FEDERAL ST AT WASHINGTON ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or D olis a
\ One-or Two-Family Dwelling
n �+I This Section For Official se'Only
Building Permit Number: I Date plied:
Building Official(Print Name) Signal# /ODate
SECTION 1.SITE INF TIO
1.1�Pr1operty Addressn, / 1 ,. 1.2 Asse Parcel Numbers
O f x may.yle ,,d c IN OISK in Cv�Q vt S+
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Prope Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2 jxOw,per/f Record: /i n
Name(Pr' �/ �f(�.,^ City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Wor k2: vv. �—,- (O
v eil Ik g4a Of
/ -ZZ
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire Suppression)
$ Total All Fees:$
�` Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ' S U Q 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street - Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M: Masonry
RC Roofing Covering
WS - - Window and Siding ---- -- -- -- - _
SF Solid Fuel Bunting Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) -'-
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name - -
No.and Street Email address
City,/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 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 ..........Ay No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
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.
s,, k (nrz(u
m Owner's or Authorized Agent's Name(Electronic Signature) Date
q7K1-1& ,-7. ' &$ 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 not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor 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
3. "Total Project Square Footage"may be substituted for"Total Project Cosf,, -.
it
We5dju/n/c/c/
ISSUED BY Manufactured by Date treated or
Verseidag Fred's Tents & Canopies manufactured
A'E: $ 973-252-1189
_ 7 Tent Lane 03/11
Stillwater,NY 12170
This is to certify that the materials described below have been flame-retardant treated(or are inherently nonflammable)
FOR Event Company
PO Box 0419
Gloucester MA 01930
Certification is hereby made that: (Check "a"or"b")
( ❑ a)The articles described below this Certificate have been treated with a flame-retardant chemical approved and
S registered by the State Fire Marshal and that the application of said chemical was done in conformance with the
laws of the State of California and the Rules and Regulations of the State Fire Marshal.
E
Name of chemical used Chem.Reg.No.
Method of application
(b)The articles described below are made from aflame-resistant fabric or material registered and approved by
the State Fire Marshal for such use.
NFPA-701 (large scale)
Trade name of flame-resistant fabric or material used WHITE Reg.No. F50501
The Flame-Retardant Process Used WILL NOT Be Removed By Washing
Fred's Studio Tents & Canopies, Inc. —
Plant Supervisor
Product Description (25)7x20 Cathedral Window Walls Customer Invoice# 12244
Jun 05 12 07:55p The Event Co 978-283-4163 p.1
The Commarrweahh ofMassaehrtsem
Department ofLtdmxhialAcciden&
,q ace ofrtvestigaSaru
R 600 Washington Street
Azi Baston,MA 62111
fwvw.a=&go 1tfia
Workers' Compensation insurance Affidavit:Builders/Contractors/Mectricians/Plumbers
Applicant Information r / Please Print Legiblya Name(BasinesslO h2tion/Individuat):'1 L 9 (mot 12"x'1e; [ 'L
Address:
City/StaWZi :
Are Yfs an effiDI°yel"Check the appropriate bow
1. I am a employe with_[ 4. Q lam a geoelal mnn�tor and I Type of protect(required):
ees(full and/or 6• New construction
employ. ��)r have hired sib-co�ractos
2 ❑ I am a sole proprietor or partner- listed on the attached sbeet 7_ ❑Remodeligg
ship and have no employees These subcontractors have . S. ❑Demolition
worminges:forme in any capacity. employe and have worloets'
[No worts'comp.imsnrance eomP.nta;,atims 9. 0 Building addition
required] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions
3.❑ I am a Lomeownerdoing all woik offices bane exercised tbeir n.❑Phrmbing repairs or additions
myself [NoWaAers'camp. A&ofexempdmpwMGL 12.❑Roof repairs
mra innce rcgmred.)t c. 15Z§1(4),and we Lave no
emplcyem[No workers' 13.t lmu
comp-msiham a regnued.]
'Aar awlkwathat ebecks b=91 mustsiso fie u dceo
dem swdmbelow showingtbeirwa 'compmsetieapolicy i�'o®miea
t Hameowomwtosubmittbisamdav$mdvalmgtheymedoing an we&mdthmhire owsddn co�aeton muaaobmitanew e9"Aavit indir rig sucFi
tOont 1heI chart arts bmc ours[ubrLcd m adddimul>lastsbowIDgihen+me of the mlrc�az2ms and slate whemerornat these emetics have
empb➢em Ifthesub-oonka =it cmPloyas.they.stpeovidao=wmkaa•c®p.pOECynomber.
I aim anenyl0ya that fsyrowdargtamkers'compensabaminsuranmfm'myengrloyees. Bdowirdrepo&cyandjohste
inforrnatiml.
inmrwnce Company Name: -I,-CA t e-L2/S
Policy#or Self-ins.Lic_#: (J �9 � �j �() rurpiiatiwn Date:
Job Site Address: W_6mx, C ty/StamfLip:
Attach a copy of the workers'compensation policy declaration page(showing the policy umber and expiration date).
Failure to secure coverage as required under Section 25A of M&c. I52 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-yearimpAsomnem as well as civil penalties in the form of a STOP WORK ORDER and a 5ne
of up to S250.00 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 ins:.ance coverage vefiicaiion.
