16 MEMORIAL DR - BUILDING INSPECTION The Commonwealth of Massachusetts
Town of
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 71"edition
Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a �
One- or riro-Famili Duelling
This Section For Official Use Only
Building Permit Number: ^ Date Applied: / r
Signature: ""v'�' ` 2 /O
Building Commissioner/Inspector of Buildings Date /
SECTION 1:SITE INFORMATION
1.1 Property Address• 0 � 1.2 Assessors Map dr Parcel Numbers
AA t 0(,r'o l C' • 5
I.la Is this an accepted street?yes—!ff no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,S54) 1.7 Fiood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal O On site disposal system
O
Public O Private O _ Check if es0 P po y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Qwner of Record:
Name Print) Address for Service:
Signature Telephone
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building❑ Owner-Occupied O Repairs(s) O 1 Alteration(s) ❑ Addition 1
Demolition C3 Accessory Bldg. O Number of Units_ Other O Specify:
Brief Description of Proposed Work': '04 0
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: ORlclal Use Only
Labor and Materials
1, Building f I. Building Permit Fee: f Indicate how fee is determined:
❑Standard City/Town Application Fee
1. Electrical f
O Total Project Cost (Item 6)x multiplier x
J. Plumbing T 2. Other Fen: f
4. .Mechanical (HVAC) S List:
S .Mechanical (Fire S Total All Fees: S
Su ression
� ,may Check No. _Check Amount: Cash Amount:
6. Total Project Cost: S 7S ❑ Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
" - L.ccnse Number Evpuuuan Dote
N;poe ul CSL Hglder List CSL Type(,cc below)
a
T Descn uon
Address
U Unrestricted(up to 35,0O0 Cu, Ft.)
R Restricted 1&2 Family Dwellin
Signature ,M Masonry Only
RC Residential Roofn Covering
Telephone wS RevdenuaI Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 ge�istered Home Imp[ovemfnt Contractor(HIC)
I" to is poi V!Ze t
HIC Company Name or HIC egist
� / 5tb ration Number
.40yO 1-- eabe/U 1 ,ace
Addte:s %7s.i� —SO 3S Expiration Date
-SiChatruIv Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 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? Yea .......... No...........❑
SECTION 7s: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I 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:OWNEW OR AUTHORJZED AGENT DECLARATION
I, Ke-� }C,c� (' ✓Pv1 Y5 FOr Or Lef)¢6i,t f t�—,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
behalfy. //// � /'! /
1�5j_A KIce (Cidekl'S �r fr � ��/eg��/.0 5� �K9ui� L/,, r
Print N
Signafure or0iiiater or Authorized Agent Date
Si ned under the sins and penalties of perjury
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 M have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basementiattics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of healing system Number of decks/ porches
Typeof cooling syslem Enclosed Open
3. "Total Project Square Footage" may he .uhstituted for 'Total Project Cost"
CITY OF S.�LE.`t, �L�SSACHL;SETTS
�. BUILDING DEPART.%WUNT T 4
120 WASHINGTON STREET, )ae FLOOR
"ICI_ (978) 745-9595
FAX(971) 740.984
K(-(ggRIBY DRISCOLL
su THos ST.Pmm
MAYORDR
DIRECTOR OF PLBLIC PROPERTY/gVILIMNG CO.%L%(ISSIONFR
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrfcfans/Plumbers
Applicant Information r� Please Print Leaibll
.Naine (Busim• orpanituiomindiv,d")'_'ye4f5 1-cJ� 2G,n•"l"� IIP4 rGy� s/,/ (7�>ai4P.-r-f ('OCg)
Address: %0z/ 'S`{ .
City/Statc/Zip: G 0( (00 Phone N:
.trey se employer'Check the appropriate boa: Type of project(required):
I. 1 am a employer with 4. ❑ 1 am a SmLral contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub•contracsors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet �• ❑ Remodeling
ship and have no employees Them subcontractors have a. ❑ Demolition
working for me in any capacity. workers'comp.insurance 9. ❑ Building addition
l No workers'comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. (No workers'comp. c. 152,$1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees. LNG workers' 1J.❑Other Tm S2 ✓,�
comp. insurance required.)
It-
'Any applicant this cidaks box el musi also rill out the sacrioa below showing their workn'rampesnsarwn policy infunwlon.
