Loading...
10 WHITE ST - BUILDING INSPECTION (8) C rY-O-F LEI PUBLIC PROPERTY rl DEPARTMENT KIMMU-eY Daxuu. MAYOR 12D WASHINLTON S7REEr•SALLK HASSACHLSE"i-M 01970 TEL 978-745-9595• FAX 978-740.9&16 APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION / Grp, yG ,/ Location Name: Building: Property Address: 5X- Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: G✓ ° t�_ sjr..1 s� Address: o / f Telephone: 7 U •— a�j� 3.0 COMPLETE THIS SECTION FOR WORK IN EXLS1IbLQ BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation of existing building New RrA Description of Proposed Work: Mail Permit to: .:S � k �� ��r ; 1 f rr/c PS a4, co!eye) What is the current use of the Building? Material of Building? If dwelling, how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Project$ Permit Fee Calculation Permit Fee$ Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to b itd to the above stated specifications. Signed under penalty of perjury X 2�� Date U 0 N � O r Vl co 96 9 O r - _ w e v -a l- - - - A N T D O C U M E N 5 5 5 �PrtitiratP of �lamp 3.PgI5taRrP 5 5 REGISTERED ED BY 5 5 APPLICATION a U(iF to CHO�® Dale of Manufacture 5 10 NUMBER v N TRIES INC. r0 EVANSVILLE, INDIANA47711 Order Number 5 5 F121.4 '�f E M��oP MANUFACTURERS OF THE FINISHED 5 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 55 S657150 S 5 PETERSON PARTY CENTER INC 5 S 139 SWANSON ST 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California Fire 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 Serial S: 5 8109t00(I) 5 Description of item certified: r5 5 CENT MATE 30W X 60 VL W W 5 5 - Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOIiN 130YLE STA'I'ESVILLE INC Signed 2 g"--C" 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. rJJJ ^ 0 rJ�rJ�rJ�rJ�rJ�rJ�rJ�r�rJ"1r��.Pr�rJr�rJ�r_PrJ�rJ�rJ��PCPrJr���rJ�Pr.Pr�r�r�r�clrJmrJ�r.PcPr�r.PrJ�cPrJ�CPrJ�rJ�rJ�rJ�CPr�cPr�r�rJ�rJ�rJ�rJ�rJ�C Pr.PrJ�rJ�rJ�rJ�rJ�rJ�rJ�r�rJ�r�rJmr.Pr�rJCPrJ�rJrJrJ�r�rJ�rJ�rJ�rJ�rJ� 5O IMPORTANT DOCUMENT E 5 5 5 Certafirate of if taw Re5c5tanre 5 21 REGISTERED ISSUED BY 5 APPLICATION Q r O Date of Manufacture 5 �? : CN®RO 3/06/98 5 NUMBER N wousraies wcID '? . 5if v©D�5�`Z EVANSVILLE, INDIANA 47711 Order Number S 5 F121.4 9y °Rc M� o� 183326 5 5 E Ret�p MANUFACTURERS OF THE FINISHED 5 TENT PRODUCTS DESCRIBED HEREIN 7 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 55 PETERSON PARTY CENTER INC 5 5 139 SWANSON ST 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant 5 a approved 5 chemical and that the application of said chemical was done in conformance with California Fire 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 5 5 Serial4: 8001800 (0001) 55 Description of item certified: FI TOP 20W X 30 VL W W r� 5 - 5 5 Flame Retardant Process Used Will Not Be Removed By 5 ((Washing And Is Effective For The Life Of The Fabric IS 5 TATES�ILLE NC_---- - Signed: a r1Z IS 5 Name of Applicator of Rame Resislait Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. C � rJCPCPCPCP[.PC([P[P[JmCP[P[P[P[P[P[PCP�PCPCPCP[P[J�[PCPC.ILIcPCJmCPCPCP[PCPCP[P[P[P[P[P[PCJ�LI�[JmCPCPCP[P[P[P[PLf[P[P[la[P[_Fa[PCJmGP[P[P[P[PCP[P[PLf�[P[P[JmCP[PLPCJmCPCPCPCP[P[P[P 7�° Jul 31 09 02: 12p Hawthorne Cove Marina 19787409994 p. l Peterson Party Center, Inc. PROPOSAL 340493-2 139 Swanton Street - -" Winchester,MA 01890-1918 DAY: SATURDAY Tel: (791) 729-4000 p r c n er DATE OF USE: 08-08-09 Tent: (781) 358-4000 TIME OF USE: 10:00 AM Fax: (781) 729-4999 - 1 DAY RENTAL http:'rwww.ppcinc.com Special Event Equipment and Tent Rental BILL TO: SHIP TO: HAWTHORNE COVE MARINA RUSSVICKERS 10 WHITE STREET MA SALEM MA 01970 I