The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #812-11 - 1160 GREAT POND ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r // Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ��c �; �7� I�U G� /P�, - Prm PROPERTY OWNER 69c-Oks �j�r�I Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 14 New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 9 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other V. ®Septic' q W ll D Fioocipla ®1Wetlandsa bi Watershed istricti �_❑_Water/Sewers __ f DESCRIPTION OF WORK TO BE PERFORMED: i 7�2G'/pct a 0 K 10-0 //0 XA-10 �o x )CD � 3 1/-2 x I (Id tification 7".7 a or Print Clearly) _ OWNER: Naive: 25/�C1z��S � Phone Address:,/f&,c� c�(26,4 kpaml( *t7n, I CONTRACTOR Name: � 'f?s a /!�'� �i� � Phone: �Tf—7a g Ycr� Address:. 12) �GzJ��- '� � L.r //1/ r� �, law- a/ c,"U Supervisor's Construction License: ��? Exp. Date: _ �� /3 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: ' Address: Reg. No. FEE SCHEDULE..BULDING PERMIT.-$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /-7&1-ZYV r FEE: $ O 7 d Check No.: a l e Receipt No.: ,-NOTE: Persons contracting, ith unregistered contractors do not have access to the guaranty T d .z Signat�=u e of1A`geR (b,wner, Signature of contracto J 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: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools El 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 C. Conservation Decision: Comments Water & Sevier Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 i ® Notified for pickup - Doc:.Building Permit Revised 2008mi Location //6 ��"r'� �✓�� C,� No. 2 - " Date NOR,h TOWN OF NORTH ANDOVER _ o F � R • s Certificate of Occupancy $ CM <� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / a 244, b 9 ® Building Inspector ORTH TONNM of 0Andover No. o :�w :. r t.. h z �_ o dover, Mass. LAKE ' ' L /fes COCHICHEWICK AORATE O PGj SS BOARD OF HEAL'T'H Food/Kitchen PERMIT T Septic System 1 THIS CERTIFIES THAT 6l'�, �s � BUILDING INSPECTOR Foundation has permission to erect.................. ...... buildings on Rough .. ........................................................................... to be occupied as......:/...�� l' r . ........6.0 5�.1. ..' .. . ...r:...... ..moo,x:,.y.�... .. . .. ... . ......�3. ....,��X.l......... �G i�' ��? � 2 Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations PLUMBING INSPECTOR 'Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .......................... ��... �--- ,e•.��...• ..................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Display in a Conspicuous Place on the- Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done F Until Inspected and Approved by the Building Inspector. IRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. I)cp:rrtntcnt 44f Puhlfc `.jf'c(\ B++:trtl 4+1, Btriltfin.