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7 LOONEY AVE - BUILDING INSPECTION 0 t The Commonwealth of Massachusetts CITY Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CMR. Tn edition OF i ReviseddJanua Junua!v Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit. umb : Date Applied: ZIl Signature: `-� w Build' Commissioner/Inspector of Buildings Date SECTION I:SITE INFORMATION 1.1rop�f�Y Address: 1.2 Assessors Map& Parcel Numbers P I.I a Is this an accepted street?yes v no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Arca(sq Il) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I,c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2 wner of ecord: Name(Pr' Q V I Address for Service: 97k-- 7V5'�- 3y �� Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief QSscri do of P,rg� ork': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building 1. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S r1D-ca '-' ❑ t Total Project Cost (Item 6)x multiplier x 3. Plumbing S — 2. Other Fees: S 4. Mechanical (tIVAC) S List: Aw P6. echanical (Fire S Total All Fees:S ression � Check No. Check Amount: Cash Amount: otal Project Cost: S 6fl ❑Paid in Full ❑Outstanding Balance Due: � A SECTION 5: CONSTRUCTION SERVICES 5.11 Licensed Construction Supervisor(CSL) /�r/� er 2 License NumberGs ratio )alC Name of St.-1Io] er ` ^ / �p ' / (. h L C17 L'- � List C'SL"type Isee below) I t .4JJres T Descri lion U I Unrestricted(up to 35.000 Cu. Ft. It I Restricted 1 @2 Family Dwelling i}n,.,a��tu. !! M MasonryOnly 7lX-S Zl 2— G S C / RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5 gL{tered me Impye so otractor(HIC) l0 S� �D 6I Z-F ilC Co any Name or HI 'Registry t Name Registraation umber r ( fo l AJdre q- Expirafion Date . ignutu Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 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 Affidavit Attached? Yes ..........O No... .....❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize - to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION as Owner o Authorized Agent ereby declare that the statements and info ation on the foregoing application are to and accurate,tote st of my knowledge and be Print Name D yture ofO a Aut rized Agent Date (Signed under the ains ies o 'u NOTES: I. 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 loj have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115, respectively. 2. When substantial work is planned,provide the information below: Total floors 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/balhs Type of heating system Number of decks/porches Type of cooling system Enclosed Open J. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF SAIX.M. AXSSACHUSETTS XMDLYG DUAAT IUNT 120 W.tjHRVGTON STRER'Te 1"FLOOR -n[L (978) 74S.9599 F.ax(978) 74498" KIM®EA"y ORMOLL IIWHASST.FixRRs gAYOlt DlltacrOR Of PL ALIC PWPERTY/KfLDLVG COMQSSIO-%ER Workers' Compensatlots Insurance Aff1devit: guilders/Contractors/ElectrlclsnslPfnmbers Annifirxiiii Information - /i A � less VatTelgwurrna.Orgaw,rriewln,kruhrall: (�'r �c- l7 .9" -ec� Address cily;stitazip Pflags 2 fl Ste/ .tree for an ewOlsyw!Cbeeh the appe+pdste boar Type of prolecs(rptakreelic -. I.a 1 ate a cmployw with d. 1 am a gtmenl commum ad 1 L ❑Nor consauc%ion c,nployses(fwj mayor part-dare)." have hired the Sal.-C mseson 1. 1 am a eased propeies are prrrten tined ass that aWaeitsd reheat = T. RerttaMling .hip and Irew to ampbyeo These su►eoar aatats have a Minalition „,dung roe tyre is any,capeciry. ,vorken'comp.Inamsaoa 9. a OviWuy addltiass 1 No workers'tomµ insurance ). awe am a eospender eed its regttil.tLl often haw estsefatd lhsir 10.0 Elscwical repo"or arklitiane ).a 1 am a homeowner doing all work risw of a=mpios Pre Mom. 11.(]Phunbing mpain are additions myself[No workers'comp. c. ISS>LI(�jV and we haw no 12.0 Roolrepsin insurance requi"I t eTp (No workew 13.(3 Otiose Cornµ insuratacs m4pkoLl •nwy+p►a�tti ahraa bw et aww A M on uw the atawa bates a ewI MW wor owapwwdwn puaay imdwtwrre� 'Ihr,wenww who suit"dak tA1dwis indlrWe Amy am doing are wart and dr him swWde awremteetm~sins"a New,allhbis wwringi/wm► i-.vwe.nmw 1hr Awh,w r mow awwhW m addlthwd ohm ahwwlwe dare war ss,he w+ewrtwa m and hub wwhw'0MV.polio istYowsdan, /rut are etwpieys that AN peoWdIn/worhw s'cowpnwdes laswsawfM sqr empV"@* Miser If rAa pNky srN/Is1 AM ;nferneadmra In,urarace Company Name: Policy s or Salf-ins. Lis.a Expiration Date: Job Sim Addresr City4later zip: .