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7 LORINGS HILLS AVE - BUILDING INSPECTION '11 The Commonwealth of Massachusetts 1 l) Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, T"edition OF SALEM "'www Revised Junuur, Building Permit Application To Construct, Repair, Renovate Or Demolish a /. 20MV One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I Date Applied: Signature: y Building Commissioner/Inspector of Buildings Date SECTION 1: SITE INFORMATION L(_Prgperry Ad ess: // ✓e— 1.2 Assessors Map dt Parcel Numbers I.Ia Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(B) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: I' .� , 7ori `r-rss �- (r 55 v e K� /D rk— /O pu bllsr u F // ✓2 Name(P 'ni Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ AdditiodO Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: 011lelal Use Only Labor and Materials I. Building Is 1. Building Permit Fee:S Indicate how lee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S LOtherS 4. Mechanical (IIVAC) S 5. Mechanical (Fire SSu ression Check Amount: Cash Amount: 6.Total Project Cost: S y�O 0 Outstanding Balance Due: P_ SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CJR Number Expiration I}Jle Name of CSI--I lulder 'rype(see below) Description Address tlnrestricled u to 35,000 Cu.Ft. Restricted IR2 FamilyDwelling Signature M Only Residential Roolin Coverinfclephone Residential Window and SittinResidential Solid Fuel Bumin A liance Installation Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) I IIC Company Name or HIC Registrant Name Registration Number Address Expiration Dale Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GJL to 152. 1 2SC(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 Issuance of the building permit. Signed Affidavit Attached? Yes ..........0 No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OJW,NERI OR AUTHORIZED AGENT DECLARATION I, Z;I✓e K f$ f-p/- as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. PrinCName // Signature ofOwner or Authorized Agent Date' (Signed under the pains and penalties of 'u NOTES: 1. 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(HIC)Program),will Vj have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations I I O.R6 and I IO.RS, respectively. �. When substantial work is planned,provide the information below: Total floors 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 half7boths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 1 I M P O R T A N T DOCUMENT ?nPnrnrr��n�nrn�n�r��nrnnrr�nrnnrrrrrsrrrsr��nrrrr� 5 5 ,rertmtate of f lame taurp 5 REGISTERED ut, Date of Manufacture 5 APPLICATION t 03/07/00 5 NUMBER NDUSTPIES ING. $ ~ EVANSVILLE, INDIANA 47711 Order Number 5 FINA 5 ' ' 311549 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 1101119 5 PAUL W. GRILLO CO.#13528-8 5 t+ 464 LOWELL ST. C, 5 PEABODY MA 01960 rM ITLJ Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California Fire S Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. S The method of the FR chemical application is: c Serial #: 8106400(14) 5 Description of item certified: 5 TENT WALI&S26-10X222/CAW Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of Th//e Fabric 5 Signed: 5 JOHN BOYLE STATESVILLE NC 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. cfcPcPc!r@pE rL3pLFlrncPcjr:9ocjj0EPrJ@PrlrJ�rJrJdr�cPcPcPcPrJrfdcPCPrJ�cPcP[lucfrPrJ�rlJcPcl�rJcPcPrPcPcJcfJrJdrJcPcPcPcP[PcJ�efocPcPrPr�cPrJdrfCPcPcPcPrJ�cP�cPr frJ@PcPcPrJ�CPrJ�rJ� S rJ�rJ�r P�Pr Pc1'rPrJ'rJ'rJ@f'cPm®rc1'rl 1 M