The URL can be used to link to this page

2 FORT AVE - BUILDING INSPECTION - �IYEfl INS'REC , M4L SERVICES The Commonwealt'hj� N ss cos t I II / Department of I�N�i��: � '�' - � •+,�YL Massachusetts State Building Code(7,0 Cbi R) Building Permit Application for any Building other than a One-orTrvo-Family Dwelling (This Section For Official Use 01 1 ) Building Permit Numbe ,. Date Applied t Building Official: SECTION 1:LOCATION(Please indicate Block It and Lot R for locations for which a street address is not available) �Jfko�3s ?A-rk S'9zem mq -Nri No.and Street City/Town Zip Code Name of Building(if applicable) 2— Q C SECTION 2:PROPOSED WORK Edition of NIA State Cute used_ If New Construction check here❑or check all that aPP Y I it,the two rows below Existing Building❑ Repair❑ Alteration ❑ r\dditiun p Demolition ❑ (Please fill out aml submit Appendix I) Change of Use ❑ Chan};e of Occupancy ❑ Otlter/�Specify: 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: S'eT 7eivT5 r� RrvC�� tiia SECTION 3:COMPLETE THIS SECTION IF EXISTING UUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here Ilan Existing Building Investigation.and Evaluation is enclosed(See 780 CNIR 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(ft.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ 1^ Facto F-1 ❑ F2❑ E: Educational ❑ H: Hi�h Elazard H-I❑ H-2❑ H-3 ❑ FI-4❑ H-5❑ L• Institutional 1-1 ❑ 1-2❑ f3❑ 1-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-I❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use SECTION 6:CONSTRUCTION TYPE(Check as a licable) IA ❑ Ill ❑ IL\ ❑ IIO.❑ IBA ❑ IIIB ❑ IV ❑ VA ❑ VB Cl SECTION 7:SITE INFORMATION(refer to 730 CbiR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: 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:Beallg Yes❑ No ❑ Hazards to Air Navigation: V A I li,t n c'ominiai ,i IL:y,u,+ I n„i.,; Not Applicable❑ Is Structure within airport approach area. Is their review completed? or Consent h+Build enclosed ❑ Yes❑ or No❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Etitiun of Code: Use Group(s): Type of Construction: _ Occupant Load per Floor Does the building Contain an Sprinkler Systenn?:_ Special Stipulations:_ �oSL�I�N /',Zq • 33s . 331b The Commonwealth of Massachusetts W Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Faruily Dwelling (rh is Section For Official Use Only) Building Permit Number Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block N and Lot N for locations for which a street address is not available) idlikows ?krk'_ s z-M No.and Street City/Town Zip Code Name of Building(if applicable) z U — SECTION 2:PROPOSED WORK Edition of Mr\State Code used_ If New Construction check here❑or check all that d IPP Y m the ttvo rows below Existing Building❑ Repair❑ r\Iteration ❑ rldditiun❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy _ ❑ Specify: Are 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? Brief Description of Proposed Work: Yes ❑ No ❑ SC'T 7eiv7-S r- RWCe2 nip Iv SECTION 3:COMPLETE THIS SECTION!F E)(ISTING 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 UseGruup(s): Proposed UseGroup(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.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ F: Facto F-1 ❑ E: Educational ❑ : i9 azard FI-1 ❑ H-2❑ H-3 ❑ H-4❑ Fi-5❑ h Institutional I-1 ❑ 1-2❑ I-3❑ !