WINTER ISLAND - BUILDING INSPECTION The Commonwealth of Massachusetts
SL\ /37/
Board of Building Regulations and Standards SALEM
Ulf Massachusetts State Building Code, 780 CNIR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
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1.1 P r pZ'Add[7 1.2 Assessors Map&Parcel Numbers
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1.1 a 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 ft) Frontage(1)
1.5 Building Setbacks(ft)
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: 1.8 Sewage Disposal System:
Public 0 Private El Zone: Outside Flood Zone? Municipal El On site disposal system El
Check if yes[]
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2.1
Ter'ofR d
Name(Pri6t) City, State,ZIP
Not Street Telephone Email Address
..........
SECT WN,3-,,ESCRIP-,Tp ,F PROP that
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New Construction 0 Existing Building 11 Owner-Occupied 11 1 Repairs(s) 0 Alteration(s) 0 1 Addition 0
Demolition 13 Accessory Bldg. 0 Number of Units_ Other 0 Specify:
Brief D scription of Proposed Work :
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VC-P&
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Estimated Costs:
Item
(Labor and Materials)
1. Building
2.Electrical
3.Plumbing
vs 2'1��
4. Mechanical (14VAC)
5. Mechanical (Fire
Supp ession) $
6-Total Project Cost: $ 7ql. 0
SECTION 5:" CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No. and Street Jype Description
U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
City/Town, State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
- SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 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 Issuance of the building permit.
Signed Affidavit Attached? Yes ...........d No........... ❑
SECTION 7a: OWNER AUTHORIZATION;TO 13E COMPLETED WHEN <x;'
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,
I, 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZTD AGENT DECLARATION.,`
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
PriL Owner's or Authorized Agents Name(Electronic Signature) Date
NOTES. .3.,
1. An Owner who obtains a building permit to do his/her own work,or an owner whohires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.triass.=ot v oca Information on the Construction Supervisor License can be found at www.mass.gov<!ns
2. When substantial work is planned,provide the information below:
Total floor 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"
C CCY U F S:\L.HMI \r L\SS.\CH US ETTS
a.
OUILOING DiipmtrNLEI\T
120 WAMLNGTON STREET, )aa FIUUR
TEL (975) 7)5.9595
F.1x(979) 7 W846
Ki>tpEALEY DRJSCOL
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DI&ECTUR OF PL21LIC PROPERTY/0L•11.OINU C016LMSSIU\E1,t
Worker' Compensation Insurance ,kilidavit: Builders/ContractncvlElectrtcians/Plumbers
1ili leant Information Plea to Print Lellhir
.NainC ll III situv to U(ganl»Iiaro InlllV it u.11):
Address: 2a ?25�2 )p q ( Q —
Cily/Stalc/Zip: ,SbE� _ Phone N:
Are you an employer'!Cheek appropriate bon 'Type of project(required):
I.0I am a employer with i 4. ❑ 1 a(rs a general contractor and 1 S. New cunstruciian
unlplayeae(Pull and/or part time).' have hired the sub-contractors
2.❑ I am a wle proprietor or panzer. lived on the auuhcd.+hecL 1 7• ❑Remodeling
.hip and have no employees These subcontractors have 1. Demolition
working for me in any capacity. workers'comp, insurance, 9. Building addition
INo workers'.comp, insurance 5. ❑ We are a corporation and its
required.) ofilcers have exercised their 10.❑ Electrical repairs or additions
J.❑ lain a homeowner doing all work right of exemption per MOL I I.❑Plumbing repair or additions
myself.(No workers'Gump. c. 152, 11(4).and we have no 12.❑Roof repair$
insurance required.) I empluyaes. (Noworkers, 1J,QOIher
cump. insurance required.)
'•.buy applla:ua dun chasYa boa At must alru 1111 nul Iha meliw below shawine(hair••arlta s'ccmpeasadun pultay,nAlrmmlan.
I h,.nauwnarl who mhnrif this rinMvis Indlealne ihry sr$Joins all%wrt and than"ualride eantraetera mull nlhmit a new,a111davil indicting twit,
:t\mrcw Wn that whaelr his box must auaahud un:,Walurud.htwf.huwine the n atotthe abwonem"And(haltwortfre,camp,pullay inreme,11 e,
l um on empluyet(hut h pruyiding works rs'rumpa(radon losuruncelor my employees, Seluw is du pall y andTub site
in/umwdnn.