P®R`! ANT DOCUMENT'''cPc''�J'rl'ct@1'`P`P`n`P`P`''`P`''`P o Certificate of f lannle ses1st2avice 5 ISSUED BY Date of Shipment REGISTRATION S APPLICATIONa azvzoosNUMBER IN Tent Identification 5 EVANSVILLE, INDIANA 47725 040s0135 5 =12L4 MANUFACTURERS OF THE FINISHED S TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: 5 692825 5 RICE RENTAL CENTER TAYLOR RENTAL CENTER 5 115 CABOT STREET 5 BEVERLY MA 01915-5108 S 5 5 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 Serial# 802.3,000(1) 5 5 Description of item certified: PI]All 101'20W X 20 W W VI. Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric S S Signed' Q J01-IN BOYLE STAITSVILI L NC'. U SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. EI cP rPcPcPcP Pg III cPr rP Pr� rPcPrPrJ lt'1rJtPcPfc cPcPcPcPcPcPcPrPcPcPcPrJ�rPcrcPrJc PrPr�cPcf�c P[ cPctcPcPcPrlcP�PcPcPcP�PrP�PcPrJ�rP�Pr Pcff2l�cP UMENT r.nrlrJ�rPrP�r-cPrPr-PrPrJ�cn�nrPrl�nrli 5 5 Certificate o �lam: `Rc:�tstax�c�; 5 EI ISSUED BY N REGISTRATION t A Date of nufacture 5 3lZ3104 APPLICATION Q s NNoc e�IR C5C NUMBER Order s Number 5 5 0 Fi EVANSVILLE, INDIANA 47725 382274 P121 4 r MANUFACTURERS OF THE FINISHED _ 5 21 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to:293200 5 C5� EVENTS FOR RENT INC#13528-8 5 5 5 5 464 LOWELL ST 5 5 W PEABODY MA 019602741 5 5 5 5 5 5 Certification is hereby made that: 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California 5 55 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 The method of the FIRchemical application is: ..,.---1 �5 SSerial Si 5 80z3300(3) 5 5 � 5 Description of item certified: 5 F11;SFA P.XPANUABLF MIDDLE 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 55 5 „ , ,,,., rrrcv❑I P NC Slgne : 5 STENT DEPARTMENT-ANCHOR INDUSTRIES INC. 5 cPcPrJ�rfcPcPcPrJ—rPcPrPrl�PcP�PrlrPrJ�rPcPcPrlcPrPrPcPr1cP�PrPrPcJ�cPr1rJ�cPcfrJcP�PrlrJ� cPrJ�cPcPcPcPcP�P�PcPcPucPcncf�rJ��cPcPcPcnrPrJ�cPrJ�cP�PcPrf� NUffleftym CERTIFICATE OF LIABILITY INSURANCE OP AR °""'I HORTB-! 04 08 10 ISSUED--'rWC6]RTIF1CATe IS AS A MATTER OF INFORMATION ONLY AND CONFERS NO RrAM UPON THE CERMICATE Berry IIIBVSance Agency HOLDER.THIS CERTIPICAT9 DOE$NOT AMEND,EXTEND OR 9 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Franklin MA 02038 Phone: 800-824-5201 Fax:508-520-6914 INSURERS AFFORDING COVERAGE NAICa INSURED WSURER 4 . PaoT nPe c Ha2sP! aaA. m. RNBaiRER e: N 1h Sgle Rental Inc. ;BrefRERc Peabody eKh01960 INSURER m xNSDREa B, COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.MOTWTnaSTANDMG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNICN THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL ME TERM&EXCLUSIONS AND CON1MTIOM$OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L N9 TYPE OF WSU LANCE - POLICY NUMBER ' A ME" LBD1T9 ceNBRAt LLAeaRY - EACH occuRREINCE _ S1,000,000 A : --X??'iC��OMMERCwL GENERfffAL LIABILITY CXOO220071 04/01/10I O4J01/101PRFy19E $ l0O 000 CLAMS WOE EX] OCCUR MEo EXR(AAT ere pwnpll) !l 5,000 PEa$ONAL$ADV INJURY I11,0001000 GENERAL AGGREGATE 1% 2,000,000 I GENL AGGREGATE LOWT APPLIES PER: I { PRODUCTS-CONP/OP AGG !31,000,000 POLICY ,fiC L% AUTONOBp.E L1ABILtN , COMBINED SINGLE LIMIT $ 1.000,000 A IX ANY AUTO MA00200332 04/01/10 04/01/10 (S.octltl ) ALL OWNED AUTOS i BODILY INJURY $ SCHEDULED AUTOS HIRED AUTOS aKlDllr iMURY ' NON-0YMED AVTOS ! j(PeremlDAni1 PROPERTY DAMAOE I GARAGE LIABILRY AUTO OMY EA ACCIDENT I$ AUTO ' OTHER 714M EA 4CC ! AUTO ONLY, AGG-S IDtcEBS I UMBRELLA LWmLT' EACN OCCURRENCE $1,000,000 A occuR CLAMS MADE 502XABS14 04/01/10 i 04/01/11 