63 FLINT ST - BUILDING INSPECTION (2) UlfThe Commonwealth ofkt'3ERVIGES
Department of Public a et
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other thlN$QW er2fQ46i4bwelling
(This Section For Official Use Only)
r Building Permit Number: Date Applied: Building Official:
(� SECTION 1:LOCATION
t /� _63 Flint St Salem 01970 Landry&Acari
U No.and Street City/Town Zip Code Name of Building(if applicable)
1
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
1 Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:—Tent
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:—Install 30'x50'tent from 6/17/15-6/22/15
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) ❑
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(fL)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H4❑ H-5❑
1: Institutional 1-1 ❑ 1-2❑ I-3 ❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 ❑ R4❑
S: Storage S-I ❑ S-2❑ U: Utility❑ I Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ HA ❑ LIB ❑ IIIA ❑ HIM ❑ 1 IV ❑ 1 VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 1053 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Private Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
❑ or indentify Zone: or on site system❑ required❑or trench or specify:
P '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:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Landry&Acari_ 63 Flint St Salem _01970_
Name(Print) No.and Street City/Town Zip t
Property Owner Contact Information: _
Jerry Acari .978_-_744_7_5909 _
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 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.fl 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 coordinating document submittals
Name(Registrant) Telephone No. e-mail address Registration Number -
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
The Event Co
Company Name
_Taylor Hedges
Name of Person Responsible for Construction License No. and Type if Applicable
_PO Box 419 Gloucester MA 01930
Street Address City/Town State Zip
978_-_283-_4884 617 -_967_- 5666 _tavlor@rentent.com
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 thisapplication? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $975 - Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $ Note:Minimum fee=$ (contact municipality)
4.Mechanical (HVAC) $
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $975 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name ow,I hereby attest under the pains and penal[' f perjury that all of the information contained in this application is
true and accurate to the b of my knowledge and and ding.
Daniel Weinrebe 978 -771 - 9561
Please print and sign nam Title Telephone No. Date
_15 Whittier St Beverly _MA_ _01915 _dweinrebe@gmail.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: �
Name Date
The Event Co.
P.O.Box 419 JOB CONTRACT
Gloucester,MA 01930
the event co. Voice: (978)2834884
Fax: (978)2834163
• •• 1
INVOICE TO: DELIVERY ADDRESS:
Order Status: Confirmed Order
Landry and Arcari Landry and Arcari Sales Person: Missy Pierce
63 Flint St 63 Flint St Last Updated:MAY 29 15 11:07AM
Salem,MA 01970 Salem,MA 01970
ATTENTION: Megan JOB SITE: Landry and Arcari PO'
PHONE: (976)744-5909 Ext: ROOM: CUSTOMER#:
TERMS: COD
FAX: CONTACT:Jerry Arcari
EMAIL:megand@lwdryandaread.com PHONE:(978)744-5909 CELL:
ORDER DATE&TIME: Delivery DATE&TIME: Event Start DATE&TIME: DELIVERY VIA:
MAY 281512:43PM JUN 1715
Event End DATE&TIME: Pickup DATE&TIME: DATE&TIME: RETURN VIA:
JUN 2215
JOB DESCRIPTION: Tent Summer Sale 2015
EQUIPMENT
QTY DESCRIPTION DUR UNIT$ EXTENDED DISC NET
Tents-Sidewall extra
1 30 X 50 Frame tent 1.0 w 975.00 975.00 975.00
Sidewall
160 7' French window sidewall 1.0w 1.25 200.00 200.00
Accessories
10 350LB Ballast Block 1.0d 20.00 200.00 200.00
MISCELLANEOUS
QTY DESCRIPTION UNIT PRICE EXTENDED
1 Permits 100.00 100.00
EQUIPMENT TOTAL: $1,375.00
MISC TOTAL: $100.00
DEL&PICK-UP: $75.00
(MA Statej'AX TOTAL: $85.94
GRAND TOTAL: $1,635.94
PAID TO DATE: $0.00
BALANCE: $ 1,635.94
Customer Signature
Customer Printed Name Date
Quotation Updated on MAY 29 15 at 11:07AM 1
The Commonwealth of Massachuseds
Dgmwftmt of&&wWd Aeddenrs
Offlcw of lnvesngatioaa
600 Washington Sired
Boston,Marx 02111
www.messggv/tea
Workers' Compensation Insurance Affidavit: Builders/ContractorsWeett'icians/Plumbers
Applicant Information Please Print Lefibly
✓/
Name(Business/Orgunimtion/lniividwl):J L0.
Address: PC> f')rhtr
City/State/7dp.64//e5�r( r 6) Phone#:_/ 4-ZZ
Are you an employ?Check the ayproprb to boa: Type of project(required).
