271 LAFAYETTE ST - BUILDING INSPECTION Cf,ty of
PL Rr.lc PlzcW] izrN�
11, -178'-IS-95';5
APPLICATION FOR PLAN E XAiMINATION AND 13UILDIN(; 1'EI2MIT 1
ALL STRUCTURES EXCEPeTpl AND 2. FAMILY DWELI_7NCS
INIPORTANY:Apelicarus must complete all items on this page
SITE INFORMATION -
Location Name Building—
Property Address( isirr-
Map#
L,o<.:ated in: Conservation Area YM Historic district YiN
Use Croups
(check one)
Residential(3 or more Units).
Type of improvement Residential(hotel/motel RI _
(check one) Assembly(churches) AI _
New Building_ Assembly(nightclubs etc) A2_
Addition Assembly(restaurants, recreation) A3_
Alteration Business B_
Repair/Replacement Educational E_
Demolition Factory(moderate hazard) F1 _
Move/Relocate Factory(low hazard) F2
Foundation Only___._ High Hazard If_
Accessory Building Institutional (residential care) I _
Other(describe) Institutional (incapacitated) 12_
Institutional (restrained) 13
Mercantile :tiI—
Storage(moderate hazard) sl —
`Stoiage(low hazard) *gft,,,,.d S2
OWNERSIIII'INFORNIA'HON(Please type or Print Clearly)
OWNER Nat,e
Address
Telephone 6 ` -7.
DESCRII''HON OF WORK'1'0 BE PERFORMED
ESTIMATED CONS'1'llUCTION COST
CONTRACTOR INFORMATION f� ^ f 4 Name 17 ur L.YDIL/ Y
Address 4f 9 Dra 'ra., Del
Telephone cr7� �?S L/S�
Construction Supervisor's Lic # C3�' f}Tl 4�i-,(
Home Improvement Contractor# 0f17- S-4 5- S_
ARCHITECT/ENGINEER INFORMATION
Name
Address
Telephone
Mass. Registration #
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00 =
Commercial est. cost x $11/$1,000 + $5.00=
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of nzy knowledge under the penalties of perjrtry
.Signed
Date c�,
01 :05 9769691265 CORNERLOT APPRAISAL PAGE 02
r
Aulson Roofing, Inc.
PY 49 Denton tts 01
Methuen,Massachusetts O1844
(978)975-4500 Fax:(978)9754)987
Pro osal
P,apwad eaemwedW p4sac Dail.,
Rich Newburg (617)939-8584 5/23/2008
Jrieer Joe AFAIW C,a.aaarPertm
271 Lafayette Street
Cm:score,ay race Jab LoonO A
gay MA 271 Lafayette Street,Salem,MA
We hereby propose to farnlsh labor and aartena/a to hralaN new shbrgle roof to maaafaclares
apedfleadvas by rhefot7owing
• This estimate covers the following shingle roof areas.Front,left and rear.
• Remove the existing(3)layers of shingles and felt down to the wood deck.
• The building will be tarped 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
We would match the existing diking as close as possible.
• Out proposal is based on removal of(3 )layers of shingles.If there is an additional
layer of shingles this would be 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 15ib felt paper.
• All valleys to be weaved.
• The shingles will be installed by using roofing nails.
• The shingles that will be used are G.A.F. Royal Sovereign.
Your choice of color`
• Reuse and seal the existing chimney flasbimg. Any new would be additional cost.
• Reuse and seal the existing skylight flashing.Any new would be additional cost
• Install 8 inch white aluminum drip edge along all eaves and rakes.
• Clean and remove all outside job•telowd debris. We may require space for a dumpster.
• Provide standard 25 year shingle n m ufactr mes guarantee.
• Provide standard Aulson Roofing,Inc.2 year workmanship guarantee.
• Carry all necessary worker's compensation and liability insurance_
• Any foes or permits will be an additional cost to the custiner.
Contract Notes:If both roofs are done at the same time deduct 5%fib _
Estimated By: Bruce Tinkham
Weprgrme hereby nsfarmhh maarrdwa ordhow,CMWVWe re aemrshmee Agar a&ure ,for otr eon of.