-' Rc-ulatlows :rntl �t:rnc►:rr+i. Construction t action Supervisor License I License: CS 60219 MARK TRAINA 33 HANFORD RD STONEHAM, MA 02180 JIL ---5- Expiration: 4/27/2013 c <�nm�i��i�•ncr Tr4: 13389 YY Call" -;al;I rea?1h, Of ltjtj.'i";c"".1j. f 021 /J, 10, fo) Wo Addi-css.- Phone - Are you an employer?Ciiecl(tlieappropriate bo,-;: Type of project(required): I ryl 1 2m ? employer n i 4- a general contractor and I I 'r-11 — :.1 . - genconsinicti Ja_ 6- Ef 1 1011 211 1 ail, a sole proprietor or partner- listed on the al-taclied sheet. 7. El Remodclingo ship and have no em 'loyees These sub-contractors have 8. El Demolition Nvorkin- for mein employees and have workers' 0 in any capacity. . ['N'o workers' comp.. insurance comp. insurance.--t9 El Building addition 5. ❑ We are a corporation and its MOM required-] 10.0 Electrical repairs or acid- - 3.❑ 1 am a homeowner doing-all NvorR officers have exercised their -1-1„E] Plumbing repairs or additions myself- FNTO workers, comp. right of exemption per MG], 12.E] Roof repairs insurance iequi-red-] 1 c. 152. §1(4); and we liave no C-Mployc�-S. [1\,10 workors, con1j). uisurance rcquircd 'Any applicant that checks box#i must also fill out the -1 section below showing their workers'compensation policy information, I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the nzm-c of the sub-contractors and state v,hether or not those entities have employees. If the sub-con',racters have employees,then mast provide thti-r workers'comp.policy number. Below is the policy and job sire Insurance Company Name: ?e�IJ Z/I CO3 t , I Policy'-or Self-ins-Lie.#:,(,Q G �3 G9 0 3Q Expiration Date: Job Site Address: //(,C) Aw C/ City/State/Zip.- Attach s-copy of the Ile Workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1"52 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Off-ice of Z� Investigations of the DIA for insurance coverage verification. Ido hereby ce'riiiiify under the s a.rd penalties Ofp elill iy that the information provided i4ded abo e is trite all d correct. 2nat-Ore: Date: Phone 7d 4"OV-0 Official t4se oyzlj. Do not ivrife in this area,to be completed by city or fox,li offieiat PC rril i: Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbinu ji--:-j:'u-ctor 6. Other Contact Person: Phone i": U I -- - CERTIFICATE OF LIABILITY INSURANCE - �:: ;: t,f,:YYYY, j TI'IIS c F f"i P Ic.AT(_ 15 I'-SUED A' . - --__— 0�J/_�0—nrf�TT[ OF NFow,IATION ONLi _ ANDfCONFERS NO RIGrH t S UPC THi. C'_f?ll(ICA7i HO(;J; nl i Lf fill( IC,':li h.lt NOT A((I(<f1liIVELI OR NEGA1WE( Y At1ENO, EXTENC OR ALTER THE COV-r" Sr LOl d I .ti I 1If It.! r (}! Ir { (`! C.tla„, `1E P(iL1CIL: J (t4Cf DO. ., NOi CONSTITUTE A CONTRACT PEI W(='c l' THE IS.iUVdG ;f ',t ff,Enl.-y ;.IJ'!tr)I; •r ., Tl i(- CFRT:rI:;l.TF I-'J: 17.11`l11t1, v I. t'1,• r.-'rt. I.r>f.- I . :In A ti lll'!1. r,I I'1 >II( .) IIIxilu its•,• n - I - �•( r 1:1;l bo <•ndU:1,C 11 .r,l,l 0C,"',- r ifT :Or,,c1T:':11. A r.:a1<vn;vTI On 11w, ; r.