FEDERAL STREET @ WASHINGTON STREET - BPA-11-374 � l\� , The Commonwealth of Massachusetts
i
`A .� Board ul'Bwlding Regulations and Standards CITY
Massachusetts State Building Code. 780 C'MR. T"edition OF SALEM
Revised Juntiorr
Building Permit Application To Construct. Repair, Renovate Or Demolish a /. :INAV
One-r t -Fumilr Dwelling
is Sec ion For Official Use Only
Building Permit Num r: 4 Date Ap ied:
Signature:
Bu ummissiamr/Inspector u B tldings Date t
S ION 1:SITE INFORMATION
tj Properrryry Addna:�)) 1.2 Assessors Map dt Parcel Numbers
t—e d ra..(" _7 oy'SHI'Ve My S l
1.1 a Is this an accepted street?yes no Map Number Panel Number
I Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Ares(sq 11) Frontage(11)
1.5 Building Setbacks(R)
from Yard Side Yards Rear Yard
Required Provided Requiml Provided Required Provided
1.6 Water Supply:(M.O.L c.Ja,§SI) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private❑ Zone: _ Outside Flood Zone? Municipal O
Check if esD PV On site di sposel system ❑
SECTION is PROPERTY OWNERSHIP'
I.1 Owge 'of Record• � ^. 1 )�
62/1 It
Name(Print) �— Address for Service:
Signature Telephom
SECTION J: DESCRIPTION OF PROPOSED WORKS(check aU that apply)
New Construction O Existing Building❑ Owner-Occupied O 1 Repairs(s) ❑ Alteration(s) ❑ Addition j103
Demolition ❑ 1 Accessory Bldg.O Number of Units_ Other ❑ Speciry:
Brief Description of Proposed Works:
d 3D
SECTION d: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 011leld Uso Only
Labor and Materials
I. Building S 1. Building Permit Fee:f Indicate how fee is determined:
v. Electrical f ❑Slandard City/Town Application Fee
O Total Project Costs(Item 6)x multiplier x
J. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) f List:
J. Mechanical (Fire
Suppression) S Total All Fees:f
heck No. _Check Amount: Cash Amounf:
6. Total Protect Cost: S I(C13 paid in Full O Outstanding Balance Out:
C
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
l.iccnsa Number F%piration Owe
Name ul CSI.• I luldrr 1.isl CSL Type 1 see below)
f Ppleon
:Wdress U Ilnrestricted to 3S.000 Cu.Fl.
R Restricted 132 Farm Uwellin
Signature M M Onl
RC Residential Roulin C'overin
WS Residential Window and Sidin
I'cleplaurt SF Resitkatial Solid Fuel Bumin A fiance Instsibliun
D Reii denial Demolilion
5.2 Registered Home Improvement Contractor(HIC)
Reyistralion Numbs
I IIC Com rn me
any Name or IIIC Regiatt Na
Address Expiration Data
Signature Tdeplruna
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.is IS2. 12SC(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...........O
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.
Si ure of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I. �(it T� ,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
belle .
Print �( (/ 6
Si ure '(honer or Auth ad Agent Date
St the ins and penalties of u
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 of have access to the arbitration
program or guaranty fund under M.G.L.c. 1 42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations I IO.R6 and I WAS.respectively.
i When substanlial work is planned,provide the information below:
Total (loon area(Sq. Ft.) (including garage, finished basemen✓anics,decks or porch)
Gross living area(Sq.Fl-) Habitable room count
Number of(replaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of healing system Number of decks/porches
Type of cooling system Enclosed Open
J. "Tidal Project Square Foolage"maybe substilutcd for"Total Project Cost"
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Oct 05 10 08:46p Carol Hedges 978-283-4163 p.6
Certificate of .Flame Resistance
REGISTERED ISSUED FABRIC Date of Marw
JOHNSON OUTDOORS INC. faedue
NUMBER BINGI AMTON.NEW YORK 13902 MAY 2009
F-140.01 AUnaradwats offhe�
Tent PMducis Desrnbed hiamin
This is to cw"fy that the products berein have been manuFadured from material inherently fian a retardant as
here after specified by the materlai supplier,
NAME THE EVENT CO.
CITY_ GLOUCESTER MA
certification is hereby made that-
The articles desrnbed on digs certificate have beery m.m#ack vd vvigr an approved flame retar0ant cheviot in oornpfiance with
Ca6forrria Stage Fire blarshar Cade. NFPA-7(1'I',Underwriter;Labmatuy of Ca,retla,a„d t®ve hr� te5[ed M accordance vviF17 the
Federal Test Mefhod Sperifiptions arai meet or exceed lie Afi�ry Flame Specif ads.rs of MIL-G 43Dp6G.
Type,mlor and vreW of materra! 140Z-WSO
Desafation of item ce0fles EFS 15 MID 30 WBO
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc_
r
Nsmfachear of Flamm Re�rdam vtr'a tarrmnts THIT DEPARTUENT.JIH NSM
- - ... 'large Seale
Oct 05 10 08:46p Carol Hedges 978-283-4163 p.6
Certificate of ,Flame Resistance
REGISTERED tiSslJl�BY
NUMBER JOHNSON OUTDOORS INC. Date OF Manufacture
BINGHAMTON.NEW YORK 13902 MAY 2009
F-140.01 6larudardraers of the FeresY
Tent Ploducts De=bed herein
This Is to certify that the products herein have been manufactured horn material inherently flame retardant as
here otter specified by the meWrial supplier.
NAME THE EVENT CO.
CITY: GLOUCESTER,MA
certification is hereby made Ong:The arddes descnbed on tl>8 certificate have been mangy vA th an approved flame reWdaw chemical in eomplancs aifh
CaRtomla State Fire Marshal Code. NFPA i01•. Under rflars labaoalay of Canada.and have been tested if aceordance with the
Federal Test Method specifications and meet or exceed the hStary Flame Specifita@ons of MIL-C-43006G_
. -Type,color and weight ofmater®t 1407-W80
DesniDfwn of ilarn certifies EFS 15 ND 30 NlB0 .
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing, Inc.
n
Nerndacnaer of Rarnv Rt�ruar¢veer lames TENT OEPARTtEM.JMNSON _ .--
- 'Urge Scale
Oct 05 10 08:47p Carol Hedges 978-283-4163 p•7
•
Certzpcate o,f Flame Resistance
REGISTERED ISSUED BY Date of Manufacture
FABRIC JOHNSON OUTDOORS INC_
NUMBER BINGHAMTON.NEW YORK 13902 MAY 2009
F-740.01 A6amdarhuars of the Finast
Tent Hnducts Desnbed Herrin
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 an Ibis cent'iraie have been manufactured with an approved flame retardant chemical in compliance with
Ceiforoia State Fire Marshal Code, NFPA-701'. Undenu ites taboratoryr of Canada.and have been tested in accordance with the
Federal Test Method Specifications and meet or exceed the Mirmary Flame Spedfcaia s of MIL-C43006GL
Type,color and weight of matemi 14 OZ.WBO
Des-intion of item certifies EFS 30 X 30 2 PC WBO
Frame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
i Snyder Manufacturing,Inc.
Ma�Wr3ck r of Ran.ReMrdmn Vhwi lamkmMs TEW DEPARn W%M.JDHPSON
'large Scale
Oct 05 10 08:48p Carol Hedges 978-283-4163 p.10
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