The URL can be used to link to this page

10 WHITE ST - BUILDING INSPECTION (25) -- o ---QED I VELD ' The Commnwealth of Ma lwnt CERy'DFS Department of Public Safety fµ `f " MOSSdeIMSVIISSl.noliuildingCole(7 _Nlll �s�kr a ,r Building Permit Application for any Building other than bil�n 112y I315elling ('I'hfs Section For Official Use Only) Building Permit Number: Date Applied: __ Building Official: SECTION 1: LOCATION(Please indicate Block If and Lot p for locations for which a street address is not available) lzeweiEa f�fli�,zn�__/t'larz rn t-Q- No.and Street CAN /Town Zip Code Name of Building(if applicable) SECTION 2: PROPOSED WORK n [dilion of NIA Stale Code used If New Construction check here❑or check all that apph in file two rows below U1 , Existing; Building❑ licpair❑ Alteration ❑ Addition❑ 1 Ucntoliliun ❑ (Please fill out and Submit Appendix 1) Change of Usu ❑ Change of Occupancy Cl Other lA Specify:. TGN t Are building plans and/or construction d,xuntenls being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineerin, Peer I'm• 're'1tred? .--, Yes ❑ Nu s— Brief Description of Proposed W'Vt er e,' 0. cv70 XXZ) /?iM.pOR e,+/ Tenip QVI e ILN Oil GYt SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CNIR 34) ❑ Existing Use Group(s): Proposed Use Group(s): _ SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Flours/Stories(include basement levels)dr 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-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-IM R-2❑ 11-3❑ R-1❑ S: Storage S-1 Cl S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use SECTION 6:CONSTRUCTION TYPE(Check as a licable) IA ❑ IBO IIA ❑ 118 ❑ IfL\ ❑ IIIB ❑ IV ❑ VAO VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Renew if; Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be LICCnSetl DispoS.d Site❑ royuired ❑or trench or specify:___ - - Pricah•El or indentify Zono: or on site System ❑ permit is enclosed ❑ Railroad right-of-way: Ilazar Is to Air Navigation: �i i .i„u, ninn �' •, ..__- Not :\ppliC•tbly❑ Is StniClu rc within airport approach art•a? Is Iheir review Completed? or Consent to Build rn,los, ❑ 1 cs❑ or:NO❑ YeS❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Fdition of Code'. Lsr Group(.S): Iepe of ConStruClion: Occupant Load per I Ioor: Fors the I,ui ding;Con la in an Spri nklcr Ss tom.':_-.-_-_SPrCial tit i pilot inns: __ _.- SECTION 9: PROITH IN OWNER AU 111ORIZA'IION unr,uxi :\ddn•ss a I'roprrly(lwnrr 2PwP? nervG� o - --_yM—/ 4 n Nana(Print) No.and Street City/Io%%11 ._ Zip -- ?y})perh Owner Contact Information: l itle Telephone No. (business) Telephone No. (cell) a-mail address gtPP Cable, the property owner hereby aulhorizos rim �4 (-,4 36 cG��ta./ �i��d,z/1 --Q/Far Name Street Address City/down State "Zip to act on the property owner's behalf, in all matters relative to work authorized by this buildiag permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,0W cu.ft.of enclosed space and or not under Construction Con Irill then check here O and skip Section III.i 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date l General Contractor Xparry Name ;W l2arna C sz- Name of Per vp Rysponsible for Construction // License No. and Type if Applicable -?6 4 0 �� `CJDl�u2f1 W- U/ S-r// Street Address City/Town State Zip Av Tole+hone No. business Tcle phone No. cell e-mail address SECTION 11:nt mar) ; c O%wi `,,.\i_u r''I,xr:u_I\'ANC1_ I i in,'+vu M.G.L.c.152.§ 25C 6 A Workers'Conppensation 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? Yes O No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ D .S^v'>D Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 1. plumbing S 1. Mechanical (HVAC) S Note: Minimum fee=$ (contact municipality) 3, Mechanical Other S Enclose chock payable h+ _ 6. Total Cost $ ,J 0-to (contact tnunicipalily)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attests nder the pains and penalties of perjury Thal all of the nifonuation contained in this applicuion is true end accurate to tho best of cop know ledge,cod understanding. Please print and sign name— —_—._ Title _— .telephone No. Dale Street Address CitN fawn Stale Zip Municipal Inspector to fill out this section upon application approval: Name I-)tc o ��n�nLlu ff-Pu-PLr�r ,pLuar! M F�O RT14IV T D O C ll N0 E IeD T'r�'Lr�nrn�n�sErs��nr 5 Certificate of Flame Resistapce 5 5 5 REGISTRATION � ISSUED BY Date of Shipment 5 5 APPLICATION a "_0 �°�/�� 07i2v04 5 5 NUMBER I. � INDUSTRIES INC. 5 5 .