Six Thousand Nine Hundred Eighty dollars sad no cents $6,980.00
Payment terms are to be as follows:
• 1/3 deposit,babom at oompletian
All materiel to guaranteed to be as specified.Al work to be completed in a substantial woddnanbke manner acoordilgf
to hIadlketlonb aWN~,per sfendard pracaeps.Arty aharavon or deviation fan above speciacations invom rg extra coats
wN be executed onty upon wriven orders,and wn beourre an extra charge over and above the eetbnate.
All ayreemerds conbr"pt upon gtdkes.accidents or delays beyond our oonbd.Owner to carry fire,tornado and other
necessary klsuranoe.Our workers are fully,covered by Worlunang Compensation Insurance,
Wove:Tt" beethdraen Nnot 000mpled within 30
Aulson Roof". Inc,Aulhodzed Sig wwre
Acceptance of Proposal-The above piees. a a.n ebrrmeens are and aro Ireraby anbpeee
You are warwtMd to do are vrork as .Palmrad ova ben n ouarred above.
Date of Acceptance
signetene
01/30/2009 22:05 . 9789691265 CORNERLOT APPRAISAL PAGE 01
Aulson Roofing, Inc.
COPY 49 Dardon Drive
Methuen,Massachusetts 01844
I (978)975-4500 Fax: (978)975-0987
I Proposal
Praposa!submttted ro: Phone Date
Rich Newburg (617)839-8584 5/23/2008
Street ob NOW Contact Person
271 Lafayette Street
City,State and Tip Code Job Locanon
Salem,MA 271 Lafayette Street, Salem,MA
We propose to furnish and&rstaff a new EP.D.M. roofing system to Gemj1kr manufacturers
speclfrcations in the fo/lowing manner:
* This estimate covers the following areas: Upper flat roof(22'x34')
` Prepare the existing roof to install the new roof directly over it.
• Mechanically fasten 1/2 fiberboard with 3" insulation plates and coated screws.
* The .060 EPDM membrane will be fully adhered to the insulation.
* All seams will be primed and seam tape applied.
` Remove the existing edge metal.
* The roof edges will have installed new.032 white aluminum edge metal and 5" EPDM cover strip
* Vent pipes to be flashed with EPDM flashing membrane.
* Chimneys will be flasbed with EPDM membrane and properly terminated.
* Skylight to be flashed with EPDM flashing membrane. (up under shingle area)
Properly tie in with existing shingle roof.
" Provide standard Aulson Roofing two year workmanship guarantee.
* Carry all necessary iianonace,worlmran's compensation and liability.
' Remove all outside job related debris.
* Any fees or permits will be charged as an additional cost to the contract.
NOTE- 1f both roofs are done together d`educt 5"/o from total.
Estimated By: Bruce Tinkhm
We propose k&N*mf rabb motafah and wmw,oangW&a to ecow daaae wft atone ry alfreaaon,for the oast of
Two Thousand E t Hundred Sixty dollartx and no cents $2,860.00
Payment terms are to as ows:
* 113 deposit,balance at cotepledon
All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike manner according
to specifications submitted,per standard practices.Any ateetanon or deviation form above sptxiftcations involving extra costs
will be executed only upon written orders,and will becotne an extra charge over and above the estimate.
All agreements eootiagent upon strilm,accidents or delays beyond out eontz 1.Owner to carry fire,tornado and other
necessary iaswance.Our workers are fury covered by worb=Ws coanpetiaatien Insurance.
Note:This proposal may be widtdrawn if not accepted within 30 days
ACCEPTANCE OF PROPOSAL,-The above prices,specifications and conditions are satisfactory
You arc autluxized to do the as eciflcd.Payment will be made as outlined about.
