10 WHITE ST - BUILDING INSPECTION (26) The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standaz
SALEM
WMassachusetts State Building Cod I�7S8� NALE?RV ICEB Revi ed ar201?
Building Permit Application To Construct,Repair,Renovate Or Demolish a
(t 1 One-or Two-FamilyDwellin
DOO This Section For Official U ly
I V) i d:
Building Permit Number: Date Appl
t �js�
✓pe �
i�rN
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro ddr s• �I ` 1.2 Assessors Map&Parcel Numbers
I.Ia Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTYOWNERSIiIPr
2.1 Pwt tr of Reco
r h��n �aJa / tt link �ri�� JYl�
Name Print City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK;(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work":
X
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Five $ Total All Fees:$
Suppression)
Check No. Check Amount: Cash Amount:
6.Total Project Cost: I $ C' t ❑paid in Full ❑Outstanding Balance Due:
GI VI.� Qb1� WtLI, p �U Fro—
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Sttpe isnn
t or License,(CSL)
old `l"�-�'rp' License Number Expiration Date
Name of CSL older
List CSL Type(see below)
No.and Street KJ Type Description,
U Unrestricted(Buildings up to 35,000 cu.ft.
City/Town,State,ZIP R Restricted 1&2 FamilyDwelling
M I Masonry
RC I Roofing Covering
WS I Window and Siding
SF I Solid Fuel Burning Appliances
I I Insulation
Tel hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
H
HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date
No.and Street
Email address
Ci /Town State,ZIP Telephone
SECTION 6t WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§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 Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By en in my name below,I h reby attest under the pains and penalties of perjury that all of the information
Lconi thisappication a and ac a to the best of my knowledge and understanding.
�7er's or Audrori d A ent's Name(Electronic Signature) Date
NOTES:
1. 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. 142A.Other important information on the HIC Program can be found at
wxvw.mass. ov..'oca Information on the Construction Supervisor License can be found at www.nmss.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
TAYLOR RENTAL CENTER 4161
City of Salem — 8/13/2015
25.00
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'Penfucket Bank Chec 25.00
law
�Cernfute of fflaw �irYce
GtsTER� REGISTERED Q�. ISSUED BY Date treated or
APPLICATION manufactured
Academy Tent & Canvas
CONCERN No. 5035 Gifford Ave.
v ��rr.f ov 02/27/03
MF RE7 P� F-419.01 Los Angeles, CA 90058
(323) 277-8368
This is to certify that the materials described below hereof have been flame retardant
treated(or are Inherently nonflammable).
FOR TAYLOR RENTAL ADDRESS 531 BROADWAY
CITY HAVERHILL STATE MA 01832
Certification is hereby made that: (Check"a"or "b)
❑(a) The articles described below this certificate have been treated witha 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 Regula-
tions of the State Fire Marshal.
Nameof chemical used............................................................. Chem. Reg.No. ........................
Methodof application,....................................................................................................................
(b) The articles described below hereof are made from a flame-resistant fabric or material regis-
tered and approved by the State Fire Marshal for such use; Fabric has been tested and passes
N FPA701-96.
Trade name of flame-resistant fabric or material used ................Y..INYL...... Reg.NbjA19,01,,,
The Flame Retardant Process Used .. Will Not...Be Removed by Washing
(will or win not)
David Bradley By Tom Shapiro - President
Name of Applicator or Production Superintendent Title
THIS FABRIC WAS USED IN THE MANUFACTURING OF THE FOLLOWING
JEA 40X100 U/W 160Z.PVC LAMINATED CANOPY TOP
CONTROL NO.
CUSTOMER ORDER NO. 55650
CUSTOMER INVOICE NO.