'I hvneuw sus who submit this affidavit indicting they ane doing all work and then him amide cownbclma must submit a new atltdsvis indicting suck
:r,mn:nosa,hat cheek dhia box mua anachod an additwnnl shnm showing an nWmf of the au►swtwsra- and dbek wwkws-camp.policy intornutiow
/am an employer that b providlnig workers'rompensadom inauronee jar my employers, Below/s the pal/ry car/Job silo
injormarion. A
Insurance Company Name: rdCk-1^tN(ef,`�liK �TKSvrakce (�(,.
Policy MurSelf-im. Lit. p: L()C- j-o-io- 73S--DU Expiration Date: /!/Ot10,5
hub Site Address: Zlo City/stave izip: �� �Cu� "Y' . 691P 70
,
.track a copy of th@ workers'compensation policy declaration page(showing the policy number and expiration daft).
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 51.500.00 and/or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a ring
Of up to 5230.00 a Jay against the violator. Ile advivcd that a copy of this statement may be forwarded to the Office of
Invcasigariona ul'ehe DIA for insurance covcraga vcriticatiun.
l do hereby serriJy under the pains and penaldes of perjury that the injormarlose provided above is�true and correct.
utreturt. �/ Dat 7
P"ore ,i: 971l"S3,5--.5-0�S
iOffirial use only. Do not,/rite in this area,, to be:anrpkfed by city or sown oJJlcidi
I
City or ruwn: __ _ PermiulAcense
Issuing Aulhorily (circle une): -_ - --
I. ItdwrJ of IlruhA 2. 9uilding Department 1. City/town Clerk J. Electrical hrspector 5. Plumbing Impeewor
6. 01 her
Gmtact Person: ._. __. Phone g'
06/01/2009 14:10 603-964-1484 ALLEGIAM MG4T CORP PAGE 02
MELTBOW,9�yYyy,
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L CERTIFICATE OF LIABILITY INSURANCE
atE Is Issue as A MATTER INFoRNArro
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
. ALT�RE7►IHC�OYeRAQE AFTFEOFIeD BY 7IA END FX B�LORet;Sufte 606
2129ReSURERBAFFORDeiOCOVERAGE MAIOAllegi NSURERA ZuNc A7mwfoen lr su7ence CATmpaFy
$00Latasuent Rg�, Corp, HSUFKRa.
SOD lafeyeRe Rd.
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THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED A80VE FORTHE POLICY PEW00 INDICATED,NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wrTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED SYTHE POLICIES DESCRIBED HEREIN S SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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IOERMENaEq EXCLUDED/ EA.VMA4E-EAEMKM a 1,DI70,000
M YaAtlnnO' x
SP f.L06FASE-Pa,JOYOW Is 1,000,000
OTHER
Loaatlon Coverage Period: 10/18=08 t 1/01/2009 OArtlfkeDAP: OSNHOD278M-98
ClIsI 921
MMP"OPOPHMATM21LOCATIMRMG/VRYME IOMLUMMACDWVVEMMM Marr,MWKLPA&MIOMA
Clrvorage Is provided W only North Shore Rental,Inc.dba:Events for Rent
those"Weyeca leas cd 464 Lowell ST
OW nol K6cOTMaclar, of: Peabody.MA 01960
CERTIFICATE HOLDER CANC61"IM
SNOULOAIMYOFTHEAAOVEOMCg PO<IL1ES9E CANOGIAFA SaPeea THEOPRWTMON
OA72 TMEREOF,THE RAVING RMAURFIM VIM ENDEAVOR TO MAIL Lo DAYU VNtITTER
North Shore Rental,I no. NOi1 E WINE OERraRCAIR"GUM W NISID OTHIS IFFT,MAR FAiwRE TO DO 20 SMALL
d6aL Events for Rent 464 Lowell6t 00� =M DALNMpTRIN DR UAR►RY OP ANY MO w THR-MMERI,O8 ACWTO OR
Peabody,MA 01960 IRMFEBMffA7MED.