p' Slgaomrrp
Date of Acceptance S 0
Sigwearre
CITY OF SALEM
.i-,ny,_-S,
PUBLIC PROPRERTY
'-Y•�K U�'%
DEPARTMENT
'.I .UI I[\( SIlul r • "Al ref, NIAiiA, !r a i , _P, '-
llu: v'8-74 i-9;e5 • I AN: 984(,
Construction Debris Disposal Affidavit
(re(Iuired fior all denwlition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CN1R section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit fk is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
I lie debris will be disposed of in
(name of facility)
(address of facility)
signature of permit applicant
-- date ------
I
ti
m
S
u:
�n I
F
,D
00
l�
LT
00
i
-. . —..—_. _.�.. LC
-- - - ' .._---�ke-L"'nnrnnxruealrhv�✓{Grctac�ra�s _
Board afluddingRegolatians and Stand2rds i.itenseorregis[rntlonvalidforiodividul lase 9017
before the expfralton date. If faund retora to:
flotAE IfdpROVEMENT CONTRACTOR. Soard of Building Regulations and Standards
RegishatWil_�11969 one Ashburton PffteO f301
EfI-Ld7.t6n_7t7,f1t1l79 Tr# 127022 Boston,wy1 92108
:: .`^
'.ate corparnfion
i'
AULSDN ROOFING.INfF - ���"'�
ALAN AULSON
' Notvalidwithoutsigaattae '
49 DANTON DRIVE i
Administrator
BOW Of wilding Regulations and Standards
one Ashburton Place - Room 1301
Boston. Massacbusetts 02108
Home Improvement contractor Registration
ReptStfatton: 1 I'1989
;'1 Type: powe Corporation
6ptratfon: 2l2:2069 Tro 127022
AULSON ROOFING, INC. -
ALAN AULSON = --
49 DANTON DRIVE _ - -- - --- - - -
METNUEN. MA 01844 _
Update Address and return Card-M- 3,k reason for change.
Address [; Renetva! r] 1.0s4 Card
cvSrm sl 5tA1-0SM)B-PC659`J
I
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home ImprovemenLkao itractor Registration
Registration: 111969
w'
Type: Private Corporation
Expiration: 2/2/2009
AULSON ROOFING, INC. E >t Trti 127022
ALAN AULSON ;
49 DANTON DRIVE
METHUEN, MA 01844
?DPSLA7 A 50M-05/06-PC8990 Update Address and return card.Mark reason for change.
w Address Renewal Employment Lost Card
i
ACORD„ CERTIFICATE OF LIABILITY INSURANCE Att°s'o°°-z �ii/os o7
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.
DeSanctis Insurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
36 Cummings Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Woburn MA 01801 ' 1
Phone: 781-935-8480 Fax:781-933-5645 INSURERS AFFORDING�COVERAGE 1 NAIC#
INSURED INSURE3 A: Aaarmeamr.Pirti xmuianoa W.
INSURER 9: n,CPa®ar..
Aulson Roofitng, _ Inc- INSURe-roc: amar:aaa aaw Aaaama� ca. !
iva
Methuen MA 01844 wsuREgo:
INSURF3(E:
COVERAGES I
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE APFORO®BY THE POLICIES DESCRIBED HEREIN IS SUi ECT TO ALL THE TERMS.QXCLUSIONS AND MADMO74S OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - -
LTR NS TYPE to INSURANCE POLICY NUMBER pA� MMm GATE MNN CYExPIRAIIUN LINKS
GENERAL LIABILITY EACH OCCURRENCE $lj000 000
A X coMMERCIAL GENERAL LIABILITY' G23901401002 10/31/07 10/31/08 PREMt sEaaaT force); $50,000
CLAIMS MADE ®OCCUR HIED EXP(Any ails PGl Y $5 000�
X Lead 6 Asbestos W/ POLLUTION & MO PERSONALdADVINJURVY $'1 000,000
Abatement Liab. Gv+ERALACGREGAi'E $2 000,000
GEN'LAGGREQ47EppLECI'pIM�ITAPPLIESPER PRODUO •COMP/OPAOG s2,00O 000
POLICY X J LOC
AUTOMOBIIJ$LIABILITY CSMBINEdVNGLSLIMIT $1,000,ODO
8 ANYAUTO 07MMCYY1459 10/3i/07 10/31/08 ' (EA Amde�
ALL OWNED AUTOS BODILY PMEIRY $
X SCHEOULEOAUTOS (Pe PB19�P
X HIRED AUYOS BOOILYIMIURY
X NON-OWNED AUTOS
.I
. PROPERTY,IOAMAGE $
.. f?�ecddelrt) '
