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54 TURNER ST - BUILDING INSPECTION (10) What is the current use of the Building? Material of Building? If dwelling, how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# QUO 2- 1 9 HIC Registration # Estimated Cost of Project$a?3 0L Permit Fee Calculation Permit Fee$ Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury Date N y � � H a a u ,, a a ` t EI'I�-BF�rYL J , PUBLIC PROPERTY DEPARTMENT KIMWER!"DRI5COLL MAYOR 120 WASMNGTON SMEEr•S LL '.,MASUCHLSEI-rS 01970 1I1:978-745-959S 0 F=9M740-9946 APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY Y EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION of ve Location Name: Building: Property Address: Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land c� Name: df Address: Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing , . Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: TC� Tec� o� y0 X(PQ' -Y-16 rY3a' —7—e,�7f M 71 i/D 7, jern dir-eoC art -7 1319 Mail Permd to; n h 't % ,-, man St 1", `ej cp I qa IMPORTANT DOCUMENT 5 5 5 5 Certifirate of ,f taint Roi5tance 5 5 REGISTERED 5 5 APPLICATION CMORO Date of Manufacture 5 5 NUMBER F inous.RiEs INC 5 F 5 EVANSVILLE, INDIANA 47711 Order Number 5 5 F121.4 MANUFACTURERS OF THE FINISHED 111USA5 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: 5 5�5J 657150 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 I5 5 WINCHESTER MA 01890 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 If 8020500C(1) 5 5 5 Description of item certified: C 5 FI TOP 16WX32'VL W W lPC c 5 - Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabrics 5 JOHNBOYLE STATESVILLENC Signed: z1Z 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. O r�rJ�rJ�rJ�rJ�rJ�r1rJrJ�J�cPLPLPLPLPLLPLPLFL3 Jd-L3rJ@PJ�rJ�rJ�rJ�rJ�r�rJflJ�rPrPrJ�P�rPrJ�rJ�rJ�r1rJ�ePcP�PrJ�rJ�rJ�rJ�rJrJ�rJ�r�rJ�rJrJ��rJ�rJ�rJ�rJ�rJ�rJ�rl�rsrJ�rJ�cPrJ�rJ�rJ�rJ�rJ�rJ�rPrJ�rJ�r�rJ�rJ�rJ�r� O IMPORTANT DOCUMENT ��'�� LP �-�� 5lpeeCert�ifleat�e of lsflame 1Resista 5 REGISTRATION 5 w Date of Manufacture 5 APPLICATION o- �`sd RVR R� 09/23/02 5 5 NUMBER � NousTaiE�iNC, 5 EVANSVILLE, T Order Number 5 5 F140.1 �yf [M*p°r MANUFACTURERS OF THE FINISHED 361634 7 TENT PRODUCTS DESCRIBED HEREIN �5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:657150 S 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 5 WINCHESTER MA01890 5 5 5 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 U 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: r5 5 Serial # 8108985(1) 5 5 5 5 Description of item certl'Ified: 5 5 CENT MATE EXP END 40W X 20 SNY 5 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 55 S5 SNYDER MFG NEW PHILADELPHIA.OH SI ned: .