19 1-2 WASHINGTON SQ - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
f; I, Department of Public Safety
-,.✓ \lassachusetts Slate Building Code(780 CMR)Srevnth Edition
City of Salem
U ` Building Permit AEplication for any Building other th a 1- 0 2-Fam' Dwellin
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Ins) r: T
SECTION 1: LOCATION (Please indica& k M and Lot M for locations for whichjIsKeet address is not available)
"� �►tGZn �x/Ke G�'�and Street City /Town Zip Code ame of Building (it applicable)
SECTION 2:PROPOSED WORK
If New Construction check here O or check all that apply in the two rows below
Esistirg.Building ❑ Repair❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are Ludding plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:
"L K/is Y/ C � �
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed (See 780 CMR 3402.0) ❑
Existing Use Group(s): Proposed Use Group(s): r
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No. of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area (sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ - A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2 Cl 1-3❑ 1-4 ❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 ❑ R-4 ❑
S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
*131,B
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IB ❑ IIA ❑ 118 ❑ IIIA ❑ IIIB ❑ IV VA VB ❑
SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
I Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Y� Check ifoutside Flood Zone❑ Indicate municipal ❑ A trench will nut be Licensed Disposal Site❑required ❑ , trench ur.pecifc:or mdentil% Zone: or on.Ilesv.tem ❑ ),remit is enclosed ❑ad right-of-way: Hazards to Air Navigation: \In I l,nr\pplicoble ❑ I.tit n,i lure+nlhm airnrt arnach a' Is lheu" rer,e+c completed.'
to Bu,ld encloed ❑ Yc. ❑ or.No❑ Ye>❑ \o ❑
SECTION 8: CONTENT OF CERTIFICA"rE OF OCCUPANCY
Esteban LIe(;roupl.): r_\prof Constriction: OCCupdot Load per Ilooe
Uoe. Ihr bu,ldmh nmlainan Sprinkler Scslem.': Spacial Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION -
Namc and Address of 'ro surly Owner
Name(Print) No.and Street City/Town Lip
Pro s•rty Or.ner Contact Information:
Title i Telephone No (business) Telephone No. (cell) a-mall addrass
If.ip�lii able, t e pTrperty owner hereby authorizes �--�-_
-F m-,M M �2v 4 �-
Name Street Address - City/Town 'state Zip
to act on the pro pert% try ner',behalf, in all matters relative to work authorizer]by this buildin • permit a >,lication.
SECTION to:CONSTRUCTION CONTROL (Please fill'out Appendix 2)
(If building is less than 35,001)cu. it.of enclosed space and/or not under Construction Control then check here O andskip Section I0.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. - e-mail address Registration Number
r 3
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name:
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
Telephone No.(business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? YeqAV No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6) =$
1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ - appropriate municipal factor) =$
3. Plumbing $
Note:Minfmumfee=$ (contact municipality)
4. Mechanical (HVAC) $
5. Mechanical (Other) $ �p Enclose check payable to
6. Total Cost $ 'j l� (contact munici alit )and write check number here
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true,md accural i the best o ` y kf/}w,wledge and understanding. q 7 O�.� �
Please print .md>ign name -ride Telephone No. —D—a�tte--
?_Q 3aY_ e-F r 9 D/g' 3 r-,
titrcct Address City/Toren State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
RAPID MICRO BIOSYSTEMS - `» :�.:`-
07/Y9/08 08:44 FAX 8782719905 ;
The Commimwsafth of massaclwseffs
Depart+mt of lndusirial Accidents
office of InVMOZZOOM
600 Washing'"S&Vd
Boston.+MA 02111
www.tnassgov/diaWJ �ians/Pittnubers
Workers' Compensation Imanranee Affidavit:BuffderdCoatractorslElectriLmikk
A ttcans Ynfo (&A I 'f'Li)
Name(BttsiaeWQW=mUenRndt UA
� y�7 p
Ate• l` Phone.# ! /h''JO, 10 0
City/State/Zip: '�
Typ
bm: e of project(ragmre�_
Are you an eraptoyer'.Check F aPP�P Q 1am a general co¢ascwT and t 6, New cooazuaron
1. am a emtploye Trith f`� „ have hued the sub-comtlacbms 7. G'RermpderAUM
eyoyees(ihII andfoTparFtime)- toted on the amched sheet
2.❑ 1 am a sole pmplietar or paMm- 'thesc sub-eonnuctora have g Q Drmalition
ship snabave no smPlffecs =playees and have workers' 9. Bulling addition
wn> n8 for me in any capacity cones imma,.r t 1p❑Mecuicai cpami or additions
NO wodeets'c°mP• S• We are a corposatian and its
their 11.0 Yhmthmg iepatzs or additions
3-� Il mn as homoowna doing all work have mmomed
TiSbt Of exemp�n Per MGL 12-0 Roof repairs .
