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HomeMy WebLinkAboutBuilding Permit #261-15 - 470 Lacy Street 9/16/2014 TOWN OF NORTH ANDOVER (� APPLICATION FOR PLAN EXAMINATION Permit NO:�`0� S I ( Date Received Date Issued: W IMPORTANT:Applicant must complete all items on this page LOCATION 1/7 7 .S? _ Print PROPERTYOWNER Wtht V5�1 apzwl Print 100 Year Old Structure yes no MAP NO: PARCEL: `�_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: d "Rec a- sib ,( (S-o 30 )e-50 7-maogA,,v eN -Removecf 01 94a A/ Identification Please Type or Print Clearly) OWNER: Name: �.��i n d Ru-th F-g avin Phone: Address: q-? / 0,ySt Al, Xe1GfOve-ll n3 CONTRACTOR Name:e+eg S� pa#4 (',74,t Phone: Address: Supervisor's Construction License: Exp. Date: 7 1i Home Improvement License: /� 5 � Exp. Date: F /F /� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ f®, D U"© � FEE: $ ZO Check No.: 4 Receipt No.: NOTE: Persons contracting th unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ignature of contractor Plans Submitted ❑ Plans Waived ❑ entified Plot Plan ❑ Stamped Plans ❑ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 4 TYPE OF SEWERAGE DISPOSAL I Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 i Planning Board Decision: Comments i Conservation Decision: Comments I Water & Sewer Connection/Signature&Date Driveway Permit � i DPW Towb Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no j Located at 124 Main Street Fire Department-signature/date COMMENTS - - 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of dieter 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.$10041000 fine NOTES and DATA— (For department use II ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department artment 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 app:al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location No. � f Date ! P . - TOWN OF NORTH ANDOVER, Certificate of Occupancy $ Building/Frame Permit Fee $ qJ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ h Check e. L' Vi !i &-�� Building Inspector NORTH own of O �: .4. 1 No. * r Z ver, Mass, [O[NIC"t WICK �1' p04ATED 0"f, S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �..�..... .................................. BUILDING INSPECTOR Foundation has.permission to erect .......................... buildings on ...41A........LA(V-t- ..S�.................... 8-.0..X..1.�R� 50..�.a.� . . � Rough to be occupied as ..... ................... ...................... .... ..... ............... 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 CONSTRUCTIONAV 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 T No Lathing or Dry Wall 1 o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. F �. , . f w. } it r� J � A i"k'l `"479 Lacy St, North Andover, PSA 01845 USA .. i ys Goth I �ea h ) � | ?----------^---------- �� *-------- ------- -- " | ` - --- - -----'' i ( | | ' j ( > / l � ` ... __................... -_- -___. / _ - " ° The Commonwealth o 'Alassachusetts Departinelit of'IndustrialAccident-v Off ice of.1m,estigations I Cong) -ess Street, Suite 100 Boston, MA 02114-2017 ;vj*yjv.mas.,v.gov1dia Workers' Compensation Insurance Affidavit: Btiilders/Contractoi-s/Electricians/Pluinbers Applicant Information Please Print Legibly Name (Busiiiess/Oi-gaiiizatioii!ltidivicitial): PETERSON PARTY CENTER Address:36 CABOT RD City/State/Zip:WOBURN,MA 01801 Phone#:781-729-4000 Are�bu­idi ap-propiiate"box'i- 200 4. F� I am a general contractor and I 'rype ofproject(required): I.A I am a employer with C, 6. F� New construction employees (full and/or part-time),* have hired the sub-contractors 2. 1 an-i a sole Proprietor or partner- listed on the attached sheet. 7. Ej Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity, employees and have workers' 9, F�mBuilding additiori C. [No workers' copcorp. insurance.