138 FEDERAL ST - BUILDING INSPECTION IIllit"S 1AU6T-eE fILvEG--A d0 APPROVED BY T*IE
.W5PXTOR ,PRWfl TA A.PERMIT.BE NG GRANTED
CITY OF SALEM
NDMr
Date
,5
Ward
>mn9 ` Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:% *'ee,-,4& 2X�
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name �D777n/d� .i,me lt7l
Address & Phone /3F F;�,69,rLAL V Z� 7V 45Z ,,
Architect's Name
Address & Phone ( )
/Y xA 73e4h'v14
Mechanics Name e
/3f 9"P,/O— / r7- 7T/ 77 5zn5
Address & Phone 1,e-,1n1e1vcs77-n ?*,.iol RW44&7-t�
What is the purpose of building? 1?£e2£.4?le^J
Material of building?�w�4>A-4�A4 IiiIti /L If a dwelling, for how many families?
Will building conform to law? Yzu Asbestos?
Estimated cost Xb— City License# Sta a License # 61 D G D 2 /5P
Home Improvement
Lic. 1
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�•f�r2 A42 z,AJ A --1) A/U �!/Lk�n/� s2 SlyJmkinJJ,)
lin.rJ�rL- stir
MAIL PERMIT TO: l'15FAqT: L
A3f Sv-
No.
APPLICATION FOR
PERMff TO
i lUcr ,-64yA � u�
LOCATION
138
PERMIT GRANTED
APPROVFD
L
S ECTOR OF BUI DINGS
° L3pLj-E3rL3_r_1-LJPELp'��ELJJPEI IMPORTANT DOCUMENT
5 Certificate of Hanle lResistapee 5
5 REGISTRATION t ISSUED BY 5
5 uc,, Date of Manufacture C�
APPLICATION o- 0
5 NUMBER s CN�RE 05/17/02 5
� INOUSTRIE INC.
5 rf M'aa�� EVANSVILLE, INDIANA 47725 Order Number 5
5 F121.4 E ° MANUFACTURERS OFTHE FINISHED 354616 5
5 TENT PRODUCTS DESCRIBED HEREIN 5
5 This is to certify that the materials described have been flame-retardant treated 5
5 (or are inherently noninflammable) and were supplied to: 5
CSJ 657150 j
5 PETERSON PARTY CENTER INC 5
5 139 SWANSON ST r5
WINCHESTER MA01890 5
5 5
5 5
5 Certification is hereby made that: 5
5 The articles described on this Certificate have been treated with a flame-retardant approved 5
5 chemical and that the application of said chemical was done in coriformance with California 5
5 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5
5 reee7775� The method of the FR chemical application is: 5
Serial # 8002100(2) 5
certified:
Description of item cer 5
5 FI TOP 20W X 40 VL W W 5
5 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 JOHNBOYLE STATESVILLENC $I ned: 5
5 Name of Applicator of Flame Resistant Finish 4Z
C
TENT DEPARTMENT-ANCHOR INDUSTRIES INC. 7
O cPrJ�rJ�rJ�rJ�cPr PJ�rJ�rJ�rJ�cPrJ�rJ�rJ�J�rJ�rJoEJ�J�rJ�rJ�rJ�c PrJ�LI�cPr�cPcP[fJo J�rJ�Pr PEPr�cPrsLfEPrJ�cPr PrJ�rJ�cPr�r�cPrJ�cPcPcPcPr�rJ�rJ�rJ�cPO PLPr PrJ�cPrJ�rJ�cPrJflJ�c1� O
.v t The Commonwealth of Massachusetts
,�r
u� r' Department oflndustrial Accidents
z' office oflmesByetlons
600 Washington Street, 74 Floor
Boston,Mass. 02111
Workers'Compensation Insurance Affidavit: Bwldiin umbing/Electrical Contractors
AoDlicanfmformation:' �=-:;- - '�� �i'7easePRIlV2•leeibly %- . -.n—im f
._ m" '
name:
address:
city state: zip: phone#
work site location(full address)'
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition
-.- mr.M -_f -.:�T
[ I am an employer providing workers compensation for my employees working on this job
ri =h.�' x^x. M'i. N i' �°. an. ,... stir.,, �`"b +k9 t'x�'• y w.,.
comoanvname: PEt?_t'v 'j0AY�761 rr/��/L /L" E= f t
address. >3 �?� �('7i(ivChtl7D 7"
fohone
insurance cazl YLIIYIr..//C.,� ` 0OV&&'TIZ� Bi% nobcv# file �G% ??a",' `" ' `
::,z
ie°d+:#7'a...;m�"�"+�a'+ve�r' b..u�a�_.u&' '+de:.n t-'iySte' 4�ita�Gavz3.:_�PEau�*"":` SJ' 'S*uaex i+NeM
❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers compensation polices
coin ao name: '.
address:,-"
, Y rs`t5` \ �
city �� • r s ems _ '`" �m a A, / � ae: t��nyhOnO# � � s
3��,i 4 S. i,eII
Snsurance co r ' °` 's` £"f4 ` "'"' oohcv
^ag.£»;�+ux ',tka+. f"�'�'
a� ., C�,d+s:tifrx 4 t t7z�y, -•s s i' x c &
TCOIIIY 80 name. car xe x:�-,.,A � &tr yrt" sM
.w _ P �
& €,f �r ---ee ' c� �s,�.,,.,�`` f°-::. i� x' ,gay. Q �"
address. - ,�,. . E; :. b-w s € aR� .,a tea., t ' :�;.
n r n a "`n1:.,t -7 ar ssK ti� ism'as •.�a",,' ea �Y
IC, ,a.
CRY P a* <0 {�&'£i—'
q�, �a .t.Rt�� $�""€ i, �,N `b4p . » .y En.,2 h�yppY�Ea� tC i` tip' L.
r. r5, � zX.52'" fc' ,x._. ths: t'°u w''"$",,,,as [v .z Y #E �..', ��.6?p3kdi
insurance co ,t'. ._ < • � hcv:# - '
Attach additional sheet if ne$gssa3Ulm�
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penafties of perjury that the information provided above is true and correct.
Signature f T Date
Print name ?1e 01A14 Phone#JI'•/-7a�''" �����
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(.vmd Sept 2003)
�12e U�o�nvn2a�rr,�rP,ar� o���.�!/�1Jac�2�e�Q
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 060219
B i rt h d ate: 04/27/1954
i
Expires: 04/27/2005 Tr. no: 9542
Restricted: 00
MARK TRAINA
33 HANFORD RD
STONEHAM, MA 02180 Administrator