PROPOSAL DATE TELEPHONEYAX ORDERED BY,PHONE DELIVERY DAV&INSTR PICK UP DAY&INSTR I 07-29-09 (978) 740-9890 KEITH MCCLEARN FRI SUN (978) 740-9994 (978) 740-9890 x22 AM OR MON'DAY _I WE ARE PLEASED TO QUOTE THE RENTAL OF THE FOLLOWING: 1 0.00 0.00 1 30' X 60' CENTURY TENT, WHITE (1,800 SF) 1,300.00 1-300.00 1 20'X 30' SERVICE TENT 650.00 650.00 1 APPROXIMATE- PERMIT FEES* (FIRE/BUILDING ONLY)* 185.00 185.00 1 TRANSPORTATION AND SITE LABOR* 110.00 110.00 THE ABOVE EQUIPMENT TO BE INSTALLED AS DISCUSSED. j Payment to be as follows: S800.00 DEPOSIT,BALANCE DUE NET 10 DAYS SUB-TOTAL: 2,245.00 Acceptance of Proposal- The above prices,.specifications and conditions are satisfactory SALES TAX: 121.88 I and are hereby accepted.You are authorized to do the work as specified. Payment will be made as I LABOR: oudincd-above. Deposits arc not refundable or transferable unless otherwise specified.Sub-rental ' DEL/PU FEE: et equipment to others without authorization is prohibited. _ FUEL SURCHRG: $ 0.00 TOTAL: $ 2,366.88 Note: This proposal may be withdrawn by us if not accepted within 1 DAY Authorized Date of Customer Signature: Acceptance: Signature: PAUL WHITNEY Please sign and return one copy of this 1,1114osal with deposit. The Commonwealth ofMassachusetts Department ofhrdustrial Accidents Office ofInvestigations 600 I ushington Street Boston _11A 02111 www.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name lBusiness'Oreanization.'Individualt: Q� Address: J74 City/State/Zip:l�(IJn, La Phone #: 7F/- ;d;Z S/�uti A�rre,�ou an employer? Check the appropriate box: 1.1�-1 am a employer with O� 4, g Type of project (required): ❑ I am a general contractor and employees(full and/or part-time)." have hired the sub-contractors 6' ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. �. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for tme in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. 9. Building addition ❑ We are a corporation and its 3.❑ required.) officers have exercised.their 10.❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 1 I.Q Plumbing repairs or additions myself. [No workers' comp, C. 152, §1(4),and we have no insurance required.] t employees. 12.❑Roof re airs [No workers' comp. insurance required.] 13.[ Other�.O/y_r,p �lj 'Any applica,u that checks box#1 must also fill out the section below showing their workers'compensation policy information, r--7 t Homeo,�nem who submit this affidavitindieaung they are doing all work and then him outside con ,must submit a new affidavit indicating such. Contractors that check this box must attached an additional.sheet shoving the name of the sub tralto-contranors and their workers'comp.popsy Information. 1 am an employer that is provid1mg workers'compensation Insurance or m employees. Below is the of information. / f ypolicy and job site Insurance Company Name: 14r% v� Policy# or Self-ins. Lic. # e ren —' Expiration Date:_�� Job Site Address.- Attach a c City/State/Zip: opy 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. 152 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. m hereb v cerryt under the pains prnalttes ofperjrgt that the information provided above is true and correct. Si nature• —Z Date: Phone#: Official use onit•. Do not write in this area, to be completed br c/4,or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6. Other achu.ctt. - Dcpartfucnt ul Public a(c: Fti j b(lard of Buildin' Re,--elation, and Standards Construction Supervisor License License: CS 60219 Restricted to: 00 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 Expiration: 4/27/2011 ( nnmizsima'r Tr#: 14425