14 LEMON ST - BUILDING INSPECTION (4) 4-70� C-r.
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALE�M ✓�
RevisedL) 20/
Building Permit Application To Construct,Repair, Renovate Or Demolish a
One-or Two-Family Dwelling 7=3rn
Q This Section For Official Use Only t m
Building Permit Number: co r
Date A ied:
rTt
0
Building Official(Print Name) Signature Dat ' n
4 SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
14 Lemon St
Lla Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Debra Kirchheimer Salem, MA 01970
Name(Print) City,State,ZIP
14 Lemon St 978.979.8840
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORfe(check all that apply)
New Construction❑ Existing Building CDC Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Remove eXISYln9 roof, Install new roof, I
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ �a_�� 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
i1 pG Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ �� ❑Paid in Full ❑Outstanding Balance Due:
S E-"P T"O
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-054528
1 1/�0/9015
David J Benson License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
1 Donegal Lane
No.and Street Type Description
Danvers MA 01923 U Unrestricted(Buildings u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
978-531-7663 David@aspenroofing.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 118825 4/96/9015
Aspen Roofing Services Inc HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
58R Pulaski St davori @aspenroofing com
No.and Street Email address
Peabody MA 01960 978-5317663
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 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 Affidavit Attached? Yes .......... aC No...........❑
SECTI 7a: O UTHORIZATION TO BE COMPLETED WHEN
OWNER'S G TOR C TRACTOR
APPLIES ING PERMIT
I, is O er of e subject p Perry,hereby an orize /�l/n��
to adXonyhalf,in al tters relative t ork authorized by this building permit application.
i
Print Owner's a(Electrons S' atme) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering a below,I hereby attest under the pains and penalties of perjury that all of the information
contain application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
w�Yw,mftsspo_y/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
-
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
T° Page No. of pages.
MA 01960
CSERVISPEN ROOFING 58R Pulaski Street
CES, INC. Peabo978-31-7663 PROPOSAL
Fax 978-531-7667
TO: Debra Kirchheimer PHONE: 978-979-8840 DATE: 1-30-2015
14 Lemon Street
Salem, MA. 01960 JOB NAMEILOCATION: Same
We the undersigned agree to furnish material and labor to do the following specified
work, subject to terms and conditions on reverse side hereof.
If work is accepted, please sign one copy and return with deposit to our office. We do not schedule any
work until a signed copy is on file.
Shingle Roof:
1. Rip existing 2 layer shingle roof system down to wood decking on driveway side.
2. Install CertainTeed Ice&water protection 6'ft wide at gutter edge.
3. Furnish and install a new Lifetime CertainTeed Landmark shingled roof system complete with
CertainTeed Shingle Mate roof paper.
4. Install 2 new low laying vents on shingle side.
5. Install CertainTeed Starter shingles on perimeters.
6. Install new matching ridge caps.
7. This is to include the small mini roof that runs along the back side of the dormer.
8. Furnish and install new F-8 white aluminum drip edge at perimeter.----- COST $3,397.00
Flat Roof;
9. Furnish and install new '/2" recovery board over existing flat roof to be screwed down.
10. Install new fully adhered rubber membrane roof over the 1/2"recovery board
11. Install new rubber membrane flashing to chimney.
12. Install new 6"metal edge cover tape, caulking and all flat roof accessories including a rubber vent pipe
boot with stainless steel clamp and water cut off mastic.
13. Fabricate and install 3" white edge metal on perimeter.---- -----------COST $2,285.00
Oations #1•
14. Remove and install 2 new Velux skylights with Low E glass and shades attached to the
skylights with skylight flashing kits
15. Install ice&water around each skylight and seal with a Geoseal caulking —CO 2.904.00
Option #2;
16. Remove existing chimney down to roof level and build back up to original height with new brick
install new lead flashing.-----------------------------------—----------------------COST $1,L62.00
Option#3
17. Install a new snow and ice guard 2 rail systems on flat roof.-----COST$ 1,141.00
s
NOTES,
18. Will tarp the side of the house and grounds.
19. Will run a magnetic around on the ground to help pick up any stray nails.
20. Furnish ten year labor guarantee.
21. All work to be done in a professional and timely manner. All job related debris to be removed from roof
and properly disposed. All grounds to be left in a neat and orderly appearance.
22. For your convenience, please see enclosed Certificate of Insurance. �� -
23. Furnish roof work permit as per local building department.
24. Check for rotten or damaged roof decking. If found,there will be an additional cost in addition to the
base price of$3.75 per foot.
This proposal is valid for thirty 30 days.
The undersigned property owner agrees to pay for the work specified, the sum of($5,682.00)dollars
Five Thousand Six Hundred Eighty Two Dollars
Deposit Installment Balance
$ 568.00 10% at signing $ 3,409.00 at start $ 1,705.00
to be paid upon completion
Aspen Roofing Servi , Inc. I have read the abov contract and hereby accept the same.
Approved bye
eorge A. V�n Hillo
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DAVIII .I; .UNSON
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LICENSE NO EXPIRAr.-ON DATE SEERIM NO.
