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14 SUNSET RD - BUILDING INSPECTION (6) _ The Commonwealth of MussaCIMSetlS I t BoatJ 1/t Building RCgnlatlons alld Siandal'ds I t IIt - r ,'• \I( Nit II'.\I fl Y- :� MassuchusettS Stale building Code. 780 CNIR. 7e' cJitiurl SI Building Permit Applicalion To Constl'LIC1. Rep . R nosate Ut Demolish a R, J huui�u I Me- Irr Tn�rFluniA n rlliag phis Section Fur t'ticial Lis Only Building Permit Number: Appli Siullature: -- - ----- - BuIlJlug ('uuum„nmeri In, •nor ui Buddwgs Uatc i ///�� SECTION 1: SITE INFORMATION 1.1 Pro ter . \ddn3y;r �// r^ 1.2 Assessors Nlup :C Parcel Numbers------- E4r I.la Is this ;in accepted street' ye%_ nII Map\umber - Parcel Xunlher 1.3 Zoning Information: ^11.4 Property Dimensions: Zoning District Proposed Use Lot Area tsy lit ---_ Frontage I11) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear YurJ Rcyui and Pmvlded Required Provided Reyuhrd P:u.ldCd I I 1.6 Water Supply: (M.G L c 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ❑ On site dis xnal ,ystrin ❑ Public ❑ Private❑ Check if yes❑ P gf� SECTION 22: PROPERTY OWNERSHIP' _ 1r) (PG,riat!y Address For Servi — �1� (/_ Z a G �2 Signature Tclep wn SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repait:s(s) ❑ Alter:uionl s) ❑ \dJitim ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specily: Brief Description of Proposed Work': -- SECTION 4: ESTUMATED CONSTRUCTION COSTS Estimated Ousts: - --- _ Item Official Use Only Ilabur and M:Costs: sl L Buildine S I. Building Permit Fee: $ Indicate how fee I] determined: ❑Standard City/Town Application Fee 2. Electrical S ❑'total Project Cost' (Item 6) x multiplier .x . 3. Plumbing S 2. Other Fees: S 4. Mechanical MVAC) S List: _._.- 5, Mechanical (Fire 5 Total All Fees: S Su) resswn) Check No Check .\mount: .— Ca>h \nnuun:-- --_ b total Project Cost 0 Paid to Full ❑ Outstanding Balance Due SECTION 5: CONSTRUCTION SERVICES 1; 1 1_icensed Construction Supervisor (CSL) -----__—_-- ---_----- --_--. .'L _.--__— _— License Nunlher I:\pu.dian Dale Mimic d(SL Ilulder 1,,,, C'SI. T,lie na• below I PC l t'nre'lnacd(up to ;1,000 Cu 1*1 R Raslrlcted F2 Fmmh Dwclhne llgn:uun• >I \Luonn Onb fcicphome \1) 12:,Id,nual \\l ndw' .ind lJdil sF Ra,i dcnual '),did I'•.Icl ISuiiiin_ \ •,I i_._lu.l.il kiln u.ti D Rim Wdnt"d Dctotlugt 5.2 Registered Home Improvement Contractor (I110 111C ContpanN .Name or IIIC Registrant Name Regutruu,m .Number Addres, ---- L!tptrauun D:ua Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 2506)) Workers Compensation Insurance affidavit must be completed and submitted with this apphcutinn. F:aline Ili pn„ode I this affidavit will result in the denial of the Issuance of the building permit. � J Signed Atfi davit Attached'? Yes .......... ❑ No . ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner ot'the suhlecl property hereby authorize _ _---_ to act on my behalf, wall matters relatl\'e to •.%ork authorized by this building permit application. _ I Signature of Owner Date SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION _ 1 , as Owner or Authorized Agent hereby declare that the st:uements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Pont Name Signature of Owner or Authorized Agent Dale ISrmed under the pants and penalties of perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work. or an owner who hires an unregistered contracnu (nut registered in the Hume lmpruvement Cuntracior (HIC) Program). will not have access to the :ohmauon program or guaranry fund under M.G.L. c. IJ_A. Other important information on the HIC' Program :Ind Construe lion Supervisor Licensing (CSL) can be found in 780(,'MR Regulations I I0.R6 and I I0d25• respecn%e, When ,ubstanual work is planned, provide the information below: ro(al flours area lSq. Ft.I tincluding garage. finished baseoiem/atttCs. decks ur p,trhi ! 