CORNER OF WASHINGTON & FEDERAL ST - BUILDING INSPECTION • f
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The Commonwealth of Massachusetts 5
4 Department of Public Safe4'ffI„p G —b P 3: 3l
MassachuseltsState Building Code( C'h
Building Permit 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(Please indicate Block k and Lot R for locations for which a skeet address is not available)
r,
No.and Street City own Zip Coale Name of Budding(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used_ If New Construction check here❑or check all that apply I inthe two rows below
Existing Building❑ Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix I)
Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an independent Structural Engineer' g Peer Revi equired? Yes ❑ No ❑
Brief Descriptio of Propos l Work: _ �Q ' x 6 w
SLl
SECTION 3:COMPLETE 111I5 SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANCE 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):
SECI'lON 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Flax(sq. ft.) -
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as a licable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ 11: High Hazard H-1 ❑ H-2❑ H-3 ❑ FI-•I❑ H-5 O
L• Institutional 1-1 ❑ 1-2❑ f-3❑ 14❑ M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ Rd❑
S: Storage S•I ❑ S•2❑ U. Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check m a licable)
IA ❑ Ill ❑ IIA ❑ IIB ❑ IIG1 ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORM TION(refer to 780 CMR 111.0 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❑n or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: hazards to Air Navigation: \L_\I l y�ni �_,nm i,gum It �irtq.Pr
Not Applicable❑ Is Stnnclure within airport approach area? Is their review connpleted?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): type of Construction:. Occupant Load per Floor
Does the build illy, an Sprinkler System?:__ Special Stipulations:
{
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address orrr erly . wner
Name nt No.and Street City/Town Zip
! r .r p
Pnr erty Osvnei Conta ctd_r f nri11 ion':�56'/1
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 act on the property owner's behalf,in all matters relative to work authorized by this budding permit application
SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
In o e, l-m
Company Name
Name of Person Responsible for Construction 6f/ License No. and Type if AAf p�licable
�} f%L�J7.C14 S� 1GL
Street gAddddreesss�'�c� City/Town - State Zip
Telephone No. business Telephone No. cell ma it address
SECTION 11:%%'0MF:K1j'C0M11FNSAHON 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❑ No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) - Total Construction Cost(from Item 6)_$
L Building .S Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
d. Mechanical (HVAC) - g Note:Minimum fee=S (contact municipality)
S. Mechanical Other $ Enclose check payable n able to
6.Total Cost 5 3 (contact municipals )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERhIIT 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 knowledge and understanding.
4 lR f r-( ce Lo , 1q'Q
se ' tmidsign ane Teleph j. Dal
�' d
Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: v Q
/
Name Date
The Event Co.
P.O. Box419 JOB CONTRACT
Gloucester,MA 01930
the event co. Voice: (978)283.4884
Fax: (978)283-4163
. .
INVOICE TO: DELIVERY ADDRESS:
Order Status: Confirmed Order
Radio 92.9 WBOS Sales Person: Missy Pierce
55 Morrissey Blvd Crnr Washington and Federal St Last Updated:JUL 9 14 12:38PM
Boston,MA 02125
ATTENTION: John Mullett JOB SITE: PO.