myself.(No workers'cep- h 152,$1(4),and we have no 132P odd
insn=m regWmd.)t Coaployesa.[Na wodm ] Y'C.
camp.iamlra=
hetw«shewtea tteR�t�• . nsanm peecrtdlmam-
d1 waieand that Eve ;aeeomsetoattsmaas�t ane+r a$ vittB A't'-
•Mr t@atehdie hex p1 eaeeabd fin.8& a 4
t srao mL.oitanaa&dsvit tee@�wY andoma eftLe subconmetos masorear6�rar aortim�mfiaalme
Hcm-'owners misrmtraue+n8� °C -
'CmoactasawtdtisDtucmueamr8od m�stP�e.•�M Otsa wesloxs` a•P°wan .
ertmtoyeo. if enesutKona�msha+w�ttl%"' Rd w is the peaW andjeb she
warkers•'eompomadun mssamree jer asP aePleYeaS
I am an eatployer"it providing /
vfarau80n
Insurance Company 2iame' IJ % �y 7D I xpirrtt /on Date
pow#or Self-ins-
Job Silm A %T- - mPensati°a policy n azPlratlon datn}mb
de p a pia(sg
Attach a Copy o the woara'eo
Of criminal penalties of a
Faunae m se nre co`' mr.as i eoluitcd�Section 25A of MGL c I52 can lid to the iumo TO ER'and a 9ne
as wcli as eivrl Pis in the form of a STOP P WORK.ORD of
ride up to$1,500.00 andlar one-yes<iUV isomer ofthis sta��I'�{p1wmdodto theO15Oe
of up m.$250A0 a tiny against lire violator- Be advised
a egry —
Invesba afthe DT° forinsar+nce covetaECv
m3 EW mew ormattea provtd is tree one
I do herebY eadfy seder the pacts and pmatttm ofpa7ury
. - or wmu of�at
m amen Do atx wade iA rbn area.sa
Permwimense#
City or Town- .
lssoint:AmhorW(ctrde ane): d-$leeRttai Inspector 5_Yril d b,"Rman"'
1.Board of Health 2.StAlding DepartlMst I CkyfPovtn Clerk
6.Other
Phone
Contact Person'
Owd
Certificate of Flame
Resistance
Date treated or
* ISSUED BY Manufactured by manufactured
H Burlan Corporation Fred's Tents &Canopies
1-704-867-3548 7 Tent Lane 07/03
Stillwater, NY 12170
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
Gloucester MA 01930
Certification is hereby made that: (Check"a"or"b")
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 application of said chemical was done in confomnance with the
laws of the State of California and the Rules and Regulations of the State Fire Marshal.
i
Name of chemical used Chem.Reg.No.
Method of application
(b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
IX I NFPA-701 (large scale) &CPAi-84
Trade name of flame-resistant fabric or material used Blockout White Reg.No. F-76101
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc. �lJo
Plant Supervisor
Product Description (2) 6x30 Marquee Customer Invoice# 10950
Certificate of Flame
Resistance
Date treated or
ISSUED BY Manufactured by manufactured
v Burlan Corporation Fred's Tents &Canopies
.-- 1-704-867-3548 7 Tent Lane 07/05
Stillwater, NY 12170
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
Gloucester MA 01930
Certification is hereby made that: (Check"a" or"b")
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 application of said chemical was done in conformance with the
laws of the State of California and the Rules and Regulations of the State Fire Marshal.