AUTHOR MREPROBWATNE a
ACORD 25(2007/08) 9 ACORD CORPORATION 1988
610537 6/5/2009 1:08:4& NM rAun 41VV0 rM. ��- •�-
1' n -4191242 M 99
DATE(MWDwWI
ACOBQ,N CERTIFICATE OF LIABILITY INSURANCE o61os/os
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
pRO
PRO Rental Specialties ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O.Box 5331D ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW-
Irvine,CA 92819 INSURERS AFFORDING COVERAGE
800 854-3298
INSUREDINsuRERA: St Paul Fire and Marine Insurance Co
North Shore Rental,Inc. INSURERS:
dba:Events For Rent INSURER C:
464 Lowell Street INSURER D:
Peabody,MA 01960 INSUHERe
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOURREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS.
INSR POLICYEFFECTIVE POLICY NPRATION LIMITS
OF INSURANCE POLWYNUMSER
A GEHERALLuelurr CK00220071 04101/09 04/01Np EACHOCCURRENCE $1 000 000
FIRE DAMAGE WY mA fat $100000
X COMMERCIALGENERALLIAWLITY MFDEXP(An y Py ) S500(0
CLAIMSMADE EX OCCUR
PERSONAL 6ADV INJURY 51000 DDD
GENERAL AGGREGATE s2 0OD ODD
PRODUCTS-COMPIDP AGG 51 000,000
GENC AGGREGATE LIM IT APR IES PER:
IX PO PRO. LOG
LICY
A AUTOMOBILE LIABILITY MA00200332 04107109 04/01110 coNEDsIN LELIMIT
E7,000,000
(Ea axi�nt)
X ANY AUTO
ALL OWNED AUTOS BODILYIWURY $
(Pw P�)
SCHEDULED AUTOS �'�
HIREDAUTOS y S BODILY�IU'Y S
NOµCMED AUTOS -
PROPERTY DAMAGE $
(Pm a¢Nen[)
AUTOONLY-EA ACCIDENT $
GARAGE LIABILITY EA ACC 5
ANY AUTO oTHEa THAN
AurooNLr. AGG s
A ExCEW LIABILITY 502XA8914 04/01/09 04101110 EACHOCCURRENCE $1000000
X OCWR CLAIMS MADE AGGREGATE _ E1000000
S
S
DEDUCTIBLE f-1 Is
X RETENTION Et DODO IWC STATU- OTH-
WORItERS COMPENSATION AND
EMPLOYERS'LMBILITY E-.EACHACCIDENT S
E .DISEASE-EA EMPLOYEE S
El.DISEASE-POLICY LIMIT S
A OTHER CK00220071 I04/01/09 t14/O7/1D
qulpment Floater $185,000 Limit
Cial Form $2,500 Deductible
DESCNPRON OF OP TIONSM1OCATIONSvEHELESIFJLCI-UWN8 ADDED BY ENDORSEMENTSPECUU.PROVISIONS
This certificate Is Issued as a matter of proof only.A Except 10 days
notice of cancellation for non-payment.
CERTIFICATE HOLDER ADprtpNAL RED wsuRERLEDEa: CANCELLATION
SHOUMANYoFTNEAROVEDESCMEDPOUCffSBECMCELLEOSUOMTXEEMUTIM
DATE THEREOF,THE SSUINB INSURER WILL ENDEAVOR TOMAA-3L�--DAYS W RRTEN
NOTIC WT ECERUFICATEHMOERNAMFJ) OT ELEFT,BUTFNWRETODOSOSHALL
IMPOSE NOOSLIGATION OR LIABILILYOF ANY HIND UPON THE INSURERJTS AGENTS OR
pEPRFBEMTATNPB
AIn ,pp REPRESENTATIVE
AXING 0ACORD CORPORATION 1988
A 2"(W97)1 of 2 #S3873256IM3873253
DELIVERY
Page 1 of 1
Events For Rent Status: Reservation
464 Lowell Street 978-535-5035 phone Contract#: 210937
Peabody, MA 01960 978-535-4561 fax Reserved Date: Thu 7/16/2009 9:OOAM
www.eventsforrent.com Operator: KEITH R.