-L) +� Name of Applicator of Flame Resistant Finish TENT DEPARTMENT-ANCHOR INDUSTRIES INC. 5 0 J�J�J�LfJ�J�J�cP�cPu�J�PJ�JJ�S�ncPcP��fJ�rJ�cPcPJ��PcPr PrJ�l3J�J��PcPc1�rJ�111 1 rJ�Lf�PcPcP�J�cPc E PL Pc PgPgLLig L Jgm7crJLrJ�LauLr FL LfE?A O o PF�9QKKF��'�-''��9�r'MMM I M P O RTA N T DOCUMENT 55 Certificate of 1phupc 1ii<esistapee 5C REGISTRATION k ISSUED BY 5 5 APPLICATION InQ Date of Manufacture 5 NUMBER � 1�CHES i� ` 5 5 ; g Num ber Order ume f o-5 r EVANSVILLE, INDIANA 47725 Or 5 5 F140.1 �M CMS MANUFACTURERS OF THE FINISHED 361877 5 �j TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:657150 5 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 WINCHESTER MA01890 5 5 5 5 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 cherical was done in conformance wiih California 5 5 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FIR chemical application is: 5 5 Serial # 8108975(1) Description of item cert 'ee 5S C�N�MATE EXP MID 40W X 20 SNY 5 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDERMFG NEW PHILADELnHA.OH Signed: . 2 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT-ANCHOR INDUSTRIES INC.11 5 O r1nrJ�rJ�rSrJ�rJ�rJ�rJ�cPcnrPrJ�rJ�rJ��c.�cPrJ�cPrlr�r_P�PcPrJ�rJ�cJ-cPPr�cP�PcPr�LPrJ-r�Pu�r�rJ�rSrJrJ�rPJ�rJ�rJ�rJ�rJ�r�c1�r_f�r�rJ�rJ�rJ�rJ�._PclrJ�rJ�rJ�rJ�rJ�r�cPrlacPrJ�rJ�rJ�rJ�rJ� � o ��I��r. ffl I M P O RTC►N T ®O C U M E NT�'��''�'��'�'��'�'��' 5 Certificate of Flan?e Resistance 5 5 REGISTRATION ISSUED 8Y 5 5 APPLICATION v Date of Shipment 5 C5� NUMBER s cN3rR� snoizoos 5 C NDUSTRIE INC. 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F14U 1 MANUFACTURERS OF THE FINISHED 04263446 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 r 5 657150 5 5 PETERSON PARTY CENTER INC 5 139 SWANTON ST 5 5 WINCHESTER MA 01890 5 ZI 5 5 I 5 5 5 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 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 5 Serial k 82 1600(2) S 5 Description of item certified: 5 5 5 5 PARTY rEN I END 40WX20 SNYDER 5 wiirm VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 n n 5 inuni anvi G Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 O rJ�rJ�r�rJ�cPr.PcPc1rJ�cPcPcPrJ�rJrsr_PrJP.PrlcPrJ�rJ�rSlrlcPrli_Pr�r�cPcPrPcJPP_ f�rJ�cPr.PcP��rJ�cPrJ�rJ�rJ�rlcPrJ�rJ�r.PrPrJ�rJ�c.fEPrlr�clrJ�rJ�rJ�rJ�rJ@PcPcPrJ�rPcPr�cPrP O _ -- - CITY-OF—SALEM PUBLIC I R�I'FcLR I Y --'; -DEPARTMENT -- - Krl tnERLEY DRISCOLL MAYOR 120 W;15ViLVGTOV STREET $ALEA1,VIASSACHCSEI-IS 01970 TEL:978-745-9595 ♦ FAX:978-7400.9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �o Please Print Le ibl Nagle (Business/Organizatia✓individual): / z -S G� , "`' City/State/Zi�:��(�j ��Ll2 m/9 Phone n: � 7o Are you an employer? Check the appropriate box: Type of project(required): 1:[ -I-am a-employer-with 2 0 4. ❑ I am a general contractor and I _- _ 6.-❑-New-construction employees(full-and/or part-time).' have hired the sub-contractors - 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t7. 0Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition t o workers' comp. insurance 5. ❑ We are a corporation and its [N P required.] o 10.❑ Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions 152, 1 , and we have no myself. [No workers' comp. c. § O 110 Roof repairs insurance required.] t employees. [No workers' 13.