%nach a cop of The wortan'compeovatfon pe ty declaragss pop(showing The pelky somber sad eeplrulos dab} Failure to s"witi coversp as required under Sectlos 2SA o(MGL e. 152 can Ind to the imposition of criminal penalties of a fine up to S I.100.00 and/or one-year impristeur ena,as well as civil pesakiaa is the form of a STOP WORK ORDER and a Roil Of up to 5270.00 a day against the violator. I14 advt+ed that a espy of this statement maybe rurwarded to the Office of In>c>u gmiuru ul'drw nfA for insurance cowntlis vcrilkaiwa 1 Ja hereby cat w/err yew era /aq rhN tAw in�wrwwNes prwr;rM ubw s t wad awned O/J7cid rate a IA %net weiM he this rreq to pI a urwp/i/cal by riry o//�wne..//hYw( City or ru,an: YermiNl.leenrs e__. _ I,suint.%uthanay icircle one►: I. lluard u(Ileallb 1. nudding Witirtmunt 1. Ciiyfrown Clerk 1. electrical inspeclor S. Plumbing Inapoaor 6. Other _ � l .naacl tenon: _ .. Phone s: CITY OF S A L EM PUBLIC PROPRERTY DEPARTMENT I'.O: FIN ^IIIV .dI Construction Debris Disposal A171davit (retluired lur all demolition :uttl "Ovation work) In accordance with the sixth edition of the State Building Code, 73o CMR section 111.3 Debris, and the provisions of MGL c 40, S issued MGL c is issue d with the condition that the debris resulting from Building Permit iY��; I licensed waste disposal facility as defined by This work shall he disposed of to a proper Y ed Ill. S 150A. The debris will be transported by: p,ome ul houlerl The debris will be disposed or in : (n:unt ul r s ty - tl,lwr"s 1/1•Gullityl nature of 'rmit apyImant ats A CORD. DATE(MM/DDP/YYY) CERTIFICATE OF LIABILITY INSURANCE 6 1 2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John V. Zannino Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 16 Foster Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody, MA, 01960 978-531-5757 INSURERS AFFORDING COVERAGE NAIC# INSURED MARK DORMER COMPANY, INC. INSURERA: Western world Insurance Co INSURER B: 4 D STEVENS STREET INSURER C: PEABODY, MA 01960 INSURER D: 978-532-0941 INSURER E: COVERAGES 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.AGGREGATE LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD•L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSBD TYPE OF INSURANCE DATEMM/DD/YV DATEMWDDM/ GENERAL LIABILITY EACH OCCURRENCE S 1 00O 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 1001000 CLAIMSMADE CI OCCUR MED EXP(Any one person) $ 5,000 A NPP1115288 09/02/09 09/02/10 PERSONAL 8ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 1 ,000 ,000 GENT AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 1 ,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Eaaccident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAALC $ AUTOONLY: ASS $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR C CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONAND STATU- TH- EMPLOVERS'LIABILITY ' TORYLIMI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH AGGID DENT $ OEEICE IMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ Ifyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS lob location: 7 Looney Ave Salem MA 01970 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFDRIrTHE EXPIRATION City of Salem DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIDS DAYS WRITTEN Building Inspector NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL 93 Washington Street IMPOSE N BLI ATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Salem, MA 01970 REPR NTATI ES. AUTH RIZED SENTATIVE ACORD25(2001/08) ©ACORD CORPORATION 1988 wi:t .Rhusctts Department of Public S:d'ctl Board of Building Regulations and Standards Construction Supervisor License License: CS 18423 Restricted to: 00 x a# GEORGE N PAPAMECHAIL y 2 SPARROW LN EXT PEABODY, MA 01980 .< Expiration: 9/17/2011 ('onuuisvionrr:' Tr#: 2975 (p� Tie �omtiitoieaea�lre n�✓C�afa��uaella �-\ Board of Building Regulations and Standards HOME IMPROVEMENT 105 CONTRACTOR Registration: 10509090 Expiration:. 7/16/2010 Tr# 271617 -Type: Private Corporation MARK DORMER CO. INC...�_.. George Paparnechial, - - 4 D STEVENS STREET: w C; ` Peabody, MA 01960 - Administrator ' Customer T9K. Y....snd..Toig...Ctriffj'n........................... ............................. MARKDORMER CO. Address..7...Looney..ave.............................................................................. JobAddress...Same........................................................................................... 9050m°dmie4mom Salem Mass 01970 Peabody, MA 01960 City...............7.......................................State. ........