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1 KERNWOOD ST - BUILDING INSPECTION (7) :Sa The Commonwealth of Massachusetts Board of Building Regulations and StandardsRECEIVEO CffY OF G Massachusetts State Building Code, IMEi1QTIONAI SERVICSALEM revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tlvo-Family Dlvelling 2114 JUL -2 P 2-- 3 2 4 'this Section For Official Use Only ' Building Permit Number: Date App ' ed: 2D .ryc 4 1 I Building Ofncial(Print Name) Signature Date SECTION I:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map,& Parcel Numbers I.I a Is this an accepted street?yes __ no Map Nurnber Parcel Number 1.3 Zoning Information:— --�--- 1.4 Property Dimensions: Zoning District Proposed Uu; Lot Arca(sq 11) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided ItequireJ Provided Required Provided 1.6 Water Supply: (M.G.1.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check ifyes❑ Municipal ❑ On site disposal.System ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 J ner'of Recor : Name(Print) / City,State,ZIP I No. a td Slrcet "telephone Enn it Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Spccily: _ BricFDes•ription of Proposed Work': �� - - �t/ `�= 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/fown Application Fee ❑Total Project Cost'(Item 6)x multiplier 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (I IVAC) $ List: 5. Mechanical (Fire $ — Suppression) Total All Fees: $ Check No.__Check Amount_ Cash Amount_ 6. Total Project Cost $ �30 0 0 Paid in Full 0 Outstanding Balance Due: F SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) i • a '1 yq ' License Number Expiration Date Name of CSL Holder List CSL Type(see below) !" No.and Strcet 'LTYPe Description U Unrestricted(Buildings up to 35,000 cu. ft.) Citylfowq State,ZIP R Restricted I&2 Famiil Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(111C) (/L"''5 - r "�'`^'� 1-IIC Registration Number Expiration Date HIC Company Name or 1-IIC Regas rant Name No d Sir et D Email address Cit /Town,Stat ,ZI - Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(IDLG.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 Issuan of the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEWN IT 1,as Owner of the subject property,hereby authorize eGe yL�s fi;0— 6& y— to act on my behalf,in all matters relative to work authorized by this building permit application. / C'y( L.700' en�/14-tr4 Club /) am Print Owner's Name(Electronic Signature) t I I Dale SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below I hereby attest uinformation tinder the pains and penalties of perjury that all of the inrmation contained in thi appli.. ' n is true an curate to the best of my knowledge and understanding. r Pon( w son dt t re Agent's Name(I?leutronic Signature) Date 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[Ionic 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-ntass.,-,ov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dos 2. When substantial work is planned,provide the information below: "notal 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 ofcoolingsystcm_ _-- Enclosed___----Open_ 3. "total Project Square Foolage"may be substituted for"Total Project Cost' rr+r 'ftA-Y, v .rt✓ fF::7'....^...lk` �ii��� x,tY'.is nl4 +.:ti�.,7.{ aa" r��.��t�+;,.,,t =,ars, ,tan G`eliflcate of flame Desistance PAGE. 1 ': >.; Date Manufactured AZTEC TENTS f INV NUMBER: 0179791 ' 03/24/2010 2665 COLUMBIA ST TORRANCE, CA 90503 P.O. NUMBER: 1800) 228-3687 CUSTOMER NO: EVEN019 +y " j; This is to certify that the materials described below have been flame retardant *: treated (or are inherently flame retardant). . 'E Allied Financial Solutions r Events for Rent 7103 Turfway Rd Ste.306 gar]oga , c: Florence KY 41042 464 Lowell Street o.r ±S Peabody, MA 01960 m. 0o m $�X: a+tage st S:r -'60A5 q iu Certification is hereby made that the articles described below hereof are made rn1 -,ge 0,q r= from a flame-retardant fabric or material registered and approved by the 77,77"'. =,g.a.-7 California State Fire Marshal for such use. The fabric has been tested and -nVanage n1 ..c �e passes NFPA 701 Large Scale. See chart to right for trade name of s 6 ass flame-resistant fabric or material used and additionally referenced on the label +`kILL: of the fabric panel. ` q,. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING l David Bradlev General Manager- Manufacturing �x Title of Applicator or Prod uction Superintendent .,� Name of Applicator or Production Superintendent pP y r lT r k .-nt Y'9+1?A "S§F W3 eyrxt fvd'tsahh"Fyy4 fi Y'S, *,�a cm*"a t:rx"',v� t 7th ! 3 } }i , 41'. �,�t�w �t;`J ',�`���y �' �{t�f�ii��, +t,'�A�S's ea}✓7�,tw`�A v% q.9., r . .:.e' A ITEMS MANUFACTURED TYPE PRODUCED 15x15 1pc Festival Top UW S 1 w/ Rope Tensioners & Flag with secondary valance 15x15x8 Festival Frame Only S 1 15x30 1pc Festival Top UW 5 1 w/ Rope Tensioners& Flag with secondary valance 15x30x8 Festival Frame Only S 1 (2Peak) 20x20 ipc Festival Top UW S 1 w/ Ratchet Tensioners& Flag with secondary valance 20x2Ox8 Festival Frame Only 5 1 2000 Ipc Festival Top UW 5 i w/ Ratchet Tensioners & Flag with secondary valance 20x3Ox8 Festival Frame Only S 1 (2Peak) 20x40 Spc Festival Top UW S 1 w/ Ratchet Tensioners & Flag with secondary valance 20x4Ox8 Festival Frame Only S 1 (2Peak) 1 tp DATE(MMNOttT ACORO CERTIFICATE OF LIABILITY INSURANCE U2ro6/2U14YV) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the cer ifiote holder is an ADDITIONAL INSURED,the pol"Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,certain policies may require an endorsement. A statement on this certificate does not corder rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Tom Henan do Hays Companies of New England PHONE 617 7237775_- Second AIc.No Efil_ (. ) - Federal Street Amoss: Floor .- _ ____, .. .__— Boston,MA 02110 _ _INWRERISTAFFONONIG COVEMGE_ _ ___ MNCR_ _ INURER A:_Zurich-American Insurance Company__-___ 16535 _ _ - _.- IN UREO Allegiant Management Corp. MSUREgc,.___ _.._____., 300 Lafayette Rd INsuRER Rye.NH 07870-000 MWIRER F COVERAGES CERTIFICATE NUMBER: 13NH002780696 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 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_ _ IMSR _..-. IA6O4TISUBR� POLICY EFF 7F'9t fI(P LIMITS LTR TYPE OF INSURANCE POLICY NUtlBE0. M OIYY M ryYYY GENERALLIABIUTYEACH OCCURRENCE $ __ 'OAMnGE Ta ifOT`ED l COMMEPCIAL GENERAL UABILnY � � PREMI$€$1Ea ou+nrexe) ;S . .._I NED EXP(Any au PtlFa 1. S ... :GWMSaWDE __._j OCCUR - -R : i PERSONK d ADV INJURY S _ - !!GENERAL AGGREGATE S NL AGGREGATE LIMIT APPLW PER PROOUCiS.COYPIOP AGG ,9 GE _._ 5 FAUTO�EL�rrf tEa acdeerin, _._.__._� .___.__.__. __._._aODLYINJURYiPerp S AUTO _ _. _OWNEO ISCNEDULEDfOS IAUIOS 'PROPERTY DAMAGE NONOwNED . £DAUT05lAUTOS $ RELLA LIAR OCCUR EACH OCCURRENCEESS I" AGGREGATE .,S _•. __CLAItlS-MADE l _______-___._. ._ 5 DFD ! RETENnIN14VA;STATU- IOT !WORItERS COYPEMSATION i ` _X_ .T08TR5.. ER.) ANo EMPLOYERS'LMBILITY Y I N I ! E L EACH AGODENT f 1 000,O6o_ ANY PROPRIEtORIPPRTNERIF.%ECUTIVE�I WC 50-90-735-05 1110112013 ;11101r20l4 .- .. A I DFFICERINEARSER EXDLUp-.' I`J EL DSEASE EAEMPLOYE 5 1,000.000 !iMmWmwylo NN) �._. 'rl yyeess oes E 'ER" E.L.DISEASE-P011'Y UWT .s 1,000,000 � DE$CRIPTNDFOPERX" UMPN l Location Coverage Period: 111012013 1110112016 Clientif 821 I DESCRIPTION OF OPERATRMS I LOCATIONS I VE LES(AnxM1 ACOAO 101,A44iliontl Nmrlmhs Sctr4ale.M mon•PPFe la rep"^M) Nonh Shore Rental,Inc.dba.Events for Rent Coverages provided for 464 Lowell St only Those employees Peabody•MA01960 leased to W not suocomractws of. CERTIFICATE HOLDER CANCELLATION L464 h$hOTe Rental,InO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North EVen15 for Rental, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISWNS. Lowell St body MA 01960 AUTMd111E0 REPRESEMTATIV� ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NORTH4 OP ID:ES A�OKO CERTIFICATE OF LIABILITY INSURANCE M04130/2014l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)most be endorsed. N SUBROGATION IS WAIVED,subject to the terra 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 COME T Elizabeth Saville Insurance Group,Inc. NAME, 500 GrantreAve SW10 s .tort Np,P;II 617-479-6600___. N,t_617479-8789__ Mahon,MA 021R Daniel P Sullivan eAms_savilleLDbeninsurancesouth_com___--_,-____.__-_,-__, - INSURERISI0.FFORBDJGfXNERAGE I NAICt ----------------------------------,_._-- INSURER A:Nova Casua wsuREo North Shore Rental Inc. INSURER a Chris Leblanc -------------------------�------- 464 Lowell SL _m_wnc'-------_----------------------------- -.._----- Peabody,MA 01960 wwBER 11- RISIIRER E INSURERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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. INSRT— —TYPE OF aISI/RANCE—_.--_..� '�� PoLICY NUMBER TP�LI(:Y EFF ;MYAdYYYYD c)FERV T UMIn TR A I X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE _ 5 1,000, _-'CLAIMSMADE X j OCCUR 'IRNT-CI -0001043" 0410172D14 04M7/2095 pRR�s5P -_70_0,0 rMED ExP(Any orw perNon) 15 6,00 I �PERSONAL BADV INJURY IS 1,000,00 GENT AGGREGATE UNIT APPLIES PER GENERAL AGGREGATE .5 2,000, 000 POLICY r�,JE T 1 LOC i PRODUCTS COMPIOP ACG I$ 1,000,000 OTHER' L_ AUTOMOBILE UABILRY 1 '„ C NEO SIN LE LIMIT IS 1,000,00 _ Ea aaiaen9.___-- O"1=15 BODILYINJURY(Pe1RerNOPI !,S A I �ANV AUTO ;RMT-MH-0010M.0 04N1/2014 i, __—I AUTOS O,VNED X :.AUTOSULED BODILY INJURY(Per ar�0 p $ALL .- SC NONOINNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS - - - I$- I X UMBRELLA 11A8 iX OCCUR 1 EACHOCCURRENCE A ExcEssuA9 _ cLUMSMAcei iRNT-UM-0010271- %04/0112014:04101f2015 AGGREGATE s 1,000,0 F ---T 10,000: i ._— s DED X RETENTIONS ;WORKERS CONPENSAnON - STATUTE ERTM AND EMPLOYERS'LIABIUTY ' - "----- - i' "'-- ANYPROPRIETORIPARTNERIEXECUTNE YG�NIA EL EACHACCIDEW I DFF)CER:'MEMBER EXCLUDED' ;(WnOabryin NH) E1_DISEASE EA EMPLb_EE_S __. _". .___ 'It %,CBeaiUe uneer i _ �DESCRIPTION OF OPERATIONS Dawn ' E.L.DISEASE-POUCV UM1T Is i :i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD let,AMQtlaMI(mmrls SYJIemrle.may M AUAcNali V m `H aces M') Party Goods Rental. Evidence of Insurance Coverage CERTIFICATE HOLDER CANCELLATION NORTHSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Shore Rental inc- ACCORDANCE MnTN THE POLICY PROVISIONS. 464 Lowell Street Peabody,MA 01980 AUTHOR=REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 2S(2014101) The ACORD name and logo are registered marks of ACORD