0017 BARNES ROAD - BPA-06-171 ROOF .t.
No\�\
APPLICATION FOR
PTO
,577e4P
LOCATION
/? .&�eNeS �
PERMIT GRANTED
APP OVFD
oR OF B.UlUWNGV
1 .
gPWM A11 W fMA 9#ND ANPROVED BY we
JdSPJ:CT -PWR T7D A PEi1M AZING GRANItD
CITY OF_SALEM
No. sWe
wwd
zawq ow id
Is PIOP01Y tAmt1m of
ft t�itlotie O` Yu No lai]Aiaa r� gCU �e�
bPlOWYLoonledtn
N»Cionmr Mon AMR? Ye No
Permit to:
BUILDING PERMIT APPLICATION FOR:
�
(Circle whichever apply) Roof, Reroofl UNtall Sidin% Construct Deck, Shed, Pool.
Repo , oth.r:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSM
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build acoorft.to the folbwktp'
" oHications: /
Owners Name n
Address A Phone 1-7 (2)(A �`J r�V \ 4 i (q-M-7Ll 5- `7 qc? a
Architect's Name
Address d Phone i�
Mechanics Name t1(4Lrk'L �n/l�lS�r1PS
_/
Address A Phone ,� 6(P .f �l l lei wau ( g8b 11P ix - -lu&j
What Is Vo prpm it b~
md"d 6krdkq? N a for how runty rrnaa?
wa bAdnp m*ggn to haw? As6Ntlos?
fetNnntod colt JI54 (071 ply umm N aft Limes N
/J ` at Slign�alu ore f Applicant
SIGNED UNDER THE PENALTY'
OF PWUUIRY
DESCRIPTION OF WORK TO E DONE `
w
MAIL PERMIT T0:
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
_ 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition
of Building Permit# ,all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL cc R S 150A.
The debris will be disposed of at: J 0 A r ' . Y V VI t,U ' ( �' /wvJ
Location of Facility
F3 -11 --(Y
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
GfUA'-�
Name of Permit Applicant
Firm Name,if any
Address, City& State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cHL S 150A, and the building permits or licenses are to
indicate the location of the facility.
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluulbers
Applicant Information Please Print Legibly
r_
N (Busness/ rganization/Individual):
Address: �
City/State/Zip: ) & U) one #: FJ�B - Q 8 00
Are you an employer? Check the appropriate box: Type of project(required):
1.tI am a employer with )LO 4 ❑ I am a general contractor and I 6. ❑ 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. t ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their ME] Electrical repairs or additions
3. ❑ I am a homeowner doing all work right of exemption per MGL I LD Plumbing repairs or additions
myself. [No workers' cornp. c. 152, §1(4), and we have no 12.CK Roof repairs
insurance required.] t employees. [No workers'
13.❑ Other
comp- insurance required.]
Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information:
Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information.
am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
aformatlon..
osurance Company Name: y(��►(v t f�} f�r (\l ' 7
'olicy#or Self-ins-�Li1c. #: A-1 V C A /I/ZU D V I aDCA Expiration Date:
G IOC'„-�
A Site Address: 1 I b Ave 1� City/State/Zip: J/] I L t V l M(A- G (ddC J
Much a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ne 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
f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
ivestigadons of the DIA for insurance coverage verification.
do hereby/Icertif/y,under the pains and penalties ofperjury that the information provided above is true and correct
ignature l / Date:
hone#:
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.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
ACORD _ CERTIFICATE OF LIABIUTY INSURANCETHO
_ corrw=lm Is mmum A KATTM .�..
bralli L•aarweea LOwnq., Ine- OMIT "m Cowm MO mmm upm > oR
OT
HoLom "m tmrflio"'m am MOT #ARM,
11 ?><apwlo Ad. AL. TM WVEtl1E ArPOPOW 9T THE P9UCEa M9.OM-
alaont, MA. 02479
aMMlliRa AiT'DR CO•dMOF A "/
WIND
�wrior Iohutriaa, Int. Mrna�a 11Mnoadat..! Ins�lltrinr of was _
3 Giwat 11d. A!rl�c Mfrtr IAy_ Cb
a ........