® Other /el" h comp. insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 urn an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. / y� Insurance Company Name:— Policy#or Self-ins. Lic.,#t:�AIC 2n �� a�=%V/ — 0a'7 Expiration Date: Z9 U Job Site Address: / �UiZZ7lrt �S f City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Date' Sienarure -/ii'Gf� s��'� �s Phone 4- Ojfieial use only. Do not write in this area, to be completed/by city or town offtciaL City or Town: PermitiLicense# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: -- -Phone#: • -. IP 68 This tf t a: Ily Liberty Mutual lnwranc p_ re ects:u htmurara!_s is affor&d by thou coa onic. Certificate of Insurance TI tf t r i maser of mfonnaOa onlYn codea 10 rithn t Mn y, l,e certificate hddv Thn cemfieate is aat an insurance policy and does not am end,extvd,orah•r that er - — OacAhyll,.Il Liw slulcd below. Tit is is t0 cc r ify that(Name and addres c of I ns:',red) Prtcl un,Pacb, Ccncr Inc ---- --— -- - Li Ibe.r it�I.r 1�93wanto I It ]��( }- 1 W'it,;hratcr.'?IA 0189,1-1918 M.L1�L�' ��nu k.:n t M issue;(r a of this¢ttificate,inwrM by the Crop; ty,, d.the Pillq(tes)lieta'F below. The insurance afforded by the liucd policy(ies)is wbjecl to alI m<ir terms,exclusions uid conditlonn is I'd! m — is nnl deer tr,aYs_, n:ment,mrm v condiltoaofa ., t_trad•,'oIh,,documem vmh cl to which this certificate ma beissue . Limits of LiabHit ---- Ex�i.athln T e I?R�l Dahl: Poll Number s <.oPsinuous' 10/09/20f1; 10.'OS•!008 WC2-:.1 .259617-027 Coverage afforded under WC 12W of Employers LiabJ itV _ the following stairs: Bodily Injury By Accident _ Er.'enGed X i-alicy Term MA $500,000 Each ,\c[ dent ...—..— Bodily Injury By Disew e $500,000 Policy Lit::lt- Bodily Injury By Dises:c- _-- Worker: GAmp ensation $500,000 Each Pel +0 1 10/03/iG0:' '10/0:;200II TB7-I I ' 59617-037 General Aggregate-Other than Prod/Completed OperalioW Geu•:ral Liability $2,000,000 ----- ---- Products/Completed Operations Aggregate C I::ims Made $2 000 000 EPe, ounrna� Bodily Injury and Property Damage Liability$1 000000 vrrrn:e Personal and Advertising Injury Pft'0.1/ Dena D.rte $1000000mi,anon -' - Other Liability Other Liabiliy 10/33/2(N1' /10!0 /2008 AS2-111-259617-017 Each Accident-Single Limit-B.I.and P.D.Combined Aucen•.obile Liability $1,000,000 --- Fr Each Person X M•:,ri hvmd Each Accident or Occurrence t Ili ec. Each Accident or Occurrence 10'03': 4/2IX)8 TH2-5 i 1-259617-067 $5,000,000 B&u�DWComplcted Ops $5,000,000 _ tjm!1.I:E 7I EXCESS SS OOO OOO General A tale .,-.—.. Llcsci aimu,fOperations:Re lnsmed'sol mtiow: 'cnting equipment for business Br.social functions,including erecting ernes. C C � 11J Pd l: If I niix of a ni xlbmn::(nm applicable unl¢s a monbcr�-1:!s s'rnt::-d helawl.nerort art etntM eaP^anon Mee the compvtY will rot wxd or redo¢the imureace aRaMen under lM1e above LI ;s a.ortl ,0 t.y,na0a ara:Kn eaaenllat i nma„ua'. --_. --- Office: WESTON,MA£OUll. Phor.e: 731-891-BS({• { ,.f t� !' itl liy 1I• KATHERINE MACDONALD Cr atif:sate Holder: "----""--' Authorized Re resemmtive P�,i,or.son Party re.itn r 119 Swanton Street FinChester, MA JJB', Datelsseted: 10/17/2007 Prepaccd By: K.S J� �671vrr[47t,1/lfp,L[/1, o�!��nL1IJ(�y((GP�d Board of Building Regulations and Standards Construction Supervisor License License: CS 60219 Birthdate: 4/27/1954 Expiration: 4/27/2009 Tr# 11766 WA Restriction: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Commissioner o �