CORNER OF WASHINGTON & FEDERAL - BPA-15-1065 The Commonwealth of Massachusetts
RECEIVED Department of Public Safety
�Vyyuu NSPECCKINAL SERVICESMassachusetts State Building Code(780CMR)
t Building Permit Application for any Building other than a One-or Two-Family Dwelling
's Section For Official Use Only)
O Building Permit Number: Date Applied: Building Official:
SECTION 1: OCATION
'u^' No.and Street i /Town Zip Code Name o ilding(' a plicable)
Assessors Map# Block#and/or Lot # '
I - 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❑ 1 Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ I Other ,V Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineer`�8 Peer'Reviiewn
! required? Yes ❑ No ❑
Brief S 10.ef Description of Proposed Work: In. .C.X
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) O
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.) I
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ - I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ I 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)
IA 111 ❑ IIA13 IIBO I IIIA ❑ IIIB ❑ 1 IV ❑ I VAO VBD
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information:' Sewage Disposal: - i
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❑ 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: t
n�AtL-,-XD t13lk5 �1S
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address,of Property Owner
"--.
Name(Print) No.
and Street City/Town Zip -
Pro,Perty Owner C taut jnformafion: !p� W96S
( h�tn !X(dLe �(Z-90-- 6 V<) J 1 ea r kin.wok,
Title Telephone No. (business) Telephone No. -(cell) a-m ' 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 0.
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 -
10.2 General Contraccttor -
e,-en�
Com any Name
�a-r,
Nam Person Respomibg for Construction License No. and Type if Applicable
f d .mac Ll/`l � -
Street Address City/Town - State Zip
-,�ff o�n _ r*z 9-&�&6 r an eA;-f- C&r?
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? YeBVf No O
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 know edge and understanding.
f 1
r 97y_ 7
P e se t and sign n me ��// Title eleph�_on�e No. Date
t� rKn art 7`. ca
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval:
Name Date
The Event
P.o.Box
er ' JOB CONTRACT
Gloucester,
,MA 01930
the ao. 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:SEP 29 15 10:28AM
Boston,MA 02125
PO:
ATTENTION: John Mullett JOB SITE: CUSTOMER#:
PHONE: (617)822-6720 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:
SEP 29 15 10:26AM OCT 31 15 10:00AM OCT 31 15
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
OCT 3115 OCT 31 15 10:30PM
JOB DESCRIPTION: Haunted Happenings in Salem 2015
EQUIPMENT
CITY I DESCRIPTION DUR I UNIT$ 1 EXTENDED DISC NET
Tents-Sidewall extra
40 Solid Sidewall 1.0d $1.25 $50.00 50.00
Dressing room behind stage
180 7' French window sidewall 1.0d $1.25 $225.00 225.00
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
Beer tent
80 Solid Sidewall 1.Od $1.25 $100.00 100.00
For20x2O
1 20 X 20 Frame Tent- Eureka 1.0d $300.00 $300.00 300.00
Behind stage -
Tables and Chairs
5 3' Round Table 42" high 1.0d $8.50 $42.50 42.50
Table installation extra
13 8' Banquet Table-Stacked 1.0d $8.50 $110.50 110.50
Table installation extra
10 White plastic chair 1.0d $1.25 $12.50 12.50
Chair installation extra
40 7' Solid Sidewall 1.0d $1.25 $50.00 50.00
for 10x20- back and sides
Decorations
180 Perimeter Lighting 1.0d $1.25 $225.00 225.00
60 Perimeter Lighting 1.0d $1.25 $75.00 75.00
for10x20
80 Perimeter Lighting 1.0d $1.25 $100.00 100.00
for20x2O
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
34 500LB Ballast Block 1.0d $20.00 $680.00 680.00
MISCELLANEOUS
QTY I DESCRIPTION UNIT PRICE EXTENDED
1 Permits- estimate $250.00 $250.00
EQUIPMENT TOTAL: $3,640.50
MISC TOTAL: $250.00
DEL & PICK-UP: $300.00
(MA State)TAX TOTAL: $227.55
GRAND TOTAL: $4,418.05
PAID TO DATE: $0.00
BALANCE: $4,418.05
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
JANUARY 2003
Mamdadwers of the Finest
F-140.01 Tent Products Described Herein .
This Is to certity that the products herein have been manufactured from material Inherently flame retardant as
here after specified by the material supplier. Made In the USA.
NAME: THEEVENTCOMPANY
CITY: GLOUCESTER,MA
Certification Is hereby made mat:
The articles described on rob certificate have been manufactured Win an approved flame retardant Chemical in Compliance with
California State Fire Marshal Code,NFPA-701'.A-A-55308.FMVSS-302.CAWULC-SI09MB7•CPAI-84,Underwriters Laboratory of
Canada,and have been tested In accordance Win the Federal Test Method Spedfloatbns and meet or exceed the Military Flame
Spwftatiors of MILCA300e3,
Type,color.&weight of material: 14 OZ Vinyl: WHITE BLOCK OUT
Description of Rem certified: EFS 2OX20 2PC ,
Flame Retardant Process Will Not Be Removed By Washing. Eurekol Tent tops that am designed to
meal Temporary Building codes are supported with a Registered Architect Stamp. For that stamp to remain valid,the had
top must be Installed with 100%Eu akal Manufactured fabric eumponertte.
Snyder Manufacturing,Inc.