YARDS OR QUANTITY
COLOR
STYLE_
DATE PROCESSED
ALL MATERIALS ARE CERTIFIED BY THE CALIFORNIA STATE FIRE
MARSHALL AND MEET THE REQUIREMENTS OF THE NFPA 701 AND UL214**-
531 Broadway
9,7ARTORRM Haverhill, MA 01832_-= 978-374-0136 Status: Reservation
Contract#: 19593-1
Fax 978-521-5669
►71 arf ius.com Event Beg: Fri 015 10:OOAM
www.
yp yp Event End: Monn 8/24 8/24/2015 10:OOAM
Operator: Rich Hassell
Customer# 17516
Antique and Classic Boat Festival 617 666-8530
16 Preston Rd
SOMERVILLE, MA02143
DELIVERY AND PICKUP -
Delivery Date: Fri 8/21/15 10:00 AM Contact:
Pickup Date: Mon 8/24/15 10:00 AM Phone:
Address: 16 Preston Rd ; SOMERVILLE, MA 02143
Tent is going on gravel, can be staked down
event is 1 pm Friday
Frank 978521-0281
Del to 10 White Street to Brewer Hawthorn Cave Marina
Pat Wells ordered:
oty .Pa t# Items Renied ,` Event End Dater '' Status _ dv Each Price
2 BATTERY BACKUP.x t"SIGN EXIT LIGHTE_,J1 8/24/2015 10:OOAM Reserved $85.00 $170.00 1
C200
0X 60FRAMES 8/24/2015 10:OOAM ;Reserved $1,395.00 $1,395.00
PR FT• LIGHTS,STRING-SM CLEAR FT' 8/24/2015 10 OOAM Reserved 5 $1 0.00
_ -.-.. .BASKET 50'STRING Ew 8/24/2015 10 00AM E Reserved $0.00 $0.00
CITY OF; „ TENT PERMIT 8/24/2015 10 OOAM Reserved $100.00 $100.00
TABLE,BANQUET 6 -- �- = ' 8/24/2015 10 OOAM$`'^Reserved '� * '° n $8.25 $297.00
W/#45 ;:g CHAIR,BROWN SAMSONITE 8/24/2015 1O.00AM �Reservetl' �` a, $1.10 $132.00
,,,,.Qty „.. # tltemslSold .T Part#X. zStatus _ Each Price
`"""' DELIVERY,MISCELLANEOUS CHARS, Delivery ' $85`K $85.00
.a.
Cancellations will result Ina 25/o reservation fee
RENTAL CONTRACT =Waiver:
The back of this contract contains Important terms and conditions,Including Taylor's disclaimer of all liability for injury or damage $2,244.00and details of Renter's responsibilities to care for and return the item(s)rented.They are part of this contract-Read them. "I have
read and understand the terns&conditions listed on the face and reverse hereof,specifically item 3." $0.00$0.00Delivery is door to door only,no exceptions will be made"Please"kee all rented 'gy
p egmpment secure. . - $85.00You are responsible for theft.Tables&chairs must be folded&stacked for pick up ,; a-d : $0.00
Folding and stacking charges are 1.50 per table&.25 per chair. M ---.
Reservation fees are non-refundable or non transferable. Subtotal: $2,329.00
All delivery and pick up times are estimated and are subject to change with or with-out notice €
8
Sales Tax: $0.00
.. N '
Q �. .TOTAL: $2,329.00 $
SIGNATURE: PAID: $0.00 m
Antique and Classic Boat Festival AMOUNT DUE: $2,329.00 E
Printed on 8/17/2015 8:35:00 am Mon-Sat 7:30am -5:00pm Closed Sunday Modification#5
Store Hours: Mon. - Fri. 7:30 AM - 5:00013 bySai"stma`ytao POINT-OF-RENTAL.0 ,hank you for youf cd M-46'1
TERMS AND CONDITIONS
1.INSPECTION. Customer acknowledges that Customer has had an opportunity to personally 14.COLLECTION COSTS. Customer agrees to pay all reasonable collection,attorney's and
inspect the equipment,and finds It suitable for Customer's needs and in good condition,and court fees and other expenses involved in the collection of the charges or ern'orcement,of
that Customer understands its proper use. Customer further acknowledges Customer's duty to Dealer's rights under this contract. .f
inspect the equipment prior to use and notify Dealer of any defects. 15.REPOSSESSION. Upon a failure to pay rent or other breach of this contract.Dealer my
2.REPLACEMENT OF MALFUNCTIONING EQUIPMENT. If the equipment becomes unsafe terminate this contract and take possession of and remove the goods from wherever they are,
or in disrepair as a result of normal use,Customer agrees to discontinue use and notify Dealer and Dealer and his agents shall not be liable for any claims for damage or trespass arising out
who will replace the equipment with similar equipment in good working order, if available. of the removal of the goods.