7Y6F,tYl9 li
TE Foums OF OKMANEE upw K OW IMF M337 MUED TO THE WKWW MAAW ASOW FOP THE POILY PIFWD rpfiUID. ROTYMP/6T^WM
ANY Rfaumm w•T, raw On 1o•MQI OF AMT COMMAC7 OR O'/•EA DOfJBIBIT MATH MFBPECT TO M)WI n43 Cb•7FG1E W/ E '93" OR
MAT PtRrAK Tla aaMMM *VGft*D r M POIHZS DOiOEMED 043MM a 3LOEtT M ALL TTE I M/. FJOCUAaO•a AIO n0•dTTQ! of SUCH
,OUMi.AOOREQATT L"M SHOW*WYRAYE gM*WkM It M NAD CLAAW. ._.
e Twe asAlwnAr:: r'o,eriAM� a MM '�"
ar�auavrr � uo.aoo•.!� •L,000,000_
uaa�r��uVAn. • 100,000 _......
41-I-w-tm I12/17/04 12/17/OS agolOOAd ..
1 •wwrr•.ovwAAtr 11,000,000.
a.l�a+AwrAn •2,000_000.
•ACprTr-oars Arr 12,D00,,
•aR AAaaigTT un•+wEi.ioc
arTlAoaeurn. (c•arro aw ELL"I .1,000,000
A✓1 -
Au o.ao n,ry . m..A.w. • -
1C otouarnv 1317609 01/08/04 01/00/05 tia�
— ,®Nno• •oar uuer ., •
ti•edLLA
- noMnuJM� •
ANOa.ar.u•ormrt •
A.rau.aur.
•rtrrrto
only tlur uroc •
irglomAraai • -
a•cwua•!u u•ru•T '
•oar• ... ...
•
Af10111or •
�r maaarbAlA .
AMP n . . .. . ..._
ANC7011362012001 22/17/04 12/17/05 [a,wl ALman •2,000,000,
imam, rL mou"-M ana! A 1,000,000,
•w••.w.i ua•wA['roue.un • 1,000,ow
roan AaaAua��
WPM
,M W rA•ra••wrr,AaM••rMMlllfYa,YaJO Ar M mAM�A,OwiL AOWw
FOCATEHOLMM CMFCE"TOM
"it Tom m raw amnia MILL nowma » W 30 "a lAlal
roar to as agdM IY/w AW >e r �iT. N rArAE 10 m e MYL
!et m dar11•r a 1allR/ I wM we Vur na Wart Alma a
wrArr
AV11YMf�afMlla
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Regislrallon 144426
1.Elipna[IrJn 1P/aF2006
`{3y(sg Per wall
e Corporation
I SUPERIOR INDUSTRIE,$ YNC'
SEAN GREEN Iv.
33 GREAT RD
SHIRLEY, MA 01464 Adminisbalor
•
peed
INDUSTRIES, INC.
ROOFING GUTTERS RUBBER ROOFS
August 10, 2005
Robert Provencher
17 Barnes Avenue
Salem, MA.
Roof Will Be Hand Nailed Only
1. Details of area to be completed: Complete roof system on main roof of house.
2. Remove existing layers of asphalt shingles (1)and dispose of properly.
3. Completely de-nail roof and re-nail roofing boards as needed.
4. Replace any rotted or broken wood at no cost up to 100 square feet of plywood or 100 linear feet of
roof boards. (Additional square footage available at$2.25 per sq. ft. for %2' plywood or$4.00 per
linear foot for roof boards.)
5. Apply six feet of CertainTeed Winter Guard along the eaves of the roof, three feet along the
sidewalls, three feet around chimneys and pipes, three feet in all valleys and three feet along the
rakes.
