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14 SUNSET RD - BUILDING INSPECTION
7 he Commonwealth of Massachusetts 0� C+, Department of Public Safety ' to� (] Massachusetts State Building Code(780 CMR) MISR PAn#:Kpgl4V on for any Building other than a One-or Two-Family Dwelling r. (This Section For Official Use Only) 1 .Building Permit Number: : Date Applied: Building Official: �Y SECTION 1:LOCATION l No. t i Ci /T wn Zip Code Name of Building(if applicable) LJ Assessors Map.p## Block#and/or Lot # ® rf70 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 2) Change of Use ❑ Change of Occupancy ❑ Other R Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineer.n Peen Revi�jw�re uired? v / Yes ❑ No ❑ Brief escriptio ofP oposed Work: �n.SttC�C�C q l.L� � /l.�LtIZT- QyYI_ /U�'q p �oj/ �-- 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❑ 1 B: Business ❑ E: Educational ❑ F. Facto F-1 ❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile ❑ 1 R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IAO 111 E3 IIAM IIB ❑ IIIA ❑ IIIBO 1 IVO 1 VA VB 13 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❑ 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 C3 Yes❑ 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: ' (YIAtL ^O lb( lZ SECTION 9: PROPERTY OWNER AUTHORIZATION ' Name and Address of Property Owner f e rxr66 I L( Sunse� � orad Nah int) No.and Street _ City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address 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 pmfessional coordin ting document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10�.2/General Contractor Com anyName ff lk�g�s Name#f Person Resp ible for Construction License No. and Type if Applicable 176/ V, q11, - 6l. J�a 0,#- 6i 3,) Street Address City/Town , State Zip q Z8 .41W4_( (LZ 5 JCt . /or P_ ►cen-ke f C 017 Telephone No. (business) Telephone No.(cell) —j e-mail address SECTION 11:WORKERS'COWENSATION 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 13 No 13 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE 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)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 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 accurate to the best of my mowl ge and understanding. n�1nn,a��se int and sign Qniame / Titl p f Teleph/9n/�No. p Date 'It�IJ © ct t--1 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 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia \Y rkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leidbly Name (Business/Orgmization/Individuai):The Event Co. Address:PO Box 419 City/State/Zip:Gloucester MA 01931 Phone#:978-283-4884 Are you an employer?Check the appropriate box: Type of project(required): I.Q I am a employer with 20 employees(full and/or part-time).- 7. ❑New construction 2.[—]l am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling any capacity.[No workers'comp.insurance required] 3.E]f am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.[:][am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I staThese general contractor have and I have hired the sub-contractors co listed on the attached sheet. 13.❑Roof repairs These sub-contmclors have employees and have workers'comp.insurance.[ 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other Tents 152,§1(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 this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-cuntrnclors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:The Hartford Policy#or Self-ins.Lic.#:6S60UB-9F40753-3-16 Expiration Date:1-12-2017 Job SiteAddress:1q SGtiws-ekfz-s, -�f%�-X�`-+'�-- City/State/Zip: O Lg Zc-) Attach a copy of the workers'compensation policy declaration page(showing the policy 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cernQ under the pliiat d-penalties of perjury that the information provided above is true and correct. Sienamre �// Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Event P.O.Box erQUOTE Gloucester, ,MA 01930 the event co. Voice: (978)283-4884 Fax: (978)283-4163 • • INVOICE TO: DELIVERY ADDRESS: Order Status: Tentative Order Vinwood Catering Sales Person: Missy Pierce 3 Union St 14 Sunset Rd Last Updated:OCT 3 16 12:59PM Ipswich,MA 01938 Salem,MA PO: ATTENTION: Jessica Colucci JOB SITE: CUSTOMER#: PHONE: (978)356-3273 Ext: ROOM: TERMS: COD FAX: CONTACT: Peggy O'Toole EMAIL:Jessica@vinwood.com PHONE:(976)985-8327 CELL: ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA: SEP 916 10:34AM OCT 12 16 OCT 1416 Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA: OCT 14 16 OCT 17 16 JOB DESCRIPTION: Party in Salem EQUIPMENT QTY I DESCRIPTION DUR I UNIT$ EXTENDED DISC NET Tents-Sidewall extra 1 30 X 30 Frame Tent 4.Od $600.00 $600.00 600.00 Sidewal I 120 8' French Window Wall 4.Od $1.25 $150.00 150.00 1 Gutter 4.Od to house Decorations 1 Bistro Light Package for 30x30 Tent 4.0 d $180.00 $180.00 180.00 120 Perimeter Lighting 4.Od $1.25 $150.00 150.00 Accessories 1 170,000 BTU Heater 4.0d $250.00 $250.00 250.00 Includes one 100 Ib propane tank per Heater $50 non-refundable deposit per heater if cancelled less than 10 days before event. MISCELLANEOUS OTY I DESCRIPTION UNIT PRICE EXTENDED 1 Permit $100.00 $100.00 EQUIPMENT TOTAL: $1,330.00 MISC TOTAL: $100.00 DEL& PICK-UP: $100.00 GRAND TOTAL: $1,530.00 PAID TO DATE: $0.00 BALANCE: $ 1,530.00 Customer Signature Customer Printed Name Date Certificate of Flame Resistance 1 _ REGISTERED _ ISSUED BY Date of Manufacture FABRIC 1 NUMBER JOHNSON OUTDOORS INC. BINGHAMTON,NEW YORK 132 MAY 2007 I uNmof the Finest F-140.01 Tent nr ProdRotlucrs Described Herein i 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 CITY: GLOUCESTER,MA certification Is hereby nada that: The The articles S to Fire rs this ode.N to have been manufa�ab win an o approved flame retardant chemical c mnpaanco vdM CaGfamla State Fire Marshal Cade.NFPA-701'.Undenwreere Leborelmry W Canada.and have been tested in axobenCa with the I F Militant FIMg of MIL-C-430060. Tvme.color and vreiahl of matedal 140Z vinvl WHITE BLOCK OUT Desaiation of Rem ceNTied: EFS 3OX30 2PC Flame Retardant Process Used Will Not Be Removed By Washing And ' Is Effective For The Life Of The Fabric Snyder Manufacturing,Inc. ManutaMrerd Flame Reladam VimA Lemloatm TENT OEPARTMa1T,JOHNSON RS IN -!arae scats