- . insurance 5. F] We are a corporation and its I O.F_j Electrical repairs or additions required.] oficers have exercised their I LF a I am a homeowner doin(z all work officers _] Plumbing0 repairs oi-additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t c. 152, 51(4),and we have no TEMP. TENT employees. [No workers' Othcr_______ 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 in(licatine.they are doing all work.and then hire outside contractors must submit a new affidavit intlicating 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 culplovec.s. ila,v i114Iy irltjSi 1)10ik their ivfkt;fo'cu,nj,po:icy I ant an employer that islwovidin- tvorkers'compensation insurance for my employees. Beloit,is the policy and job site information. Insurance Company Nanie:AIM MUTUAL INS CO Policy P,or Self'-ins. 1,ic. -#:WMZ8006586 Expiration Date:10/9/14 Job Site Address: city/State/zip: Attach a copy of the workers' compensItion policy declaration page(showing the policy nu'rnber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penahles of fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the forin of a STOP WORK ORDER and a fine Of LIP to$250.00 a(lay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investioations of the DIA for insurance coverage verification, 0 1 do hereby certilj,under the pailts and penallies ofpeijwy that the information provided ahove is tr te and correct. Signature: Dat c: Phone it: 781-729-4000 Official itse only. Do ito1write in this area, to be completed by cit))or to;V11 official. City or,rown: 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 ,aco CERTIFICATE OF LIABILITY INSURANCE 10/1D11m1IDD/YYYY) `-� /2013 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) 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). PRODUCER CONTNAMEACT Michael Bonacorso Bonacorso Insurance Agency, Inc. PHONE {7$1)273-3200 FAfC No:(781)273-0600 "IC83 Cambridge Street E-MAIL ADDRESS:mike@bonacorsoins.com P.O. BOX 1502 INSURERS AFFORDING COVERAGE NAIC# Burlington MA 01803 INSURERAAcadia Insurance Com an INSURED INSURER B:C N A Insurance Co. Peterson Party Center, Inc. INSURERCAIM Mutual Insurance Co. 36 Cabot Road INSURER D INSURER E: Woburn MA 01501 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 Master 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. INSR ADDL SUBR EXP LTR TYPE OF INSURANCE INSR D POLICY NUMBER MM/DIDNYYY MM/DDY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE aOCCUR X X PA 5061026 10 10/9/2013 0/9/2019 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X jEcT PRO F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,0_9-0 AIR ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED X X 5063173 10 10/9/2013 10/9/2019 BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ Uninsured motorist BI split limit $ X UMBRELLA LIABX OCCUR X EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DEC) I X I RETENTIONS 10,00 085996458 10/9/2013 0/9/2014 $ C WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I TORY - ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) Z8006586 10/9/2013 0/9/2014 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1.$ 1 000 o o o DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN -- ACCORDANCE WITH THE POLICY PROVISIONS. -- — AUTHORIZED REPRESENTATIVE__ Michael J. Bonacorso ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSf125 r7ninnst ni Tho Annan ­1 f--- a �E-C3Pr ��n`n�r��n���n�n�r-�I-�nEpr C J'E3 rl I iVl P O R T A N T D O 4 U IVI E N T ���.n�cn��c n�Ln�n�n��n�����n��n�n�r��n� o 5 5 5 5 5 ertffirate Of lameRe.5i'5tanre 5 S �5 REGISTERED ciF ISSUED BY G Date of Manufacture CJ 5 APPLICATIONo- s� �I01M® 5 NUMBER INDUSTRIES INC. EVANSVILLE, INDIANA 47711 N5 5 J Order umber 5 5 5 F140.1 MANUFACTURERS OF THE FINISHED 113094 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: 5 5 .657150 Pj PETERSON PARTY CENTER INC S139 SWANSON ST 5 S _ 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: 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 Fire 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. -- 5 SThe method of the FR chemical application is: 5 5 Serial #: 8152120(2) 5 Description of item certified: 55 5 CENT MID 80WX30 SNY 10'SPACE 5 _ Flame Retardant Process Used Will Not Be Removed By 5 5Washing And Is Effective For The Life Of The Fabric 5 SNYDER MFG NEW PHILADELPHIA,OH Signed: 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. r�[Pct[1�CPrJ�r�3 r3r3PLPPC1C PLLI-cPEP[1[!�[J�[n[1C1�CJ�r�cPC P[l�Cl[PCn[PLIC[([1�C 1[fG1�r�CPrJ�[J�CP[J�L1GP[PLI�r�[!