100 MEMORDAL DR - BUILDING INSPECTION p The Coinnwn\%calth ul MaSSarhusrus
e t boded 01 IitllldlnL! RCg Ulalio s and Standards I l tR
� ititassarhusetts Stale Building Code. 7SU ('!Y1R. 7°i edition \II \I('IP I tit.
Building Permit Application To C'onsu`uct. Repair. Renov,ate Or Ihniolish a
(brr- ur /4'o-/unriII 1)11 Hill t
This Section For Ol fit:ial Usr Onlv
C
ing Permit Numhet ate Applied:ture: ___
Building C•onunts.wncv Inspector of Buildings
SECTION I: SITE IN'FORINIA HON
1. Pli 6crh .Ydr dress: (�' �r 1 \»eSsors �Iap .� Parcel Numbers
I.la '� ! n is a•.._rpted sore'. �cs no
1.3 7uidog I;n's,rma5an: j .d '?r•.11;+,; 1.
ZonwK Uisirict Pmpused Use Lot A,-,a l'_�.•�_.____._______ Fnm Llge IItI
1.5 Building Setbacks(ft) — _ ---
Front Yard Side Yards Rear Yard
RCyUi red Provided Reumned Provided Reyulred Pais idrd
1.6 Water Supply: (M.G.L c. J0. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood 2'une" Municipal C7 On site disposal }l s srnn ❑
Puhhc ❑ Private ❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 qwner'of Record: �GGa
L't--y of S��m
N.uua i Prinn Address for Scrcice:
jtit gnature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (ctieck ail that apply)
New Construction ❑
r Existing Building ❑ Owner-Oc,u ied ❑ — A--r:ruion(—s) ❑--J \ddn �ut ❑Reis) CI —...I
I p_molition ❑ 1 Accessory Bldg. U Number of L'nits Other pcctiy:
- ricf Deacnption of Proposed Work _ -,.-- —�- ---- ------
/J���F2�LT_ J _ _ > Sm9� /.. .�loX '� 2 NoftS�loeE
------------
-- --- SECTION J: LN EMIATED CONSTRUCTION COSTS -
Estimated Costs:
Item (Labor and Mate:iais) Official Use Only
[2.
. Building �� S 3St70 1. Building Permit Fee: $ Indicate hors tcc a deice mined
❑ Standard City/Town Application Fee
Electrical 5 3 .❑Totul Pro�ect Cunt (Item G) x multi liarJ P Plumbing S '. Other Fees: '6 Mechanical (HV:1C) List:Mechanical (Fire S ------
Su i re•onm) Total :\II Fees: S
G Check No. Check Amount: _ ('.uh \mount-- _
0 rotal Project Cost S ��0 3p I 0 Paid in Full 0 OUIST:mdire Balance
SECTION 5: CONSTRUCTION Sk:RVIUrS _ 4
5.1 Licensed Construction Supervisor IC's
.N.m r ul'CSI. 11older
last CSI_"f%pr Iser below 1
� - lv r Desin tom
1. ('nrcsoined i up to i;,(N)0 Cu. Fl.
R ! Resuiclyd I.@_' Fdnul� Uw:lhn_e
R ! R,
RC ItesiJ:nual Ruolinc( mrnn;v_ �
I':Irphunr r�� \YS Kr�iJ;nli.J \1lndoo .mJ Sahnc _
al Solid Furl Bunun_e
OO V V D Rr.�J:utial 1)rni�iLw�u
5.2 Registered Home Improvement Contractor(HIC)
MC Company Name or HIC Reg sirant Name Registration Numher
Address
Fspouuon U:ur
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. e. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. F:ulure to pni1lde
this affidavit will result in the denial of(he Issuance of [he building permit.
Signed Atfidavit Attached'? Yes ...._.... ❑ NO ........... />
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 m:uteis
relative to work authorized by this building permit application. -
i
— I
Si natureof Owner Date
SECTION 7A: OWNEW OR AUTHORIZED AGENT DECLARATION
1, , as Owner or Authorized Agent hereby declare
that the statements .Ind information on the tbregoing application are true and accurate, to the best of my knowledge and
behalf'.