Name of chemical used Chem.Reg.No.
Method of application
(b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
NFPA-701 (large scale) &CPAI-84
Trade name of flame-resistant fabric or material used Blackout White Reg.No. F-76101
k The Flame-Retardant Process Used WILL NOT Be Removed By Washing
a
Fred's Studio Tents & Canopies, Inc. l
Plant Supervisor
Product Description 9x10 Marquee Customer Invoice#
15026
Certificate of Flame
Resistance
D treated
Dale t ea ed or
OR
ISSUED BY Manufactured by manufactured
Burlan Corporation Fred's Tents &Canopies 1-704-867-3548 7 Tent Lane 06/05
Stillwater,NY 12170
P
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
j Gloucester MA 01930
Certification is hereby made that(Check"a" or"b")
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 application of said chemical was done in conformance with the
laws of the State of California and the Rules and Regulations of the State Fire Marshal.
Name of chemical used Chem.Reg-No.
Method of application
X (b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
NFPA-701 (large scale) &CPAI-84
Trade name of flame-resistant fabric or material used Blockout White Reg.No. F-76101
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc. ' 1�7
Plant Supervisor
Product Description 6x10 Marquee Customer Invoice# 14914
6x5 Marquee
9x18 Marquee
Certificate of Flame
Resistance
Date treated or
la` ,Ti ISSUED BY Manufactured by manufactured
.v Burlan Corporation Fred's Tents &Canopies
'=�v 1-704-867-3548 7 Tent Lane 06/08
Stillwater,NY 12170
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
Gloucester MA 01930
Certification is hereby made that: (Check"a"or"b")
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 application of said chemical was done in conformance with the
laws of the State of California and the Rules and Regulations of the State Fire Marsbal.
Name of chemical used Chem.Reg.No.
Method of application
Ex (b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
NFPA-701 (large scale) &CPAI-84
Trade name of flame-resistant fabric or material used Blockout White Reg.No. F-76101
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc.
Plant Supervisor
Product Description 6x30 Marquee Customer Invoice# 21378
Certificate of Flame
Resistance
Date treated or
ISSUED BY Manufactured by manufactured
Burlau Corporation P Fred's Tents &Canopies
1-704-867-3548 7 Tent Lane 06/01
Stillwater,NY 12170
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
Gloucester MA 01930
Certification is hereby made that:(Check"a"or"b")
a)The articles described below this Certificate have been treated with a flame-retardant chemical approved and
Ll registered by the State Fire Marshal and that the application of said chemical was done in conformance with the
laws of the State of California and the Rules and Regulations of the State Fire Marshal.
Name of chemical used Chem.Reg.No.
Method of application
(b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
IX I NFPA-701 (large scale) & CPAI-84
Trade name of flame-resistant fabric or material used Blockout White Reg.No. F-76101
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc. ower
Plant Supervisor
Product Description 6x20 Marquee 9 Customer Invoice#
7049
Certificate of Flame
Resistance
Date treated or
ISSUED BY Manufactured by manufactured
e Burlan Corporation Fred's Tents &Canopies
1-704-867-3548 7 Tent Lane 07/08
Stillwater,NY 12170
this is to certify that the materials described below hare been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 419
Gloucester MA 01930
Certification is hereby made that: (Check"a" or"V)
a)The articles described below this Certificate have been treated with a flame-retardant chemical approved and
El registered by the State Fire Marshal and that the application of said chemical was done in conformance with the
laws of the State of Califomia and the Rules and Regulations of the State Fire Marshal.
Name of chemical used Chem.Reg.No.
Method of application
Ix I (b)The articles described below are made from a flame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
NFPA-701 (large scale) &CPAI-84
Trade name of flame-resistant fabric or material used Blockout White Reg.No. F-76101
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc. 17
Plant Supervisor
Product Description 9x 8' Marquee Mid Customer Invoice# 21519
9x 10' Marque Mid