6. Next, apply a CertainTeed Roofers Select felt paper to the remainder of exposed roofing area.
7. All wall flashing will be inspected and replaced as needed. Any and all rotted or damaged trim or
siding that needs to be replaced to ensure proper flashing will require a Master Carpenter and will
be billed out at an Hourly Rate plus material cost if completed by Superior Industries, Inc. Any and
all lead or copper wall flashing which needs to be replaced or installed will be done so at an
additional charge.
8. All skylights will have ice&water shield around them. Older skylights may require new flashing
kits, which will be purchased and installed by Superior Industries Inc. at an additional cost.
9. Chalk lines every five inches.
10. Install eight-inch aluminum drip edge to all rakes and eaves (White).
11. Install pipe flanges as needed. (1)
1-888-618-ROOF (7663)
978-425-0812 Fax
33 Great Road • Shirley, MA 01464
Serving New England
12. All slungles will ne tastenea using 1 -/a-1 -/z nana nans.
13. Apply a 30-year CertainTeed AR Shingle.
Color: Landmark- TBD.
14. Re-lead chimney? YES (1)
15. Install a CertainTeed Air Vent on the House to allow for proper ventilation. (YES)
16. Install 4"x 16"Rectangular Eave Vents?NO
17. Work site shall be cleaned on a daily basis and all areas will be gone over with a magnet to pick up
the nails.
18. Superior Industries will supply the customer with any and all permits pertaining to the job.
19. Superior Industries will furnish a CertainTeed SureStart warranty that entitles homeowner to fifteen
full years of non-prorated coverage including labor, materials, workmanship errors and disposal
costs.
20. Superior Industries will supply the customer with a liability ($2,000,000.00) and workers'
compensation($1,000,000.00)insurance certificate. (All workers are employees,not
subcontractors.) Massachusetts License#144428. Better Business Bureau#83356.
21. 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 the
estimate.
22. Any and all carpentry work that is not stated in this contract will NOT start until the roof is
complete and paid in full.
23. Payment to be made as follows: 1/3 deposit due upon signing, 1/3 due halfway through the job and
the balance due upon completion of the job.
All Jobs to be started approximately 30 days after contract is signed& deposit is paid
(Pending Weather)
Cost: $9,375.00 Complete Roofing System
$300.00 Re-Lead Chimney
$3,996.00 Re-plywood main roof of house
$1,400.00 Furnish and install 2 new skylights and 2 new flashing kits
$600.00 Furnish and install new soffit vents
Total: $15,671.00
Prior to Superior Industries Inc. commencing the roofing project, a Superior Representative must
Inspect the attic for m �
( a es rep) (� (Customer)
COMMENTS: Be extremely careful around all foundation gardens. Additional carpentry work that
needs to be done will be done at an hourly rate of$65/hour for a master carpenter and $35/hour for
an apprentice(if needed). Thank you for the opportunity to earn your business. If you have any
questions, please give me a call (978) 580-0069. Once again,thank you,Tyler Dyer.
IffaME�MBEERRn , @qs� ■r. E■�e W M s(ML fllfe
^QO
f ELECi
$HINGE[ROOfLR'
Q812t11nTEed® INDUSTRIES, INC. 4ENCA
enrwunam,w.
ROOFING CONTRACT
Sales RepAr?
T
This ROOFING CONTRACT(this"Contract")between contractor(the"Contractor")and owner(the"Owner")named below
OWNER( CONTRACTOR
Name: SUPERIOR INDUSTRIES,INC.
