Coat %11s s1oN 22:F%s Strw-Swim 44 Salem.MA 01970
978.740.0444 M—979-744.6173
%Vmv.e sQ: 11rdit age.L,mg
11. CHANGES: This Agreement may only be changed by written agreement which specifies
the terms being revised and which has been signed by both parties hereto.
12. TERMINATION: This Agreement may be terminated by either party upon ten(10)
days' written notice should the other parry fail substantially to perform in accordance
with its terms through no fault of the party initiating the termination.
13. DISPUTES: In an effort to resolve any conflicts that arise during the project or following
the project's completion,Essex Heritage and the Consultant agree that all disputes
between them arising out of or relating to this Agreement shall be submitted to
nonbinding mediation unless the parties mutually agree otherwise.
BOTH PARTIES HERETO WARRANT AND REPRESENT that they have full right,power
and authority to execute this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as specified below.
Annie C. Harris,Executive Director Chris V. Pocoli,Chief Engineer
Essex National Heritage Commission,Inc. The Aulson Company,LLC
221 Essex Street, Suite 41, Salem,MA 01970 199 Pond Street, Georgetown,MA 01833
arm ieh(a)�essexheri tape.org chrispnaulsonlIc.com
w(978)740-0444;c(617)680-3230 w(978)500-0248;c(978)609-7526
BY:
Signature Signature
Q O 1 2-
Date Dat
i
Ogee of Co¢s¢mer Atf¢irs&Ba8n1lss R
ti¢¢
_ OME IMPROVEMENT CONTRACTOR
Type
Regishahon 11'1969 UP01ament
Exp�retf4rx z/yZa'F3.,: ,
AULSON ROOFING" iNC
Bruce-TinkhM
ONO
49 DANTON OR
METHUEN,MA Undersei retary
--License or registration valid for individat a only
` to: .
before the expiration date- If found rem latioa
Office of Consumer Affairs and Business
LeP
10 Park Plaza-Sol,5170
Card Boston,MA 112116
i
l
Not valid without signatare _
J
a
Massachusetts- Department of Public.Safeth
111111M Board of Building Regulations :mtl Standard
Construction Supervisor Specialty License
License: CS SL 999n
Restricted to: RF,WS,IC
BRUCE TINKHAM
20 BALDWIN STREET.
PEABODY, MA 01960
Expiration: a11312D13 ,
— _ ('onnnis.ianer Tr*`: 401
t
JUN-27-2012 21:01 P.01/01
`' CERTIFICATE OF LIABILITY INSURANCE °^0"Y1e41%. 112
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: II the certificate holder is an ADDITIONAL INSURED,the policy(es)must bs endorsed H SUBROGATION IS WAIVED,subject to
the terms and conditions of Me policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In 0eu of such endorsame s.
PRODUCER 781-93541"0 CON -
D SSenetl8 Insurance Agey,ine. 781 A335645 PHONECL
—
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100 Unicom Park Drive
Woburn,MA 01801 AULSO 2
g RealS1 ATTDNWNOCOVERAGE _ NAICe
INSURED Aulson Roofing,Inc INSURER A:Star Surplus Li as Ins Co
AWaon Industrial Services Inc WsuREne:The Commerce Insurance Com - _
49 Danton Drive INSURER c:Star Insurance Company— _ 1012245
Methuen MA01844 INSURERD: _--_-- —-- I —.—
_IN SURERE: _ - -__—
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANOING ANY REOUIREMENT, 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
estro EFT V LIMITSIL TYPE OF INSURANCrm
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Abatement Liao. I GENERAL AGGREGATE I S 2,000,00
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AGGREGATE :3 5:D00,00
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CERTIFICATE HOWER CANCELLATION
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SHOULD ANY OF THE ABOVE DESCaaRD3FA POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PAI SION NOTICE BILL BE DELIVERED IN
AUTHIr REPRESENTA E
® 988-2009 ACO TION. All rights neerved:
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