54 TURNER ST - BUILDING INSPECTION (8) A..1
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JdSAECIL�A NY4A T IE .FING GRANTED
CITY OF SA.EM
Dom. G , ? -041
4 PMPWtV Loaded In Location of
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Remof, Install Siding, Construct.DsoK Shad, Pool,
Rep ir/Replace, Other.Ewtrd�ArG1 �
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROC
TO THE INSPECTOR OF BUILDINGS:
The undersigrW hereby applies for a permit to build according to the following
specifications:
Owner's Name sew-A,/ 4,464e3
5� 7Gs2.uf-28V�
Address & Phone Yac -,, Aa,4 -,oi97za &/xi
ArchkwWa Name
Address & Phone L
ia19� TX+0��4
Mechanics Name
/1'? S"Avvun✓ av-
Address & Phone 01,Mlcl>/9179-- , OV,4 0P94, (7VI) 7aR-,1ov,)
wlw Is aw wvM•a a,rmns? `:�s✓v_rr<s,4-.�az`l �;L�;;,
L�"W of tx k%W�LLla9�uLx� 1141v�/L, M a dwalYq,for how awrryr hnlaM?
wr wav conform to law?
Edhged ocmt. J 7.—.�z¢, my tSmasra: P` abb Lkmm e CJ bA Z/`f
Lie. ,
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Signature of Applicant ,�^ � •
SIGN40 UNDER THE 10611110"1
9�a a OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TOL j,1 YW An2��vr r
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APPLICATION FOR
PERMR TO
-Ny uy
OCATION
PERMIT GRANTED
APP �fl) '
1 PECTOR F BUILDINGS.
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 060219
Birthdate: 04/27/1954
Expires: 04/27/2005 Tr. no: 9542
Restricted: 00
MARK TRAINA
33 HANFORD RD
STONEHAM, MA 02180 Administrator
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The Commonwealth of Massachusetts
Department of Industrial Accidents
exce 011mresz6vil/oos
_ 600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
name,
lotatinn_
city- phone If
O 1 am a homeowner performing all work myself.
O 1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
�
companyname•7�/—F- Q,cxc5AJ ( 9,f L7,
iddrgis, _fiy t'A1fV 1V ST
ctrw: /Ni�llt✓AAf5'7 2 /YIiO [t>y c> phonea: 710- 7a4- �aDU
insurance co. N• �'� ' volicvM 70/U i'/G C) /Z�G L
(] 1 am a sole proprietor, general coatractor, or homeowner(circk one) and have hired the contractors listen below who have
the following workers' compensation polices:
Somvanv name,
address
city: vhone.p-
insunntt f:a<_ oolicv p
companv name:
address:
city: phone k
insurance co volicyq
Attar . aihooa i VC
Failure to secure coverage as,required under Section 25A of MCL 152 can Ind to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one years'imprisonment a well as civil penalties in the form of a STOP WORK ORDER sod a fine of S100.00 a day again$(me I understand that a
copy of this sta(emnt maybe forwarded to the Once of Investigations osf the DIA for coverage verification.
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t do hereby certify under the pains and pena4ies of perjury that the information provided above it true and correct.
Sgnaturc_S� Date �� !7�
Print name �/rcYGf 6 A- 7 — Phone M—7
official use only do not write in this arcs to be completed by city or town official
city or town: permit/license if f1Building Department
7 oLiccnsing Board
O check if immrdia(e response is required oselectmen's Office .�
)Hcs(th Department
contact person: phone a; rlOther p
(n.er(ns pw(
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'Y141 °I S 1 •Nr-`Z E'I h }}. t {I i t
epYri 1'� OvSTf
REGISTERED r of catrF b ISSUED ev
{ I P ., Z Date of-Manufacture (a � -
APPLICATIONI ANCHOR INDUSTRIES INC. . r • ;` : 1141
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NUMBER II EVANSVILLE, INDIANA 47711 Serial
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rl� I h r 25911' .. 3/8/93 N
Qlf'lr xM i 9 fygE N,P Qi' ' MANUFACTURERS OF THE FINISHED I. !`tx1 'Y3`�
9*' I { F121,4 �!F RETPa' TENT PRODUCTS DESCRIBED HEREIN
i This is to certify that the materials described have been flame-retardant treated(br,are.
inherently noninflammable) and were supplied to: 'I -
tk t NAME: PETERSON i PARTY CENTER INC ' t 1•; : � 'f 7, _ I
M ? MA
CITY ,_WINCHESTER STATE
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=,wN Certification is hereby made that:
k I The articles described'on,this Certificate have been treated with a flame-retardant approved:
chemical and that the application of said chemical was done in conformance with California q
14 1�w , Fire Marshall Code, equal,;,to or exceeds NFPA 701, CPAI 84 GOVERNMENT CERTIFIED LAB 41056 � w
u++wtr9r.., 9 F o-rF _^ = II ,.� U.L.-214
�al< Method of application: LAMINATED
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Type, colorand weight of canvas/vinyl: BOYLES BIG TOP VINYL LAMINATE White -o ' I J F„oz
1ai9911t"�.r y . . � + • ' �.. '.
$�rl rover I r'n
4 Descripti 'on of Item certified: E MidI if
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1Z, r, Flame,Retardant Process Used Will Not Be Removedl',
Washing And Its Effective For The Lif Of The Fabrics
nw JOHN BOYLE h CO. iSigns yi`
:Name of _Applicator of Flame Resistant Finish 9 r.=a4,r y1
! TENT D ARTMENT—ANCHOR RUSTRIES INC.. M1 # I7 ,Kc - !
v STATESVILLE, lC
LOIIIS R. IBEOAN
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+a�" s CnPrtiftr
ate of
` >' REGISTERED ISSUED BY
� ' J. • APPLICATION _ ANCHOR INDUSTRIES INC. °at8°"'a "a""`e
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NUMBER EVANSVILLE, INDIANA 47711
3/17/94
Order Number
Nr11x 6 F121.. 4 MANUFACTURERS OF THE FINISHED 055928
+�Yi RET TENT PRODUCTS DESCRIBED HEREIN
This is to certify that the materials described have been flame-retardant treated
ywk; (or are inherently noninflammable) and were supplied to: p•
P � It PETERSON PARTY CENTER INC i ° f
th j in 139 SWANSON. ST Jui d.
`1tlpr. 11` a� WINCHESTER MA 01890
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Certification isl hereby made that:
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4," an The articles described on this Certificate have been treated with aflame-retardant
„! approved chemical and that the application of said chemical was done in conformance,
' I• , with California Fire Marshall Code, equal to or exceeds NFPA 701 CPAI 84' ►.
Method of application:
Type, color and weight of canvas/vinyl:
8025000 (0001 ) "
-
Description of item certified:
J" $I 'l-; FI EXP TOP 30W X 30 VL W W
Flame Retardant Process Used Will Not Be Removed By
lu 1Y�,
Washing And Is Effective For The Life Of The Fabric , ; "4
rib I•u, ./
7+ JOHN BOYLE & CO ��✓// ►a
ii Signed: "4�s.. `G• � •R. _ '' !1I/
Name of Applicator of Flame Resistant Flnlsh
d I eq jury TENT DEPARTMENT—ANCHOR INDUSTRIES INC
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