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10 WHITE ST - BUILDING INSPECTION (9) k. . The Commanwcalth of Massachusetts Town of Board of Building Regulations and Standards �.4 Massachusetts State Building Code, 780 CMR. T"edition Building Dept `JJBuilding Permit Application To Construct. Repair. Renovate Or Demolish a t13'Igmowmm One- or Tito-Fumilt Duelling _ This Section For Official Use Only Building Permit Num Datt Applied: .� 4 Signature: Bud iqiCommtsstoner/Inspector of Buildings Date SECTION 1: SITE INFORMATION t.l ';enly A¢drep� 5 !_ 1.2 Assessors Map& Parcel Numbers N[� rr f M Number Parcel Number I.la Is this an accepted street'?yes no Map 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District W Pro scd Use Lot Area(sq it) Frontage(R) 1.5 Building Setbacks(10 Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,SSa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system O Public❑ Private ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 221 O er' Record Name(Print) Address for Sery Signature Telephone SECTION l: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: d/n- Brief Desc tion f oposed Work": SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building f I. Building Permit Fee: f Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical f O Total Project Cost(Item 6)x multiplier x J. Plumbing S 2. Other Fees: f 4. Mechanical (HVAC) S List: - Mechanical (Fire S Total All Fees: f Suppression) Check No. _Check Amount: Cash Amount: 6. Total Project COSI: S ��� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construct n Supervisor(CSL) r— 6 1 License Number Expiration Dale N.4MC of ti � / �{ _ List CSL Type face below) AJJddt r T' Description -10 U Unrestricted u2 to 35,000 Cu. Ft.j R Restricted 1&2 FamilyDwelling 5ignwure M I Masonry Only RC Revdenual Roofing Covenn Telephone WS Residential Window and Sidra SF I Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 2SC(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........... O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRA TO R BUILDING PERMIT 1, 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. Signature of Owner Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION 1, , as Owner or Authorized Agent hereby declare that the stiitertrients and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. / Gr Print Name Signature of Own Er or Authorized Agent Date E (Signed under the pains and penalties of peru NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contraclor (not registered in the Home Improvement Contractor(HIC)Program),will3[have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS, respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basemenb'attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfbaths Type of heating system Number of decks/ porches Type of cooling system Enclosed Open 1. "Total Project Square Footage"may he substituted for 'Total Project Cost" 0Trz8i08 08:44 FAX 9782710005 RAPID MICRO BI0SY57L>1t9 50002 . _.. Ad Commmmeam of ikfmwhasem Dqwnvaoof A off 600 Wazkh%q rSftd Bad^MA 02111 l+lew.masago��a Workee' Compensation lunn ce AffidATW.8nt sJContrat tms/B APPUCaMthfM=XdM Name AGdiesB: � . Are you as emploW Cbeck&p aRxvprim b Type d prowl t k 1-I&EMaomployawa l . 4 lam agm2azd fuftactoiandt 6 0Naww 4zwyam(f=dfartK"iZw-a LaveI- Idw 2•Q lamam;eprcpaidmorpuuw- tisadan the amwhed dupot 7• ❑Refmbaw abipandba noaVloyers - Those shave 8. ❑Dmolitim wad tg thrwoiat� y a�Ioyatamdhavawadra®' 9. 0 Dooldiogadditim [No wmdmw comp lann=w comp m�3 requjmdl S.© We me a and ib 30[]ldmlatpaita a af1a 3_0 IamahamoewnerditmRw & Odin alacved&wcmd8 = 11.0 ra=bbgop imorA mgszwoWosbefs'MUVL nweof perMm 12.C]Raofzepaim insmra>m regmtod J t h � ' n°GZADWIL 13r�ONer amLL%wrmw •N9'�a®stiiedcalmaal�ui�o�laa0...�onsm.aeMegm�a�de�'enapmmmet�pi�m t liom>�aaawLo>d�nmiaatBaate iammivg�agmedWug�.adeaeatam>,oemeoasnam�aamuaowat�+�iodeeaw6•. . ' �onoac�a&a�Ledcdmborzax�umadudd+ddmOmslAmcmowiagawomeotweoawem®am®samao�mervaecmoemSdsB�e ammym Irmo bmcm%mpatm=zakym.ibgmk wvfine tam.pwwaubw IonamawplwwAWlsprovA tagwasi+ars'asp saraok*eepmffiw ndja6*ff hfsfaaacaC.ampmyDTaex: � trS Palicy#erSadfrbmLie l� Y lr 13 &FO lob SNe Addrax �1Gc rlol� t2fy13c_ ✓Dt AVwl a ropy dthe worMW compe»pfbm policy 11adlor2flum pop(etiwwtog thaVdicynambe and expiMm ftbW Faflme to same cavmw as segmndomdm$=am25A of IM a.152 om Ind to the hrpooffim ofad®si ponaM a of a Mw ap to$1300.00 amlfor om-yasr is5 1 ,as well as civil ymaitrea in Poe Rmnoft SLOP WORK;CRDER�md a 8ne efap m S230A0 a day aga t R vn bm= Be advised*w a cWoftics stsdmfaotzyhe fatward w the Ol$m of . ei - oftlmDlAfhri mvfna_eeved8id& ldoAmefrs '�e►�apa5►amadpwaamfso/•prrJmja4vr8taaywiamisn� aaoaamaaw,Yce 9 If oe. ne! �ea,m asfsea,�8orac LHofvdafBeaHh 2.Sa$diagDepar�md '3.(St}ft'ownC[erk >ReehiealInspe�r SY7nepaella. a.Otbw Contact Pcaom I'timc#e Fl01 ame 'Ri"esistance REGISTERED - ISSUED BY Date of Manufacture NFABRIC UMBER JOHNSON OUTDOORS INC. BINGHAMTON,NEW YORK 13902 DEC 2003� Manufacturers of the Finest F-I40.01 f erti P:nduct's Deesaibed Herein This is to certify that the produce bereln hafe been merutactured from material inherently flame retardant as hereafter specified by the material supplies. NAME: THE EVENT"CO CITY: GLOUCESTER . STATE: MA Certification is hereby made flat: - approved fume retardant chemical in compliance vrith The articles described on this certificate have been manufactured with an _ California State Fire Marshal Code.NFPA-701', Undenwiters Laboratory of Canada,and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of Mh1-C-43006G. Type,color and weight of matertat 14 OZ Ymyl WHITE ENDURA Description of item certified= 2Y RAID FOR 40' TWIN TUBE PLUS . Flame Retardant Process Used Will Not Be Removed By Washing And is Effective For The Life Of The Fabric Snyder Manufacturing,inc. TENT DEPARTMENT.JOHNSON OU- OORS C. •Large Scale .:.F �erti c to P , esistance REGISTERED - ISSUED BY Date of Manufacture FABRIC "OHNSON OUTDOORS INC. NUMBER BINGI-FAMTON.NEW YORK 13902 DEC 2003 AAanuiadurers d the Finest F-140.01 — Tent Products Described Herein This is fa ertify that the Froduc's herein t'ave Seer: manufactured from material inherently flame retardant as here after specified by the material SUPPlier. NAME: THE EVENT CO CITY: GLOUCESTER STATE- MA CeeMcation is herebY made O-L- The articles described cn this certificate have been manufactured with an approved flame retardant chemical in compliance H4th California Test state��Marshal Code,NFPA-701*. Underwriters S���and meet or exceed the PAWaryY�tory of Canada,and have been tested Spedficatiom of MR-C-43006G.in accordance with the Type cow and we0t of ma*iiat 14 OZ Vinyl WHITE ENDURA Description of item c.med: 20' MID FOR 40' TWIN TUBE PLUS Flame Retardant Process Used Will Not Be Removed By Washing And Is Ef fe. ve For The Life Of The Fabric Snyder Manufacturing, Inc _ TENT DEPARTMEPtt,JOHNSON O DORS C. •Large Scale