-1❑ ivh hfercanNle❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use. SECTION 6:CONSTRUCCION'rYPE(Check as a plicable) IA ❑ 113 ❑ Ile\ ❑ fill ❑ f11A ❑ BIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CRIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit. Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indcntify Zone: or on site system❑ required❑or trench or specify: Railroad right-of-way: Hazards to Air Navi ation: nnnit re\I uloscal❑ `I ' g VIli.l n ( muni.bnl 7nw.�: Not Applicable❑ Is Structure within airport,,pproach area? 7s their review completed? or Consent to I3od(I enclosed ❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONI'EN'C OF CERTIFIGCI'E OF OCCUPANCY Edition of COde: Use Group(s): Typcof Construction: _ Occupant Load per Floor: Does the building coolain eo Sprinkler System?:--Special Stipul.niaus: ------ 2014 North Shore Cancer WALK Salem Willows Park P: t Tn? MAIN STAGE REST P. KW d ROOMS 'd r t Truck P, ' Recyc llog3fj .` ' �` 1 eft TamSe�'. Refra,bments 13)to'z to' `§ Tanta._' North Coast -oeerMiddle Truck Izbles Whole Pootla` ,10-art tables 4-B ft table,:?' 10,taMons 10 x,f0'lent �� NSMC t e n teblee p. �/� Trailer, 4 chaps /'• w" �r Noiq Shon W® ?Map§ � DUNKS Team Photos iu,. + �•�s' "Volunroer Check IN f'- � ,�.-70 chelq.rise re,�y y± �� e.iJ+ {;, n s tOFx 10 Tent :• ernhrrt: WALK Regis antlon yp 20 x20 TBnt 1 aft bble i' Ambulance wDaoking IChein�.;i Cbalra,.¢, : # f ' Tdbum b Booy ,Ma9n1 1 CC lent f t�-10[10 Tant kl KW "'2 nntablas w {Chaln M.vgZn Tribute t T'a ' +s mYO� WIKWmnd ' Park fentei.:'�% ^ 91t to zt0 rune`. tehxn"ir' t-8 ftbblw Storagei Wall 2chmn ��? Shed" rnaloanc®` 10xto fMla 1 mtbble f0{sxw 8 Main i0 x/0 Tant ILdgrierBak -, 1 enrem, a ygP,b eAC ISa9an Eastern Bank ^ Salem Fi've:,. 2Cbaka}. a Aomwity 10'x 10 Tent I t0'x 1w Tent 'LI,Pstmng; ,O¢ a-9a1L1 2-eNbble fie Rbble, e OM IFSchaih r t08/tlble; "Ale"a s„NSMC ' AF tFF oe�da NIGH Cancer Cents ero TENr Oanvmebenk g.. Spaulding X,10.10 tat `"Insvahce 10'1 to,Tent' Water - 4 10x10 tent e2Still, We 10,Tent 1-afttable; 2RAbble c,k Chain 1- ftbble - -2 Mairm S(Op -`r,' .e+ • er WALK 8 it able ry ty 1111 heap line — s.ri. ® � 1 it table 2 � •,';C 11 11 Needs Elec. -�•.-yz ®® c___A1yUrg---J 1-20 amp circuit, y -, `�.,.Stet Client#:415544 ACORD,u CERTIFICATE OF LIABILITY INSURANCE BAYSTTEN DATE(MMIODIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD/ER/THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ct to CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subje the terms and conditions of the policy,certain Policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Rental Specialties co A NAME. P.O. Box 53310 -R�IONE ac No Irvine, CA 92619 I E-MAIL ac,No: ADDRESS: 800 854-3298 INSURER(5)AFFORD_ING COVERAGE '�_----- _ NAICp _ _ I INSURER St Paul Fire$Marine IOSUrante INSUREp --- _, - Baystate Electronics Inc. INsuRER B:Traveler 24767 s Indemnity Co of CT '25682 DBA: Baystate Tent&Party INSURER c: 150 Lorum Street INSURER D: Tewksbury,MA 01876 INSURER E: COVERAGES CERTIFICATE NUMBER: (INSURER F: THIS A D, CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE iADDL!gUBR A GENERAL LIABILITY JNS MD POLICY NUMBER POLICYE F I POLICY EXP I MMIDD/Y1'YY I MMIDDIYYYY LIMITS 1/20 1041 1120 141 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY ZPPION373431447 410 I I g11000 QQQ CLAIMS-MADE O r pAMAGEE TO RENTE OCCUR D i PREMISES Ea so urrence S100000 I I IMEDEXP(Any one person) $5,000 PERSONAL&ACV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLES PER: GENERALAGGREGATE g2,QDQ OQQ t .—_._.—_..___—,--____—.... X POLICY J CT E,LOC I I 1PR000CTS-COMPIOPAGG s2,000,000 AUTOMOBILE LIABILITY -- ANY AUTO I I fEe_aBBINE—SINGLE LIMIT g -- ALLOWNED —=--_..—_..—. AUTOS SCHEDULED BODILY INJURY(Per person) S AUTOS BODILY INJURY Per accident S HIRED AUTOS NON-OWNED I ( ) AUTOS PROPERTY DAMAGE Per accident S A XUMBRELLA LIgB X OCCUR S EXCESS LIAR ZUP10N811451447 4/01/2014104/01/2015 EACH OCCURRENCE CLAM&MADE 31 000 000 X DED RETENTIONS 10 OOO AGGREGATE 31 000000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY I i I XEUB5899Y49714 113112014j 0 113 112 0 1 X ,WCSTATU- �.GTH- $ ANY PROPRIETORIPARTNER/EXECUTIVE YIN I c OFFICER/MEMBER EXCLUDED' CIINIAi EL EACH ACCIDENT (Mandatory Ie aNHjnd I 51 QQQ QQO Il yes,describe under I EL.DISEASE EAEMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below A Inland Marine E,LDISEASE-POLICY LIMIT -1,000,000 IZIM131,1038831447 4/01/2014iO4/01/2011 Limit$900,000 Equipment Floater ! j i Deductible$10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach AC ORD 1a 1,Additional Remarks Schedule.if more space Is required) Re: Small Inflatables- (1)Backyard Obstacle, (1)Boxing Rings, (4)Castles, (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05 - ©1988-2010 ACORD CORPORATION.All rights reserved. 1 Of 2 The ACORD name and toga are registered marks of ACORD #S12334105/MJ1977322 AXLJG (Certitirate of REGISTEREDi,�'{ APPLICATION AZTEC TENTS Date treated or W, # CONCERN NO. 2665 COLUMBIA ST manufactured + TORRANCE, CA 90503 + CAL COMB F-019.01 (800)228-3687 0712008 •-+ ny< fR This is to certify that the materials described below hereof have been Flame retardant treated(or are inherently nonflammable). _ FORj BAY STATE APRTY RENTALS 150 LORUM STREET TEWKSBURY, MA 01876 ATTN: DAVE KNIGHT 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 registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. ' Name of chemical used............................................Chem. Reg.No. ........................ Meathodof application ............................................................................................... , ' (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. Trade'name of flame-resistant fabric or material used..�mmamn F.e,m . Reg.No.......f.9rs;ol ..... The Flame Retardant Process Used waL NOT Be Removed b Washing " (win or will not) •••• y - 9 David Bradley Chuck Miller - President Name of Appllcalor or Prorfucoon Superintendent ill. The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 UVP Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):Baystate Tent Address:150 Lorum Street City/State/Zip:Tewksbury, MA 01876 Phone#:978-851-2002 Are you an employer?Check the appropriate box: 1. I am a employer with 20 4• ❑ 1 am a general contractor and 1 Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance.* 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL insurance required.]t C. 152, §1(4),and we have no 12•❑ Roof repairs employees. [No workers' 13•❑Other comp. insurance required.] Any applicant(hat checks box H 1 must also fill out the section below showing their workers'com t Homeowners who submit this affidavitpensation policy information. indicating they are doing al I work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name:St Paul Policy#or Self-ins. Lic. #XEUB5899Y49713 1-31-201� Expiration Date: Job 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /r!n hereby certify under the pains and enalties of er'ur that tire information p ded a ve is ru nt!correct. avid Knight ° "'"'g° "° ° gM Ox.[n�0aritl Rn9 M.q oµ ema W 1nigMPmNalertnl,[wn,f-V$ Signature o Phone#:978-851-2002 Date Official use only. ((Do not write in this area,to be c•onipleted b y city or town official. City or Town: 1 Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PlumbE7[nspee]tor 6.Other Contact Person: Phone#: �\ CITY OF SALEM, MASSACHUSETTS ,l I PARK, RECREATION&COMMUNITY SERVICE'S 5 BROAD STREET,POST OFFICE BOX 465 SALEM,MASSACHUSETTS 01970 KINIBERLEv DR ISCOI.1, TEL. (978) 744-0180 OR(978) 744-0924 MAYOR FAX(978) 744-7225 ICPARTANEN @SALE.tit.COn I KAREN PARTANEN DIRECTOR June 4, 2014 Dear Rose Fisher, The North Shore Medical Center has permission to use Salem Willows/Salem Common on June 22, 2013 for the North Shore Cancer Walk. If you have any questions or concerns, please contact me at (978) 744-0180 Thank you, Karen Partanen January 14, 2014 Meg Wright North Shore Medical Center 81 Highland Avenue Salem, MA 01970 Dear Ms. Wright: At a regular meeting of the Salem City Council, held in the Council Chamber on Thursday, January 9 2014 the City Council voted to approve your request to hold the North Shore Cancer Walk and use of city streets on Sunday, June 22, 2014. The Course to be used must be approved by the Salem Police Department and the use of the Salem Common needs to be approved by the Park and Recreation Department. Yours truly, CHERYL A. LAPOINTE CITY CLERK CC: Police Chief Police Traffic Capt. Brian Gilligan Watch Commander Chief Fire Dept DPS Director Health Agent Planning Director of Park, Recreation & Comm. Services Special Projects Coordinator Invoice # 125024 Baystate Tent & Party EVENT INFORMATION 150 Lorum Street BAYSTATE 6/21/14 Tewksbury, MA 01876 (978) 851-2002 TIME OUT Sat 9AM RETURN 6/21/14 BILL TO TIME IN Sun aft 12PM EShorecal Center Willows Park ce Salem, Ma ORDER DATE PAYMENT AMOUNTEEP PHONE# 978-825-6116 ALT. PHONE# 978-335-3316 6/21/14 Net 30 Days Rose EVENT DAY Sunda QTY DESCRIPTION DAYS RATE AMOUNT 2 20 X 20 Ultra White Festival Frame Tent(Reg Photo) I 275.00 550.00 1 30 x 30 Quicktrack Ultra White Tent 1 650.00 650.00 7 Leg Extensions I 12.00 84.00 19 10 X 10 Ultra White Festival Frame Tent(vendor) 1 120.00 2,280.00 2 8'x 20'Solid Wall I 20.00 40.00 2 of THE WALLS ARE FOR ONE SIDE EACH OF THE 20X20 24 4'x 4'Stage Platform W/Adj Leg(24x 16x2) 1 32.00 768.00 14 Stage Rails 1 0.00 0.00 I Adjustable Stairs 6 Step w/rails 1 45.00 45.00 170 Chairs Samsonite Bone/Neutral 1 1.00 170.00 75 8'Banquet Table 1 8.00 600.00 10 Chrome Stanchions 1 8.00 80.00 2 4x8 Riser 1 64.00 128.00 3 Yellow Rope 1 0.00 0.00 Labor 3 a 12 Hours 900.00 900.00 Bring 6 milk crates Discount 1,495.00 1,495.00 meet rose 9AM on the 23th 2 Permits 105.00 210.00 Payments/Credits $0.00 Subtotal $5,010.00 Sales Tax (5.0%) $0.00 Total $5,010.00