CUSTOMER#:
PHONE: (617)822-6752 Ext: ROOM: TERMS: 25/25/50
FAX: CONTACT:
EMAIL:jmullett@greatermediaboston.com PHONE: CELL:
ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA:
JUL 9 14 12:34PM OCT 31 14 11:OOAM OCT 3114
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
OCT 31 14 . OCT 31 14 10:30PM
JOB DESCRIPTION: Haunted Happenings in Salem 2014
EQUIPMENT
QTY I DESCRIPTION DUR UNIT$ EXTENDED DISC NET
Tents-Sidewall extra
40 Solid Sidewall 1.0 d 1.25 50.00 50.00
Dressing room behind stage
180 7' French window sidewall 1.0 d 1.25 225.00 225.00
1 30 X 60 Frame Tent 1.0 d 1,170.00 1,170.00 1170.00
Beer tent
Beer tent
1 10 X 20 Marquee 1.0 d 225.00 225.00 225.00
Front of house for sound guy
40 7' French window sidewall 1.0 d 1.25 50.00 50.00
for 10x20- back and sides
1 20 X 20 Frame Tent- Eureka 1.0 d 300.00 300.00 300.00
Behind stage
80 Solid Sidewall 1.0 d 1.25- 100.00 100.00
For20x2O
Tables and Chairs
5 3' 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 1.0 d 1.25 12.50 12.50
Chair installation extra
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
Accessories
1 170,000 BTU Heater 1.0 d 250.00 250.00 250.00
$50 non-refundable deposit to hold, customer must confirm or cancel 24 hours before delivery
1 Exit Sign 1.0 d 25.00 25.00 25.00
34 500LB Ballast Block 1.0 d 20.00 680.00 680.00
Quotation Updated on JUL 9 14 at 12:38PM
MISCELLANEOUS
QTY DESCRIPTION UNIT PRICE EXTENDED
1 Permits -estimate 250.00 250.00
EQUIPMENT TOTAL: $3,640.50
MISC TOTAL: $250.00
DEL & PICK-UP: $200.00
(MA State)TAX TOTAL: $ 227.55
GRAND TOTAL: $4,318.05
PAID TO DATE: $ 0.00
BALANCE: $4,318.05
Customer Signature
Customer Printed Name Date
Quotation Updated on JUL 9 14 at 12:38PM
j Certificate of Flame Resistance
REGISTERED^ ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
I NUMBER BINGHAMTON,NEW YORK 13902 MAY 2007
Tent
ProductsDofmadHin
F-140.01 Roau
Tart products m or"d Hereto
i
This is to certify that the products herein have been manufactured from material Inherently flame retardant as
hem after specified by the material supplier.
NAME: THEEVENTCO
CITY: GLOUCESTER.MA
Certification is Mnaby male and:
The aNdes desa0ed on ads eeruecate have been manufactured Mth an approved name Ietamant emrnical in ewnglance Win
CaWomia Slate Fire Mar"Code.NFPA-701'.Underv4ltda leboremry of Canada.Arid have been twad In a otudance wm the
F
Tree.maraW..htofm hTI2I 14OZ viral WHITE BLOCK OUT
Desaiotien of don caninea: EFS 30X30 2PC
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric —
Snyder Manufacturing,Inc.
Manidsmaera Fhmo RLLvdan VfiM lanYnatn TENT OEPi MIiNT.JOW-%0N IN .
Zeretif:cate of blame Resistance
REGISTERED •— - ISSUED BY Dam of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON.NEW YORK 13902 MAY 2009
F-140.01 Atamnackrers of ma F/nast
Tani Pro&&S Daaalbed Mersin
This Is to certify tltal the products herein have been manufactured from material Inherently flame retardant as
here after specified by the material suppller.
NAME: THE EVENT CO.
Cyry; GLOUCESTER,MA
_ Certification U Mmbymade drat:
The aNdw desaleed en feescemDam baw been manuhxMed Wth en appmveo Name mtaroaN rtienlml In compllenra wim
Cafibmle Slab Fire Momhel Code,NFPA-701',UMimMUMS I.aboramry of Cara.mro ruvo bean tesme In w0w'l-nee vaN the
Federal Tint MWW Spedfiraamc end meet of exceed me MWary Flame Spediced"or MIt.043006D.
Type.mbr and weiatit ofineterlal 100Z WBO
DesaipUgl01 hen ce5fies EFS 15 MID 30 WBO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Lffe Of The Fabric
,t Snyder Manufacturing,Inc.
I
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Certificate
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Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON, NEW YORK 13902
5/22I2009
FA-49303 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',
Type,color and weight of material: 13 OZ Vinvl 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
FABRIC Date atManuNclure
NUMBER JONNSON OUTDOORS INC.
BINGHAMTON,NEW PORK 13902 dANl1ARY 2008 j
F•140.01 Maft am of the Finest
PmRo
Tem ducls9esanbed Nnrein
This Is to certny not the products herein have heal manufactured from material Inherently Hems retardant es -
hem enter spectned by the material supplier. Made In the USA.
NAME: THEEVENTCOMPANY
CITY: GLOUCESTER,MA
CeNfla lon Is hereby made tlmt
The arides desdeed an this ceNlkate have been manufaclwen with an approved dame remtden is enical In cwnpllande MM
Ca*Mla State Rre Marshal Code,NFPA•701',A-A-65306,FMVSS302,CAWULCS109M87,CPAW,tbdemTaem Lat mawry of
Canada,and have been Install In aoaordanca with Ore Federal Tea Method Specification;and meet w exoead the Miltary Flame
Spedhratbm of MILC43006G.
