35 WINTER ISLAND RD - BUILDING INSPECTION (5) a The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
It Massachusetts State� Building Code, 780 CMR, Tin edition OF SALEM/ t RevisedJuna,vs-
t Building Permit Application To Constrwq. Repai , Renovate'Or Demolish a
Z;
One-or Two-F ,,,Dwrl'ing
This Sectionli For Otl'ici i Use only
Building Permit Number: , Date'At blied•
Signature:
Building Commisrioned Inspecturbf Buildings Date
SECTION 1:SITE WORMATION
1.1 Pro erty Address 1.2 A4sessors Map dt Parcel Numbers
1.la 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 R) Frontage(R)
I.S Bulidtng Setbacks(B)
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: 1.3 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yesO Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O/w/ rne of Recorrd: f'�
/!lk 1nL n�& /)1 el VIC TQ l'ILI,- -,2, ( k�/kwJL r
Name(Print) /J- / Address for Service:
0— 7 9- 7 L t_J
Signature' Telephone
} 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 or Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building 5 1I. Building Permit Fee: S Indicate how fee is delermined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost)(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (tfVAC) $ List:
5. Mechanical (Fire S
Suppression) Total All Fees:S
p Check No. Check Amount: Cash Amount:
6. Total Project Cost: S S�� ❑paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number IixpIfJllaO DJIC
Name of C'SI.•I M1dJer List CSL"type(see below)
T Diescription
Address U (lnresuicted(up to 35,000 Cu.Ft.
R Restricted IR2 Family Dwelling
Signature M Masonry Only
RC Residential Routing Covering
felephrme WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
mt:Company Name or 111C Registrant Name Registration Number
AJJreu
Expiration Date
Signature - Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 Issuan5p of the building permit.
Signed Affidavit Attached? Yes ..........Lff No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR 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:OWNEW OR AUTHORIZED AGENT DECLARATION
V- as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Namc
Signature of Ownceor Adtho`rized Agent Date C
(Signed under the pains and penalties of 'u
NOTES:
I. 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_W have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 I O.R6 and 110.115, respectively.
2 When substantial work is planned,provide the information below:
Total floors 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"
e ICa e o ame @SIS ante PAGE 1
_ Date Manufactured AZTEC TENTS
2665 COLUMBIA ST INV NUMBER: 0179791 �,'.
03/24/2010 TORRANCE, CA 90503 P.O. NUMBER: ''
(800) 228-3687 CUSTOMER NO: EVEN019
This is to certify that the materials described below have been flame retardant ¢y,.
treated (or are inherently flame retardant).
aNin me.n
1 Allied Financial Solutions 71nnn-i+c.m um-a.12,ae,lc,18. F-419.01
Events for Rent uea.vnw 1.g.7 zoo+ Fs7oo e
7103 Turfway Rd Ste.306 oeF Fe.,mna 1s„i 209a F sw o1
Florence, KY 41042 464 Lowell Street ppF oaF F.102
Peabody, MA 01 960 `" �� `a tusoz Fa30o,
Rn+n rreeont,ai^t 702 F n,$
PoII-p5T0[w mnT..uoet Fsoom
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Snyder "themp+n Fa9o.01
Td vaned. nreydn S-dreda
- - --- TO vantage .do Soo F111 oz "++^
Certification is hereby made that the articlesdescribed below hereof are made Tn Vantage am Td, F 12a a0 ..
from a flame-retardant fabric or material registered and approved by the T,Vantage 0+ng°+td W.a�on 1069,01
California State Fire Marshal for such use. The fabric has been tested and Ta Vantage Waldo,coaX,.. F-069.01
passes NFPA 701 Large Scale. See chart to right for trade name of Oes1d°° °o�°k1n B1673B1ss F-510.01
flame-resistant fabric or material used and additionally referenced on the label -
of the fabric panel.
THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING
David Bradley General Manager- Manufacturing
j Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent
I
ITEMS MANUFACTURED TYPE PRODUCED
15'x15 1pc Festival Top UW S 1
w/ Rope Tensioners & Flag
with secondary valance
V
15xl5x8 Festival Frame Only S 1
15x30 1pc Festival Top UW S 1
w/ Rope Tensioners & Flag
with secondary valance
15x30x8 Festival Frame Only S 1
(2Peak)
20x20 1pc Festival Top UW 5 1
w/ Ratchet Tensioners & Flag
with secondary valance
20x2Ox8 Festival Frame Only S 1
20x30 1pc Festival Top UW S 1
w/ Ratchet Tensioners & Flag
with secondary valance
20x3Ox8 Festival Frame Only 5 1
(2Peak)
20x40 1pc Festival Top UW S 1
w/ Ratchet Tensioners & Flag
with secondary valance
20x4Ox8 Festival Frame Only S 1
(2Peak)
04/08/2010 12.24 603-964-1484 RLL1=111RTNI M7MI UUrtr rcwz uz
AC PM. ;CERTIFICATE OF LIABILITY INSURANCE °"1110112009
11ro1/zoo9
oRODUDae THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
)FrBnkVenuto ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
clo ABTA, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
529 Main Street;Suite 806
Boston,MA 02120 INSURERS AFFORDING COVERAGE NAIC#
WSUPAD W3IIRERAI Zurich-Ameriwn Insurance Company
Alleglant Management Corp. INSURER B:
300 Lerfayotte Rd. INSURER C:
Rye.NH 03870.000 INSURER V.
INBURERe
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IHBR TYPEOPINSURANCEPOLICY LAUNDER U Y TINE POLITY ITa
OENERnLUAB4 EACH OCCURRENCE S
VERrEb—
COMMERCIAL GENERAL LIABILITY I RaWn—(EF 2eeEll S
CLAIMS MADE 7�OCCUR MWEXP FIm ,rrrn $
PERSONALAADYPIJURY $
GENERAL AGOREOATE S
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S
POLICY F7 PM E Lac
AUTOM091LELIABILITY COMaINSD aWLE G LIMIT S
(Ee ecddeid)
ANYAUTO
ALLOWNEDAUTCS BODILY
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SCHEDULEOAUTOS —^-
1 HIREOAUTOS I IML-y IRY q
NOWOWNEDAUTOS
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OARAOELIABILITY ALMD ONLY•EA ACCIDENT S
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EACH OCCURRENCE S
EXCEaSNMBRELLALLABRnY
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RETENTION $ S
x WC BTA LL O'itl.
WORMERS COMPENSATION AND
EMPLOYERS,Ukuww -LEACHACCIDENT T 1.000.000
A ANY OFFIOEOPRI B�XRNINER MMS WC �90-7.3&01 11/01/2009 11/O1/2010 .L, �E-EA EMxOVEE S 1,000,000
9 ,MpwDlbaun00rNq E.L DISEASE.POLICY LIMIT s 1000.000
OTHER GD CerBriaate 09NH002780889
Loetlo an Coverage Period: 11/01l2009 11/0112010 1 CIIeM#: 821
DESCRIPTION OF OPERATIONS f LOCATIONS I VaNCLES/PAC W SIONS ADDED BY ENDORSE/ENTI SPECML PRDYCdDN9
CDYsraeo is provided fa only I North Shore Rental,Inc.dba:Events for Rent
those employees leaead to 464 Lowell St
but not subcorltril ol: peayody,MA 01960
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED PDMCIFM or CANCELLED 6E1NORE Tel BXPRATION
oATE THEREOF,THE FFMIM RRIVRRR WILL ENPFAVOR TO MAIL 30 DAYS WRITT9L
k North Shore Rental.Inc. NOTICE 70 THE CERTtjCA7r HDUEB HOMED To itB LEFT,BUT PAILURE TO DO BD MALL
dba:Events for Rant IMPOSE NO CBLIGAT10N OR LIABILITY OF ANY RWO UPON THE WSUIll nS AGENTS OR
464 Lowell St IuePREBExTA
Peabody,MA 01860 AUTHORIZED REPRESENTATIVE 4e
ACORD 25(2001/08) ®ACORD CORPORATION 198E
04/08/2010 11:08 5085206914 hLNKY INS I-tMMLIIN taut n[rns
CERTIFICATE OF LIABILITY INSURANCE o 4 DATE(L.jilc D o
PRODUCER IS CERTIFICATE 15 ISSUED AS A I OF NiFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Berry Insurance AgenCy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
9 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Franklin NA 02038
$hone. 800-824-5201 Pax:SOB-520-6914 INSURERS AFFORDM COVERAGE NAIL#
INSURED INSURER A at Faaa PL.e A NaxAae 1". co.