Customer# 9940
RUSSELL JOHN 978 825-0792
16 MEMORIAL DR
Salem, MA 01970
City Loaded Key Items Rented Status Agreed Return
1 0 1900330 ( 745) TENT FRAME 20X30 Reserved 7/20/09 5:00pm
1 0 1900245 ( 1052) TENT FRAME 14X14 Reserved 7/20/09 5:00pm
1 E� 1900260 ( 725) TENT FRAME 1OX20 Reserved 7120109 5:00pm
City Loaded Key Items Sold Status
1 650025000 ( 956) LABOR CHARGE Selling
1 E� 101970 ( 1027) DELIVERY&PIU SALEM, MA Selling
DELIVERY AND PICKUP
Delivery Date: Thu 7/16/09 Contact:
Pickup Date: Mon 7/20/09 12:OOAM Phone:
EVENT IS ON SATURDAY 7/18/09
DELIVERY WILL BE ON THURSDAY IF POSSIBLE IF NOT FRIDAY
PICK UP WILL BE BETWEEN MONDAY AND WEDNESDAY
***** EVENTS FOR RENT WILL GET BUILDING AND FIRE PERMITS *****
CUSTOMER MUST HAVE TREES TRIMMED BACK TO HAVE CLEARANCE FROM TENT TOPS
CUSTOMER MUST CONTACT DIGSAFE (888) DIG-SAFE FOR TICKET#
IF IRRIGATION LINES ARE INSTALLED THE LINES AND HEADS MUST BE MARKED
*** EVENTS FOR RENT IS NOT RESPONSIBLE FOR ANY DAMAGE TO IRRIGATION LINES, HEADS OR***
UNDERGROUND UTILITIES ***
NON-REFUNDABLE RESERVATION FEE OF $600.00 WAS PUT ON CARD#**** ******** 8629 EX 04/13 ***
BALANCE WILL GO ON CREDIT CARD ON DAY OF DELIVERY ***
Reservation fees are non-refundable
RENTAL CONTRACT Rental: $1,005.00
*This is a contract.The back of this contract contains important terms&conditions including lessor's disclaimer from all liability for
injury or damage&details of customer's obligations. These terms and conditions are a part of this CONTRACT! Damage Waiver: $0.00
*If equipment does not function properly notify lessor within 30 minutes of occurrence or no refund or allowance will be made. Sales: $120.00
*RESERVATION FEES are NON-REFUNDABLE if cancelled.
*ALL rental items should be considered USED unless otherwise noted. Delivery Charge: $50.00
*ALL deliveries are strictly TAILGATE deliveries unless otherwise arranged.
*EFR is not responsible for and will not secure rental items in/on customer vehicle upon pickup of items-customer is responsible Misc.Charges: $0.00
for securing items to his/her vehicle for safe transport to&from Events For Rent
*Unless declined,1 agree to the Damage Waiver charges for the rental items for which Damage Waiver is offered. D.W.C.is Subtotal: $1,175.00
offered on only selected items.
*Events For Rent reserves the right to apply appropriate charges to Master Card,
Visa,Discover or American Express for late,lost or damaged items.
*Upon receiving rental items,I acknowledge receipt in good order of the items rented. Massachusetts: $50.25
*1 certify that I have read and agree to all terms of this contract.
TOTAL: $1,225.25
PAID: $600.00
SIGNATURE:
RUSSELL JOHN AMOUNT DUE: $625.25
Printed on 7/15/2009 8:07:16 am Modification#4
i. Physical condition of Rental Item(s) Dealer or its representatives may enter your property and you
You acknowledge that prior to taking the rented item(s), you hereby waive any right of action against Dealer for such entry and
examined it, saw it in operation(if appropriate), and are aware of retaking. In addition, you acknowledge that the failure to return
its condition and that it is in good condition except for any defect rented item(s)within the contracted time and the sale or conceal.
noted on this contract.It is your responsibility to return the rented ment of rented items) are prohibited, and that such action may
items) to Dealer in the same condition, except for ordinary wear constitute a crime.Dealer, in addition to any other action we may
and tear. take, may notify the authorities and take other action, including
the filing of criminal complaints. subjecting you to prosecution.
2. Use of Item(s)
You agree that you are satisfied with the instruction given by 7. Charges and Payments
Dealer in the proper and safe manner of using the stem(s)or that Time is money:You are responsible for rental charges from
you are so familiar and told Dealer that you were. You further the time the item(s)is"Rented Out"as specified on the front until
agree that the items)will be used only at the address designated it is,"Returned" and other charges hereunder. Return the item(s)
and only for the purpose for which the item(s) was manufactured promptly, clean and in good condition.
and intended. Subleasing or improper use is prohibited.