Dealer is not responsible for any incidental or consequential damages caused by delays er 16. INSPECTION OF TRAILER HITCH. Customer agrees to inspect the trailer coupling
otherwise, mechanism and safety chain before leaving Dealer's premises. Customer also agrees to
3.WARRANTIES. THERE ARE NO WARRANTIES OF MERCHANTABILITY OR FITNESS, inspect the equipment periodically(every 100 miles)and to maintain the coupling and chain In
EITHER EXPRESSED OR IMPLIED.THERE IS NO WARRANTY THATTHE EQUIPMENT IS a safe and secure condition.
SUITED FOR CUSTOMER'S INTENDED USE.ORTHAT IT IS FREE FROM DEFECTS. 17.SEVERABILITY The provisions of this contract shall be severable so that the invalidity,
4.POSSESSIONTfITLE. Dealer owns the Equipment,and title in and to all of it will remain unenforceability or waiver of any of the provisions shall not affect the remaining provisions.
Dealer's at all times.Customer is entitled only to use and possess the Equipment for the 18. LOADING AND UNLOADING EQUIPMENT. Customer is responsible for loading and
Rental Period;subject to the terms of this Contract.If Customer retains any of the Equipment unloading equipment. If Dealer's employees assist in loading or unloading the equipment,
beyond the agreed Term without Dealer's express written consent,Customer will be deemed Customer agrees to assume the risk of,and hold Dealer andlor its employees harmless for any
to have materially breached this Contract.Customer will not take,grant or permit the taking property damage or personal injuries, including damage and personal injuries attributable to
of any(and Customer hereby waives any and all)liens or other similar claims on any portion the negligence of Dealer.
of the Equipment,and Customer will take such actions as may be necessary,at Customer's 19.PROPERTY DAMAGE. Not responsible for any damage whatsoever as a result of on-the-
sole cost and expense,to ensure that any and all such liens are released as soon as possible. job deliveries or pick up by Dealer
5. HOLD HARMLESSIINDEMNITY. Customer assumes all risks associated with the 20. FEES, LICENSES, PERMITS, TAXES AND FINES. The Customer shall be solely
possession, use,transportation and storage of the Equipment.ACCORDINGLY,CUSTOMER responsible for payment of any fees,licenses,permits,taxes or fines,required by or resulting
HEREBY WAIVES ANY AND ALL LIENS AND CLAIMS ARISING FROM OR ASSOCIATED from the Customer's use or operation of the vehicle/equipment&Tents.
WITH, AND AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE DEALER 21.UNDERGROUND FACILITIES.Customer agrees to have all Underground Facilities,in the
FROM AND AGAINST,ANY AND ALL LIABILITIES,CLAIMS,DAMAGES,LOSSES.COSTS vicinity of the Equipment installation,clearly marked prior to the arrival of Dealer's work crews.
AND EXPENSES(INCLUDING WITHOUT LIMITATION,ATTORNEYS'FEES,CLAIMS FOR Customer assumes full responsibil(ty for damage to all Underground Facilities.To identify
BODILY INJUI IES)(INCLUDING DEATH),PROPERTY DAMAGE,LOSS OF TIME ANDI Underground Facilities,Customer must call one week prior to installation.