-......................................... NORTH SHORE 532-0941 Telephone..97,$..74....391. ..........................Cell,,..Bus97A..Z3. ..81,9.3,.... SOUTH SHORE 331-3290 / 0 Pe 6 / 7 Job No. (office use only) Page 1 of 1 The Mark Dormer Co. will furnish the labor and materials necessary to complete the work herein specified. All extra materials remain the property of the Company. The homeowner authorizes Mark Dormer Co. to sign his name for all matters pertaining to building permits. The Company shall exercise care in performing all work but shall not be responsible for cracks or nail popping when working above or against finished walls or ceilings. It is sometimes Impossible to match perfectly the color and texture or existing materials and Mark Dormer Co. will not be responsible in case of Inability to do so. Examples: Brick, Roof Shingles, Aluminum, Asphalt or Asbestos Siding, etc. In the event the home owner cancels this contract for any reason whatsoever, after 72 hours, from date of signing, the homeowner agrees to reimburse the Company for any expenses it may have Incurred. Example: ordering custom materials such as windows or siding. These may be purchased from the Company at cost. 1. T ,of Additlo , lze and Sg itications:.Remodel first floor bath to include; Gut out bath including wall s, ceiling, floor, and all fixtures saving toilet and dispose :................................................................................................................................................. ............................. of same. Repair floor and tub walls as required. Install all necs. plumbinq to"'iriclucTe; a emo as required, install all owners new fxtures � ncluding ....................................................................................................... ................ ......................................................... tub with tub..saround,...exi,sting,,,toil,et.,...KAp ty..to,p..with.,, new.,fauc,et.,..,new.,shower head and valve Electrical to include rework existinc3 as requiredr new fan ... ........ light seperaEe switch f..reach, G.F.I . outlet, and anew light over vanity ............................................................................................. ........................ ..................... .............. ............... ........ . supplied by owner. Insulate„ all...four.,wall.s..with_.3''"...insulation for sound. . ............ ................ In's'£all z" kilueboard and skim coat of plaster to all new work and patch to .......................................................................................................................................................................... ...... old as required. Install "' durarock under„new..tub..saround. Install '-z" .. und'erlaymerit on floor ready for new vinyl, new trim around existing window ................................................................................................................................................................................ and door. Install base„ as...requi.red....Tnstall a new pc..of.,baseboard heat. .......................................... ............................................... Install owners new Medcune cabinet. Supply and install a new vinyl floors . .......... ......................................................... . ... . ... i'14................. $46O .00 alowanc.. for material and labor included. NO PAINT, NO PAPER ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ 2. Windows and Doors: .R1.4........................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ 3. Roofing:.N/.h ........................................................................................................................................................ a. Siding:..N/A.............. .......................................... ............................................Corners:....................................... 5. Underlayment: 15lb. Felt Paper unless otherwise specified.N/.A...................................................................................... 8. Gutters and Downspouts:N..A................................................................................................................................... ................................ ............................................................................................................................................... 7. Inside Framing:.aS$..r.eq.LU.Xed...to...install...t.ub........................................................................................ ....................................JJ.t�........................................................................................................................................... 8. Floors:.