Print Name
Signature of Owner or Authorized Agent Date
fSi ned under fife ❑ins and penalties of rr u
NOTES: _
I. An Owner who obtains a building permit to do his/her own work or an owner who hires an unrc�slSlcrcd cMnrt..wr�
(not registered in the Home Improvement Contractor (HIC) Program). will rent have access to me arbitration
program or guaranty fund under M.G.L. c. I42A. Other important inhumation on the HIC Program and
Construction Supervisor Licensing (CSL)can be found in 780(AIR Regulations 1 10.RG and 110 R5. respecn%chr.
When ubstantial work is planned, pros ide the Information below:
(including e, finished basemen Uattics. decks ur �o rihl
Total floors area !Sy. FL) @ garage.g 1
Gross living area I Sy. Ft.) Habitable room count
Number of tneplaces Number tit hedrooms _—_.--.__--
Number of bathrooms Number of halt/halhs --
1\pe of heating cstem _ Number of decks/ p,,tchcs
I ape of eooling Sy,tem I.nih,cd __ _Upcn ____._
tTaud Prnjtet Square Footage• rnev be substituted fir 'Total Project Cost-
CertiTI mate Of Fl
ame Resistance
esistance
FABRIC
NUMBER ISSUED BY
JOHNSON OUTDOORS INC. Date of Manutacture
F-140.01 BINGHAMTON. NEW Yp
Manufacturers of the Fnest
3902
Tent Products Describe d Herein F'EBRUARY 2007
This to certify that the products herein have been manufactured from material inherently flame retardant as
here after specified by the material supplier,
NAME: BAYSTATE PARTY RENTAL
CITY: TEWKSBURY, MA
Certification is hereby made that:
The articles described on this certificate have been manufactured with an rwr approved Flame retardant chemical in compliance with
California State Fire Marshal Code, NFPA-701', Underwriters Laboratory of Canada, and have been tested in accordance with the
F a T M17 •h d o d m or x-
h Adni ry PI m ifi a n
TVoe C..or Ma
weight of material 16 OZ vin': v!T=_ BLOCK OUT
_� -.c.n of item certifies _. OLUTi� FS 31; =�)'TP
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder ManufacturinO-, Inc.
u r'.a'3CTVIef of Flame Re'z,c: ."'i Lamina:=s -_V TDEPARTMENT,JOHNSONOUT ORSIN
._ ._. _ .. ._. 'large Scale
f
a ive Pf -gyp
o _>
x. a
Designs by /�.��•� 9,+�;.,..1 , %g�P
888) . 4-8368 �'
'lVWW-cFe;�l#ivp6ty.fi,L - ET
W9: palb Apr-05
-- ---- P.01#: 200W4,5
6Pvim, Qw �•- .. . — -IneF�►'� '-_-_�-- .
NIN
—x5Windo AkQCjVPA TEWoR
jkV
gwkwz' ` 7FA-820 Wall Aw4w_ TaENINGW�THEPfench:ANDOUBT Db•
THE
:r w
Certificate of jftame Rem.5tance
REGISTERED AZTEC TENTS Date treated or
APPLICATION 2665 COLUMBIA ST manuhaauretl
CONCERN NO.
TORRANCE, CA90503 U5�20U8
CAL COMB F-419.01 (800)228-3687
Ibis is to certify that the materials described below hereof have been flame retardant treated(or are inherently nonflammable).
FOR
BAY STATE PARTY RENTALS r
150 LORUM STREET
TEWSBURY, MA 01876
es
Certification is hereby made that. (check "a"or "b'7
(a) The articles described below this certificate have been treated with a flame retardant chemical approved
and registered by the State Fire Marshal and that the applicationof said chemical was done in confor-
mance with the laws of the State of Califomia and the Rules and Regulations of the State Fire Marshal.
Nameof chemical used............................................ Chem. Reg.No. ........................
Meathodof application ................................................................................................
(b) The articles described below hereof are made from a flame-resistant fabric or material registered and
approved be the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96.
