CRNR WASHINGTON & FEDERAL ST - BUILDING INSPECTION a
The Commonwea a sachusetts
Department of Public Safety
Ib OCT _LL'' pp Massachusetts State Building Code(780 CMR)
Ai1Hin jP"it Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION
Mnte ;1 t
No.and Street Ci /Town Zip Code Name of Building(if applicable)
t dIR-76
1 Assessors Map# Block#and/or Lot #
n(�l SECTION 2:PROPOSED WORK
C Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ Other 10 Specify: : Lan
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑'
Is an Independent Structural Engineer{flg Peer Review required? Yes ❑ No ❑
Br'ef De caption f Proposed Work: �0 S1K�..C�C Q� ml( Y60(Y 60 t� �t ��1 16
T,, s a n 1101131 Ki f0
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.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5 07 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 13H-2 13H-3 13H-4 13H-5 0
I: Institutional I-1❑ I-2 13I-3❑ I11❑ M.
Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage 5-1 ❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 111 IIA ❑ IIBO IIIA0 IIIB ❑ 1 TVD 1 VA 13 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 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 0 required 0 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 0 or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
1ID1 %7- TW7-'Mvr
SECTION 9: PROPERTY OWNER AUTHORIZATION
Nagte and Address of r rty Owner
�T P
Name(P ' t) No.and Street City/Town Zip
Property Owner Contact Information: -
,09,n '.be)kxr�j Wecs 7S;7- gUrk/,? gr.eCLAr» Acd: .Sbn -c@"
Title Telephone No.(business) Telephone No. (cell) —'e—m il address
If applicable,the property owner hereby authorizes:
SSI1�orrr ss 6W
Name Street Addr s City/Town State Zip
to apply for and 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 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O.
Otherwise provide construction control forms see section 107 in the code as required.
10.1 Registered Professional Responsible for Construction Control the professional coordin ting document submittals
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
102 General Contractor
Com any Name
r
ame qy Person Responsibl or Construction License No. and Type if Applicable
U 6 cru_cf,s-�t- M/'L o 19m
Street Address City/Town State Zip .
q _0 _�8��
Telephone No.(business) Telephone No.(cell) 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 O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Buildin $ Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ - (comactanunicipali )
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 accur - to the best of my howl dge and understanding.
97j-
Pose rint and signname \ // T' e Tele hone No. ale
YU � ` f(0 UlGu c�.s�c✓ //7/t 0/4 3d a
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval:
Name Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
U,kritears'Compensadon Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMTTING AUTHORITY.
Applicant Information Please Print Leeibly
Dante(BusinessfOrgmizatiordIndividual):The Event Co.
Address:PO Box 419
City/State/Zip:Gloucester MA 01931 Phone#:978-283-4'884
Are you an employer?Check the appropriate hot: Type of project(required):
l.O I am a employer with 20 employeas(full and/or part-time).. 7. []New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in $. F1 Remodeling
any capacity.[No workers'comp.insurance required.)
9. Demolition
3.D I am a homeowner doing all work myself[No workers'comp.insurance required.)t
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. i will
ensure that nit contractors either have workers'compensation insurance or are sole I l.❑Electrical repair's or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
S.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet, t 3.QRoof repair;
These sub-contractors have employees and have workers'comp.insurance)
l4.[]✓ OtherTents
6.E]We are a corporation--itits officers have exercised their right of exemption ran MGL c.
152,§I(4),and we have no employees.(No workers'comp.insurance required.)
•Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit ibis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractom that check this box must attached an additional sheet showing the name of the sub-connmtors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'eampensadon insurance far my employees. Below is the policy and job site
information.
Insurance Company Name:The Hartford
Policy#or Self-ins..Lie.#:6S60UB-9F40753-3-16 Expiration Date:1-12-2017 ,r
Job Site Address: F—e Y -( � ,A�City/State/Zip: t , G z�F70
Attach a copy of the workers'compensation policy declaration page(showing the parley number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the ndpeunttiesofperjury that the information provided above is true and correct
Signature,
Phone#:
Official use only. Do not write in this area,to be completed by city or town offlciat
City or Town; Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person- Phone#-
The Event Co.
L► P.O.Box 419
,
Gl
Gloucestersten,MA 01930 JOB CONTRACT
the event co. Voice: (978)283-4884
Fax: (978)283-4163
. •
INVOICE TO: DELIVERY ADDRESS:
Order Status: Confirmed Order
Alt 92.9 WBOS Sales Person: Taylor Hedges
55 Morrissey Blvd Crnr Washington and Federal St Last Updated:SEP 9 16 12:17PM
Boston,MA 02125
ATTENTION: Sean Doherty JOB SITE: PO.