F7E LIAWLDY AUTO ONLY-
EA ACCIDENT S
YAUTO EAACC S
rFR TL
A TC ONL . ,� $
9ICEMUMRRa,1A LIAABILITY EACH OCCFIRRENCE 5,000,000
A X7 OCCUR CLAIMS MADE m.99 014 4 9 0 02GL/V94LAOLD 10/31J07 10/31/03 AGGREGATE $5 OQO,OOD
1 GL/CPL $
DEDUCTIBLE I�TLD EL $
R RETENTION $10 000 '' s
WORNERS CONWENSATION AND ' X Tow IMTB`I 'ER
EMPLOYERS'LIAWLITY
C ANY PROPRIETORIPARTNERIMECUTIVE WC5310893 10/ /07 10/31J0931 E.1..EACHnccloENY $1 000,000
OFFICERNISMBERIXCLUDEOT W., y,4S,cr,ae,Pe [¢.FL " E.LDISEA$E-EAEMPLOVE $1,000,000
SFEC a PROVISIONS
EL DISEABE-POLICY LINIU $1,000,000
SPECIAL PROVISIONS tlelDw
OILIER '
DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDOIRGEMUNT I SPECIAL PROVISIONS
ILLUSTRATION OF COVERAGE '
I
I
CERTIFICATE HOLDER CANCELLATION
TOWHO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO90 SHALL
TO WHOM IT MAY CONCERN IMPOSE NO OBLIGATION OR LIABILRY OF ANY IOND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
6LqNED REPRESEMAT
ACORD 25(2001108) v 9)ACORD CORPORATION 1888
I
I
LO 'd N:OL LOR 6 AON 9V95££6L9L:Xed SNI SlIONVS30
CITY OF SALEM
3 ) PUBLIC PROPRERTY
,
DEPARTMENT
N% orkers' Compensation Insurance .\1'tidatit: liuilders/Conlractors)Elcctricians/Plurnbers
li 1 Ilit.ant Information Please Print Leflibly
`.11 Ili IBr..Iai., t h__am a.tb�In Iu.11l:.lu.tl l: �.� ls �rs,
Wdress: cl icti
C'lt) tit Ile,Zip: M� �Jtn/ n
lire s uu an employer:' Check the appropriate box: Type of project(required):
t un a employer D nh 4. ❑ 1 :un a general contractor and I h. ❑ New construction
clnpluyees (full and'ur art-time).' have hired the sub-contractors
p' 7. ❑ Remodeling
?.❑ I .uu a sole proprietor or pariner-
listed on the anached sheet.
ship and have no employees Ihese sub-contractors have S. ❑ Demolition
Dorking for me in any capacity. workers' comp. insurance. y_ ❑ Building addition
ance
No workers' sump. insur 5, ❑ We area corporation and its
officers have exercised their 10.0 Electrical repairs or additions
rcyuireJ.l 1 1. Plumbing repairs or additions
{.❑ I am a homeowner doing all work right of exemption per MCiL ❑ B P"
myself. (No workers' camp. c. 152, $1(4), and we have no U tttoof repairs
insurance required.) t employees. [No workers' 13.0 Other
comp. insurance required.]
•:\ny.Ipplo,int Ihat checks box NI must also till out the sermon below Aowing their workers compensation policy information.
I lonnrowners who submit this al'fidavil Indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
�('onmactors That check this hox must attached an additional.sheet showing the name of the sub-contractors and their workers'comp.policy information.
l a,n an amplayer that is providing workers'<vnnpen.sution insurance jar my employees. Below is the policy rind job site
informarion. ���
Insurance Company Name:__ e4
Policy it or Self-ins. Lie. a: 000i�" e S .f Expiration Date:
Job Site Address: 7 LFj F S _L City,State/Zip: Q to F�
.\ttach a copy of the workers' coal pensatio policy dectaratton page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25:\ of VIGL c. 152 can lead to the imposition of criminal penalties of a
tine tip to S 1.ioo oo and'or one-year Imprisonment. as well as civ tI penalties in the htrm of a STOP WORK ORDER and a fine
M till I,, \:51)III)a ,Iav .14m1 t the a iolator. lie ad\i cd that a copy of Ill's statetnent May be tllrw'arded to the Office of
Ir,,esn_.in,tns ,il din I)I:\ ti,r insur.ince .o\crage aenticallon.