• i �K.I' I•„!.:. , lu•u t• i:,r I nt r li( ! 7.. U i .. < .j' i Ili 7: 1 ori-;. l ItJSLRFR(i)AFFORDIN,CnlrC ru(,L. ; It's uRLr.Aj?cpub)1c Frank.i"in Tats t'c i , ilr,SURFRs:Trav<a):'r<; Tnc�ina; 1 ,r.suRk-Fc)?a-t u*� 7;T;,uranc(:• Co- af (� { rNSUREn C 1�".`�_ITCFIn•;•.. }., INSURES V: - O L c 1 It�(JRCr t f L('t I OF !NGUi,A^,IC,- LI It r , i Vt i AVF BEE?! ISSUED TO IH[ INSURCU t -ifrC ABOVE r INC' TAN i VR TIT( PO. 1(-Al r{, ' tii.711 af'1 FE.tUUfRFA4EN1 TCI M, Or CONDITION OF ANY CONTRACT OR OTHER DOCUMENT lA9TH RESPECT T f IL\ PERIOD Lr,{a�` CERTIF,I q71, MA) EC I SSULD OR M.;,Y PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERFiN IS SUBJECT T O tr"RICH TRI$ E K<;LUSIOtd,;;p,rvq,1 COlJ01T1C1N (.7F Si-It;.ii POL1t=,lES.CR�fITS SHOWN A!inY HAVE BEEN REDUCED BY PAIQ CLAIMS. O AU THE TE-RA4 . Ot .LnR . YI E(it It�L t.t;;!� i < r - POLCY EFF POLICY OCP - PoucY uBFR F - -- -_ - TtI ..11 - - S - - --- - i '.f 12'! :1- IT' _!r zr•J -( ..- a'(•J a ,I I .Cs f 71 PIE lyt 11 a«c, SOD,000 'PF < •61 c l0/J/?070 10;9!2{1'1 i I COMHrraCDcrrJ(;;.[i,r,HT - -�_.--� --- An"':' ••` :(t_a 1 '000,000 AU.(jt'.SdL t'rallC3'> 1' !.�-Tir 9?96fi036 F30Dil_Y INJURY(Per per»n < \, ?: no/9/2clo ^o/9/zo11 :_.._ _ . ) BODILY INJURY(Per aca0�10 S I - PROPcPlyCrAMA.GE - t03'. Ung s rea rm(ons E,c,ar S1,000,0 10 -,000, 00 ILIA I_rt.^ - EXCESS ILIAC EACH OCCURRE:JCcCLAri5-MACEc -5,000,060 AGGREGATED5,000,0010 DF _ != RFTENi:(lyd ?: X kTtm 4361631 "0/9/2010 110/9/2011S. ------ _ - -- - 1.I;O ANY PRI),-..... 1. �.i1 -?t:l \f - - -• Orf" t t '�.tlll T� NIA CLEACj+AtCI �N1 � trxLlmry�lr ,f E --. i;c 4361630 �oJs/zolo 7oi 9/lou - - 500,COO -H yyc- a•crnta uuxr EI. OISFASI EAEMPLOYEE S .`)00,(100 DCSt121PHOn - _ F t_D1SfSF-F'OLFCI•UMIT c 'COQ 000 t. Eaui_nmt>f)t F'lcatel � -- -- -- FE DET_£>vdI trED 10/9/2010 (10/9/2011 Leasco anC Renlea Cru",-------.L0-0 -000 _- --- 100,000 Uri t - 'Gi,G r.;�:i r.el F:ma4..�.,....•rb.. L mores star c m re..,u,rc Cl --'-'- -------'--'—__'-"_--_.-"_ t-:F=F;i!1=ICAiF F'C>I D1 R _.._.__.-------__-_-- -- ---- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE LVILl. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZLO RFPRf_SCNTATTVE __ _ `aicilaeT. J. I3onaco:-s•-• :CORD 25(201:. ---- ------ -------� — --- -- j NS025 E2009p91 The ACORD n:.'^-,and logo are realstered marks of 19M-20 00.-J�3RI)CORPORATION. All rights rc .. �dl'81):ai\k l'.. ..... .. .. . . ...1...........+....•......_. .........'Ara.....:.. . JW✓. 11.t.u.,........__..,_.•.vr...'.Wi.JI....aa��a.:fL.hi�l4Li•f�Y��:ia`L'a',tr'hY{1�Ys.