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Home My WebLink AboutBuilding Permit #745 - 1160 GREAT POND ROAD 5/9/2013 BUILDING PERMIT of"°oT b qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ° � b Permit NO: ° Date Received SACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page 31 LOCA?l0N f � ,fgtt =x1 ; Yf PROPERTY O1NIER 'ds � ` n mr EMAP 21I) PARCEL ZONING ,'STRtCT . 'istor�c is#riot yes o I1llachmage yes nog TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: —.6Mp 77-1h Demolition Other Septic VIle11 Floodplain 1lUeflarads : 1 ,aershed District WateriSeweTv _ y DESCRIPTION OF WORK TO BE PREFORMED: Y- d0 Xao Ire- rcaKv 7-ell ori (0 Xn m o-v e cf &vi (P A 3 Idification Please Type or Print Clearly) OWNER: Name:-Z-61-75 S'c�i�/ Phone: 97F- 630D Address: x ON "RA TOR,,.Narne- _ �� Ph .4 Address u 4pervisor.s Consthuctioa� license' t ( 1. E�tp� r irnproverraent tcense h` date _ , r :._ T - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Sim FEE: $ U. a-n Check No.: �jc �1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc ss to the guaranty fund Signature of Agent/Owner ,�, ,,�, �, Signature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H:I.C. And/Or C.S.L. Licenses ❑ Copy of Contract. ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass _check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBSwinunirig Pools ody Art Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on- Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &-Date Driveway Permit DPW Town-Engineer: Signature: Located 384 Osgood Street A:F;Ik D°EPAftiTIM 1T l'emp umpster on site' yes k ' r nO Located at Itll 24' am y 4a k r :Fre Department.signatulre7date i Dimension Number,of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of . -Electrical Inspector Yes No- DANGER ZONE LITERATURE: Yes No " MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date" Doc.Building Permit Revised 2010 n . Locatic�� No. Date TOWN OF NORTH ANDOVER -� Certificate of Occupancy $ Building/Frame Permit Fee $ d Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r- Check#— fp f 26370 Building inspector - ,. NORTH - W. _ )ver 0 h ver, Mass, ' -� coc"Ic"twick �•9 A�RgTED Cl S t7 BOARD OF HEALTH Food/Kitchen .PERMIT T LD' I- Septic System THIS CERTIFIES THAT -Q..C7..! ..........3<-0 ot.).................. BUILDING INSPECTOR ........................ rr has permission to erect .......................... buildings on ....... .. . . ?. .. :(4f�1................... Foundation Rough to be occupied as �vV 0 �e~'! �. e nTS .............. ...................:. .......... ........./^.............................�....................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of.North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough Service ................... ............................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE i I I TRUCKS TO ENTER HERE I W /CYn_ 0'.20 v 1 9'.10'CANOPY 60'x 100' TREE Z :TREE 65'FROM TREE TO , TREE CORNER OF TENT TREE TREE W I I EE E) TREE TREE TREE W L ri I BUILDL W - DRIVEWAY BUILDING I STREET STREET r' I 2 3 4 5 F 100 Please dropall cables on stage side 9 ti D D D D stage 100 Multi , O — 5-QB X00 foo ?disonYdi 60 100' Multi O ison 00P1==0 L�- 66TP n p _...__.._.. ------ All Cables are marked with- "To Peak" 10' should fall inside the tent! THANK YOU ! "`E ._.. .. .... veNue DIIAFTED BY: OE916NED DY: i +corzD CERTIFICATE OF LIABILITY INSURANCE DATE J:N Pd,'DD;YY2 `-� 10/19 , 0. THIS CERTIFICATE IS ISSUED AS A h1ATTER 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) must be endorsed. If SUBROGATION IS WAIVED, subject to 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). ROOL!CER CONTACT r;A Michael Bonacorso raE ionacorsc Insurance rgency, Inc. PHONE /B1 273-3200 FAX fG' r� F,rl' (� ) (A" Nol: (75' 273-0600 13 Carit.br_Cd e Street 6N!AIL , g A.DDP,E� I^,i,{e@DOnaCOrsoins.CO?