OR INCONVENIENCE) RESULTING FROM OR ARISING IN CONNECTION WITH SUCH 22. EQUIPMENT FAILURE. In the event any of the Equipment fails to start, breaks,
POSSESSION, USE,TRANSPORTATION ANDIOR STORAGE, REGARDLESS OF THE malfunctions, becomes unsafe or is in need of maintenance or repair, Customer agrees to
CAUSE AND INCLUDING ANY INJURIES AND/OR DAMAGES SUFFERED BY CUSTOMER, immediately discontinue use, notify Dealer, and if directed to do so, return the Equipment
CUSTOMER'S EMPLOYEES ANDIOR ANY THIRD PARTY(iES),EXCEPT TOTHE EXTENT to Dealer.Customer further agrees Customer will not repair or have anyone else repair any
DIRECTLY RESULTING FROM DEALER'S INTENTIONAL MISCONDUCT. Equipment.Failure to timely notify Dealer will result in Customer being charged for all Time
6.ASSIGNMENT AND SUBLETTING.Dealer may,at Dealer's sole option,assign all or any Out,
portion of Dealer's rights anchor remedies under this Contract without Customers consent, 23.FUEL SURCHARGE.Equipment with gas/diesel engines must be returned full of fuel or
CUSTOMER MAY NOT ASSIGN CUSTOMER'S RIGHTS OR REMEDIES UNDER THIS Customer will be charged at the current Dealer's rate,
CONTRACT, NOR MAY CUSTOMER SUBLEASE OR LOAN ANY OF THE EQUIPMENT 24.SITE PREPARATION.If Dealer has agreed to deliver any Equipment,Customer agrees
TO ANY THIRD PARTY WITHOUT DEALER'S PRIOR WRITTEN CONSENT.ANY SUCH to have the Site clean and ready for the delivery and installation or dismantling and retrieval.
ATTEMPTED ASSIGNMENT OR SUBLEASE BY CUSTOMER WILL, AT DEALER'S and Customer agrees to pay an additional charge for any delay incurred,or additional labor
OPTION,BE DEEMED VOID AS INITIO. performed by Dealer resulting from Customer's failure to timely do so.
7.ASSUMPTION OF RISK Customer acknowledges that the possession,use,transportation 25, INSURANCE. If any of the Equipment is to be used for a commercial purpose or is
and/or storage of the Equipment may give rise to the risk of personal injury and/or property otherwise designated as"Customer Insured"on Page 1, Customer agrees to maintain (a)
damage.CUSTOMER VOLUNTARILY ASSUMES ALL SUCH RISK AND RELEASES AND property damage and casualty insurance on an "all risks basis for the full replacement
DISCHARGES DEALER ANDTHE EQUIPMENT FROM ANY AND ALL LIENS,LIABILITIES cost of the Equipment (including without limitation. all risks of loss or damage covered by
AND CLAIMS ARISING IN CONNECTION WITH THE SAME, INCLUDING, WITHOUT the standard extended coverage endorsement) with such deductibles, If any, as may be
LIMITATION, ANY AND ALL CLAIMS ARISING FROM OR IN CONNECTION WITH acceptable to Dealer in Dealer's discretion;and(b)commercial general liability insurance with
DEALER'S NEGLIGENCE(OTHERTHAN DEALER'S INTENTIONAL MISCONDUCT). minimum limits or$1,000,000 per occurrence.Such insurance shall coverall operations and
8.PROHIBITED USES. Use of the equipment in the following circumstances is prohibited, contractual obligations, as well as any and all damage or liability arising in connection with
and constitutes a breach of this contract. (a)Use for illegal purpose or in illegal manner.(b) the handling, transportation, maintenance, operation, use or possession of the Equipment
Use when the equipment is in bad repair or is unsafe.(c)Improper,unintended use or misuse. during the Term,and shall name Dealer as an additional insured and loss payee on a'closed
(d) Use by anyone other than Customer or his employees,without Dealer's written permission, clause"basis.All such insurance shall be primary,without any self-insured retention,and shall
(e) Use at any location other than the address furnished Dealer without Dealer's written waive subrogation against Dealer.Customer agrees to provide to Dealer copies of the proper
permission. (Does not apply to mobile equipment.) endorsements for the above coverages specifying that they will not be cancelled during the
9. ASSIGNMENTS, SUBLEASES AND LOANS OF EQUIPMENT. Dealer may assign his Term.Any insurance Dealer carries will be deemed to be in excess of Customer's insurance,