1 Gloss living area ISq. Ft.) Habitable room count Number ct tneplaces Number tit hedruom, I Number of hathro„ins Number of 11AL'halt" _ .. I\peot healing syelenl _..-- Number tit deck,,' pm,hcs Iv'pe 11 C"ohong, s\,rem ! z. "Total Prnjca Square Footage" m:tv be ,ubsututed for "rnl:d project Co,t- ° WL'u�'�'�'"'�'u��"I M P O RTA N T D O C U M E N T'I@I'rJ'rJ@J'rJ@PLPLI @1'rJ'cJ'rJ'rJ'�1@f' 5 Certif icate of vianle Resistance 5 S REGISTRATION ISSUED BY S 5 APPLICATION Is CYn/��R Date of Manufacture 5 5 NUMBER V!! NDUSTRIES INC.® 04J0v02EVANSVILLE, INDIANA 47725 Order Number r� 5 F121.a MANUFACTURERS OF THE FINISHED 350615 e� 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 5 5 892825 5 S RICE RENTAL CENTER 5 TAYLOR RENTAL CENTER 5 115 CABOT STREET 5 5 BEVERLY MA 019155108 5 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California S 5 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 Serial # 8025300(1) 5 Description of item certified: 5 FI EXP MID 30W X 10 VL W W 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOHN BOYLE STATESVILLE NC $I ned: e5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT•ANCHOR INDUSTRIES INC. 5 o u��suasrn�u�r��nsu�u�su�u��n�ns��9L3PPLLPuLrL3 .nuju�&QjnuPL�n�n�ru�rns�� u��n�nFL3ffl u��n��nrs�nssu��ns�n�nu�rn�uan�ru�� o r, on�uu�rcs nuu�u��u�uLL nL�L3PL 2u01 I M P O R T A N T DOCUMENT cl�uu�rru�r�u�cnrsuu� L3pLpLr pLpc rrcPLPL P dau qr a o 5 REGISTERED �Certlflcarte Of if taw 3.egt.9tar�fe 5 5 ISSUED BY APPLICATION q, Date of Manufacture 5 NUMBER INWSiRIES INC. ov,9/o, 5 EVANSVILLE, INDIANA 47711 Order Number 5 5 MANUFACTURERS OF THE FINISHED 333649 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 5 5 5 692825 RICE RENTAL CENTER TAYLOR RENTAL 5 11 CENTER 5 CABOT STREET 5 5 5 BEVERLY MA 01915-5108 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California Fire 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 5 Serial k 5 9020560C(4) 5 5 Description of item certified: 5 TENT WAL 6'IOX40'VL W W WACA 5 - Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric SIOFIN BOYLE STATESVILLE NC Signed: 5� 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. J CJCPCP[PCJO[PCPfJCPCPfJ�[Pf�C PfJpPfJ�CP[PCJCPfJ�CPfJ�[PfJ�C PCPCJ@PC PLPL OCPC.PLj-L3 CPfJCPRI_PCPfJPPCJOCPfJ�CPf�C PCPf1dPCPfJ 3CPfJLPfJ�fJ�CPCPCPfPCP[PfJ 3CPCPfJ�C1GPCPCPC PLPfJ@Pf1CPflfJ� ❑1 IMPORTANT DOCUMENT OPRIEL PRRr��n�n��n rs o 5 5 Certl� � � 5 II 5 fltate Of ,lame Rol5ta ate 5 5 REGISTERED ISSUED BY 5 5 5 APPLICATION aaa,��,yyynnn�AA��^� sY�IRr Date of Manufacture 5 NUMBER INDUSTRIES INC. O.V09I00 5 FI21 4 EVANSVILLE, INDIANA 47711 Order Number 5 5 312193 5 CU MANUFACTURERS OF THE FINISHED 5 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:692825 5 5 RICE RENTAL CENTER 5+ 5 TAYLOR RENTAL CENTER 5 5 115 CABOT STREET 5 5 BEVERLY MA 01915-5108 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 5 Serial #: 5 8105960(1) 5 5 Description of item certified: STENT WAL 6-10 X 30 VL W W 3/CA 5 5 - Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 5 JOHN BOYLE STATESVILLE NC Signed: _-� Q 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. O rJrJrJ�cPr_PrJ�r?PrPrJrJrJ@PrJ�rJrJrJcl�rJ'cPr�cPrJ�c.(rJ�rJrlrJ�rJ�r?PrJrJr�rJrJ�rJ'rJ�rJ�r?PrJ�rJr?lorJr.Pr�r�rJ�rJ�r�r�rJ�rJ�rJ'rJ�PrJ�rJ'or.PrJ�cPrJ�r?PrJ�rJ�rJ�r.PrJ�rJ�cPr�r.PrJ�rJ�rJrJ�rJ'rJrJ�rJ'dr?PrJrJ�rJAJO O