CUSTOMER#:
PHONE: (617)822-6752 Ext: ROOM: TERMS: 25/25/50
FAX: CONTACT:
EMAIL:sdohertyggreatermediaboston.com PHONE: CELL:
ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA:
AUG 23 16 12:02PM OCT 31 16 OCT 31 16
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
OCT 31 16 OCT 31 16
JOB DESCRIPTION: Haunted Happenings in Salem 2016
EQUIPMENT
QTY I DESCRIPTION DUR I UNIT$ EXTENDED DISC NET
V credit on delivery for 2015 only 1.0 d $-100.00 $-100.00 -100.00
Tents-Sidewall extra
60 Solid Sidewall 1.0d $1.25 $75.00 75.00
for 10x20
one 10'side open
1 10 X 20 Marquee 1.0d $225.00 $225.00 225.00
Front of house for sound guy
1 30 X 60 Frame Tent 1.0d $1,170.00 $1,170.00 1170.00
Beer tent
needs good sized entrance and emergency exit
80 Solid Sidewall 1.Od $1.25 $100.00 100.00
For20x2O
1 20 X 20 Frame Tent- Eureka 1.0 d $300.00 $300.00 300.00
Behind stage
Tents-Sidewall extra Total: $1,870.00
Tables and Chairs
5 T Round Table 42"high 1.0 d $8.50 $42.50 42.50
Table installation extra
13 8'Banquet Table-Stacked 1.0 d $8.50 $110.50 110.50
Table installation extra
10 White plastic chair 1.0d $1.25 $12.50 12.50
Chair installation extra
180 7'Solid Sidewall 1.0d $1.25 $225.00 225.00
Sidewall Total: $390.50
Decorations
180 Perimeter Lighting 1.0 d $1.25 $225.00 225.00
60 Perimeter Lighting 1.0 d $1.25 $75.00 75.00
for 10x20
80 Perimeter Lighting 1.0 d $1.25 $100.00 100.00
for 20x20
Decorations Total: $400.00
Accessories
1 170,000 BTU Heater 1.0d $250.00 $250.00 250.00
$50 non-refundable deposit to hold, customer must confirm or cancel 24 hours before delivery
1 Exit Sign 1.0d $25.00 $25.00 25.00
or 30x 0
34 500LB Ballast Block 1.0d $20.00 $680.00 680.00
Accessories Total: $955.00
Accessories
8 Trash Barrel 1.0d $10.00 $80.00 80.00
30 gallon
Accessories Total: - $80.00
Equipment Total: $3,595.50
Tax: $230.98
MISCELLANEOUS
QTY DESCRIPTION UNIT PRICE EXTENDED
1 Permits -estimate $250.00 $250.00
Misc.Total: $250.00
- EQUIPMENT TOTAL: $3,595.50
MISC TOTAL: $250.00
DEL & PICK-UP: $300.00
(MA State)TAX TOTAL: $230.98
GRAND TOTAL: $4,376.48
PAID TO DATE: $0.00
BALANCE: $4,376.48
Customer Signature
Customer Printed Name Date
Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON, NEW YORK 13902
5/22/2009
FA-49303
Manufacturers o1 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: 13 oz Vnvl Snyder white block out
Description of item certified: 10x10 Marquee Mid
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
HANWHA POLYMER CO.
TENT DEPARTMENT,JOHNSON OU OORS C.
'Large Scale
Certificate of Flame Resistance
REGISTERED - ISSUED BY Date of Manuteeture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON.NEW YORK 13902 MAY 2009
F-140.01
Manufacturers Of ore Rnest
Ted Products Oasulbed HOMO
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,MA
Certification L5 hereby Mario mel:
The articles described on this cerOfloate have been manufacwred Wth an appmved flame retardant chemical In compliance vith
California Slate Fre Marshal Coda,NFPA-701',Underwrites Laboratory of Canada.ane hove been tested In accordance with the
Federal Test MCOod SpedGeations and meet a exceed the Mililary Flame Specifications of MIL-G43006G.
Type.--a-raw--w W material 14 OZ W90
DeaOiptiOn W Ilan ceNfles EFS 15 MID 30 WBO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc.
Mondmauer otFlano rtemdaevla.+lemuara, TF.rT DepamueNr.iowasory
Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK 13902
Manufaulwars of the Finest JANUARY 2008
F-140.01 Tem 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. Mede in the USA
NAME: THE EVENT COMPANY
CITY: GLOUCESTER,MA -
CartiBcation is hereby made mec
The articles described on this cenificate have bean mmutactlaed with an approved flame retardant chemical in compliance with
California State Fire Marshal Code,NFPA-701',A-A35308,FMVSS.VZ CANNLC-Sl03MB7,CPAW,Underwriters laboratory of
Canada,and have been tasted M accordance with the Federal Test Method Specifications and meet or exceed the Military Flame
Specifications of MIL-C-030080.
Type,color,&weight of material: 14 OZ Vinyl: WHITE BLOCK OUT
Description of item certified: EFS 20X20 213C
Flame Retardant Process Will Not Be Removed By Washing. Eurehaf Tem tops that are designed to
meet Temporary Building codes are supported with a Registered Architect Stamp. For that stamp to remain valid,the tent
top must be Installed with 100%Eurelial Manufactured fabric componerlte.
Snyder Manufacturing,Inc.
MmWaNrmr of Rome ReMNam VIml WnHabe TENT DEPARTMENT,JOHNSON OUTD ORSW .
-large stela
Certificate of Flame Resistance
' REGISTERED y ISSUED
By
Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK 13902
I Manufacturers of the Finest MAY 2007
F-140.01 Tent Products Described Herein
This Is to certify that the products herein have been manufactured from material inherently flame retardant as
j here after specified by the material supplier.
NAME: THE EVENT CO
i
CITY: GLOUCESTER,MA
1 Certification Is hereby made that:
The strides described on this cerbli ate have bean manufactured Win an approved flame retardant chemical In compllanoe Win
i California State Fire Marshal Code.NFPA-701'.Underwriters Laboratory of Canada,and have been tested In accordance vAth the
Fthe Militant,Fleare SjIg�=J[Qm at MIL-"3006G.
Tvoe.mbr end wetoM of material 14 OZ vinyl WHITE BLOCK OUT
I
Description of item certified: EFS 30X30 2PC
1 Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
i
Snyder Manufacturing,Inc.
1 ManurOCMer of Flame RerardvA VMd lamMates TENrO�ARfMENT,JOMil50N RSI
'Large Swb -
l