$ee„i.tem...p.I......................................................................................................................................... ......................................................................................................................................................................... Length of Joists: Front:................................... Rear:..................................... Size:...................................................... 9. Rubbish Removal:...xR.C.luded.............................................................................................................................. 10. No Wiring, Heating,Plumbing, Inside Finish, Insulation,or Painting unless otherwise specified In Item Mt, 11. Building Permit and Blueprints furnished by Contractor:.................................................................................................. AGREEMENT The undersigned authorizes Mark Dormer Co. to complete the work described In the above proposal. All specifications are mutually agreed to by all parties which have set their hand, have been read, understood, and accepted and a copy received by signers. See Warranty on reverse side. Contract Price:..NiAQ...Th0.V5rna..............................................................Dollars 5. .,.(IOD.voo............................... Terms: 500.r oo..depos.it.,balance..o9...G.4.mp.J f t.] oTl.............................................................................. Payments must be made,when due,to Company foreman or representative. Final payment to be made before foremen leaves complet- ed job unless otherwise specified above. �^ � Date:.April...�.4.r....2,010�Qj.Q......................................... Owner..- .... ................ .. Rep resentative:..George_..Pa_pamechai.1.................. owner:, ;.,,., , . / ........... Acceptedby;................ ......... ......... .............. Agent:...........! ......... :... ......I................................. 1 1 The Commonwealth of Massachusetts µ� Board of Building Regulations and Standards LRevisedJw },!y Massachusetts State Building Code, 780 CMR, 7ih edition EM 'a;✓ nurBuilding Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling V / This Section For Official Use Only T� Building Permit Num er: Date Applied: v ` Signature: f//Z //P Building mmusioner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Pr p rty Add a s* /`r 1.1 Assessors Map& Parcel Numbers I.la 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 11) Frontage(R) 1.5 Building Setbacks(R) 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: 1.9 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private[3 Zone; if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.l�t Ow 7'of Record: L/� /J /) yq rc r.)'/O[rl! O! OJoJIirl. Ci�j ✓✓'�✓ ✓d/H/tPdrtil^/7rr Name(Print) Address for Service: Gil -2.ry -O/O Signature 'telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Buildin Owner-Occupied ❑ Repairs(s) Afteration(s))<Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': & �aty J- ,! y r✓� /9tI F XI Y SECTION 4: ESTIMATED CONSTRUCTION COSTS 2 Z o,, — Item Estimated Costs: Official Use Only Labor and Materials I. Building S 22 6, — 1. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S r Check No. Check Amount: % Cash Amount: 6.Total Project Cost: S Z .2177G ❑Paid in Full ❑Oulstanding B lance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction/Supervisor(CSL) 1y,29 <7-r/ VL/ S4 t A License Number Expiration Date N;une of CSL- ,&r J List CSL"Type(see below)41 C/ 1J7A15 - ) ✓' ) f pe Description :'iddres /A/ U Unrestricted u to 35,000 Cu.Ft. G R Restricted 1&2 Family Dwelling gna Lure M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Im rove ant Contractor(HIC) 112119 T0/7 Z f w �t� � Registration Number I IlC Cum yI anyy a or5 IIsCn gJ Re ut t Name 1�/ �. 717. O /�• L�/�/// Address,' � `r!� G �j�- 'j ly y_G���' Expiration Date %i nature Telephone 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 Affidavit Attached? Yes .......... 