INSURER 0:
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t�1 ShOC_Rent81 InC. INSURER C:
Peab000dyeMA 01960 INSURER
INSURER E;
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY FERTAN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED MERSIN IS SUBJECT TO ALL 1"E TERMS.EXCLUSIONS AND CONDRIONS OF SUCH
POLICIES,AGGRF-OATR LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR TYPE OF INSURANCE - POLICY NUMBER TE LIMITS
GfiTIfi" LIABLLPTY EACH OCCURRENCE E 2,000,000
A I% COMMERCIAL GENERAL ryLIABILITY CR00220071 04/02/10 04/01/10 PREMISES KbN Wwr- 1 $ 100,000
CLAPASMADE EX OCCUR I MED EXP(Arq ane pnnwI) $ 5,000
PERSONAL A ACV INJURY I L 000,000
GENERAL AGGREGATE s2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COM1FIOPA00 $ 1,000 000
POLICY ACT LOC
AUTOMORE.E LIABILITY
A �% ANYALO MA00200332 04/01/10 04/01/10 COMBINEDBNOLELIMIi E1,000,000
(Ea ecGdanp
ALL OWNED AUTOS BOOILY INJURY
SCHEOULEOAUTOB (Perpemen) E
VIREO AUTOS BODILY INJURY
NON-0YMEOAUTOS (RIF eeeaenU S
j PROPERTY DAMAGE S
(Pera cidw)
GARAGE LIABILITY AUTO ONLY-EA ACCDENT S
1 ANY AUTO OTHERHAN EA ACC S
AUTO ONLY; Sj ADD 6CMIS l UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000
A R OcOUR ❑ CUVMSMAOE 502NA9914 04/01/10l 04/01/11 AGGREGATE a1,000,000
DEDUCTIBLE li .
S
R RETENTION E10 000 S
WOPKERII=mMNsaTI*M UTFF
AND SUMMERS LKIRLITY YIN T R'I LIMffS ER
ANY PROPRIETONPARTNERS(ECUT1VFRIM j-1 E.L.EACH ACCIDENT E
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OFFICEEMSER EXCLUDEDP �_j
(Meelery In NH)
K e deewlbe order El.DISEASE.EA EMPLOYE E
SPMdA'L PROYNTIOHS tew1. E,L.DISEASE-POLICY LIMIT i
OTHER
A Equipment Floater CS000220071 04/01/10 04/01/11I Zcpapment $600,000
mscwmw
G OF ocI RATIONS!
LOCATIONS TVEHICLE9lETICLUWONSA Dad. $1,000
ENCORSEMBMfyL'CM PROVpmNS
Party Gonda Rectal
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ASGVE DESCRIBED POM,,,BE CANCELLED BEFORE THE EXPIRATION
NORTESS DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W WrITM
NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 90 SMALL
IMPOSE NO OBLIGATION OR LIA 1UrY OF AM KIND UPON THE INSURER,(Ta AOENTS OR
North Shore Rental REPrdMENrAmEs
464 Loll St:.
Reabody NA 01960
ACORD 2S(2009MI) -fife reasrved.
The ACORD name and logo BITE m®httered marks of ACORD