In..urulce CmYipany .Name• /� � V __ ...rS
Policy 9 or Sclf-ins. Liu. rl:� le 0 E ZY' Cq
70 E..piralian Data:
/ub Site Address: ou-s CilyiState/2ip;
.\lt icb A copy of the workers' compensation policy declarailon page(showing the policy number and expiration data).
P.tiluru to wcurc rnvamga as required under Section 2JA ti(M C e. 152 can lead to the imlposilion of criminal penalties of a
ri,x ilp to 11,500.0 und/ur one-year impriemmoten6 it well as civil penakies in the form of a STOP WORK ORDER and a tine
of.ql to 52,MAIO a day Igainst Ilse violator. Ile adviwd that i copy of This,talemwnt may be furwardcd to ilia Ol lica of
I,Ive,lig�tiuns,dihc OL1 Ilsr insunnee coverage vcriliclliun.
I du hrreby
:... r y rI rt that a/nr p, ryru1(u iglur rallaa
rt proyiJrJ ubuvlr ie nve�urJ a•arrrrG
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I)1/rcr�/me Judy, p•!,r��r .vile in/lrir:Iron, N�e rurnpltA'd Sy rr'ry ur luron n//It'iu(
City-If 1'mva; ___ _. _. i'crmiaLln•nae i
I. ;Lrard ul Ilrallh !; Ihlililln•� fh•ILln meat 1. 1'ity(fnnn Clerk 1. I•:I.efric ll In,pcahu i. I'bl,nhinti Inlpector
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. The Event Co.
P.O.Box 419 QUOTE
)7 Gloucester,MA 01930
the event co. Voice: (978)2834884
z Fax: (978)2834163
• •
INVOICE TO: DELIVERY ADDRESS:
Order Status: Tentative Order
Kristin Jay Winter Island Sales Person: Taylor Hedges
425 Berkshire Tr Salem,MA Last Updated:JUN 25 12 11:12AM
Cummington,MA 01026
ATTENTION: Kristin Jay JOB SITE: Winter Island PO.
CUSTOMER#:
PHONE: (413)634-5449 ROOM: LOCATION TBD TERMS: COD
FAX: CONTACT:
EMAIL:Iam.fury@gmail.com PHONE: CELL:
ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA:
JUN 11 1210:11 AM SEP 22 12 SEP 22 12
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
SEP 22 12 SEP 22 12
JOB DESCRIPTION: Tent on Winter Is - Rain Plan
EQUIPMENT
QTY I DESCRIPTION OUR I UNIT$ EXTENDED DISC NET
Tents-Sidewall extra
1 30 x 30 Pole Tent 1.0 d 500.00 500.00 500.00
Rain Plan. Non-refundable deposit of$125. Please call Taylor at 617-967-5666 24-hrs before delivery to confirm or
MISCELLANEOUS
QTY DESCRIPTION UNIT PRICE EXTENDED
1 Permits 100.00 100.00
EQUIPMENT TOTAL: $500.00
MISC TOTAL: $100.00
DEL &PICK-UP: $110.00
MA State TAX TOTAL: $31.25
GRAND TOTAL: $741.25
PAID TO DATE: $ 0.00
BALANCE: $741.25
Customer Signature
Customer Printed Name Date
Quotation Updated on JUN 25 12 at 11:12AM 1
The Event Co. TO:Kristin Jay
' P.O.Box 419
Gloucester,MA 01930 Kristin Jay
the event co. Voice: (978)283-4884 425 Berkshire Tr
—� Fax: (978)283-4163 Cummington, MA 01026
Phone: (413) 634-5449 Ext:
Fax:
Email: lara.fury@gmall.com
From: Taylor Hedges
Attached: Job for Tent on Winter Is -Rain Plan
Status: Tentative Order
Job Start: SEP 22 12 Job Total: $ 741.25
Job End: SEP 22 12 Terms: COD
Our Job#: 12389-1 Pages:
1.The Event Company shall deliver and install the[eased property on or prior to the dates specified for each Item In the manner in
which It was leased.
