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57 WHARF ST - BUILDING INSPECTION " The Commonwealth of Massachusetts tv Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR, 7"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a lt%Nmwkvo One- or Tuo-Family Agivelfingl This Section For OfficialVse Only Building Permit Number: .b lied: /; ) / Signature: ✓ �ti �� 6 (/ - l(J4) Budding Commissioner/Inspect"of Buildinghl I Date SECTION II TE INFORMATION I.1 Property Address: 1.2 Assessors Map& Parcel Numbers I.I a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning information: 1.4 Property Dimensions: Zoning Distnct Proposed Use Lot Area(sq it) Frontage(R) 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.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if es0 Municipal❑ On site disposal system [3 SECTION 2: PROPERTY OWNERSHIP' 2..S4t21 Owner of Record• nn L�7r�,eC,��-F Name(Print) Address for Service: Signature 7elephont SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition O Accessory Bldg.❑ Number of Units_ Other ❑ Speeify: Brief Description of Proposed Work=: , (3 r, -/0` X QO t ex K„ vt-f Scr�e a GJ4fer Esas I Node) -P4rK;ng L-ot r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: IOfficial Use Only Labor and Materials y 1. Building $ I. Building Permit Fee: S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost(teem 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. .Mechanical (Fire S Suppression) Total All Fees: S i' Check No. _Check Amount: Cash Amount: h. Total Project Cast: S �,( 0 paid in Full ❑Outstanding Balance Due: f SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date N4me of CSL-1lylder Lw CSL Type(sce below) a Address RD Desen non ted u to}5,000 Cu. Ft.) 1&2 Family Dwelling Signature On' al Roofing Covering Telephone WSal Window and Sidin al Solid Fuel Bor — A liance Installation aI Demolition 5.2 Registered Home improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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.......... No........... ❑ 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. Si nature of Owner Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION 1, 4 L-e— '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. / /J 7Il�e� 4.) .0 ICC 2 mis For- tee PrintN Signature of ner or Authorized Agent Dates Si ned under the ains and penalties of perjury) 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. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5, 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 1. "Total Project Square Footage"may he substituted for 'Total Project Cost" J CITY OF S. .EM AXSSACHUSETTS BUILDING DEPARTSIENT • Is 130 WASHINGTON STREET, 3'a FLOOR TEL (978)745-9595 FAx(978) 740-9846 KIJIBERLEY DRISCOLL THOMAS ST.PiERRB ,AAYOA DIRECTOR OF PUBLIC PROPEATYf Ht;IIDLVG CO-NL%(IS5IONEA Workers' Compensation Insurance Affidavit: Buildens!ContractorstE[ectricians/Plumbers Applicant Information g� 1 Please Print Legibly Name (Busin,S Organizaiiowlndividwi): (fie o+� For Oe +n T Address: I—O t y 5+ + City/StateiZip: 4 ba f q Phone N: .ireyo n employer?Check the appropriate box: Type or project(required): 1. I am a employer with 4. ❑ 1 am a genual contractor and I b. Q New construction employees(full and/or pact-time).' have hired the sub-contractors 2.0 1 am a sok pmprietor or partner- fisted on the attached sheet 7. Q Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for me in any capacity. workers'comp.insurance. 9, Q Building addition [No workers'comp. insurance 5. Q We are a corporation and its 10.n Electrical repairs or additions required.] officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL 1 I.Q Plumbing repairs or additions myself. [No workers'comp. c. 152.