I do hereby cwrhfy und®fhepains and penalties ofPerjarythat the inforrnationpwvided/ahoveJistrue and correct
Siatatme• 4A /� Dair `all. �jly
Phone#:
[60ther
ial use only. Do not>rs in this areq to be completed by city or to wn offrciaL
i
I
or Town• Permit/License#
ng Authority(circle one):
ard of Health Z Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Phimbing lnspector
act Person.• Phtuie#:
Certificate of Flame Resistance
REGISTERED ISSUED BY
FABRIC JOHNSON OUTDOORS INC. Date of Manufacture
NUMBER BINGHAMTON, NEW YORK 13902 JULY 2009
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: . THE EVENT CO
CITY: GLOUCESTER,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 Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G.
Type,color and weight of material 14 OZ
Description of item certifies 15 MID 30 FRAME TENT
Marine Ketardant Process Used Willo e Kennoved By Washing Ana
Is Effective For The Life Of The Fabric
Snyder Manufacturing, Inc.
Manufacturer of Flame Retardant Vnvl Laminates TENT DEPAR ENT,JOH ON OUTDO@RS'1FC
\\ "Large Scale
Certificate of Flame Resistance
REGISTERED ISSUED BY
FABRIC JOHNSON OUTDOORS INC. Date of Manufacture
NUMBER BINGHAMTON, NEW YORK 13902 SEPTEMBER 2004
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: THE EVENT CO
CITY. GLOUCESTER,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 Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G.
Type,color and weight of material 14 OZ
Description of item certifies 15 MID 30 FRAME TENT
I-larne Ketardant Process Used Willo e KOmoved By Washing Ana
Is Effective For The Life Of The Fabric
Snyder Manufacturing, Inc.
Manufacturer of Flame Retardant Vinvl Laminates TENT DEPAR ENT,JOHRSON OUTDO@RS'1NC'
\ 'Large Scale
Certificate of Flame Resistance
REGISTERED ISSUED BY
FABRIC JOHNSON OUTDOORS INC. Date of Manufacture
NUMBER BINGHAMTON, NEW YORK 13902 MAY 2004
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: THE EVENT CO
CITY: GLOUCESTER,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 Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G.
Type,color and weight of material 14 OZ
Description of item certifies 30 X 30 2 PC FRAME TENT
ame Ketardant Process Used Willo e Kernoved By Was Ing n
Is Effective For The Life Of The Fabric
Snyder Manufacturing, Inc.
Manufacturer of Flame Retardant Vinvl Laminates TENT DEPAR ENT,JOHNSON OUTD00'KSIARC
\\ 'large Scale
�srtfftsats of �la�as �se�ataurs �
issued by
Amortce a Camas Ca,bw-
� C ,► A
6489 F 39th Ave. Denver; Colo SM07
THIS IS TO CERTIFY -THAT THE PRODOCTS oR MATERIALS HEREIN DESCRIBED
ARE MADE FROM A PLANE-RESISTANT FABRIC OR ME INHERENTLY NONFLAIVUBLE.
p..�.„�� Marshall Austin
�"RVYY4ED FORS— - RATE 8-20-02
AMMIWAS, 1z S. Younafield Court f Lakewood CO 80228
11ESCR1PrION_OF PROD=, 24• Stage Roof Artic Blue
FABRIC PgooLC D Bye Glen Raven Custom Fabrics LLC
ADDRESS AND REBISTNATIOM IB31 N_ Part Avn_i 61tn Rev - wr Z72r7
I1£THOD OF APPL1CATI Laminated
IN ACCORDANCE WITH SPECIFICATIONS Calif. Streree Fire Marshal
ileac 4stsadert p+waa4 aaad OUA rat 6s 44waved Ag B-
aag
As1Q g AMERICANCANI/AS00.1NC.
OBA OvwaR TEMP OD. .�
WWI
Performance Platform Productions
120 Central Street#3
Hudson MA 01749
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Hudson MA 01749
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120 Central Street#3
Hudson MA 01749
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Performance Platform Productions
120 Central Street#3
3udson MA 01749
Performance Platforms 978.562.0988
Mobile Stage Specifications - 24 ft x 16 ft
Towing Dimensions
Overall Length....................................28 it 7 in
Stage Length.......................................24 ft
Stage Width.......................................8 ft 5.5 in
Overall Height....................................9 ft 5.5 in
Performance Dimensions
Stage Floor.........................................24 ft x 16 ft
Stage Height (from ground).....................44 in
Maximum Front Canopy
Height from Floor.................................12 ft 6 in
Maximum Rear Canopy
Height from Floor..................................9 ft 6 in
Weight
Gross Vehicle Weight...........................4,240 lbs
Hitch Ton Load.....................................3501bs
Allowable Loads
Stage Floor Load..................................100 psf
Tent Top Loading
Single Side Loaded...............................1640 lbs
Both Sides Loaded................................28001bs
Wind Speed........................................50-60 mph
Maximum Uplift on Roof...............:...........13 psf
Signage
ALL Banners needs to have Grommets (zip tied to stage)
Wind Slits are advised on banners or mesh banners
Banners need to be put up at time of installation'
Fire Retardant Label is sewn into canopy top
Performance Platform Productions
120 Central Street#3
Hudson MA 01749