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10 WHITE ST - BUILDING INSPECTION (16) a - The Commonwealth of Massachusetts s;'i� Board of Building Regulations and Standards CITYOF Massachusetts State Building Code, 780 CMR SALEM Lb+ Revived I/<ir]Ill l t Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Familt DmvellhNg ^ rhis Section For Official Use Onl f )1 \ Building Permit Number: D e Applied: lAii Wing 011icial(Print Name) Signature ! Date SECTION 1:SITE INFORMATION it�.l Prop��.�'erty Ad ress: 1.2 Assessors Nlap At Pare umbers 1.la Is this an accepted street?yes_ no_ Map Numbcr ParcO Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed lJse Lot Area(sq It) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Y;ad Required Provided Required Provided Required Provided 1.6 Water Supply:( , I.e.40.§5d) 1.7 Flood Zone Information: I.S Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Munici al ❑ On site dis sai s stem ❑ Check ifn SECTION 2: PROPERTY OWNERSHIP' C^ 2 I O, wnef'o�ecordr � � -��., NJ� /1/-'C ;nic(Print) City,State,ZIP 6�6 9536 Nu.:tad Street "relephone Entail Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ .Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify Brief Description fProposed Work'-: _ n.� 1Glvr lS ��o — � SECTION a: ESTINIATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and \laterials) Y I. Building S I. Building Permit Fee: S Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)s multiplier ___..x 1. Plumbing $ ? Other Fees: S q. Mechanical III\':\CI S List: v \Icchanical IFirc -- ------------- Su t nressionl S Total :\II Fees: S _-----_--_— -_-- Check No. _('heckm:\ ount: 6. Total Project Cost: $ �� 771 paid in Full 0 Outstanding Balance Due: -_ - r SECTION 5: CONSTRUCFION SERVICES 5.1 Construction Supervisor License(C'SL) License Namher Fytiratiou Date NantC o(CSI. 11 u4 ar List CSI.'I)pc Isca helUwl Nu. and Street __ 'I.)PC Dcscriplion D I inrestricled(Buildings up to 35.000 cu. 11.) R Restricted M2 Family Dttellio Cil)irown,.Slate.ZIP M klasonry RC Rootin•Covering W'S Window arid Siding SF Solid Fuel Buming Appliances I Insulation 'Felt hone Finail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i IIC Registration Number Expiration Date 1IIC Compun) Name or I IIC Registrant Name No. and Street Email address City/Town,State, ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's None(Electronic Signature) Date SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION 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 rue and accurate to the best of my knowledge and understanding. I' ' Ow ner's or:\ulhurizcJ, gent's Name(lilectrunic.Signature) Date NOTES: I. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under.M.G.L.c. 1 42A. Other important information on the HIC Program can be found at st tits iia,.,�;o% og.l Information on the Construction Supervisor License can be found at n"kk ma,a ,II„ ?. When substantial work is planned, provide the information below: Total floor area(sq. R.) (including garage, finished bascment'attics,decks or porch) Gross living area(sq. It.) Habitable room count Number of fireplaces.—_ Number of bedrooms Number of bathrooms Number of half halhs I N pe of heating system Number of decks, porches 1'1peoleoolln_gs�Sleltl Fncosed __Open i. -I'olal Project Square Footage" ma) he substituted ror"rot:d Project Cost" Certificate of Flame Resistance REGISTERED ISSUED BY FABRIC JOHNSON OUTDOORS INC. Date of Manufacture NUMBER BINGHAMTON, NEW YORK 13902 Manufacturers of the Finest JANUARY 2007 FA-49303 Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently Flame retardant as here after specified by the material supplier. NAME: THE EVENT CO. CITY: GLOUCESTER STATE: MA Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701', Tvoe.color and weichtofmaterial: NC-16-BOR Vinvl ENDURA WHITE BEIGE OUT -r Description of item certified: 8 X 20 TT+ SW ENDURA Flame Retardant Process Used Will Not Be Removed By Washing And s Is Effective For The Life Of The Fabric HANWHA POLYMER CO. TENT DEPARTMENT,JORNSON OUTD 'Large Scale Certificate of Flame Resistance REGISTERED ISSUED BY FABRIC JOHNSON OUTDOORS INC. Date of Manufacture NUMBER BINGHAMTON, NEW YORK 13902 JUNE 2009 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: THE EVENT CO CITY: GLOUCESTER,MA Certification is hereby made that: The articles described on this certificate have been manufactured with an 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 Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G. Type, color and weight of material 14 OZ.WBO Description of item certifies TT+ 10 MID 40 WBO Flame KOtar-dant Process Used Willo e Kennoved By Washlng Ana Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,JOHIRSON OUTD00RS7FC \\ -Large Scale Sep 13 10 05:40p Carol Hedges 978-283-4163 p.3 Certificate of Flame Resistance i REGISTERED FABRIC ISSUED BY Date of Manufacture NUMBER JOHNSON OUTDOORS INC- BINGHAMTON, NEW YORK 13902 TUNE 2009 F-140.01 Manufacturers of the Fkiest Tent Products Desptbed Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: THE EVENT COMPANY CiTY: GLOUCESTM MA Certificadon is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance With California Slate Fire Marshal Code,NFPA-701'. Underwriters Laboratory of Canada, and have been tested in accordance With the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-0430aeG. Type,color and weight of material 14 OZ WBO Description of item certifies TT+40 X 40 2PC NSO Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. ManuiacWrer W Flame Retardant VmN Laminates TFNT DEPARTMENT,JORNSON OUT 1tS IN . . 'Large Scale J t