§IM,and we have no 12.0 Rao f repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] -Any applicant this chccaa has et mustalto till out the seaiao Wow stwwinx their worker'cwnpensation policy iniarmation. 'I t+smeuwners who suhmit this affidavit indicating they are doing ail work and then hits outride connectors most sulmil a new andavit indicting such. *r,,ni amnar,that ch vk(his bar most attxhcd an additio d aMxt showing the name or the sub-comracbn and their worker'comp.puliry.infommtioo. I am an employer that is providing workers'compensation Insurance for my employees. Below Is the policy and fob slre information f4cCel �Insurance Company Name: e /aur' f vrlaH4feuc e ¢ Policy M or Self-ins.Lic. D Expiration Date: Job Site Address 27 t2/Ka r� S-4Seg Le y cIt fe City/State/Zip.- fl t s 7 !7 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 imprisonmem,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. Ile advised that a copy of this statement may be forwarded to the Office of investigations ofthe DIA for insurance coverage verification. I do hereby certify ander the p ins and penalties of perjury that the information provided above is true and corner. � tart ^��jr Date: Phoned Oficial use only. Do not write in this area, to be conepleted by city or town official City ar'rusvn: __ ___ Pcrmit/i.lcense q____ Issuing Aulhority(circle ane): 1. Board of Health 2. Building Department J.City/town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other !I Contact Person: _ _ __...__. ._ Phone q: 06/01/2009 14:10 603-964-1484 ALEEGIANT MGMT CORP PAGE 02 ACMD. CERTIFICATE OF LIABILITY INSURANCE -00S 1-0/1&2-00S PRODUCER THIS CERTIFICATE A MArMR OF FORMATION FrankVtnuto ONLY AND CONFERS NO NIGHTS UPON THE CERTIFICATE G4 ASIA,Inc. HOLDER. THIS CERnPICATE DOES HOT AMEND EXTEND ON ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 629 Main Street;Suite 606 Boston,MA 02129 INSURERS AFFORDING COVERAGE NAIL F wsumm MURIA&. lurch-Amerfean InsuranceCtFr"ny AllegiaM Management Corp, wsuRERa •""""—"' 304 Lafayette Fitl. Rye.NH 03970.006 e NSIRERD: Ng} ER0 coo Ee THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE f:ORTHE 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 EY TNS POLICIES DESCRIBED HEREIN B SUBJECT TO ALLTHE TERMS,M(OLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L.KMTa 091ERA4YABadY EACNOOOURRENCE S ..._.., OCM-0ERfWL0in7ERA1CL19fUTY EAS S CLAIMOMADE ❑ecoun MEtl FJIP(An dlA mI a • NER6P.iRLaAW NJUR! S GONERALAGGRROATE S CENSAOORECATEUMITAPPUES PER: PRODUOte-0OWWAOG $ POLICY 24 LOO AUTDMLUIKELLABATYSmLr UAD S ANY AUTO lot-0= ALL OWNED AUTO$ BODAYNJURI' SWEPAWALUCS (Pm Poreanl A HLIMEDAUTOa DOIJILY NJLXRY i N0N•OWNEDAUrOa i ILY-M TIO P=E AmMRTYRie NMAQE g MRAGRIALBB.KY AViDONLY EAAtlatDEN7 S ANY AUTO OTHATRAH FAAAO B A OHLYr App S B,LAALYi9RRY EAC:H000Uf1RENDE a 00OUA F7 CIANASMADE AOOAEOATE S S I DEDUCTIBLE s S IS WORKIMACOMPENRATWMAIM X Ou"Lovew DALNLETY E.L.EAOHA00101W S 1,040,000 A paDq� Ee rt+XaNjN§f THE WC 50-90-735-00 10118/2008 11/01/2009 E.L.DIB -EA eMPLOY66 d 110001ODO tPEGf PR D E.L, mme-P0.PYumrrL Is 118001004 aINm PgMowtistateR: 06NHW27S0896 ' Location Coverage Porlotl: 1011&'2008 11/01/2009 s9m"PRONOF OATWMSILCOATWN$IVERMI CIImgO; 921 tE7cfxveKlNapam'pt1`fBROORaBUFMr'�I�NLiiioVN.AOfl4 CWorABalsprONdedtmArltp Noah Shore Rental.Inc,dba:EverdsforRent anne ernplAYees ldas 10 464 Lowell 81 bW not aW Wrttaclma al: Pgabg1Y,MA 019W CERTIFICATE HOLDER CANCELLATION SwWab AMYOFTHRADDvaD PCLMMVE DANOMA Mi69gMETfFENmRUtl7ON DATE THEREOF THE IEeUNO ROME"WDA FHDaAVOR TO MNL 30 DAVS WRr TEN North Shore Rental,inO. NO=To IRE Lamm-E NOUDER BAMTO TO LM BUTPAI.ORE TO bO 80$KALE dbe!Evans for Rent RmaeE RD DaLNATRN OR UAMOV aP AHY KMD a THE WnURBR,TNI