rights under this contract without Customer's consent,but will remain bound by all obligations 26.DAMAGE WAIVER. If Customer pays the damage waiver charge (DWC)as specified,
herein. Customer may not sublease or loan the equipment without Dealer's written permission. subject to the limitations and exclusions below, Dealer agrees to modify the terms of this
Any purported assignment by Customer is void, contract and relieve Customer of liability for accidental damage to the rented items) on
10,TIME OF RETURN. Customer's right to possession terminates on the expiration of the this contract, and for loss due to fire,windstorm, upset and riot. Dealer excludes from the
rental period ("Due In"date&time)and retention of possession after this time constitutes a waiver, however,any loss or damage due to theft, burglary,collision,misuse or abuse,theft
material breach of this contract. Time is the essence of this contract. Any extension must be by conversion,intentional damage,mysterious disappearance or any loss due to Customer's
mutually agreed upon in writing. failure to care for the rental item(s) as a prudent person would hislher own property, such
11. LATE RETURN. Customer agrees to return the rented goods during Dealer's regular as proper lubrication. In addition, if the items) rented is a truck, Customer is not relieved
store hours,upon expiration of the rental period("Due In"date&time). Customer agrees that of liability of accidental damage for the truck container(box)caused by striking a stationary
if the rented goods are held beyond the expiration of the rental period("Due In"date&time) object. If any such loss tends to indicate a crime may have been committed,a further condition
as designated in the contract,the daily rate as indicated on the contract shall be the agreed of this waiver is that Customer must file a report to the proper law enforcement authorities and
contractual rate for the entire period,notwithstanding any lesser periodic rate. furnish Dealer copy. In addition,if Customer has insurance for the loss or damage,Customer
12.DAMAGED,DIRTY, OR LOST EQUIPMENT. Customer agrees to pay for any damage shall exercise,and shall empower Dealer to exercise,all Customer's rights to obtain recovery
to or loss of the goods,as an Insurer, regardless of cause,except reasonable wear and tear, under insurance, shall cooperate with Dealer to obtain recovery and all insurance proceeds
while the goods are out of the possession of the Dealer. Customer also agrees to pay a shall be given or assigned to Dealer
reasonable cleaning charge for equipment returned dirty. Accrued rental charges cannot be 27. WAIVER OF JURY TRIAL. Each party waives its right to a jury trial of any claim or
applied against the purchase or cost of repair of damaged,lest or stolen goods. Equipment cause of action based on or arising out of this agreement or the subject matter hereof. This
lost,stolen or damaged beyond repair will be paid total its current list price.The cost of repairs waiver pertains to all disputes that may relate to the subject matter hereof,including,without
will be borne by Customer,whether performed by Dealer,or,at Dealer's option,by others. limitation,contract,tort,breach of duty,and all other common law and statutory claims,and will
13.TIME OF PAYMENT. Accounts are due and payable at the termination of the rental period. not be subject to any exceptions. Each party(A)understands that this is a waiver of important
A carrying charge of 1.5%per month(ANNUAL RATE OF 18%)will be charged on all overdue legal rights and IF)acknowledges that helshe/it has had a reasonable opportunity to discuss
accounts. this waiver and its effects with legal counsel. Accordingly,each party knowingly,voluntarily,
irrevocably and unconditionally waives its jury trial rights.
A LARGER FONT COPY OFTHESE TERMS AND CONDITIONS IS AVAILABLE UPON REQUEST.
62013 by Business Forms by In-A-Bind.Inc,All Rsghts Reserved.(12e03) Unauthcrized reproduction andlor redistribution strids,pmhlbifed.