Trade name of flame-resistant fabric or material used..��.O�Fabrx . Reg. No.......F?!1
The Flame Retardant Process Used .w2L Nor Be Removed by Washing
(will or will not)
David Bradley Chuck Miller - President
Name of Applicator a Produ ian Supwinlentenl Tge
CUSTOMER ORDER NO. R170571
ITEMS MANUFACTURED:
1 4OX402PC JUMBOTRAC TOP ULTRA WHITE
2 4OX20 MID JUMBOTRAC TOP ULTRA WHITE
A DRDTM Iuuo
CERTIFICATE OF LIABILITY INSURANCE M/DDM)
PRODUCER O4/01//O1/OS
US[ Rental Specialties THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 53310 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Irvine, CA 92619 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
800 854-3298
INSURERS AFFORDING COVERAGE
INSURED -- - -"-
INSURERq: St Paul Fire and Marine Insurance Co _
Baysta[e Electronics Inc. - -
DBA: Baystate Tent 8 Party INSURERS Travelers Indemnity Company of CT -
_..----.__...-------- -- -...
150 Lorum Street INSURER ---------suRER c:
Tewksbury, MA 01876 INsuRER D: - ----
INSURER
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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INSR!... .. __..._- -.____._____._._ —------ _
TYPE OFINSURANCE
TR
POLICY NUMBER POLICY EFFECTIVE poLifflipiRATION -- - - --' ---- - -
A GENERAL LIABILITY DATE MM DD DATE MM/OD LIMITS
E---, t.KQQ219Q9$ 04/Q1/08 I04/01/09 EACH OCCURRENCE _
I _,COM M ERCIAL GENERAL LIAB ILITY g1 000000
IX_ OCCUR FIRE DAMAGE(Any one tire) $100,0 Q
' CLAIMS MADE
MED EXP(Any one person) $$QQQ
_ PERSONAL IS AID V INJURY $1 000 QQQ
—_
- -
GENERAL AGGREGATE 82 000 QQQ
GENLAGGREGATELIMITAPPLIESPER
-_.
X : POLICY PRO LOC -PRODUCTS _COMP/OPgG6 $1,000,QQQ
.. . -- _. -_.-.
AUTOMOBILE LIABILITY
ANY AUTO
---- COMBINED BINGLE LIMIT
ALL OWNED AUTOS (Ea acdtleni) $
�- SCHEDULED AUTOS BODILY INJURY
HIRED AUTOS (Par person) $
NON OWNEDAUTOS
-- BODILY INJURY
l I _
PROPERTY DAMAGE
GARAGE LIABILITY (Per accident) $
!ANYAUTO AU ONLY TO___ -EA ACCIDENT j__o
i OTHER THAN EA ACC 1$
- -' EXCESS LIABILITY ONLY:
AGG $
OCCUR L-J CLAIMS MADE EACH OCCURRENCE $
AGGREGATE $
, DEDUCTIBLE _ $
RETENTION g
I WORKERS COMPENSATION AND XEUB5899Y49708 $EMPLOYERS'LIASIUT' 01/31/08 01/31/09 x WC STATU- OTH,
_._ .EB_-
EACH ACCIDENT $1_0001000 -,I -
EL.DISEASE-EAEMPLOYEE $1,000,0Q0
OTHER EA.DISEASE -POLICY LIMIT $1000,000
5GRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
is certificate is issued as a matter of proof only. •Except 10 days
tice of cancellation for non-payment.