You and your representative, agent, or principal shall-be re-
3. Respnnsibility for Use sponsible for and shall pay Dealer all charges hereunder. RII
You are responsible for the use of the rented item(s). You charges are due upon return of the item(s)and on demand. If the
assume all risks inherent in the operation and use of the item(s) rental charges are charged to someone other than the Renter, the
and agree to assume the entire responsibility for the defense of, Renter represents he is the agent of such party and has the right
and to pay, indemnify and hold Dealer harmless from,and hereby to charge this rental, the Renter nevertheless will remain liable for
release Dealer from, any and all claims for damage to property or the charges and for the other obligations and responsibilities of
bodily injury(including death)resulting from the use, operation or the Renter hereunder.If rental charges are not paid within 10 days
possession of the item(s), whether or not it be claimed or found of their due date, Dealer at its discretion may recalculate all
that such damage or injury resulted in whole or in part from charges on a daily rental rate basis.
Dealer's negligence, from the defective condition of the items)or
from any cause. You agree that no warianties, expressed or S. Collection Costs
implied, have been made in connection with this rental. You agree to pay attorney fees, collection fees, court costs
and any other expenses incurred in collecting any charges under
C Responsibility for Equipment this agreement, in retaking the rented item(s) or otherwise in en-
From the time the items)is rented out until it is returned,you forcing the terms of this contract.
are responsible for it. If the items) is lost, stolen or damaged
under any circumstances while rented. regardless of fault, you 9. Modification of Contract
shall be responsible for all charges, including labor costs, to re- This paper represents our entire contract, and there are no
place or repair the item(s). If the item(s) is returned not clean, a collateral, oral or, other agreements outstanding. None of
cleaning charge will be imposed. Dealer's rights may be changed and no extension of the term of
this contract may be made except in writing signed by Dealer and
5. Item(s) Failure made a part of this contract.
You agree immediately to discontinue the attempt to use the
rented item(s)should it at any time become unsafe or in a state of 10. Damage Waiver
disrepair, and will immediately(one hour or less) notify Dealer of If you pay the damage waiver charge(DWC)as specified,sub-
the facts. Dealer agrees in its discretion to make the item(s) ject to the limitations and exclusions below, Dealer agrees to
operable within a reasonable time, or provide you with a like item modify the terms of this contract and relieve you of liability for ac-
if available,or make a like item available at anothertime,or adjust cidental damage to the rented item(s) on this contract, and for
the rental charges. This provision does not relieve you from the loss due to fire, collision, windstorm, upset,and riot.We exclude
obligations imposed by other Paragraphs,including 4 and 6.In all from this waiver, however, any loss or damage due to theft,
events,Dealer shall not be responsible for any injury or damage, burglary, misuse or abuse, theft by conversion, intentional
including consequential damage, resulting from failure or defect damage,mysterious disappearance or any loss due toyour failure
of a rented item(s). to care for the rental item(s)as a prudent man would his own pro-
perty, such as proper lubrication. In addition, if the items)rented
6. Return of Item(s) is a truck,you are not relieved of liability of accidental damage for
The rented item(s) is Dealer's property and is rented to you the truck container(box)caused by striking a stationary object. If
subject to this contract for rental charges and for the period of any such loss tends to indicate a crime may have been commit-
time noted on the front. If you desire to extend the term of this ted, a further condition of this waiver is that you must file a report
rental beyond the time and date specified on the front under"Due to the proper law enforcement authorities and furnish us a copy.
In," you must immediately notify Dealer to obtain our approval, In addition, if you have insurance for the loss or damage, you
the terms for such extension and a modification of this contract shall exercise,and shall empower us to exercise,all your rights to
(see Paragraph 9). If this agreement has not been extended and obtain recovery under insurance, shall cooperate with Dealer to
you fail to return the item(s) when due in; Dealer, to enforce its obtain recovery and all insurance proceeds shall be given or
property ownership of the item(s)and to protect its interest under assigned to Dealer.
this contract, may retake the items) at any time and to do so
° '�'rsrs�L3J r2''rsrsrJ'rsrJ's�'ursu1MPORTANT DOCUMENTEp-PLrPLPLPLLPLPLd-c3jd -'LPd-rs'
5 Certificate of FlaiW Resistapee 5
S REGISTRATION ISSUED BY
APPLICATION o ' CR�R Date of Shipment 5
NUMBERYR osnnoa S
INOUSTRIE INC.