�na.. .. ... IMPORTANT ®OCUMENT 5 Certificate of Flame Resin ce51 5 5 REGISTRATION ISSUED BY Lj Date of Shipment 5 APPLICATION o- �° CH9R. 06/08/04 5 5 NUMBER IND ' USTRIES INC. 5 S5�i EVANSVILLE, INDIANA 47725 Tent Identification 5 5 F121.4 �'' °' MANUFACTURERS OF THE FINISHED 03850284 S 5 TENT PRODUCTS DESCRIBED HEREIN S SThis is to certify that the materials described have been flame-retardant treated S S (or are inherently noninflammable) and were supplied to:657150 S 5 PETERSON PARTY CENTER INC S 5 139 SWANSON ST 5 5 5 WINCHESTER MA 01890 5 S 5 5 S 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 Schemical 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. 5 5 Serial # 8023000(2) S 5 5 5 Description of item certified: 5 S FIESTA VINYL TOP 20WX20 WHITE V Nr 5 5 Flame Retardant Process Used Will Not Be Removed By S 5 Washing And Is Effective For The Life Of The Fabric 5 c5 JOHN BOYLE STATESVILLE NC Signed: cSPECIAL EVENTS DIVISION.ANCHOR INDUSTRIES INC. 5 ,1y: ia :.._ ...•!.. . _ ..,.. _. __ a ._._..._ __moi=� �1.:e' rt.3..:�cla.lr-1SW :f...`. tu, r�iet.sna „'zViihtr5a=o-.. ne».ani+ Pwwl+ wuvt? tigri7i43rzSCyvEe . . o Q��►-��L�1f 11V P O FETA bbl T DOCUMENT 5 Certificate of Fla n-N Resler ce REGISTRATION S ISSUED BY �� 5 i 5 S APPLICATION '' Date of Shipment 5 pp ® r 5 ,�` s VN®n® 06/08/04 NUMBER 5 c5 INDUSTRIES INC. EVANSVILLE, INDIANA 47725 Tent Identification S 5 FI40.1 "y E ° MANUFACTURERS OF THE FINISHED 03850284 5 TENT PRODUCTS DESCRIBED HEREIN 5 { S This is to certify that the materials described have been flame-retardant treated 5 55 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 PETERSON PARTY CENTER INC 5 S 139 SWANSON ST 5 SWINCHESTER MA 01890 5 5 5 5 5 S 5 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 5 chemical and that the application of said chemical was done in conformance with California S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 5 5 Serial # 8108985(2) 5 5 5 5 Description of item certified: 5 S CENTURY MATE EXPANDABLE END 5 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric ! S 5 SNYDER MFG NEW PHILADELPHIA,OHS 5 Signed: '.ti 5 _`SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 � u�rJ�c.rrJ�u�rJ�rJ��Pr1rJ�r�rJ��r��..rrJ�r..Pu�r�r�u�r.n�PrJ�r�u��r-r�rJ�u�r�r��P�.r�nrJ��.Pr�rJ�r�u�rJ�r�rJ��.r�.rr�rJ�rJ�u�rJ�rJ�r��nrJ�r��.rcPrJ�cfrJ��P�.rr.PrJ�rJ�r�rJ��nrJ��u� a :`w..r��1Lti' ,.....,.... _,... _ _.........,_._... ......_a..._._._..a.,:'.�abtirry,=r'."�Y::.�...a.��•'H>r_,?fi. :iarrr:•, 35!_a!�J?�a�'8�ar:.ti[7- _ ^'r% (]° CfLnC�CPLI�CPCPCPCPC�C�C�CPCPCPL)'Ll f IMPORTANT ®®� ■V, N T C�PLPL L3 PJ PLPCPGPGPC�Lp CJ LM❑° r 5 Certificate of Fian?e �e�i�tance 5 S REGISTRATION ISSUED BY S 1 S APPLICATION ` Date of Shipment 5 C 06/08/04 5 NUMBER s IND��ES fin® 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 a 5 F140.1 EM ° MANUFACTURERS OF THE FINISHED 03850284 5 STENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 S 657150 5 PETERSON PARTY CENTER INC S S 139 SWANSON ST y S 5 WINCHESTER MA 01890 5 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 5 5 chemical 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 Serial # 8108985(2) 5 5 5 Description of item