2TIFICATE HOLDER ADDR)ONAL INSURED INSURERLETrER
CANCELLATION
T;�TO
YOF TH E ABOVEDESCRIBED POLICIESBECANCELLED BEFORE THEEXPIRATION
EOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL 30*_ DAYSWRITTEN
THE CERTIFICATE HOLDERNAMED TOTHELEFT,BUTFAILURE TODOSOSHALL
OBLIGATION OR LIABILITYOF ANYMNO UPON THE INSURERJTS AGENTS OR
TATIVES.-REPRESEN7pTIVE
.)RD 25-5(TI9T)7 of 2 #S2426166/M2426165 6/.IJft/L/'+�-^ LRGJG 0 ACORD CORPORATION 1988
. . Invoice # 101466
Baystate Tent & Party EVENT INFORMATION
150 Lorum Street BAYSTATE 6/22/08
Tewksbury, MA 01876 TIME OUT
(978) 851-2002
RETURN 6/22/08
BILL TO
TIME IN j;QQ M
North Shore Medical Center Willows Park
Development Office TBD
81 Highland Ave
Salem, MA 01970
Hillary Grant
PHONE# 978-35-2008
ORDER DATE PAYMENT AMOUNT REP ALT. PHONE#
6/22/07 Net 30 Days DK EVENT DAY SUN 7'00am
CITY DESCRIPTION DAYS RATE AMOUNT
1 20 x 30 Festival 1 375.00 375.00
1 20 X 20 Ultra White Festival Frame Tent 1 275.00 275.00
8 10 X 10 Ultra White Festival Frame Tent 1 90.00 720.00
2 8'x 20' Solid Wall 1 20.00 40.00
1 20 x 40 Festival Tent 1 475.00 475.00
Below To Be Del Fri call 1/2 hr
Mac Park 31 Grove St Salem Ma Before 2:00pm
Tom Oshea 9784234689
144 Chairs Samsonite Bone/Neutral 1 1.00 144.00
31 6'Banquet Table 1 7.00 217.00
38 8'Banquet Table 1 8.00 304.00
1 Labor3@12hrs 1 900.00 900.00
Change
48 4'x 4'Stage Platform W/Adj Legx 40" 1 32.00 1,536.00
6 36"x 14ft Skirt Black 1 15.00 90.00
2 Adjustable Stairs 6 Step 1 45.00 90.00
l8 Stage Rails 1 0.00 0.00
1 40 x 40 Quicktrack UltraWhite Tent 1 1,100.00 1,100.00
1 40 x 20 Mid Quicktrack UltraWhite Tent 1 0.00 0.00
7 2ft Leg Extensions 1 12.00 84.00
36 Chrome Stanchion 1 8.00 288.00
3 100Ft Yellow Rope 1 0.00 0.00
Banner Mount For Quicktrack 1 0.00 0.00
Leave Ladder Under Stage
Payments/Credits $0.00 Subtotal $6,638.00
Sales Tax (5.0%) $0.00
Total $6,638.00
i a
/V`Iill J
ertffimtr of
/
REGISTERED o.�
It
CONCERN tk LcS Zqt
F-419.0 d Ave °'rE
Tnis is to certi/ (323i A 900c- 12rt t B treated(pr are inherent)that the rnateriais 9
FOR Inherently describeobcfp hereo; hav
nmableJ.
CITY B Y T R e been Marne rernrr;a; rl
ADDRESS _ Ma Certification is herebySTATE ' 1 KEE7
❑(a) The articles described below
that:(Check "
aPProved and registered b this certificate have been treated with a flame-retardant cne
shal
was done in Conformance With the lawste lof there rState Of California and the Rules and Regula-
tions of the State Fire t the applicationthR of said Chemical lcal
Name of chemical used
MethodMethod of application.....................................................................................................................
Chem. Reg. No.
X (b) The articles described below hereof are made from a flame-resistant fabric or material regis-
tered and approved by the State Fire Marshal for such use; Fabric has been tested anu passes
NFPA701-96.
Trade name of flame-resistant fabric or material used ....
The Flame Retardant Process Used ...wi!i,Not ....�vYL.... Reg.Be Removed b Wac.ot.
(wiu or will noq* y h in g
David Bradley
Name of Applicator or Production Superintendent By Tom Shapiro - President
Title
THIS FABRIC WAS USED IN THE MANUFAC. ,-j
'EA 40 U/�y QWIKTRAC TOP ONLY T[IRING OF THE FOLLOWING
3EA 40X20 MIDDLE U/W QWIK TOP ONLY
CONTR0W*I 2QFRFNCA WINDOW ACCRRS QWjg—a
Ar
CUSTOMER ORDER NO. 549 4E
NCH WINDOW SIDEWALL
CUSTOMER INVOICE NO. IEA 8X20' SOLID WALL CUSTOM SIDEWALL
52329
YARDS OR QUANTITY
COLOR _
STYLE
DATE PROCESSED
ALL MATERIALS ARE;CERTIFIED BY THE CALIFORNIA STATE FIRE
NLIRSHALL AND MEET THE REQUIREMENTS OF THE NFPA 701 AND UL214'4R