AGMT$oR 464 Lowell 5t t�PpBBNRA7IVE$. Peabody,MA 01960 AEmAtlI{RWRVREeBKTATrvE .a ACORD25(200ttOS) 9ACORDGOR RATIONIB� Certificate of Flame Resistance REGISTERED ISSUED BY FABRIC Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 FEBRAURY 2007 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: EVENTS FOR RENT CITY: PEABODY, 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`, Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method ifi the Military Flame Specificationsf MI - -4 Type,color and weight of material 14 OZ vinyl WHITE BLOCK OUT Description of item certified: TT+20'MID 40' W/DBL VAL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant vinvl Laminates TENT DEPARTMENT,J07HNSON OUTORS IN 'Large Scale Certificate of Flame Resistance REGISTERED ISSUED BY Date of Manufacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13902 F-140.01 Manufacturers of the Finest FEBRAURY 2007 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: EVENTS FOR RENT CITY: PEABODY, 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', Underwriters Laboratory of Canada, and have been tested in accordance with the F r 0 O Type, color and weight of material 14 OZ vinyl WHITE BLOCK OUT Description of item certified: TT+20' MID 40' W/DBL VAL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,J6HNSON OUT ORS IN . 'Large Scale Certificate of Flame Resistance REGISTERED ISSUED BY FABRIC Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 FEBItAURY 2007 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: EVENTS FOR RENT CITY: PEABODY, 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% Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method Sri fications and meet or exceed the M litarym ci s of MIL-C-43006G. Type,color and weight of material 14 OZ vinyl WHITE BLOCK OUT Description of dem cenified: TT+20' MID 40'W/DBL VAL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,JOHNSON OUT ORS IN . 'large Scale Certificate of Flame Resistance REGISTERED ISSUED BY Date of Manufacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13902 F-140.01 Manufacturers of the Finest FEBRAURY 2007 Tent Products Described Heroin 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: EVENTS FOR RENT CITY: PEABODY, 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`, Underwriters Laboratory of Canada, and have been tested in accordance with the Federal T hod Snecifications and meet or exceed the Militarym Sbecifications of MIL-C-43006G, Type,color and weight of material 14 OZ vinyl WHITE BLOCK OUT Descriotion of item certified: TT+20' MID 40' W/DBL VAL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,JOHNSON OUT ORS IN' . 'Large Scale o u��nsss�Eru�u�E n�n�Errs�ns��n�r�nu��s��r IMPORTANT DOCUMENT 'ru��'�nu�u��E ru�u��nu�u��nu��nu��n�n�n�nsu�Erls o 55 (tCPrtiflf&te of ,f law Rm'! anrp 5 5 55 REGISTERED ISSUED BY 5 i Date of Manufacture 5 5 APPLICATION CNOR® 03/07/00 r5] NUMBER t INDUSTRIES INC. 5 EVANSVILLE, INDIANA 47711 Order Number 5 F121.4 , 311548 5 5 MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to:1101119 5 5 PAUL W. GRILLO CO. #13528-8 5 5 S 5 464 LOWELL ST. 5 PEABODY MA01960 5 SCertification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California Fire 5 5 Marshal Code, equal to exceeds NFPA 7019 CPAI 84, ULC 109. c, 5 The method of the FR chemical application is: Serial #: 8106400(l4) 5 Description of item certified: 5 5 TENT WAL L&S2 6-10 X 22 2/CA W 5 5 _ Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 JOHN BOYLE STATESVILLE NC Signed: . e1Z C5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 O cPrPrPcPrJrJ�rJrJ�rJrJrJrPrPrJ�rJrJ�rJ�rJrJ�cPrJ�r1r?PcJ-21PRPr�r�rJ�rJrJcPrJ�rJ�rSrJ�rJ�cPcPcPrJr�cPr�cPrJ�cPrPPrJcPrJrJrJ�r-1 lr� i FL3FJ�rJLj-L3rJrJL3rL3rJL