certified: 5 CENTURY MATE EXPANDABLE END 40WX20 SNYDER WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5 SNYDER MFG NEW PHILADELPHIA,GH Signed: . ' S "SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. rj �° LnLnLI-'CPLI�LI�LPCPL�L)�LTLPLnLnGPLI�LI�CPLJ�L)�LnLnLI�LnCPLI�LI�LIL�LnL�LI�LI�LI�LT'LI�LI�LnLILI�LTL1�L17LI�LI�LI�LnLI�LnL17LI�LnL�LI�LI�LTL�LTLI�LI�LI�LI�LI�LTL�LI�LI�CPCPCPL�LI-'LIQ �° •,\•ti•••.ti\: :.t\.: ii�::;y. .iy-V.: j �a .'-4 ..f. .wr '� 1�#.riY:ft J r:F.f` 'l`:J7: t-Ia' •+ T. w,: •iY. r`:'iuY C.•s._ .I.._77dG'. ,Y. C7 tii• �'9�1t`. .�.�•.. .\,:�r..._,1 .vL," .....�V- t ♦.t::. '�# is � '�" s.tw.':. �i L �F.V^,�;\ "r'f.F� 4:-55�.h'i�l "YY•1Yx. is __ _ ,�i•.}S_�,35 „�4 o �rJ�rJ�rJ�rJ�rJ�r PcPc fcPr�r�cPrJ�r�rJ�cfi IMPORTANT ®O C U M E N"'1" 5 Certif leate of Iaiesis ee s 5 �� fes? 5 5 REGISTRATION ISSUED BY Date of Shipment 5 . 5 APPLICATIONQ RK P 5 SNUMBER z NousTaiE�iNc 5/10/2006 r 5 ~ Tent Identification 5 EVANSVILLE, INDIANA 47725 5 i 5 °140.1 MANUFACTURERS OF THE FINISHED 04263446 S 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated S 5 (or are inherently noninflammable) and were supplied to: 5 5 657150PETERS5 S1SWAST WINCHESTER N PARTY CENTER INC 39 5 5 5 WINCHESTER MA 01890 S 5 5 5 S 5 5 5 Certification is hereby made that: S S 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. 5 CC5 Serial # 8020500C(2) C5 Description of item certified: FIESTA TOP 12WX12 SNYD WHITE 5 V L#1023970A (IPC) 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric i 5 5 S i LWWR MPC AIfiW RHII APPI PI-1IA,GH Signed: 'W 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 FRI 19 MPORT DOCUMENT S e �la ARes"s ee 5 5 C�er� �e��e �f ��e 1 t�I? 5 SREGISTRATION ISSUED BY CJ Date of Shipment 5 S APPLICATIONS a � S x NUMBER Sri NDUSTRIE aINC. 5/10/2006 cS � EVANSVILLE, INDIANA 47725 Tent Identification C5 5 MANUFACTURERS OF THE FINISHED 04263446 S 5 FI 40.1 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 cS (or are inherently noninflammable) and were supplied to: CS 5 657150 5 5 1SWAST PETERSONPARTY CENTER INC 39 S SWINCHESTER MA 01890 5 5 5 5 5 5 5 SCertification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S Schemical and that the application of said chemical was done in conformance with California 5 S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 Serial # 8020500C(2) 5 S 5 5 Description of item certified: 5 FIESTA TOP 12WX12 SNYD WHITE 5 VL#1023970A (IPC) T Flame Retardant Process Used Will Not Be Removed By S 5 Washing And Is Effective For The Life Of The Fabric ti 5 5 cam. -D-6R._N4PC P1416hBE6RFIIA,�11 Signed: ---� S 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. S l7 ��PcP[J�[J�[J�[J�[J�r��Pcl�c.P�P�rlrPrPr�rJ�rJ�rJ�rJ�r�rlr�r�r�rJ�r�cPrJ�cPr�r�r�[J�rJ�c.PrJ�r�rJ��PrJ��PrJflJ�rJ�rJ�[J�[P[J�cPcP[�c..P�P�[J�rJ�rJ�r�rJ�rJ�r�c1rJ�rJ�rJ��Pr�r�rJ�rJ� � .� :i. .. 1 FaSttx .Y1 '�""'M"`�YYC 4' `.r.�Ct�.�.__......_ .. .,.,.. ... .., ..... ... ..__.__._....�a..,.,�'..ti.•.,e�•..s..�%a....^.wi:�: .�,::�� ,fsw.._. r- ri' i..:•a�� •r.rl:�.: '�,L•�.".�1'"'z'�+.�.Y`��L'.'�,�r J 2��`3va ^c,'1�� . ,. " I INJIM P O R TAN T ®O C U M E N T s Certificate of Ian-?eWesistapee S 5 ISSUED BY 5 S REGISTRATIONLED Date of Shipment S 5 APPLICATION a CN- 9H5 S NUMBER �� INDUSTRIINC 5/10/2006 c� 5 5 F EVANSVILLE, INDIANA 47725 Tent Identification 5 S 5 ° MANUFACTURERS OF THE FINISHED 04263446 5 1140.1 TENT PRODUCTS DESCRIBED HEREIN 5 SThis is to certify that the materials described have been flame-retardant treated 5 S (or are inherently noninflammable) and were supplied to: S 657150 S 1PETERSON PARTY CENTER INC 39 SWANTON ST5 WINCHESTER MA 01890 S y 5 5 F 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 S 5 chemical and that the application of said chemical was done in conformance with California 5 S Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S Serial # 8020500C(2) 5 5 Description of item certified: C5 5 FIESTA TOP 12WX12 SNYD WHITE 5 5 V L#1023970A (IPC) J 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5S cniSigned: Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 r�r�cPEP��PrJ�c!-r Pr�r�cPrJ��rJ�r Pr�rJ�r�rJ�rJ�rJ�r�r�rJ�rJ�E PrJ�cicP[PrJ��PrJ�rJ�cnrJr�rJ�r 1�r1r=PE PcPrJ�cPEPrJ�rJrJ�rJ�EPcJ�r�rJ��rJ�rJ�[J�rJ�E PrJ�rJ�rJ�rJ�rJ�rJ�rJ�r�rJ�rJ[PrJ� El ......r�...... .uu...-,�_.��ca.r -..tam+�a. .vi-..arw..i:r................. �_ _. - w 1 I M P®R TA N T DOCUMENT 5 5 Certificate of 'Flame Resist t"Ce 5 5 5 ISSUED BY 5 REGISTRATION Date of Shipment 5 APPLICATION Q rm"'Aaw! ® 5/12/2005 5 5 NUMBER 5 5 ~5 5 Tent Identification EVANSVILLE, INDIANA 47725 5 04048575 F140.1 M MANUFACTURERS OF THE FINISHED STENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to:657150 S S5 PETERSON PARTY CENTER INC 139 SWANTON ST 5 5 5 5 WINCHESTER MA 1890 5 5 S 5 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 Schemical 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 SSerial # 8151110(2) S 5 5 5 Description of item certified: 5 CENTURY MIDDLE 60WX30 SNYDER 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 4 5 5 SNYDER MPG NEW PHILADELPHIA.OH Signed. ^"\lit/ / 5 5 U L,)SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 DM1r�r�rJ�cJ��P[.l�rJcfrJ��frJ�rl�rJ�tPrJ�rJ��Pr�rPrr�rJ�cnrJ�rJ�tJ�r:PrJ�c1�rJ�tPrr�rJ�rJ�rJ�rPcJ�rJ�r�r�rJ�rJ�cJ��PcPrJ�rr�rJc1�c f�P[J��PrJ�rlrJ�rJ�c frJ�cPc1rJ��PtJ�rr��lrJ��lcJ�rJ�[J� 0 P. . a I M IF-o"O R TA N T DOCUMENT 5 Certificate of Fla Res is tapee 5 S5 ISSUED BY REGISTRATION Date of Shipment 5 5 APPLICATION � �® 5/12/20055 NUMBER INDUSTRIE INC. 5 5J s 5Tent Identification Uj S ,f� '�, r EVANSVILLE, INDIANA 47725 5 5 F140.1 '�' cM ° MANUFACTURERS OF THE FINISHED oaoass�s 5 TENT PRODUCTS DESCRIBED HEREINrj 5 SThis is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 SC 6 57150 PETERSON PARTY CENTER INC 5 