1.F I am an employe with / 7� _ 4.0 I am a general contractor mid 1 6.0 New construction
employees(fall and/or pat time).' have hired the sub-contractors 7.0 Remodeling
2.0 I am a soh proprietor or partner- listed on the attached sheet
ship and have no employees These subcontractors have 8.0 Demolition
worlong for me in any capacity. employers and have workers' 9.0 Boilding addition
[No workers comp.insurance COMP-inswarnoe.Y
required] 5.0 Wean a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing a0 wont officers have exercised their 11.0 Plumbing repairs or additions
myself [No worlals'comp. right of exemption perm MGL
insurance requited]t c.152,§1(4),and we have no 12.0 Roof repairs
employees.[no workers' 13,E Other /fiaPn 1 5
comp.insoranee required_]
*Any xppa®t6atetee4a eeisl and RISC®Out thesatI bdow &drwwt=eewapmdmveBrhftma+im
tnomwwmaswhwwbaat"■®davhbsdi they weMug m wwk SW tea We oeeddeemtrs t mast Submit n new smdf t sarh
tContadmUMehmk me,box mmotamshoeddMemddeaddmwing die atmeOf the W& 0*0im"an0euuwhdtyOmara,weoal=haveemployees. If
the mde" ime bm esmbfee*,&a moo movidethtrwakrd team.Egg e®ber. _
I am an employer that is prnvddng walrus'mesp mgdon brisamaesfor my=pAW G4 Bdow is drepatiey sad job site
information /
Insurance Company Name: �7csc/PL l�`�S
Policy#or Self-ins.JAC.#: A"� V iT A 71` 6 Expiration Date:
Job Site Address: City/Stateaip:
Attach a copy of the workers'Compensation policy declaration page(ahewrng the policy number and eapr mthm(date).
Failure to secure coverage as requited under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine
up to$1,5W.00 a dfor one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fore of
$250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification. -
I do herby tier*under thep®rs and pexaMa ofpajurydug dw infortuadon provided abowe is true and conks
S :E -
Print Name Phone#. . —
Of/9cta1 use only Do not wrge M flik area to be completed by eiP or town off dd
City or Town; Permit/license,#:
Isguing Aathorlty(drde one):
131oard of Reath 2. Building Department 3.Citytrown Clerk 4.Elec&fcal Inspector 3 Plumbing Inspector
6.Other
Contact person: Phone#.
Certificate of Flame Resistance
FABRIC ISSUED BY Date o/Mamdeaturo _NUMBER JOHNSON OUTDOORS INC.
BINGHAMTON,NEW YORK f3802
! F-140.07 ors yft Fib MAY 20D7
Teen P Md Cft Desb@ed Herein
Tab Is tor Specified by iha material wpplier.
e that the products hereto have
hem after been manufaIcWmd emn material Inherently Oamo retardant as
NAME: THE EVENT CO
i CITY: GLOUCESTER,MA
ThNflcatiOn b hereby rn de aft
The anldes desodMed an mb ceniDmta have been mamdachned with an l:adfonea State Fire Maul Code.NFPA-7DI*,UMenMtas Canada=W:j
ant nave bm teXetl In c d,,,arca vita
a Wtl Ore
Tm.mbr eM wehN of material 14 OZ
Desubdm of @ern aenw4d: EFS 10'MID 30'
Flame Retardant Process Used Will Not Be Removed By Washing And
I
Is Effective For The Life Of The Fabric
Snyder Manufacturing,Inc
Mva®m.vdFtaneRWrdam V6m larirob TenO MTIWEW rpsdw
a+
Certificate of Flame Resistance
REGISTERED A - A v ISSUED BY Daze of Mamdactt"
FABRIC JOHNSON OUTDOORS INC.
i NUMBER BINGHAMTON,NEW YORK 139112
MAY 2007
i F-140.01 Tames salted New
This 15 to Car"that the products herein nave been manufactured hum material Inherently flame retardant as
here after sped0ed by the material supplier.
i
i
NAME: THE EVENT CO
CRY: GLOUCESTER,MA
Cars0ce11an is txreby made that
The ankles deso0ed on tha ratlsmte have been mamdaaiae0 with an approved Itaem retaNad d., Cal In mnWarma with
CaGrama Sate Fite Marshal Code.NFPA-701'.UMMarltas Labsmary of Canada,and have teen testM in acnrdawe WM da
Federal
Tvae.cobr and welaht of material 14 OZ AW WHITE BLOCK OUT
Desoiatim of item curved: EFS 30X30 2PC
Flame Retardant Process Used Will Not Be Removed By Washing And
Is Effective For The Life Of The Fabric
Snyder Manufacturing,,=.
MwdammaF'twre Rtlwdw4YhM laNaln TENT DEPARTMENT.J09450N
vaisesrale �