^. '.0. BOX 1502 INSURER(S)AFFORDING COVERAGE I P7AIC suriirgton rL 01803 INSURERA:hcadia insurance Company ISURED i INSURER e:C N E Insurance Co. , 'eterson Party Center,, inc. INSUP.ER c: IM Mutual Insurance Co. 16 Cabot Road wsuRERD: l INSURER E: 1 fo'burP. 01801 LNSUR°R F :OVERAGES CERTIFICATE NUMBER:2012 M_sler REVISION NUMBER: THIS IS TO C_RTiFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTLMTHSTANDING ANY P._QUIRENIENT, TERM OR CONDITION OF ANY CONITRACT OR OTHER DOCUIMENT V'•ATH RESP_CT TO YMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNIS_, EXCL USIONS AND CONDITIONS OF SUCH POLICIES. LlNlITS SHO`-PIN PJAY HAVE BEEN REDUCED BY PAID CLAIMS SR I RA DDL SUER; I POLICY EFF POLICY EX? Tr, TYPE O`IriSUNCE I ip7co I y: I. POLICY NUMSER 1NVI,100fYYYY) I'.1:V1iDDlY YYY) Lli,nS GEN ERAL.LIA SILITY —. EACH OCCURRENCE I S _1 ,0()0,0O0 X I COiMMERCI;:!-GEN ER•L U-SILITY I i D.-rd.=,GE TO RENTED I I PREt•,IISES(Ea occur, S 100,000 1 I CL:MS-M_^DE �� OCCUR. A I ICP.- 5061026 1G 10/9/2012 10/9/2013 I I I, � I I" ibtEO EXP irny c. perscr; I S 10,0001 PERSONAS aA.Dv-I,vJ'JRY 1,000,OOG G_rl_RALA3GeEG�T= I S 2,000,OOOI rLAGGREG^TELIP:IITAPPLIEsPER I I FROGUCTS-COM.m!OPAGG� S 2,000,0001 o�0- I i i POLICYF Y I .I - LOC AUTC?.tOBIL=LIAcIL'T'fl i j COib?JI�1:=D,Si:NIGLeUMIT I OGO OOOI (A.0 T O I coD':L 16VJUR'(Per_=r c-) I ' I iGS _ A_JTOSJ f. iG 10/9120:_ 20L ! EOv!LY1PL!JRYI _. _ :cants! X I Hi P`v•..0 TOS X I ,TC I ' c=-OP TY DAMAG r t j X1 uh+.3REL�uaa X i OCCu;: i I EACH OCCURRENCE` j s 1G,000,OGGj i EXCESS LIA13B . 1' AGGREGATE I iG,OGO,OGO 110/9/2012 _0/9/2013GED TEPTiONI508549645 WORKERS CO`.1?cNSATiG": I +•VC SIATtJ- uTn-, j AND E-NIPLOYcRS'LIABiL ITY Y/N I T I ! s IC' I 1 ORY I_M1;IT: . desaia 0/9/2013 X : I I ELECHACIDI:Fl ; ECLJO DI� rlAr i _000,000 'cry D!S_ _ E E.tFLO E I !a da unae 1,000,000 GESCRIPTIGP OF OFERcrIC,,yj'.:!,:v EL.DISEASE-POLICYLIMIT I" 000,0001 ! I j i I I i I I I 'ESCRI?TION OF OPE.---TIOrIS I LGCATIGNS I VEh!CLES (Attach ACORD 101,Additional Remarks Schedule•if more spat=_Is required) -EP TIFICATE HOLDER, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J. Bonacorso :CORD 25(2010105) O 1938-2010 ACORD CORPORATION. All rights reserved. NS025,w,ijrS;o' The ACORD narne and logo are registered marks of ACORD The Commonwealth ofMassachitsetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Q�y,2vl, Ot Fq/ Phone #: 7.,79- y0�o Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with,,:;,?y cD 4. ❑ I am a general contractor and I employees(full and/or part-time). havehired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers comp. insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.F1I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.2 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer l a ' that is provrdmb workers compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic. #:6x,)Md U �'(p Expiration Date: /6 /9/3 lob Site Address: ��POPyf 4G1'IGC 2l City/State/Zip: / �i/l�� 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. I do hereby certify under the pains and penalties ofperjwy that the information provided above is true and correct. Signature: Date: /3 Phone#: � 1�' 4/'0 UZ} Of use only. Do not write in this area, to be completed by city or tower official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions L Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,.employing employees: However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that,"every state or,local licensingagencyshall withhold the issuance or renewal in of a icense or permit to operate a busess or to construct buildings in the commonwealth for any applicant who_has not produced acceptable.evidence of compliance with the insurance coverage r`equired." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political.subdivisions shall. enter into any contract for the performance of public work until acceptable'evidence of coinphance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out` the Workers''compensationaffidavitcompletely,by checkm'g the boxes that apply to your situation..and,if necessary;supply sub contractor(s)name(s);addresses)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Liriiited hiabilityPartnerships(LLP)with no employees other than the members or partners,are not requiredao carry workers' compensation insurance. If an LLC or LLP does have employees;a policy is,require Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents Should you have'any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance.license number.on theappropriate ------------ City or Town Officials Please be sure that the affidavit is complete and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill inthe permit/license number which will be used as a'"reference number. hi addition;an applicant that must submit multiple perrnit)license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town). A copy of 1.the:affidavit t1 1.hat has been officially stamped or marked,by the,city or town may be provided to the applicant as proof that a valid-affidavit is on file for future permits or licenses 11 A new affidavit must tie filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business'or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for.your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia t�j massachusetts - Department of Public Safety V Board of Building Regulations and Standards Construction SuperNior -u �s License: CS-060219 r , DLA RK TRALNA , 33 HANFORD RIX � f Stoneham bL4 02180 Expiration Co mrniss ssii owner` 04/27/2015 )611,c Gl l��ni:tiun�tr r\lia;rc l S:(;ernc�ti(:e�ul:riiud HOM RG AEAJT C _'-- `•-'�. _ IriiN� Vim.' CG,1TR,�. TGP. E:c,-!-kion: fi3L201 i;tc ,'i: _i.}' TRA i ORD t!IId IriC. o n ' I.,icCnse ur re_i�tr:rli�,n e;il.iil I'�n hills�.irlui rise vni. hCII)I'C the C.NIrirution tLuC. If rVunl.l c hum In: 1)rficC orC!�n�un+cr:\flairs anJ I;u�inC� 1CC��ui;rti,{:. II) I';rrh Plaza-SuifC517 U21 16 ;j NW %;Ilirl knout�i,n;ur:rc 0 Q� Q�TA T�n��n��n�L3n��rP� o sCortif lCate of IFIa si is 5 5 ISSUED Bv�� e � 5 SREGISTRATION �j Date of Shipment APPLICATION Q �' �� m e 5 5/12/2005 5 T NUMBER �► INDUSTRIE INC.5 5 Tent Identification S ! EVANSVILLE, INDIANA 47725 5 Sx140.1 c ° MANUFACTURERS OF THE FINISHED 04048575 ] 5 TENT PRODUCTS DESCRIBED HEREIN S SThis is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 5S657150T, PETERSON PARTY CENTER INC 5 S139 SWANTON ST 5 5 WINCHESTER MA 1890 5 Ul 5 5 5 5 S 5 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 Schemical and that the application of said chemical was done in conformance with California S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 SSerial # 8151310(I) 5 5 Description of item certified: 5 5 CENTURY URY END 60WX20 LOOP SNYDER �5 5 WHITE VINYL,WITHOUT WEB GUYS 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDER MFG NEW PFIILADLLPHIA OH Signed: Cj U `-ISPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. Pj frJcP�fc1��PGPcJcIcPc1�cJ�r 1�.Ic t7cnc firJ�c lc(�rJ�c1 atJr1�cJel�r�rlcPrJaePrJtJ7rJ��Pc ftJ'rJrJ��Pcf7clrJ�rJ�rJ�rJ�r.JJ.P�Pr_fc1r�cPe!"ar�r�acJ-L3PC [nrJcJ7rJ�cJ�rJ�c.I�rPr.Pr_Ji�fr1�rJ� a 99999��r 0 M P O R TA N T DOCUMENT 5 rtff I'le.te of Fla Res s e 5 5 `� 5 � ISSUED BY 5 5 REGISTRATION a 'F M f� Date of Shipment 5 S NUMBER INDUTRIES INC.