MenWxWrerd gamo Ramraenrwml laminetee TFM DEPARTMFM,JOIe1aDN0 DRa 1N
•lerrpe 9eele
The Common invealth of Massachusetts
Department of Industrial Accidents .
1 Congress Street,Suite 100
Boston,MA 0 211 4-2 01 7
tvwtv.massgov/dia
9workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lceibly
Name(Business/Organimtion/Individual):The Event Co
Address:PO Box 419
City/State/Zip:Gloucester MA 01931 Phone#:978-283-4884
Are you au employer?Check the appeopdatc box:
Type of project(required):
I.O lam a=player with 20 employees(full and/or pan-time).• 7. ❑New constrlleti0n
2.❑I am a sole proprietor or partnership and have net employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
31-1 1 am a homrnwner 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 progeny. [will
ensure that all contractors either have workers'compensalum insurance or a resole IL❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing regatta or additions
S.Q 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. )3.�Roof repairs
These sub-conuuctors have employ c<mid have workers'comp.insuranec.t
6.❑we nre n corporation and its officers have exercised their right olexemptinn per MGL c.
14.El OtherTents
152,§I(4),and we have no employees.[No workem'camp.insurance required.]
Any applicant that checks box#I must also GII out the section below showing their workers'compensation policy information.
t Homeawners who submit this anidavit indicating they are doing all work and then hire outside contractors must submit n new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contracmrs mud state whether or not Nose entities have
employees. If the sub<ontmctors have employees,they most 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:Tavelers
Policy#or Self-ins. Lie.#:XEUB2186T50511 Expiration Date:1/12/16
Lob Site Address: City/State/Zip:
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.
.[do hereby certify under the pain a/'}d ena(ties of erjury that the information provided above , true and correct.
Si arum y / ` Date:
Phone#: / 7�'- �O -3 I
Official use only. Do not write in this area,to be completed by city or town ojfteiaL
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#:
I
Certificate of Flame Resistance
REGISTERED ISSUED BY Data of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK 13902 MAY 2009
F-140.01 Manufacturers of the Finest
Tent Produds Desalbed 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 COMPANY
CRY_ GLOUCESTER,MA
certification Is hereby made that:
The adides described on this certificate have been manufactured with an approved name retardant chemical In compliance vAlh
Callfomia State Fire Marshal Code,NFPA-701',Undenmrters Laboratory of Canada,and have been tested in accordance with the
Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-043008G.
Type,color and weight of material 13 OZ WBO ;
Descdofion of item cerfifles MARQUEE 10 MID WBO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc.
ManNaGurtr W name Reardem VIm1 temhwtea TENT DEPPRTIAENT,J HNSOr10UT RS IN .
'Cacao Santa
Certificate of Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC.
NUMBER BINGHAMTON,NEW YORK 13902
FA A9303
Manufacturers of Me Finest bY12f2009
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 vath an approved flame retardant chemical in compliance with
CalRomia Stale Fire Marshal Code,NFPA-701',
Tvue.color and weiaht of material: 13 02 Vinvl Snyder white block out
Descdodon of item certified: IWO Marquee
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
HANWHA POLYMER CO.
TENT OEPMTMENT,JOHNSON OU RS C,
Certificate of Flame Resistance
FABRIC ISSUED BY Data of Manufacture NUMBER JOHNSON OUTDOORS INC.
F 140 01 BINGHAMTON,NEW YORK 13902 MAY 2007
ManWacfurms o1 dre Finest
Tent R'oWcfs�salbed HemN
i
1 This Is to certify that the products herein have been manufactured from material Inherently flame retardant as
hem after specified by the material supplier.
i
NAME: THE EVENT CO
iCITY: GLOUCESTER,MA
I Cemflcstion Is homby rondo that:
The articles desmbed on dtla cemfirate have been manufactured vnth an approved fWme retardant chemiml in compliance with
California State Fire Marshal Code,NFPA-701',UMerwdtm Labma
F my Of Canada.and have been tested in acoortlance with the
meet 0 ON Two,
Tvoe.color end weight of material it OZ vinyl WHITE BLOCK OUT
Desaiotion of¢ern camfied: EFS 10'MID 30'
Flame Retardant Process Used Will Not Be Removed By Washing And
I
Is Effective For The Life Of The Fabric
j. Snyder Manufacturing,Inc.
( Manulamrerol Fbme RetaNam V4M tandnatq TFM DEP�RTMFrrT,JOHeaON OU W .
Certificate of Flame Resistance
a REGISTERED ISSUED BY yf Date of Manufacture '
FABRIC JOHNSON OUTDOORS INC.
1 NUMBER BINGHAMTON,NEW YORK 13902 MAY 2007
l Manufacturers of rile Finest
F-140.01 Tent Produch Described Herein
I
I
This is to certify that the products herein have been manufactured from material inherently flame retardant as
ihere after specified by the material supplier.
NAME: THE EVENT CO
I '
i
CITY: GLOUCESTER,MA
Certification Is hereby made that:
The artides desaibed on this ce bate have been manufactured War an approved flame retardant chemical In tmMplianGe Will
Cafiromia State Fire Marshal Code,NFPA-701'.Underrwltom laboratory of Canada.are have been tested in accordance with Me
Fthe Militant,Flame 5jIMMOtions of MIL-C-43006G.
Tme.WfM and wei(mt of material 14 OZ virtu WHITE BLOCK OUT
Los saiotion of item amifiee: 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.
Manuaaurer W FWro RetardaN VVM lamNates TENT OFFeR1MBfr.JOKNSON A.S IN !arse 3u14
i