139 SWANTON ST 5 5 WINCHESTER MA 1890 5 5 5 S S 5 5 5 5 5 Certification is hereby made that: S SThe 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 # 8151110(2) 5 5 5 5 Description of item certified: 5 5 CENTURY MIDDLE 60WX30 SNYDER J 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 1 5 5 SNYDER MFG NEW PHILADELPFIIA.OFI Signed: "/L Lj 5 j '-SPECIAL EVENTS DIVISION•ANCHOR INDUSTRIES INC. 5 O �Pr1ffPcncPr�r��P�Pr��P�Pr D E'EP9P'E-1 10119][ 111. IVIl�rJ�rJ��PrJ��P�PclrJ�r�r�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�cPtPrJ��PcPrJ�cPrl�PrJ�r�tJ�r�cPr�rJ"rJ��P�.PrJ�rJ�rJ��P rJ� � '.i�, �.,. },'. -- .. . . .. _.'_::.i:r�':.:_. :_;ri._._L..._.._x..S'�i7�Ls�i:}:',z:.r'r��<?r7_.�Y.u1r•-} .�.,:7t rsYv „r,,.sewrYf. +N3'? ?�f+�:k'itx'""�, ..;�. .. . ;! ❑° IMPORTANT ®O V U ■,I. E N T220n, 5 � 5 �erl �c��e of Elante �e��tanee s 5 REGISTRATION a cac�f c ISSUED BY Date of Shipment 5 APPLICATION s ��® 06/08/04 S 5 NUMBER i INDUSTRIE INC. 5 5 r hi EVANSVILLE, INDIANA 47725 Tent Identification �rjl 03850284 S F140.1 MANUFACTURERS OF THE E SHED ENT PRODUCTS DESCRIBED HEREIN 5 5 5 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 S 5 PETERSON PARTY CENTER INC y 5 5 139 SWANSON ST S SWINCHESTER MA 01890 S 5 S 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 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. S 55 Serial # 8151210(l) S 5 5 5 Description of item certified: 5 CENTURY END 60WX20 HOLE SNYDER 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 SNYDER MFG NEW PHILADELPHIA,OH Signed' A) (�'•c�� 5 C5� "SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC. 5 O �Pr.P�Pr��Pr�rJ�r�rJ�r�r�r�rJ� r�r.P�Pr�rJ��P�PrJfl�rJ�rJ�c�rJ�r�r�r.�rJ�rJ�rJ��PcP�PrJ�r.Pr�r.PrJ�r��Pr..J�rJ�r�ct�[Jar.PrJ�c_f'rJ�rJ��Pr�rJfl�r..nr�rJ�rJ�rJ�r�r�rJ�r�rJ�rJ��.lr�r�rJ� !] ❑° ��rs�rsrsrsr�r��rs��r �i IMPORTANT ®OCUMENT�� ❑° 5 of leate of la wes is tapee 5 5 der 5 5 REGISTRATION ISSUED BY Date of Shipment 5 APPLICATION � o riCN R. 06/08/04 5 S NUMBER i INDUSTRIE INC. ti ~ Tent Identification S 5 5 r� �, r EVANSVILLE, INDIANA 47725 5 F140.1 ~� EM* °' MANUFACTURERS OF THE FINISHED 05850284 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: S ` 5 ' S 657150 5 SPETERSON PARTY CENTER INC 4 5 S139 SWANSON ST S 5 WINCHESTER MA 01890 5 5 S 5 5 5 S 5 Certification is hereby made that: 5 5 The 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 5 5Fire Serial # 8151210(1)Marshal Code. All fabric has been tested and passes .NFPA 701-99, CPAI 84, ULC 109. S 5 5 5 5 5 5 Description of item certified: 5 CENTURY END 60WX20 HOLE 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 C5 SNYDER MFG NEW PHILADELPHIA,OH Signed' C "SPECIAL EVENTS DIVISION•ANCHOR INDUSTRIES INC. Cj � r�rJ�cJ�rJ�rl�r�r�rJ�r�rJ�r�rJ��.P r��Pr�r�r��PrJ�r�c.J��PcP�Pr.PrJ�r�rJ�r�r�rJ�r�cP�P�P�rJ�t_!'c�rJ��.Jr�rJ�r�r�[Pr�rJ�cPrJ�r�cPr��.l�r�r�rJ��.Pr�rJ�r�rJ�rJ�rJ�rJ�r�rJ�cP�.!rJ� �