54 TURNER ST - BUILDING INSPECTION (2) PUBLIC PROPERTY �J 1
DEPARTMENT
U KIMBEA.EY DRISCOL
MAYOR 120 WASKINMO14 STREET*
SAf F ry\fA-1.sACitLS>r'i750t970
TEL-978-735-9595* FAx:978-740-9844
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: o cf .Sem�m Building:
Property Address:
Property is located in a; conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land U`cso��,, /
Name: SSL' jeS
Address:
%�rxne2
Telephone: 9 7T-- 7 vk/'- P/
3.0 COMPLETE THIS SECTION FOR WORK IN FxtcTtivr: BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bhd Description of Proposed Work:
'TC? �itrG�" �- o?v xav ' �rrinv2a� Tin 1`'"
on &/aU j
-
- - -- -- - -- - -
Mail Permit t ks f ai9k�`�Y 5 wa.� ft so
What is the current use of the Buiiding7
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone ( }
Mechanic's Name
Address and Phone
Construction Supervisors License#L"JCoGb2.I `� HIC Registration#
Estimated Cost of Project Permit Fee Calculation
Permit Fee$ Estimated Cost X$71$1000 Residential
Estimated Cost X$1141000 Commercial
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit tobuild to the above stated
specifications. Signed under penalty of perjury
Date a v
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E �r�r�r�r�r�r�r�r�'�r�r�r�r�RKw 1 M P O RTA N T D O C U M E N T a���������������' °
5 Certificate of Flame Resist�ce 5
5 REGISTRATION ISSUED BY Date of Manufacture 5
5 APPLICATION o- ` ° VNr.H�R o5m/oz 5
5 NUMBER i Nousraie iNa®
5 g Order Number 5
S EVANSVILLE, INDIANA 47725 5
5 S "� MANUFACTURERS OF THE FINISHED 354616 S
FI2,.4 E S
5 TENT PRODUCTS DESCRIBED HEREIN S
This is to certify that the materials described have been flame-retardant treated 5
55 (or are inherently noninflammable) and were supplied to: 5
657150
5 PETERSON PARTY CENTER INC 5
5 139 SWANSON ST 5
RLI
WINCHESTER MA01890 5
5
NI
5 5
5 5
5 Certification is hereby made that: 5
5 The articles described on this Certificate have been treated with a flame-retardant approved 5
5 chemical and that the application of said chemical was done in conformance with California 5
5 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5
5 The method of the FR chemical application is: 5
5 Serial # 8001500(2) 5
r5 5
Description of item certified:
c FI TOP 20W X20 VL W W 5
5 5
5 Flame Retardant Process Used Will Not Be Removed By 5
5 Washing And Is Effective For The Life Of he FabriOc 5
5 JOHN BOYLE STATESVILLENC Signed: 5
5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT-ANCHOR INDUSTRIES INC. rj
E rJ 0rJ 0JcPcPr trJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r�cPcPJ��rJ�PrPrJ@PcPrJ�r�rJ�cPrJ�rJ�cPrJ�r PrJ�rJ�rJ�r�rJ�rJ�cPcP�P cPrJ�rJ��PrJ�J�OPrJ�rJ�rJ�cPcPLPLPLcPLFL3Pr.PrP-L3PLpd-L] 0r L3PLrPLPLPLcP E
BY: CAPERS CATERING; 781 279 5150; Jun-11 -09 11 :15; Page 1 /1
1
i'Mersotl Farty Center, Inc. ROPOSAL 336653- I
swamon Street
�4lnchester, Mn 000 r-1913 p artyce`nt DAYS 06-20- 9
(781) 72x1-4(1010 � DA'T'E OF USE: OE3-20-09
-'I nt 0781) 355-4000 JRN TIMEOFUSF: '3:00PNI
11 729-4999 1 CLAY RENTAL
SpecialEvewEquipmentaen a!$II_L PO: HIP TCI:
II (y78} 744-0`)9}`
APFRSCA"I'LI21 G IF EVENC LF.S
STRF1T
21 FAIERSON STR ET MA
STOhEIIAM MA�. 021$0CIP(1tiAt-DATE: It: FPllUNF..FASFREi SY,PfipVE .IVB YDA'4 -INSTiY1CKt7YhA1'�;1f15TK06-05-09 (741) 279-5100 FLIZA NO HDESS T SIJN(7 1) 279-5150 A i AM
WE ARE PLEASEDTO QUOTE THE REN"CAL,OF TILE NG:
I 20' X30'SERVICETENT 450-00 450,00
1 TEMPORARY 'l IL DOWNS "Tir> 240.00 '_411.00
PERI�{SETER LIGHT TNG FOR ABOVFi 'IEN'T(S) } 2560 2>.0(1I APP ( XIMATF PERMI r FEE` " (FIRE/BtJtLDI ) S .Otl 85 00
I TRAI SPORTATION 110.00 I to,00
I
1
LRill � ��
t
i
THE ABOVE PR :ING IS SUBJECT TO OUR INSPECTION OF THE.SI TT.