® aisoi2oo7 5 5 S '�yop EVANSVILLE, INDIANA 47725 Tent Identification M MANUFACTURERS.OF THE FINISHED 0=4464877 5 0 5 17140.1 TENT PRODUCTS DESCRIBED HEREIN S This is to certify that the materials described have been flame-retardant treated 5 55 (or are inherently noninflammable) and were supplied to: 01 5 657150 5 5 PETERSON PARTY CENTER INC 5 5 139 SWANTON ST 5 5 5 WINCHESTER MA 1890 5 5 � 5 5 5 5 5 5 5 Certification is hereby made that: 5 SThe articles described on this Certificate have been treated with a flame-retardant approved S 5 chemical and that the application of said chemical was done in conformance with California S S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # 5 5 8151110(2) 5 5 Description of item certified: 55 5 CENTURY MIDDLUI 60WX 30 SNYDER 5SSS 5 5 WHITE VINYL WIT-1 IO 'W1-13 GUYS 0 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDER MIFG NEW PI IILADELPI-41A.01-1 Signed: 5 L___Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 COrJ�rJ�rnr�r�rPrJ�rJ�rPrJrJ�r�rJ�rJ��Pr�rJ�cPr�rlJrJ�cf�cPrJ�rJ�rJ��Pr��Pc1�r.Jar.JAG.lPr...1_c1�13PC rPj:,PLL3Pi�I�rJ�rP��rJ�rPcPrJ�r�r_fcPrJ��PrfcPrJ�rJ�rJ�r�J�rJ�r�rJ��cI��PLJ-IjMJ-1J:3 Com] u c1rJ@99PrJ�rJ��PrPrmc1MQPr11 M P 0 R TA N T DOCUMENT-r-3 00�rJ�rJ��PrJ�rJrJ�rJ�e1rJrJ�cJ�r Prl�P 0 5 Certificate of 71affw Resin A El 5 REGISTRATION ISSUED BY 5 Date of Shipment 5 5 APPLICATION T 5/12/2005 5 5 NUMBER G INDUSTRIE:INC. 5t EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F1.40.1 �� °~ MANUFACTURERS OF THE FINISHED 0404857' 5 TENT PRODUCTS DESCRIBED HEREIN S 5 This is to certify that the materials described have been flame-retardant treated 5 5 or are inherently noninflammable) and were supplied to: 5 5 657150 5 5 PETERSON PARTY CENTER INC T 5 139 SWANTON ST -a 5 WINCHESTER MA 1890 5 5 5 5 5 5 Certification Is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 5 Serial # 8151 U 0(2) 5 5 Description of item certified: 5 5 5 CENTURY MIDDLE 60WX30 SNYDER S WHITE VINYL WITHOUT WEB GUYS 5 Flame Retardant Process Used Will Not Be Removed By 5 dashing And Is Effective For The Life Of The Fabric 5 S 5 SNYDER MFG NEW PHILADELPI-IIA,OH Signed: �*^flit/(/t I e� re5 5 J v ��SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 � e1tJ7ePeJ�e.leP�PPJ�ePePrJ��PcJ��Pr�r�eJ-r�rJ��Pr.PeJ�cJ�r�rJ�r�rJ�Jr_frJ��PePrJ�rPr..f�rJ�rJ�i�PrJ�c..ncJ ticalrJ�cPc1e1c�fr�ePrJarJ��PtJ�[.r]r.P�PrJ�r�r.Prn�.l�cJeJ'e.Pel7rJa�Pe_f7r�cP eJ� � IMPORTANT DOCUMENT Ck>,rtff1cate oY qFlanpe Resista-pee S 5 REGISTRATION ISSUED BY S 5 APPLICATION 4 ' �� Date o5 Shipment S 51 NUMBER t % INE STRIE�INC. 5 �j �' Tent Identification S �� EVANSVILLE, INDIANA 47725 S 5 P1.40.1 ~ MANUFACTURERS OF THE FINISHED 04045575 5 S TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: 5 5 657150 S 5 PETERSON PARTY CENTER INC 5 S139 SWANTON ST S 5 WINCHESTER MA 1890 S 5 5 5 5 5 4 l 5 5 Certification is hereby made that: S 5I The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California U 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S Serial # 5151310(1) 5 Description of item certified: 5 CEN"CURY END 60WX20 LOOP SNYDER 5 WHITE VINYL WITHOUT WEB GUYS 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDER MFG NEW PFIILADE L13HIA.OH Signed: rj U L SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 D cls PrPcPc fc J��J?c t'�r1c1�e��rlcte17�f'rJ"c f7cfe PP�J�tJ��PtP�PrJtJ�rJ�tPrJrJ�rJ�tJ�rJ�rJ�rJ�rJarJ�IrJ�tPr�rJ�tJ7rJ�rJ�irJ�rJrJ�c1�tJ7r.�r.Pc l�t�lcJ,Jr1cJ�rJ�cJ7rJ�c1cJ7rJ�rJ�rJrJ�rJ�t PcJ rJT