'AGGREGATE J11.000,000 DEDUCTIBLE ' $ 'X RETENTION S10,000 , S AND EMPLOYERS'LMERRY rrMl I �T RY tMRs ER ANY PROPRIrTjp"ARTNERMCU EL EACH 0.CCDENT § OFFICERMEMBERE%CLUOEDY ,n _ (w IIMtP,T In NH) E.L.DISEASE,EA EMPLO S II yyss, de.vro LRddr SPRLAL PROVISIONS be w :E,L.DISEASE-POLK;YLSMT ! OTHER A , Equipment Floater CX00220071 04/01/10 04/01/111 Equipment $600,000 Dad. $1,000 OESCRIPTION TIONSILOCATMS IVEHICLES/EXCLUSIONSq BYEMDORBEMPN$ISP�.'iN.P Party Goods Rental CERTIFICATE HOLDER CANCELLATION SHOULD ANY 9P THE ABOVE oea AMD POUCHES Be CANCELLED BETTORS THE E)0Ied.T10M NORT888 DATE TIISREOP,THE b91laNG PNBURBi WILL ATIDEAtloR TO MAIL 10 DAYS WRITTEN NOTIDS To THE CETRT"I"CATE MOLDER MASSED TO THE LEFT.BUT FAILURE TO DO SO SMALL taPOEE NO OBILOATm N OR LA ILaTY OF ANY KWD UPON THE WMMIIR,RE AaEMTS OR North Shore Rental REPFaF.MMATTvfs 464 Lowell St. Peabody MA 01960 ACORD 26(2009101) Ilta Imemod_ The ACORO name and NDgO aft ra®EeMrep marks of ACORD ACO&P. CERTIFICATE OF LIABILITY INSURANCE 11/01t2009009 W0 Y) 11f PRMUam THIS GERTiFICATE IS ISSUED AS A MATTER OF INFORMATION )^� ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Frank Venuto HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Go ARIA,Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES 6 LOW, 529 Main Street;Sulte 606 Boston,MA 02129 INSURERS AFFORDING COVERAGE NAIC# 14OURED INSURER A; ZUr`Ch-Ameripan Insurance Company ANeglert Management Corp. WBURERE: 300 Lafayette Rd. WSURERC: Rye,NH 03870.000 ,INSURER o INSURER N COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT TERM OR E MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFOR ED BY THE POLICIES DESCRNDITION OF ANY CONTRACT OR IBED HEREER IN DOCUMENT UBJECT TO HALL THETERMS,WHICH XC USIONS AND TCONDI CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAN CLAIMS, INS — POLICY NY ICY THE POL4Y Lean TYPEOPINSURAMCP GENERAL LIAaaRY EAOHOCg1RP.ENCE S COMMERCIAL GENERAL UABRRY .CLAIMS MADE 7OCCUR MED EXP aN 5 PERSONALAAWMJURY Is l GENERALAfiOREOATE !i GEN'LAGGREOATE LIMn APPUESPER, PRODUCTS-COMP(OPAGG i 'L00 MO01LEiLBIUTY PRO' COMBINED AINOLB UMrt AIITO I(EDODaNmC) { ANY AUiO ALL OWNED ALTOS li I BODtLYIww" S SCHEOULEOAUTOS I ---- WREDALrtOs I SGUILYYNMURY s NON.DMMEDAUTOS I PROPERTY DAMAGE !(Pme Mono s GARAGEUARL" AUTO ONLY.EA ACCIDENT I s ANYAUTO OTHERTHAN EAACC f AUTO ONLY: D s UCrOMMIRILLALIABLRY EACH DCCURRENCE s I�OCCUR l CWMa MADE 'AGGREGATE S S ( S DEDVCTiBLE i � RETENTI N i s ' X WC 9TA U• OTFL W WIRERS COMPEITSAnON AND I VwwYER;'UA9MTY EACHACCIDENT c t,000.OW A OyF�eYPROPRIETO"AA`rMRwC ECUrnE WC $0-90-736-01 11/01/2009 111/0112010 04FIX,014EASE-FA EMPLOYEE i Too0.000 NP w R vl i�N ` GL.DtsEASe.POLICY LIMIT S I'Mo.000 OTHER CereHlDBteO: 09NH0027B089S Location Coverage Period: 11101120D9 11101/2010 CIInW. S21 DESCRernON OF OPERATIONS I LOCAMMS I VSIRCLES/E%CL MOWS ADOEO BY ENDORSEMENT/SPECIAL PROVISIONS Cover"o B prevwed fa Dnly North Shore Rental,Im.dba:Everts for Rent Irmo SM190yees Is eed tc 464 LO"I St Out not aubcoMractcls of: Peabody,MA W960 CERTIFICATE HOLDER CANCELLATION 9NO1LD ANY OPTNE ABOVE DESCRIBED POLICIES aE CANCELLED BEPORETNE ptPIMTNiM DATE THEREOF,THE WVUM D INSURER WILL ENDPAYOR TO MAIL 30 CAYB WRITMN North Share Rental,IRC. ""CE TO THE CEINNICATO HOLDER NAMED TO THR LEFT,OUT FAILURE TO DO SO SMALL dba!Evertis for Rent Impose NO OBLIOA110N OR LL48ILSTY OF ANY RIND UPON THE INSURFA."AGENTS OR 464 Lowell St REPRESBNTAINES. Peabody,MA 01960 AVTNOROEDREPR89FJfrATIYE ,Q ACORD 25(2001/08) 0 ACORD CORPORATION 1900 I