MassachuseGs -Department of Public Safety
Board of Building Regulations and Standards
of Coasnmer Affairs&Business Regulation
Constructions Supen isor - _ fCons finer Ailairs tdTRAessRe
License: CS-054528 '. W4Z1, Office
tion 4l26Mls ... Private Corporatior
DAVIDJBENSOl!J� ' ti
1 DON EGAL LN; "° '` ASPEN ROOFING SEiIYfE;ES�fNC
DANVERS MA 01923 � r
DAVID BENSON _
58 RPULASKI ST
�,/ .. Expiration .PEABODY,MA 01960
Commissioner -11/2012015 Undersecretary
CONTROL # 1 CONTROL# H J 4 U 12 3
IMPORTANT IMPORTANT
f your license is If this license is lost or destroyed, notify your Board at the:
lost damaged -isq*Sroyed;isirtaccurate;or Division of Professional Ucemure, 1flf10 Wash'leads to;tis correcttad-i,:yit otv u�ep,sit®at�ttassgoylil for Suite 910,Boston,MA 02118-6100. Washington St,
nsiruetirar's to unsure;the.pnrper,�ri`eIriifag:o-yotii Renewal
Applioatrom and-sny otl�correspondence. - If your name or address shown is changed, notify your board
his license is sublect:to Mass a-usetts General Laws and of correct name or address to insure proper mailing of next
agtytations.Yourficerrse ss aprlvtlege,and eannotbe lent or Renewal Application. Always refer to your license number.
to Any,perscin or 6hW-under penalty of law. Keep this This license is subject to the provisions of the General Laws tied
censer:your pensai i'or posted as required by law and/or as amended.it is a personal privilege,and must not be loaned
:gulations. or assigned to any other person.Keep this license on your
- - person or posted as required by law.
nrestricted -Buildings of any use group which y;� or r
lntain less than 35,000 cubic feet (991 m3)of egvitration valid for individui use only
l
before the expiration date. If found return to:
tclosed space. Office of Consumer Affairs and Business Regulation
i 10 Park Piaaa-Suite 5190
Boston,MA 02116
ilure to possess a current edition of the Massachusetts
ate Building Code is cause for revocation of this license.
Not aGd without signature
r DPS Licensing information visit: www.Mass.Gov/DPS
7 ® DAM(MWDD/WYY)
ACORO CERTIFICATE OF LIABILITY INSURANCE 12/31/2014
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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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(his) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
Certificate holder in lieu of such endorsement(s).
NAAMEACT Norwell Construct South
PRODUCER
Eastern Insurance Group LLC PHONE FAx
No
77 Accord Park Drive E-MAa
Unit Bl INSURERS AFFORDING COVERAGE NAIL
Norwell MA 02061 INSURERAAcadia Insurance CoLnpalny 31325
INSURED INSURER B:
Aspen Roofing Services, Inc. INsuRERc:
5BR Pulaski Street INSURER D:
INSURER E:
Peabody MA 01960 INSURER F:
COVERAGES CERTIFICATE NUMBER3'laster 2014 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,'FERM 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.
INSR e. POLICYEFF POLICYEXP LIMITS
IT ICY NUMBER MWDD MMR)D
a TYPE�F INSURANCE POL
GENERAL LIABIUW EACH OCCURRENCE $ 1,000,000
A NT 250,000
X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccuaence $
A CLAIMS-MADE ❑X OCCUR PA0362034 2/31/2014 2/31/2015 MED EXP(Any one person) $ 5,000
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000
POLICY X PRO LOC $
AUTOMOBILE LIABILITY Eaea"d6eD SINGLE LIMIT
t 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
A ALL OWNED X SCHEDULED 0368197 2/31/2019 2/31/2015 BODILY INJURY(per amdert) $
AUTOS AUTOS-OWNED PROPERTY DAMAGENON $
X HIRED AUTOS X AUTOS Peraoddent
Uninsured motorist Blsplit limn $ 100 000
X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 2,000,000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000
LIED I X I RETENTION$ CEIA0368199 2/31/2014 2/31/2015 S
W'C STATU-WORKE
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EMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE E
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be under - E.L.DISEASE-POLICY LIMIT $
ON OF OPERATIONS Eelm
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if mare spate is required)
Operations usual to Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
For Informational Purposes Only
AUTHORIZED REPRESENTATIVE
John Boegel/BC4
ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved.
INS025 r9nin05t n1 Thai Anon nama and Innn arc ranietcrcd mane of A(:nRn
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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODnw)
1/14/2015
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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and Conditions of the policy,Certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
certificate holder in lieu of such endorsemen s .
PRODUCER EASTERN INS GROUP LLC CONTACT
77 ACCORD PARK DRIVE ➢NNOEie
NORWELL, MA 02061 Fn"c xa•
ADDRESS:
INSURERS AFFORDINGCOVENAGE NAIC0
INSURED
INSURERA: Liberty Mutual Fire Insurance 33600
ASPEN ROOFING SERVICES INC INSURERS:
58R PULASKI STREET WSURERC:
PEABODY MA 01960 WSURERD:
INSURER E:
NSURERF:
COVERAGES CERTIFICATE NUMBER: 23052943 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,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.
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Workers compensation insurance awarega applies Only to the workers compensation laws of the state MA.
This Certificate cancels and supersedes all previously issued certificates.only as they relate to workers Compensation average.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
Libert Mutual Fare Insurance
(D 1988-2014 ACORD CORPORATION. All dghts reserved.
"CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
CL1D; ODE: 15%S5:e Ann" QUnAis[ 1111 = u:45 AN IE?]i Pa- i of L
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CITY OF S.U.&M, XWSACHLSETTS
BL'ILDLNG DEPARTMENT
• N 120 WASHNGTON STREET, 3iO FYOOR
TY.L (978) 745-9595
FAX(978) 740-9846
Kj%,tBERLEY DRISCOLL
MAYOR T HoNus ST.PIEm
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONINIISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 11 L5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
I11, S 150A.
The debris will be transported by:
Miller Waste Disposal
(name of hauler)
The debris will be disposed of in
._Miner's Transfer Station
(name of facility)
Route 114, "iddletrin
(address of facility)
signature of permit applicant -
ate
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