l Jr, hen-by,erri/Ii i dt Jrte puias td p�en/u�/!!rr uJ pa•rjury that(he information prusiideed abut a is trite and correrL
Date
�Iyn.l�urr.
pe,+Ile _
U/jh;ut rise onh'. :==
is area. try be rmopleted by=511f
iaL
( its nt foDn: - _ Vvr _ _ _ _ .- _._. .—
Issuing \ulhoriry I. Board of llealthparhncnt t. ('RN, loan Cll Inspector 5. Plumbing Inspectorh. Other .__— _._ContactPenon: .- --__- .__ ._—__--
Information and Instructions
t kncr.il fa its,c h.aptcr l t:yune, Al cnyilo,cr, I,l pnt,ide workcrs o mpcu,auon for their cmplo,ees.
V!11 .uu tit This .t.uutr. .tn enrpluree t, Jci-.n:,l .is ' ci crN pci,ou in the ,cut icc of.uunhCr under .un :ontr.rct of hire.
Yl c11 Or ngdicd, oral or \,uitcn...
\;: emplorrr t, Jciincd is .m ndn ahial. p.0 n::nhyi. .i„octa jon. .orporation or oilier !cgal euu(v. or .airy two or more
,•I the in a iouu cntetpn,e. and mcluding the k_al reprc,cntatn c, of a Jceca,ed :oiphwer, or the
en cr or ini,icc of.kit wdn ideal• par Incrnhq,. .t„o:Lis con or other Icgal Cnuty. engi loy ing cmpl os ces Itow es cr the
,..�tier of a dwelling house ha,kite not more than three ap.irinwias and is hit ic,tdc, therm n. or th c e ocupant of the
h,ctang It,m,c of .another who cngplo\, person, to do Ina tntcnance. con,lrucnon or repair work kill ,uch .Iwelling house
r ,Ilia the wounds or build uig appuI tcn.uu ihCl 0,1 ,hall not be:Ill of ,uCh ei oplm ntent he d:CHICd it be .in eniplos era
1 1. ch.iptcr I ,_'. ,2iCtn1 also ,kite, that "es cry state or local licensing agency ,hall withhuld the issuance or
renew al of a license or permit to operate a husiness or to construct buildings in the commonwealth for any !,
applicant w hit has not produced acceptable es idence of compliance with the insurance cuserage required."
\,Idmona l ly. ssR iL chapter 152• ,,2i( (-I ,fates 'Neither the commonwealth nor any of its political sut do imons ±hill
cuter into any contract for the perfitnnance of public %ork until acceptable c,idence of Compliance with the Insurance
reyuuemcnts of this chapter hate been presented to the contracting authority."
\pplicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply Sub-eomractor(s) ❑ainefs), addre Ss(es) and phone nWnbens)along with their certificate(s)of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships ILLP) with no employees other than the
nicntbers or partners, are not required to carry workers' compensation insurance. If an LLC or LLP dues have
employees, a policy is required. Be advised that this affidavit may he 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 he sure that the affidavit is Complete and printed legibly. The Department has provided a space at the bottom
of the affidavit fix you to fill nut in the event the Office of Imesligations has to contact you regarding the applicant.
Please he sure to fill in the permit,license number which will be used as a reference number. In addition, an applicant
that must submit multiple pemtivlicense applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address" the applicant should write "all locations in (city or
hewn).•' 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 tile fix future permits or licenses. A new affidavit must be filled out each
year. W here a home ow tier or citizen is obtaining a license or permit not related to any business or commercial venture
(t c. a dog license or permit to burn Ica,es ctc.),aid person is NOT required to complete this of fidav it.
f
1-lie t )tficc of I n%eshgatiuns would like hi thank you in advance for your Cooperation and should you hate any questions.
plca,e do nol hc,uate to gne us a call
I he Ocpat nncnt': .iddress. telephone and ht.x nuitiher:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Oiflce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax N 617-727-7749
www.mass.gov/dia