5 J� EVANSVILLE, INDIANA 47725 Tent Identification cS
Flzl.a ° MANUFACTURERS OF THE FINISHED 03882164 5
5 TENT 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:293200
5
5 EVENTS FOR RENT INC#13528-8 5
rj 464 LOWELL ST cS
5 W PEABODY MA 019602741
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
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, CPA[ 84, ULC 109. 5
5 Serial # 3070300(6) 5
5 Description of item certified: 5
S FIESTA MARQUEE MIDDLE IOWX10 5
S 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 5
r—JOHN BOYLE STATESVILLE NC Signed: \j ,ui
rj "SPECIAL EVENTS DIVISION•ANCHOR INDUSTRIES INC. S
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5 Certificate of 5 (Flame Resistance IS 5 REGISTRATION SUED BY Date of Shipment 5
5 APPLICATION dzn CN�IR® 5/31/2006 5
SNUMBER ON&INX4 NousraiE iNc. 5
5 Tent Identification
EVANSVILLE, INDIANA 47725
5
5 MANUFACTURERS OF THE FINISHED 04293736
ID
55
5 F 12L4 TENT 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:293200
5
5 NORTH SHORE RENTAL INC 5
5 DBA EVENTS FOR RENT 5
5 464 LOWELL ST 5
5 W PEABODY MA 19602741 5
5
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 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
800 800 �, 5
5 serial ri 5
5 5
5 Description of item certified: rirs'rA TOP 20Wx30 WHITE VINYL 5
5 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 - --
C vIL Signed:
eName of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5
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IMPORTANT DOCUMENT °
5 Certificate of Fia1ne Resistance 5
5 REGISTRATION ISSUED BY Date of Shipment 5
5 APPLICATION 4/21/2005 5
NUMBER J�NINIS%998
5
5 EVANSVILLE, INDIANA 47725 Tent Identification 5
FI21.4 MANUFACTURERS OF THE FINISHED 04050235
s4 5
5 TENT 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:692825
5
5 RICE RENTAL CENTER
5 TAYLOR RENTAL CENTER 5
5 115 CABOT ST 5
5 BEVERLY MA 01915-5108 5
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 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
5 Serial# 8000600(I) 5
Description of Item certified:
5 FI TOP 14WX 14WWVL 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 JOHN BOYLE STATESVILLE NC Signed: �y/�//.�4 5 5 z& ` SPECIAL EVENTS DIVISION-ANCHOR INDUSTRIES INC.VENTS DIVISION-ANCHOR INDUSTRIES INC 5
O cPcPr�rJ�cr�PcPrPr�rPcPrJ�rP�Pr�rPrPcPcPcPPcPrPcPcPrJrJrPcPrJ@1cPcPrlcJ�crl P�P�PcPrJ�rJcJ�t PrJ7rJ�rPcPr Ptffl3MPLr Pr rrPLr PcPrLrPrJ�cPrJ�r PcPrJ�cPcJPP r f4 O
WmmgggurR�W PO RTANT DOCUMENT
5 Certmeaw of n.Fla to RCsIS"ee
ISSUED BY s
5 Date of Shipment 5
REGISTRATION is
5 5 CMOR® 5/13l2008
5 NUMBER INATRIES INC. 5
5 EVANSVILLE, INDIANA 47725 Tent Identification 5
r-t2t Io MANUFACTURERS OF THE FINISHED 04629478 r
5 TENT 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:293200
5
5 5 NORTH SHORE RENTAL INC
DBA EVENTS FOR RENT
5 464 LOWELL ST 5
5 W PEABODY MA 19602741
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. 5
5 Serial # 5
5
S8106402(9) 5
5 Description of item certified: 5
5 TENT WALL US26'IOX22 WITH
5 2CATHEDRAL WINDOW WALLS
5 Flame Retardant Process Used Will Not Be Removed By 5
5 Fabric
�5 Washing And Is Effective For The Life Of The Fab
DOYLE STATESVILLE NC Signed:
5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5
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