2.Customers shall provide sufficient unobstructed clean spars suitable for delivery,installation,dismantlement,and removal of all
leased property together with adequate vehicle access. All tent/canopy locations must be marked prior to or immediately upon the
arrival of The Event Company for installation. Failure to do so will result In additional costs of$25.00 per man-hour while waiting
for locations to be cleared or determined.
3.6 because of ledge,rock,or other surfaces special anchors are needed to secure tents,canopies,or marquees the customer
shall pay additional equipment and labor costs to secure said Items. Customer shall mark the location all underground utilities
and facilities that may be affected by installation of leased property.
4.The Event Company shall endeavor to minimize damage to customers lawn,planting,and general premises. However,customer
assumes the risk and releases The Event Company from any and all damages to premises occasioned by the performance of this
agreement.
5.The Event Company Is excused from performance of this agreement if such non-performance Is Caused In part or whole by the
elements,disturbances of nature,fire,theft,vandalism,or act or failure to act of any government authority.
6.The Event Company Is not required to install the agreed leased property when,In the sole opinion of The Event Company,
weather conditions create an un-reasonable risk to The Event Company employees or property.
7.The Event Company may upon notice to customer substitute any equipment of equal or greater value and square footage for
agreed lease Items at no additional cost to customer.
B.Cooking is forbidden under or adjacent to tentsicanopies.
9.Customers shall not attach crepe paper,streamers,tape,or other decorations containing cheap dyes to the tent that may lead to
the dying of the tent fabric.
10.If lighting is being leased It Is the customers responsibility to have a safe and legally conforming source of power brought to
the tent unless otherwise discussed with The Event Company.
11.From the point of Installation to removal all leased Items are the full responsibility of the customer against theft,vandalism,fire,
and all other non-natural causes. If a guard is required to insure the safety of leased Items It is the customers financial responsibility.
12.Prior to the end of the lease term the customer shall remove all personal or non-leased Items in order to clear the way for The
Event Company to remove leased items. Failure to do so will result in a charge of$25.001 man-hour for the removal of said items.
13.It Is understood that leased property Is for a designated use,time frame,and location. The Customer may not sublet,remove,
or mis-use leased property without the consent of The Event Company.
14.Customer agrees to pay for lost,damaged,or dirty equipment. The customer shall pay for any damages beyond normal wear
and tear,or a reasonable fee for cleaning any leased items that returned dirty.
15.The terms or this agreement can be terminated in writing before The Event Company arrives to Install leased equipment. The
Event Company retains the right to keep all deposits if Cancelled by customer less than 90 days before event date.
16.The Event Company retains the right to change removal dates due to bad weather and the right to remove tents DRY. Failure
by the customer to Comply will result in an additional charge of 40%of the rental price to dry the tent.
17.The customer understands that The Event Company is located In Gloucester,Massachusetts and that this agreement Is
governed by the laws of the state of Massachusetts. In the event the customer Is sued by The Event Company for breach of
contract the suit shall be venued in the City of Gloucester and subject to that courts decisions.
18.Payment in full is due by the date of Installation unless other arrangements have been agreed upon. Failure to pay be the
agreed dale will result In finance charges of 11/2%per month or 18%Annually.
19.The customer and an authorized agent of The Event Company must dually sign any modifications to this agreement.
20.Permits-the customer must obtain permits as are required for the installation of tents and any other leased equipment and shall
furnish evidence of permits upon request by The Event Company. All fines resulting from failure to pull permits are the
responsibility of the customer.(See item 5).
21.Digsafe-Call 1.8884310-WE at least 5 days before installation,It is a state law to have sites checked before we drive stakes.
Date: Date:
The Event Co. Kristin Jay
Signature: Signature:
Name&Title: Name &Title:
Page 1
CC ificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON, NEW YORK 13902 DEC 2003
F-140.01 Manufacturers of the Finest
Tent Products Described Herein
This is to certify that the products herein have been manufactured from material inherently flame retardant as
here after specified by the material supplier.
NAME: THE EVENT CO.
CITY: GLOUCESTER STATE: MA
Certification is hereby made that:
The articles described on this certificate have been manufactured with an approved Flame retardant chemical in compliance with
California State Fire Marshal Code,NFPA-701',
Tvoe,color and weight of material: 14 OZ Vinvl WHITE BLOCKOUT
Description of item certified: 30x30 2PC ELITE SECTIONAL
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