POWER KIr:QUI I MENTS: ONE 20 AMI'CIRCUIT AT TENT
Par urent to be as ws: DEPOSIT OF S350,00,BALANCE DUE NEI' 10 DAYS SUPS-IOTA I..: 1,010.00
r
i
{ ACC$jJfdflG$of f J1t}Shc- TIIc choir pricCx,spccitiGa[innx and condiciun3 art v�ti4{'• �tOt}'
SALE-S TAX a 0u
snd are hcrchy accept .You aro authorized to do the work us spcahcd. Payment will be o de us { LABOR'. 0.00
outlined ubovc. Dapo its arc not refinutable or fnrnsfecsble,unlrsn otherwise altaifled_Sub- c(nut j DEL/PI1 F51, 000
{ o i ryukpmcet to odrer,s without{(uthuCIZ.A(n rs rohibils.l. _� FUEL SURCEIRG: S 0,01)
TOTAL: S 1,010.00
Note: This prupospI maty be withdrawn by us it not accepted within 5 DAY-
hillAurhoriced Date of Customer
Signature. .. Acceptance: �_.. Signature: _
VARY ROMANO Please sign And return o e copy of tl is proposal with deposit.
PUBLIC-PP.GPRERTY
DEPARTMENT
KlMaERLEY DRISCOLL
4f:fYc_)R 120 WASHINGTONSTREE"i i SALEM,MASSACHCSMN01970
TEL:978-745-9595 0 FAX:978-740-9846
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name(Business/Organizadonlindividual): e'7Ytf SGt'T 6,0
_—
Address: 1—fai g lt �!
J —
City/State/Zi�:Y&"OIL4_,_ --_ Phone : 70- 7W,9-00
Are you an employer? Check the appropriate box: Type of project(required):
1:Z-I am-a-employer with c;� - _4._❑ I am a general_contractor and_I_ . b _� New.construction_
have hired the sub-contractors-
employees(frill�and/or pail-time). - _
2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling
ship and have no employees These sub-contractors have & E] Demolition
working for me in any capacity. workers' comp. insurance. 9• E] Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.[J Electrical repairs or additions
3.Q I am a homeowner doing all work right of exemption per MGL 1 i.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roofr�paiirs
insurance required.] t employees. [No workers', 13.[ 'Othar
comp. insurance required.]
Any applicant that checks box 01 most also fill out the section below showing their workers'compensation policy information.
l Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
tContractors that check this box most attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site
information.
Insurance Company Name: �/ P&Z-
Policy#or Self-ins. Lie. D a Expiration Date: O 9 !!
Job Site Address: 1.�_Vf sGI2-P t Se City/State/7ip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 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. Be advised that 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 pains and penalties ofperjury that the information provided above is true and correct.
Signature Date
hone M
nOfficial use only. Do not write in this area, t ompleted bycity o�fawn eficlal -
-':or t --
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# — - --- -