19r No...........13 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property hereby authorize - to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION I, 7✓1 r IA-1- x, Ar'/tu'C L ,as Owner d Athorized Age u hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. / �iyrl L1/ �7t¢ Print Name SignaluFfof Owner or Authorized Agent Date Si ned under the pains and penalties of riu 1101 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&oj have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115,respectively. When substantial work is planned,provide the information below: Total floors 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" CITY OF S.U.E.til, INLISSACHUSEM 3L((Dc,4G Dar.taTTIENT I'0 W.jjHINGTON STaW. )t'FZ.00R T>*Z. (978) 715.9599 Aut(97� 11496N Kl\®E"lf C)"'COLL T160h1AfST-Mill" NAYOIL DlRacroa OF PL SLIC PWPE kTV/rK MDL%'G CO%O'rtssfO'N es Workers' Compenaatlon Insurance•tffldseir Builders/Conrr2CtorWElect►iclnnslPlumbers a llesn In n m Men flrfnt aid VainiffI e+►O�rMs,nrli�enrlmbv,mnll: /'a Z1f/®.,may GU <`' Urv/"t�n ✓ h L Address, cily/statefzip: Slip , 4�" Itbotto N: 9>& 9�i4-�lf�� Are you to employer?Cheek the appropriate boa Type of prole"(roquird$ 1.Cl 1 am a employer with '? o. Cl 1 am a Aenerd commetae ad I 6 ❑Now cosseuwan employs"(Adl and/or pan-tier].• hove hired tan aubsantraesorn 7. RemmNlin 1.O 1 am a soon prepriator or pmtneo- listed on the awahed AML: O g .hip and have no amployace Theses su`eoomwon have V. ❑Demolition wohi for me in c workers'comp insmaws. 9, mg y apsiry. ❑tSrriWirrg addition I No workers'comp insurance S. Owe am a corpondige and is I O.Q Fin call repairs or additionalr quiruL) Oaks s have erserdaad their ).Q I am a hmrrwwner Joins all work rion daxa^prion per MOL I I.Q Plumbing repair or ad diklmm mymlf.(No workers'comp a I JZ 11(4).and we hm no 12.[31 rpaim insurance regsired.l r emp"). LNe warkmn' 13.0 Other comp insurance regrisd•1 'ANY apydnr iti dude saes II nO,rN err no ra as,.Yabm aNlaw . . e,dr won Oagrdrr r.a.y iodwands. 'r 6rwrw,w who sub"sub aledtva indldq dry we doing all wk atem hie nariiamasasa nmr..b"a nw.re,Ytir in .8..\ 'r•.wN Awe Aiming dw SOON a/,b e►aern gm rd,h*+waOa',eel.Pdrry ingataadie, /war aw Iaybyer these b psrl//wR nwflrs'rswjawmdra/waoswarJir q say/ryesa OaArtr/a rAi ys/kZ as,/�r1 afb in�arararrlaa /' Insucrnce Company Nome: ��r<l ZLL Policy e or Sslr•ina. Lis.N: 8 ?7,�7'r4-1 Enpirmic s DW: .rZ/a/// Job Site Address 2* ��r't� f/ Ciry/SIaWZip: slily, /1 Attack a cep et the woriwrs'compensation pelky dsrlaratim pep(skewing lke pelley somber sad espl►w dab)6 Failum to sour coverap m m"imd under Sacllos 2SA of NOL e. 152 can lead to the impooition o/criminal ponaldes e/a fins up to S I.500.00 and/or one-year imprisonment is well as civil psnoltioa in an tarns ate STOP WORK ORDER and a hoe Of up to 5250.00 a Jay against the violator. Ilo advised'her a curry of this srahtmers maybe rurwurded to the 0171ee or Incc.ugariu,u us,,he AIA for insuranco coverage veil►catisn /,Je hII16y errtJ/l. AN Ike Pelts NAdjMxw1fff&%I/Ya.y rAes At inlerarerfw prewi"U&evo is true end i arreca O/J&vd YSI v/I/n DI S er wtife iw this orq tI 6L urwo/Nai/ey riry es,t.nns„/�IlriYt i Ciry or ru,tn: Yrrmir/Lleenrrl__, I,ruiall.\wharrty (circle une): I Iluard u(IlrAltlt 1. Ru,hling Ocpartment 1. C'ily/fawO Clerk t. EloctricAl Impactor s. plumbing Impactor 6. Other phone e: CITY OF SALEM #� PUBLIC PROPRERTY DEPARTMENT pit, lv .'.I� IBC�',�d II\L.✓NSfakCr •�•\II 11. fit.\��\t I II N I..:1'I . %I .will 1'r l:aa•NS'Avy � P�`t:'/l/•NS'IIIIh Construction Debris Disposal Affidavit (required fur all demolition auJ renovation work) In accordance with the edition of the State Building Code, 730 CMR section 11 l.S Debris, and the provisions of MGL c 40, S issued MGL c Debra .a Permit Ir��- . - is issued with the condition that the debris resulting from this work shall be disposed of ina properly licensed waste disposal facility as definod by S I SUA. The debris will be transported by: pwrrte ul hauler) The debris will be Isposed f i17' 17dll — (n:uneul �7�lurddr�11 eecary !lily' /I/t 4/4 a�nature.rf Iwrmit,tpplicaru date Professional Roofing Contractors, Inc. James W. Shea,President P.O.BOX 262 45 DEARBORN STREET SALEM,MASSACHUSETTS 01970 PHONE (978) 749r6898 M'A 8) 744-8814 March 3, 2010 Rev. Msgr. Stanislaw Parfienczyck St. John the Baptist 28 St. Peter Street Salem, MA. 01970 RE: Emergency Roof and Steeple Repairs To make the following roof and steeple repairs: 1. Replace several missing shingle on main church roof. Cost......:.:............................ ...............................$1,000.00 2. Access steeple from inside and outside with ladder and plank staging. 3. Remove and secure all debris hanging from steeple bell tower. 4. Repair framing on one side of bell tower. 5. Install wood louvers on one side of bell tower. 6. Install screen over louvers on one side of bell tower. 7. Install bracing on louver to four sides of bell tower. 8. Install steel bracing to tighten up wood framing to main support beams. 9. Clean up and remove all roofing materials.......................$21476.00 TOTAL COST........................................................$229476.00 ACCEPTANCE OF PROPOS A L . TERMS OF PAYMENTS: x �