Address: 1'7 S. A. cj 33 Great Road
City: Sq,e N Shirley,MA 01464
State: CA AI Zip: 0070 888618-7663 Ext: � Z
�
Mailing address(if different): T�7�')Sk0-Doe.4 Cell Number
Address: Registration#: 144428 Exp.10-4-06
City: Federal Tax ID#:043518271
State: Zip:
Day: Evening:Cjr7X)7Y1=7K,,"la Alt(�)7S-&- iD79
We propose hereby to furnish mater/a/and labor-complete in accordance with specifications below:
Existing Roof consists of#of Conmplayers #of Wood layers Ridgetoinstall /�
Roo tto nstall: Manufacture CfER^A N'(ifrE� Type Ct}A,t'y�xy p2,PCC,�20 Color11WeSf0N6 i�2h/
Drip Edge ❑ Vented Drip Edge (Color) W 14F '71i 2 Ae-lead Chimney [2 Soffit Vents (4'X16")Approx.Quantity�s[_
This contract is dated _$�/O�doa f— (Month/Day/Year). The work under the Contract is scheduled to begin
on or about q�D�aOn— (Month/Day/Year)and is scheduled to be substantially completed on or
about (Month/Day/Year);provided, however(I)such scheduled dates of
beginning and Completion are subject o change due to unforeseen circumstances,and(b)the Contractor shall have no obligation to begin work until the
Owner has paid the Initial Advance(as hereinafter defined). The scheduled dates for beginning and completion are estimates only,and the Contractor
shall have no responsibility or liability for reasonable delays in beginning and completing the work hereunder. In addition.the Contractor shall have no
responsibility or liability for any delays arising from permitting requirements,the Owner's loan approval and funding,loan disbursement,acts of God
weather,strikes,lockouts,boycotts,or other local labor union activities,lob changes requested by the Owner,inability to secure materials,labor Shortages,
failure of the Owner to make payments when due,delays Caused by inspections,changes caused by inspectors,delays by the Owner in making
selections,or any other cause beyond the Contractor's control.
The work described below is to be performed at the following property(the"Property'):/7 EC H e;v,.I 1H�fM
The loliawing is a detailed description of the Work to be performed and the materials to be used in the performance of this Com or:Refer to ettae-fieeN estimate.
Such work and materials are hereinafter referred to as the"Work" This Contract shall not be Construed as requiring the Contractor to perform any
work or to install any items or materials except expressly set forth above. In the event that the Con actR�i that certain materials are not
readily available,the Contractor reserves the right to substitute materials of equal or greater value.
D0 DD
Prior to the Contractor beginning the Work,the Owner shall pay to the Contractor the sum Of$ s- as� s (the"Initial Payment')in
advance,which amount(if this Contract is for Residential Contracting)shall not exceed the greater of o -third o the total contract price or the actual
cost of any materials Or equipment of a special order or custom made nature,which must be ordered in advance of the commencement to the Work.
Thereafter,the Owner shall make progress payments to the Contractor as follows: 1/3 Deposit.-i/3 Middle Payment-1/3 Final Payment.
The owner Is signing below to acknowledge that the Owner has been advised of this cancellation right described In detail on the back of
this Contract and also on the notice of cancellation form.
/ / n OWNER:
Print Name: 5ji.AR0•V a kUCj`('f`-Q Print Name:
ALTERNATIVE DISPUTE RESOLUTION
(SEE aACR SIDE OF CONTRACT,NUMBER 29,FOR OETALLEO DESCRIPTION)
THE CONTRACTOR AND THE HOMEOWNER MUTUALLY AGREE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY
INITIATE ALTERNATIVE DISPUTE RESOLUTION THROUGH ANY PRIVATE ARBITRATION SERVICES APPROVED BY THE DIRECTOR OF CONSUMER AFFAIRS AND BUSINESS
REGULATION,UNDER PARAGRAPHS(a)TO(e).INCLUSIVE,OF SECTION
FOUR OFTHE HOME IMP VEMENT CONTRACTOR LAW
CONTRA�CT{Q,�f���UPERIOR DUSTRI�ES,INC.By/_ /- z Date: r�tZ6,4 dal
OWNE6r'XX?l/.�: (,: Print Na Date: 6 —/C —O.S
OWNER: Print Name: Date:
BY SIGNING THIS CONTRACT YOU ARE ACCEPTING ALL TERMS AND CONDITIONS
DO NOT SIGN THIS CONTR CT IF THPIEARE ANY BLANK SPACES.
CONTRACT U RIO IN ST IES,INC.By Date:
OWNE iN V Date: CIO
OWNS Print Name: Date:
I METR