Type,color,&weight of material: 14 OZ Vinyl: WHITE BLOCK OUT
Description of dem certified: EFS 20X20 2PC
Flame Retardant Process Will Not Be Removed By Washing.Eurehal Tent tops that are deslipwd to
meet Temporary Building codes ere supported with a Registered ArdhRact Stamp. For that stamp to remain valid,the tent
top must be Installed with 100%Eurekaf Manufactured tebrlc components.
Snyder Manufacturing,Inc.
MMWaMerar Flm,w fled,WnrYMN lemWrea TENT OFPApn,4lVr,XIMSO01 w .
"leipe6ub
I "
CITY OF ScUEM, NWs.ICHUSETTS
4 BUILDING DEPARTNIEINT
120 %V."HLNGTON STREET, 3w FLOOR
�S T EL (978) 745-9595
F.v.�c(978) 740-98 46
KI\fBERLEY DRISCOLL
t'AYOR T HomAs ST.PIEMS
DIRECTOR OF PLBLIC PROPERTY/BCILDI\G CO\LMISSIONER
\yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Informatinti Please Print Legibly
Naine (flusinuss Org.t/�n isr�1atiom21nd�iv�idu�al
i,ddCCSS: 7 C1 / L
City/State/Zip: �/ 02 ��� e O/%�Phone #: i�{C'3 C{83 4�
Are ou an employer:'Check the appropriate bus: 'Type of project(required): ,
I I am a employer with � 4. ❑ I am a general contractor and 1 .
ontpinyees(full and/or part-time).' have hired the sub-contractors 6' ❑New conswctton
2.❑ I ant a sole proprietor or partner. listed on the attached sheet. l 7. ❑Remodeling
ship and have no employecs These sub-contractors have 8. ❑Demolition
working for me in any capacity, workers'camp,insurance. g• ❑ Building addition
(No workers'camp. insurance 5. ❑ we are a corporation and its
required.] officers have exercised their l0.❑Electrical repairs or additions
3.❑ 1 ran a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself.[No workers'sump. C. 152, §1(4),and we have no 12.❑ Roof repairs � I
insuraneerequtred.lt employees. [No workers' I3rOOther I �G/V�
cutup. insurance required.)
•Any opplwwl Owl checks box e 1 must also fill out the section below showing their workrn'cumpenaatiun policy imnrmadun.
'I tumeaw'M"who whmit this atAhnvis indicating they am doing all work and then hire uutsido contncmm mtul mihmit a new anidavit indicating such.
$'mtrwtyn Ihat cheek this box mist artachcxl an additiurul sheet showing the mane of the gubvvntnctors and their worken'camp,pulley infem,oicn.
1 ant an employer that is providing workers'eonspertsadun insurance for my employers. Qeluty is fba policy mtdJub a/la
lnfrrnrariun. n
Insurance Company Name: L x.- /`iL
Policy it or Self-im, Lie.N: 'e U J Expiration Date: 1',
Job Site Address: �A f'I'e)(.c—C, City/State/Zip:_Q..I�� � 6W e5 Jq 70
Attach a copy of the worieers'compensatlao pulley declaration page(showing the pulley number and expiration date).
h'ailure to secure coverage as required undcr.Suction 2SA of MGL c. 152 can lead to the imposition of criminal penalties of a
line up to S1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK OROER and aline
of up to SM.00 a day against the violator. De advised that a copy of this siatcment may be fumarded to the OI'liud of
Io%es(igal i tom ofthe nIA for insurance co vemgc verification. -
/do hereby e•rn�y wader the puts card penult/ . (perjury that the infornrul/un provided above is truce and correct
Si.,n r c qq D:ne:
Phone i" 1�CS
Official use unly. Do nut write in this area,to be completed by city or town oJJhiaL
City nr l'utvn: r,
--_ ktrmir/LlccmcN__. �
Issuing,l uthurity(circle one): --_ "--- " - ---
I. hoard ul Health Z. Duildln,, Department 1.Cilylfuwo Clerk J. Electrical luspectur 5. Plumbing Inspector
6. 00ier
j Contact Nrion: Phone 't: