WINTER ISLAND PARK - BUILDING INSPECTION 1Z0
The CommonweaIWNQ4I 99 c "fss
Department of Public Safety
- Massachusetts State Bug c (9rqc1D) � 35
BuildingPermit Application for an Buildin tltliertan a One-or Two-Famfl Dwelling
PP Y S Y S
r _ (This Section For Official Use Only)
�-- Building Permit Number: Date Applied: Building Official:
i SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
1 hja4< - ISlan,—J 'Tctrk c � 0/970
No.and Street City/Town Zip Code Name of Building(if applicable)
( SECTION 2•PROPOSED WORK
Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineer g Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: CC�Q� Xl Zbd t � -
ti / - , 77 �s
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 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.) 1 �5?5m (3 t 16 t
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑- Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional I-1❑ 1-2❑ I-3❑ I-4❑ M.
Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use k and please describe below:
Special Use: tL)T
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IL4 ❑ IIB ❑ IIIA ❑ IfIB ❑ 1 IV ❑ VA ❑ VB ❑
.SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑
A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed ❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System7: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
y p. y/l V am-_ • .
Name( int) W No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) a-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1
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
10.2 General Contractor
.
Company Name _
laz"rdV- L/c
Name f Person Respo le for Construction j.icense No. and Type if Applicable
Street Address City/Town pv State Zip
Telephone No.(business) Telephone No.(cell) Q e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6
A Workers'Compensation 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❑ No 13
.. SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE - 1
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$i.
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose municicheck payable to
6.Total Cost $ 7V (contact pality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I he by attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate t the besto kno 2dge and understanding.
`fg f 7124e KS
Please print and sign name itle Telephone No. Date
�D _W1 t_Cltx-lam 019� C193a
try eet Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: h. '.
Name Date
The Event
P.O.Box 419 JOB CONTRACT
Gloucester,,M MA 01930
the event Co. Voice: (978)283-4884
Fax: (978)283.4163
• • • ' 14737-1
INVOICE TO: DELIVERY ADDRESS:
Order Status: Confirmed Order
Sall Salem Winter Island Park Sales Person: Taylor Hedges
Salem,MA Last Updated:JUL 14 154:12PM
PO:
ATTENTION: Patty Macleod JOB SITE: Winter Island Park CUSTOMER M
PHONE: (508)254-1616 Ext: ROOM: - TERMS: 25/25/50
FAX: CONTACT:
EMAIL:macpalty_2001@yahoo.com PHONE: CELL:
ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA:
NOV 11 14 1:16PM AUG 2 15 AUG 4 15
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
AUG 6 15 AUG 7 15
JOB DESCRIPTION: Sail Salem 2015
EQUIPMENT
QTY I DESCRIPTION DUR I UNIT$ EXTENDED DISC NET
Tents-Sidewall extra
1 20 x 40 Frame Tent 4.Od 520.00 520.00 520.00
Buffet area next to pavillion
1 30 x 100 Frame tent 4.Od 1,950.00 1,950.00 1950.00
Upper lawn over picnic tables
Tables and Chairs
14 8' Banquet Table-Stacked 4.Od 8.50 119.00 119.00
Table installation extra 1.00 each
9 6"BanquetTable-Stacked 4.Od 8.50, 76.50 76.50
Table installation extra 1.00 each
50 White plastic chair 4.Od 1.25 62.50 62.50
Chair installation extra .50 each
Flooring
1 8 x 12 stage 4.Od 192.00 192.00 192.00
2' High
1 18' Stairs 4.Od 45.00 45.00 45.00
Decorations
380 Perimeter Lighting 4.Od 1.25 475.00 475.00
MISCELLANEOUS
QTY I DESCRIPTION UNIT PRICE EXTENDED
1 Permits-TBD 125.00 125.00
Quotation Updated on JUL 14 15 at 4:12PM
EQUIPMENT TOTAL: $3,440.00
MISC TOTAL: $125.00
DEL& PICK-UP: $100.00
GRAND TOTAL: $3,665.00
PAID TO DATE: $ 1,624.44
BALANCE: $ 2,040.56
Customer Signature
Customer Printed Name Date
Quotation Updated on JUL 14 15 at 4:12PM
1
II
_ 1
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Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Nanutachm,
FABRIC JOHNSON OUTDOORS INC.
May 2011
NUMBER BINGHAMTON,NEW YORK 13902 APPROVED oaf tl
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F-140.01 Manufedmene
remFrodws Da='WdOesnMedHerat* - CAMBRIDGE FIRE DEFgR77NENT
This is to w tty that the product;herein harm been manufactured from material inhemndy Rama retardant an
hem after epetltled by the matertal aupplter.
NAME:
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eeru0uaon Is ha mby made tlrat;
The aNa daay@ad on Nb rdi w haw!been manufactured whh an a ODOM M1228rd chemi®i in wawallde _
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F Type.rotor erM weight d maNrkt q14 oz Wnae BbdcouF
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Orcrmtbn of ternoeneks 20 a401 octoo krEFS
1 Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
.Snyder Manufacturing,Mc. ° f
Nu�uheuMrd Flom peledra Vlnw laMlaMa a TE"OEPFRT!lEM.J 110"Oa Rem .
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Certificate of Flame Resistance
REGISTERED
FABRIC ISSUED BY . .. .. - pats of Nanrdacturo _
NUMBER JOHNSON OUTDOORS INC.
BINGHAMTON,NEW YORK 13902 MAY 2007
F-140.01 Manoraaurera or me Finasf
TOM Prod¢ly DasWbW rrrareaar
This 19 to cerory ve that the products herein ha bean manufactured from malarial inherently Barre retardant as
I here after npedBed by the material supplier.
!. NAME: THE EVENT CO
CITY: GLOUCESTER.MA ,
i. CerdBcatlon Is hereby made rea:
The article"desaNed on rids F unifimla have been manufactured Will an approved flame retardant Oieedca In oomgWnca WN
California$rare Fire Material Code.and 70f'.Underwriters Labor"of Canada.and have boon Nsled In accordance WM Ma
exceed the Mi
I Tvoe.color and vielord of material 1d 02 MnN WHITE BLOCK OUT
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I. Oewlormr of ran canned; EFS 10'.MID 30'
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Flame Retardant Process Used Will Not Be Removed By Washing And
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Is Effective For The We Of The Fabric
j. Snyder ManutaetuHne,ins.
NaiamvaaFbme Retardaa yrallmuvam rorromurruwr..nKwsaw
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Certificate of Flame Resistance
REGISTERED+ ISSUED BY =2007
FABRIC 3OHNSON OUTDOORS INC.
r NUMBER BINGHAMTON.NEW YORK 13902
F-140.01 Manufeduers Of Me RMN
Tent Productr Described Hamfn
This is to certify that the produces herein have been manufactured from material inherently flame retardant as
here after specified by the material supplier.
NAME: THEEVENTCO
CITY: GLOUCESTER,MA
certification is hereby made that:
! The artdes described en ads cegbsma he"been manufacbaed vAM an aMOVed flame femNant Chan 3l In compliance%%M
CaliforNa State Fire Marshal Code.NFPA-701'.UrMmwNem Laboratory of Canada.and have bean brand in aceemenm with Me
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Tme.mbr and weiatn of materiel 14 02 vinN "rfE BLOCK OUT
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Desseret=of ban cendbd: EFS 30X30 ZPC
Flame Retardant Process Used Will Not Be Removed By Washing And
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Is Effective For The Life Of The Fabric
Snyder Manufacturing.Inc.
umwacmcrarrlemo anardw.vxm temheun Tgrrb mkwerr."Wei K N .
Certificate of Flame Resistance
REGISTERED ISSUED BY can,of Marn lacture
FABRIC JOHNSON OUTDOORS INC.: MAY 2009
NUMBER BINGHAMTON.NEW YORK 13902 1
F-140.01 Manufawuam of Me Forest
Tom Podwfe Described Hamm
This is to cefefy Mat the products herein have been manufactured train material Inherently"man,mile am as
here after specified by the material supplier.
NAME: THE EVENT CO.
CITY: GLOUCESTER.MA
certification Is homey made dot
The mildew detained en a"owddato nm a aeen mamdadumd aeh en approved name retardant dmmael In campliarve CAM
Califomio Stele Fire MaNW Coda N meet or exceed Uad Mr Flame ar Cannnoe of Mom car"need In aoomdaam wiM ere
Federal Test Madw SpecifiSpecificationsl
Typo.odor aril aeigtd G.
of material 140Z WOO
Desul EFS 15 MO030 WSO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
LL. Snyder Manufacturing..lne.
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