Loading...
10 WHITE ST - BUILDING INSPECTION (5) �L�AQS MtJ T-BE fiL-f-- i3 APPROVED BY T44E .1WECT -R PFUD.R TD A_PERMIT BEING GRANTED CITY OF SALEM No. Date t# sil Ward 9 ° - ��eC/MINK CAa� Zoning District Is Property Located In Location of the Historic District? Yes—No— Building /D / /j 1 S 5 f Is Property Located in the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, In Sidi, Construct Deck, Shed, Pool, her:Repair/Replac , Ot (P_ry-�lt2gg-an-x %..7'� PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: J I C '- Owner's Name LAJ Address & Phone �t� l� hY�P s� (9�-74) 7ytb - 9 g-96 Architect's Name Address & Phone Q ( ) -Meehemics Name /Q e-C'S rc1 . x- Address & Phone 139 SLc-,Jgo What is the purpose of building? Co/7) 0 a v7 24 At Material of building? / / It a dwelling, for how many families? Will building conform to law? Asbestos? t ed Estimated cost ) City License u State 'cense n 69, O!e0 al 9 Home Improvement Lic. / Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �G/� --�a 349,.1'loD/ el- a0`1cld �/� ©orca(U MAIL PERMIT T0: o - QS I of z r n- /3 9 /� nC�1 �5�✓Ll �?A otg9d t No. 7 APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED Afr "/ / 49- Zoo 6 AP ROVED PECTOR BUILDINGS Y A t„; :O LPL.PLPLrL3j�rsrJr1-cPr.PLnLIL: Prs�rc tcPrsrPLn�PLPL[i IMPORTANT DOCUMENT 'nrnrsr�rlrsr�rsrJ�r nrJ�r�rsrsrJ�rJ��r�r�r i�rsrsr nrnrsrJ� o V14EvPrttfiraft of 'tame Rot'5tanttISSUED BY 5 5 �j REGISTERED c�tiF p r—, Date of Manufacture 5 APPLICATION Q ��S�R� d ' NUMBER 1` _ iNousrnIes inc. 5 EVANSVILLE, INDIANA 47711 Order Number 5 lw :5 F121.4 MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN :5 This is to certify that the materials described have been flame retardant treated 5 d1 5 (or are inherently noninflammable) and were supplied to: n' S 3 657150 m5 5 PETERSON PARTY CENTER INC :I f iik 5 II°5 139 SWANSON ST �5 f ! WINCHESTER MA 01890 r7 Y 5 Certification is hereby made that: u5 ! The articles described on this Certificate have been treated with a flame retardant app ved 5 ' 5 chemical and that the application of said chemical was done in conformance with�Califprni�F.ire r �.5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. " 5 ' The method of the FR chemical application is: 5 5 Serial �,t•.5 8109100(1) 5 5 Description of item certified: 5 y h 5 CENT MATE 30 W X 60 V L W W Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 o d eCS'U JWNBOYLE STATESVILLENC Signed: It TENT DEPARTMENT—ANCHO Name of Applicator of Flame Resistant Finish R DUST.qEISINCH �r 5 #a PP i IN E ivtT;I e� i ra 5 I { O cPrJ�rJ�rJ�tPcPrJ�r.PrJ�cPrJ�cPtPc.frJ�rJ�rJ�rJ�rJ�cPrJ�rJ�cPr�rJ�rJ�rJ�r�rJ�cPrJ�rlorJ�cru'cPLPrJ�cPr1r�.J�rSrlocPcPrJ�rJ�rJ�rJ�cPcPrJ�rJ�rJ�tPr�rJ�rJ�rJ�cPrJ�cP[P[P[PtPrJ@Pr.P[P[PrJ�[P[PcPc.PcPcPrJ�rJ� 0 ns '` ° r'@''r''c''r''r''r'@''r1'rl'r'@f'��l M P O R TA N T DOCUMENT 5 Certificate of Flanle Resistartee ISSUED BY 5 5 REGISTRATION Date of Shipment 5 5 APPLICATION Q CN 5/12/2005 5 5 NUMBER sc iNousraiE iNc EVANSVILLE, INDIANA 47725 Tent Identification 5 Flao I f MANUFACTURERS OF THE FINISHED 0404857' S 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to:657150 5 5 PETERSON PARTY CENTER INC 5 Pj 139 SWANTON ST rj 5 WINCHESTER MA1890 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 c5, 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 # 80205000(2) 5 5 Description of item certified: 5 FIESTA TOP 20wX30 WHITE SNY VI. 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 S �5+ Washing And Is Effective For The Life Of The Fabric 5 5 SNY DER MFG NEW PHILADELPHIA,OH Signed: yG✓/_4 -0� 5 iJ `-SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 O rJ@Pr�rJLPd'C3cP'r3PL PrrJ�rJ�rJ@PcPcfrPrJ�rJ�rJ�rJ�r.PrJ@PcPcPcPr�cJ�cPcP�PcPrJ�rJ�r1r1rJrJ�rJ�rlrJ��Pr�rJ�rJ�rJ�rJ@PrJ�cPc 1r :I�rJ�rJ�rI :I IrJ�rJ�rJ�cPLPLPL@PfflL3rJ�PLPL O The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600'Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A Iicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: ZS21 �c7 City/State/Zip:42j`I p K Phone# Are you an employer? Check the appropriate box: t/bl_I am a employer with oD 4, general :E3 f project(required): employees(full and/ pa rime),* ❑ have e h red the sub contractontractor contractor drs ewL:� oa n 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t em ship and have no employees These sub-contractors have working for in any capacity. workers' comp.insurance. em [No workers'comp. insurance 5. ❑ We are a corporation and its Building n required.] officers have exercised their lect or additions 3. I am a�pjneowner-doing-all-work--------_...-right of-exemption per MGL— = lum myself.[No workers'comp. c. 152, §1(4),and we have noepair �or additions -- ' insurance required.].t oof employees. [No workers' comp,insurance required.] ther , � 'Any applicant that checks box of must also fill out the section below showing their workers'compensation polity information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the time of the subcontractors and their workers'comp,policy information.. - I.am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: 6 AOt9l)�og" Policy#or Self-ins.Lic.#:L(/C 5;0V 7 61 Expiration Date: Z d � Job Site.Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.I52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. S do hereby certify r r r the pains and p nalties ofperjury that the information provided above is tru�,n correct. Si afore: - Date: a Phone#: FOther only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone M r- -440444 -` ? BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 1 Number: CS 060219 B i rth d ate: 04/27/1954 Expires: 04/27/2007 Tr. no: 9737.0 Restricted: 00 MARK TRAINA 33 HANFORD RD G STONEHAM, MA 02180 Commissioner ri - -_- �'