� o©'r0 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 FA44.02 �� LM� MANUFACTURERS OF THE FINISHED oss�4554 5 5 0 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 r5 5 ' PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 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 chemical was done in conformance with California 5 55 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 r,] Serial # 8046015C(4) C 5 Description of item certified: 5 5 NT LT HIP END 20WX10 4702 S FERRARI BLOCKOUT 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 ASTRUP CO,ST.LOUIS,MO Signed: ' S 5 '-'SPECIAL EVENTS DIVISION•ANCHOR INDUSTRIES INC. O rJ�cJ�cP�PcPrJ?PrJ?rJ�rJ@Pf�J�J�rnrJ�cPcPcPrJ�rJ�cPlrPrJ?rJ�rScPEPEJ�cP EU rJ�rR� rJ�r�J�rJ0PrP�PcPEPcPrJ�cPrPcPcPcPcPcl�rJ�EPr�cPJ�rPcPfOrPr�EPrJ�El�rJ�r10rJdq[Pfr Pa O c o r��lrsrsrs�,�I�rsrs�s�l�I�r rrs IMPORTANT DOCUMENT El 5 Certificate of Frlae l�esistapee s 5 5 ISSUED BY Date of Shipment 5 5 REGISTRATION o �CHOR 5 5 NUMBER snzizooa 5 �Nousraies INCiNc 5 .� i EVANSVILLE, INDIANA 47725 Tent Identification 5 5 5 rlao.l °r MANUFACTURERS OF THE FINISHED 04617028 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 657150 5 5 PETERSON PARTY CENTER INC 5 139 SWANTON ST 5 5 5 WINCHESTER MA1890 5 5 5 5 5 55 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 Serial # 55 5 8046016C(2) (J 5 Description of item certified: 55 N'r LT MID 20 X h#702 FERRARI BO VINYL#1030i I0A 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric �p �f 5 5 SNYDER MFG NEW PHILADELPRIA,OIi Signed; l 5 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. IMPORTANT DOCUMENT 5 Certif icat of Elam e Resista ee _ 5 e 5 REGISTRATION ISSUED BY Date of Shipment S 5 APPLICATION Q ° �,� �® 07i21/04 5 NUMBER NOUSTRIE INC. 5 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 PA4a 02 �M cM� MANUFACTURERS OF THE FINISHED o'89a"a 5 �, TENT PRODU 5 CTS 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 5 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 5 WINCHESTER MA01890 5 5 5 5 Certification is hereby made that: 5 r5� The articles described on this Certificate have been treated with a flame-retardant approved 5 55 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serial # 8046015C(4) C 5 Description of item certified: 5 L'SJ NT LT I-111'END 20 WX 10 4702 55, FERRARI BLOCKOUT VINYL 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric R C ASTRUP CO,ST.LOUIS,MO Signed: 5 5 ; , `'SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. ej rJ@PcJ�r1[P[PQ cP;:PER, r_r_PEIR rNEPEPPJ�rPrJ12P- 2rN EcPrJ��P�Pc(?[1: �E I.2PJ�rJL PrJ fflJ �cPcPrJfl�J�rJ�[PrPcfr�J�cPrJ@PrPcPcPcfcPr��P[P[PrJ�cPrPcPrJ@PcPcPJ O Massachusetts - Department of Public Safety Board of Building Regulations and Standards \.rin�trul ti nn S-a arv-' a License: CS-060219 .�;n'.a Mark Traina - 33 Hanford Road � � f Stoneham MA 02480 f; Expiration Commissioner 04/27/2017 I The Commonwealth of'Alassaehusetts Department of Industrial Accidents / Offce of Investigations 1 Congress Street, Suite 100 Boston, AIA 02114-2017 wlvrv.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Narne (Busuiess/Organizationtlndiridoal): PETERSON PARTY CENTER Address: 36 CABOT RD City/State/Zip: WOBURN, MA 01801 Phone#: 781-729-4000 Are you an employer? Check the appropriate box: Type of project(required): L H I am a employer with 200 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition E working for me in any capacity employees and have workers' p 9. ❑Building addition [No workers' comp. insurance comp. insurance.' re officers have exercise r 11. quired.] 5. ❑ We are a corporation and its 10.❑Electrical 'repairs or additions d their airs or additions 3.El am a homeowner doing all work ❑Plumbing o repairs myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we h1.ave no ❑ TEMP. TENT employees. n,[No workers' Other comp,insurance required.] *Any applicant that checks box nl must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit this affidavit indicauug they are doing all work and then hire outside contractors must submit anew affidavit indicating such. iCordractors that check this box must attached an additional sheet showing the name of the sub-cantractors and state whether or not those entities have cmployees_ II ehe sub-.;ontracfor haw- enpiayeas, dreg muse provick their wor ems'comp.ychcy t,1nLex lam tin enip/oyes tliat isprovir/in;rcorkers'compensation insnrnnce for my enployees. Below is thepo/icy antljob site information. Insurance Company Nam. --:A I M MUTUAL INS CO I Policy#or Self-ins. Lic. #:WMZ8006586 Expiration Date:1019/15 Job Site Address: ��J t `t City/State/Zip: /f'/I/ Attach a copy of the workers' compensation policy declaration page(showing thepolicy 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 I 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. I -rdo hereby certify under tl pains penalties ofperjury that the information provided above is 2rueindcorrect. Sigmature- �! �� Date: � Phone#: 781-72929-4000 l Official use only. Do not write in this area, to be completed by city or town officitd. City or Town: Permit/License # lssuinc Authority (circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1 6. Other Contact Person: Phone#: