7 LORING HILLS AVE - BUILDING INSPECTION (4) /zfo 32
t S� Z � cJ� 5-
1 The Commonwealth of Massachusetts
p Board of Building Regulations and Standards RECEIVED CITY OF
4 , 7801A5.�T�G" $ER SCE$SALEM
Massachusetts State Building Code,
. . Revised rLlnr 20!/
Building permit Application To Construct, Repair, Renovate Or a lisp Q�
One-or Two-Family Dwelling III% JUL ��
This Section For Official Use Only
Building Permit Number: Date Applied:
3uilding Otfic' I(Print Name) Signature Date
SECTION 1:SITE INFORMATION
F--,ot"
erty Address: 1.2 Assessors Map& Parcel Numbers
is an accented street?yes no Map Number Parcel Number
ng Information — - IA Property Dimensions:
is'net Proposed Use Lot Amu(sy fq Frontage(Il)
1.5 Building Setbacks(ft)
front Yard Side Yards Rear Yard
Rcyuircd Provided Required Provided Required Provided
1.6 Water Supply:(M.6.L c.,10,§54) 1.7 Flood Zone Information: . 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Lone?
Check ifyes❑ Municipal ❑ On site disposal systern ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerl of Record: T ',I
N:une(Print) g9 t� City.State.ZIP )
7 4 1P(r Ut q /7/{l P x28��" ZDO
No.and Street "telephone I;:mail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief DescriptionoFProposeyd Work': '.��-- ✓ p7a3d /t2tyff—Ftom
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and itMaterials Y
I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (I IVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $_
Check No. Check Amount:_ Cash r\mount:__
6. Total Project Cost: S Uv ❑ Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder '
List CSL'fype(see below)
'71 ar
No.and Street ''' t Type Description
ft Unrestricted(Buildings tie to 35.000 cu. ft.)
Cityll'own,State,ZIP It Restricted M2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(111C)
v{ FIIC Registration Number Expiration Date
Company 11K Name or 1ilC'egistram Name
yiny 1D r- S
N u Street Email address
x bow . l� 2T 0 9 �8 S35 J"o
Cit /Town,StaQT,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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 i of the building permit.
Signed Affidavit Attached? Yes .......... Er No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEWMIT
I, is Owner of the subject property, hereby authorize-25- /6r— ��tf
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) pate
SECTION 71): OWNER' OR AUTHORIZED AC ENT DECLARATION
By entering my name below I hereby attest under the pains and penalties of perjury that all of the information
contained in t 's artwinis true and accurate to the best of my knowledge and understanding.
Print Own is or Authorized Agent's Name(F.Icctronic Signature) Dat[
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(FIIC)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.mass.,ov/oca Information on the Construction Supervisor License can be found at www.nr�ss.'_'ov/dos
2. When substantial work is planned,provide the information below:
'Fatal Floor area(sq. ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) Habitable room count_
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of balf/baths
Type of heating system Number of decks/porches
fypeof cooling system
____ Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
1
• 6 z4�i�c. A3 N,. sF fF gW'NaAre
q y$ p yv 't J F F .A t 'AY 1 y y
Sw�r1a1W �T •'J V' °i.�`";,'' V3 V ' �'_.`Q' si+vr gyS'!Y "(�'�.,Y V�, N t"`i'Q'it ,Ct . l r:
tl s UMPMu, :a wn i .- 'r.. :ay#:ir' .. .. +- � .cfi"5 �a`'S ,41i' it��ar.%''t ; :P t{#'° rr
s T L e i o lame�esisfance PAGE 1NS
Af�e
t 4 "
j, Date Manufactured AZTEC TENTS
y
n,* 2665 COLUMBIA ST INV NUMBER: 0179791 ^
try(, O3/24/2010 TORRANCE, CA 90503 P.O. NUMBER:
x f800) 228-3687 CUSTOMER NO: EVEN019 3'
`ys This is to certify that the materials described below have been flame retardant
aim? treated (or are inherently flame retardant).
I:YC!r:i pesn ' m F-223.W
"3 °«'°� mhx 12, 16.19°e F 1901 %f '
Allied Financial Solutions
Events for Rent CmreC Fx°na Oe.rV'o t6./2o'i 152002 �yGi.:•.
r 7303 Turfway Rd Ste.306 t"
464 Lowell Street o>F "' 'mar °`a =59;oz v
Florence, KY 41042 x
Peabody, MA 01960
1 imzn Nemmse n: 3 F o, '
Fa'ra� rs«,nv."•roz F oe �t�
4 i..n°•)e+v es m�'e.«^. rso0 or Y7a,.,i,
sower F ao W.�S
Ot
___ in Van[ape Frei95un°rNld i 368 t@3b.
w .. __._.. _ °3 .
r'-i 3M Certification is hereby-made that the-artictes described below hereof are 'made i°�a,�,°, ag_� F„ ,o
,�?rw from a flame-retardant fabric or material registered and approved by the r"°."<aq. °.�u.9w.=� F°s=o i# :Y;
California State Fire Marshal for such use. The fabric has been tested and TnOan'^9e w.°'°""°°""` F 06901 wp
V.n.iG<9 Wra5kin.113 .1515 FS]°°l ✓i=>
P3i passes NFPA 701 Large Scale. See chart to right for trade name of €,4>
4��� flame-resistant fabric or material used and additionally referenced on the label . '
lAl� of the fabric panel.
THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING
David Bradley General Manager-Manufacturing q+.°•
�� Name of ADPlicator or Produtt�on superintendent L[le of Applicator or Production Superintendent
�. nkA,S�51
ITEMS MANUFACTURED TYPE PRODUCED
15x15 1pc Festival Top UW 5 1
w/ Rope Tensioners & Flag
with secondary valance
15xi5x8 Festival Frame Only S 1
15x30 Ipc Festival Top UW S 1
w/ Rope Tensioners& Flag
with secondary valance
15x30x8 Festival Frame Only S 1
(2Peak)
20x20 1pc Festival Top UW S 1
w/ Ratchet Tensioners &Flag
with secondary valance
20x2Ox8 Festival Frame Only S 1
2000 ipc Festival Top UW S 1
w/ Ratchet Tensioners &Flag
with secondary valance
20x3Ox8 Festival Frame Only S 1
(2Peak)
20x40 Ipc Festival Top UW S 1
w/ Ratchet Tensioners&Flag
with secondary valance
20x4Ox8 Festival Frame Only S 1
(2Peak)
CITY OF SALEM, NL1SSACHL'SETTS
4
• 4 �f BUILDING DEPARTMEINT
120 WASHLNGTON STREET, 3`o FLOOR
sQO ) TEL (978) 745-9595
F.vY(978) 740-98.16
KI\(BERLEY DRISCOLL
AAYOR Trio\tAS ST.PIF-UE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO\I\IISS[ONEIk
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print t epibly
MImc (ilusiness OrganJiraliominJividual): /' /(JP_N / l Z In 1--
Address: y6 // z o GuP
Cily/State/Zip: J 0PhoneIt: _ 57 -Sa 3S^
Are yet n employer'.'Check the�propriate box: 'type of project(required):
1. 1 am a employer with 1_ 4, ❑ I am a general contractor and
employees(full and/or part-time)." have hired the sub-contractors 6• ❑New cunswction
2.❑ fallen sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers'comp. insurance. . 9. ❑ Building addition
(No workers'comp. insurance 5. ❑ We are a corporation and its
required.] of iccrs have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions
myself.(No workers' cutup. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] a employees. (No workers' 13.❑ Other
comp. insurance required.]
•Any apph asil dot chcuka bux rl most also rill out the wul;un Inluw showing elicit worked eumpensmiure policy inlLrmutiun.
'I lomeuw'nen who suhmit thin amdnvit indicating Ihcy arc doing all work and then hire outside aontmctnn meet juhmil a new arndavil indicating such.
:C.""I"turs elate cheek this box must mocha(an nddiliurctl A.1 showing the natne or the tub.ontnctun and their workcn'cutup.policy information.
I out an employer drat is providing workers'eunipeu.mtlon in.surunce%r my eurplayees. pelvis is the pulley and fob.ri1a
irrftrtnution.
Insurance Cant art Name: •� / f t r
P' Y- _._L..aL .`.-/�N'r qP d'i/"G H ...L r/ r�4KC.X La
1'ulicy it or Self-ins. Lie,th ��J` — b62 -�Q:,�3.5^ �.� Expiration Dole: //I
lub Site Address: � T p Pr(kl�City/Statcaip: —� ,e �.4 919 70
Attach a copy or the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MCI.c. 152 can lead to the imposition of criminal penalties of at
tine up to SI,SOUAO and/or one-year imprismement,as well as civil penalties in the form ofa STOP WORK ORDER and a lino
of up to S2.i0.00 a day against the violator. Ile advised that i copy of this,statement way be 1'urwardcd to the 011ice of
Inv e,aigatiune ol'the MA for insurance envemge vcrilicatiun.
/do hereby certify under flee poi s eJ penalties UWJ 0rjury that the inJurnrarlan provided ubuve is true and correct
Si •n t c 5 t�� 15�f2%�„�r� Uate: .f_[or/y
011iciul use auly. Do not write in this area,tube completed by city ur tolva o/Jlciut
C'irvnr'fuwn: _ Permit/I.Iecnse#
(%suing Authority (circle one): -- -. --_- ---
1. ti Unrd(it'Health 2. lluildlnl; nep.lrlutcnt 3.Cilylfnwn Clerk 'I. Elertrial hnpn'rur 5. Pinmhing Inspector
G. Oilier
i
(dulact 1'c non: Phnnc 3 I