�[�[P[P[1CPCPC�[P[nr�r�[nrJ�[P[l�r�[n[nCPCJ�[1�[n[J�rJ�rJ�r�r�[1L1rJ�CP[l[JCP o r�ru� ���n�nnn� �n ���� n �� � o������rn��illDE]lE21120r�2nRPr_PrI .Pr �-1 IMPORTANT DOCUME1T0630 n� 5 5 VIL.trtifi rate of if lame Re.64tanre ISSUED BY C5 REGISTERED , ck�F Date of Manufacture C� APPLICATION4 s Q�DOOR. CU NUMBER INDUSTRIES INC. 5 `nj5 EVANSVILLE, INDIANA 47711 Order Number 5 5 F140.1 MANUFACTURERS OF THE FINISHED 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: 5 5 ,657150 ��� 5 PETERSON PARTY CENTER INC c7 5 139 SWANSON ST 5 55 5 WINCHESTER MA 01890 Cj 5 Certification is hereby made that: S 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 Fire 5 5 Marshal Code, equal to exceeds NEPA 701, CPAI 84, ULC 109. -- 5 5 The method of the FR chemical application is: 5 5 Serial #: 8152120(2) 5 5 Description of item certified: 5 55 5 CENT MID 80WX30 SNY 10'SPACE 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 PHILADELPHIA,OH Signed: , 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 C7 r�cJ��Pr�t�rJ�rJ�cPcPtPr�cPr��rJ�r�cPtlrlrJ�cPrJ��r�rPrJ��rJ�rJ�rnr�r�r�rJ�r�c.t�PrJ��PrJ��PrJ�cPrJ�r.PrJ��Pr�rJ��P�Pr��PrJ�r��P�rJ�rJ�rJ�rJ�rlr�r�rJ�cPr��PrJ�r�r�rJ�rJ�r�rJ��.P�rJ�r�rJ�cl�r�rJ� 5� o ffln-LJPLJ � ��rr Pdr3P �r� IMPORTANT DO UMENTvi,ertift 5 5 5 ovte U-A if lame 3k5t5tanre5 SISSUED BY C5 5 REGISTERED , Gtt� Date of Manufacture C� 5APPLICATION DOOR. NUMBER 5 NUMBER I5 5 5 EVANSVILLE, INDIANA 47711 Order Number 5 F140.1 E MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN i5 S This s to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 5 5 ,657150 PETERSON PARTY CENTER INC 139 SWANSON ST 5 5 5 5 WINCHESTER MA 01890 5 Certification is hereby made that: 5 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 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. -- 5 5 The method of the FR chemical application is: 5 5 Serial #: 8152120(2) I Description of item certified: 5 5 5 CENT MID 80WX30 SNY 10'SPACE 5 _ Flame Retardant Process Used Will Not Be Removed By 5 5 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 5SNYDER 5 MFG NEW PHILADELPHIA,OH Signed: u,..�1Z 5 5 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 21 GISCn[PrjCJ-r�[nl1�[1G1�rJ�r�Eli' [Iill [��P[PrJ�[J�Gt[1�rJ�cPGI�r�[1�rJ�r�[J�r�CP[J�CPC�CJ�[nrJ�[P[PC1�[Pr�rJ��P[J�LI[1[nrJ�[nC1[P�P�Pr�Cn[ CJ�[nr�[Pc1�G1�[PGPC1�rJ�r�cl�G1rP[P[PrJ�[J�[PC�CPCJ� a �����r�I-�n�n���n�r�n�����n�n���rn��n�Wr I lift P O R T A N T D O C U Ni E N T MORIUr��OMPRI��r�n���n������n����n�n o 5 5 5 5 5 ISSUED BY REGISTERED ck�, !� Date of Manufacture CD 5 APPLICATION 4 fl �uu® fj NUMBER C, INC. 5 � rMINTRIES5 EVANSVILLE, INDIANA 47711 Order Number c� [F 140.1 E �! MANWFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN CEJ 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 PETERSON PARTY CENTER INC 5 139 SWANSON ST C� 5 5 WINCHESTER MA 01890 5 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 S chemical and that the application of said chemical was done in conformance with California Fire S 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. -- 5 The method of the FR chemical application is: 5 5 5555 5 Serial #: 8152120(2) C C� Description of item certified: ' 5 5 CENT MID 80WX30 SNY 10'SPACE L 5 - Flame Retardant Process Used Will Not Be Removed By. 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 NYDER MFG NEW PHILADELP141A OH Signed: S 55 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. C !] GIr�[Imo[P[1[P[J�CnC1�CPrf�CP[1�cP[1�[J[P[PCnCP[P[J[PG1�rJ�[PrJ�Gn�CPCJCP[1�[�rJ�[PCPGPGPGPC1�cP[PC�[�[lr�[1r1[1�[1�CP�P[1�cP[Pr�c1[PLf[J�[1�CP[J[J�[J�C1�[J�[PCPCn[PrlCJ�rJ�[f[PC1�CP[J�CJ[n[P FRI i 3 'n���n�ra�nr��r� n�n����� oIMPORTANT DOCUMENTRUM � 5 5 5vatrIF 5 5 � 5 REGISTERED CALISSUED BY F Date of Manufacture 5 _j APPLICATION s �o�� m CJ NUMBER T INDUSTRIES INC. c5 5 EVANSVILLE, INDIANA 47711 Order Number 5 5 [FI 5 5 .1 MANUFACTURERS OF THE FINISHED 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certifythat the materials described have been flame-retardant treated 5 5 5 (or are inherently noninflammable) and were supplied to: 5 5 657150 5 5 PETERSON PARTY CENTER INC 5 139 SWANSON ST 5 5 5 WINCHESTER MA 01890 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved S chemical and that the application of said chemical. was done in conformance with California Fire 5 S Marshal Code, equal to exceeds NEPA 701, CPAI 84, ULC 109. -- 5 5 The method of the FR chemical application is: 5 5 Serial #: 8152310(2) 5 5 Description of item certified: S 55 5 CENT END 80W X 20 LO SNY ]0'SP � 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 PHILADELPHIA,OH Signed: C' Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. 5 � r�r1r�CPrJ�rJ�r�r�rJ�rJ�rJ�r�r�r�r�rJ��CPrJ�CPrJ�CPrJ�rJ�C.tr�rJ�r�r�rJ�rJ�C.Pr�c1�rJ�r�CPrJ��r��PrJ�CPr�CPCPcP�PCPr�rJ�rJr�r�r�rJ�rJ�CPrJ�rJ�CPrJ�rJ�rJ�r�rJrJ�CPc.t�r�rJ�CPr�CPrJ�cPcJ�cPrJ�CPrJ�rJ� 5Fill 1 i