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10 WHITE ST - BUILDING INSPECTION (3) -= ncc ('.,nunomseaIth u1 1lassa.husens nit lloxd of Buildintz Regulations and Standards Nit NI( II' \I I I ) t J Nlo.sachuseits State BuIIJin� Code. SIR. 7 rJitit,n I /l, i I,� I Building Ile,nul :ApPhc: (' ulun T„ Ins( rt. Rel ale ,s . R� uutr Or Ik•nu,lt.h a J .I n,..u , _---- - I his on Ffir, OI k Ps t h,ly. \ Bud r-i m Permit Nuh r )u I J. wl0,er;2Q _ Building C,nnnn..0 ineu li ,c.wr,I;Rw!Jmg, 1),I,c r sec'rl«v 1; srrN INFOR.AIATTON 1.1 Properli J ess j 1' .Assessors Map & PurtO Numbers I la Is [his n accepted tieCr' ses NIIP Nunil,er Nwnhei Zv:ting Information: 1.4 Property Dimensions: - __e.1_ -- ' se Lot And(sG lit Frun�.:Iee it —_--__ 1.5 Building Setbacks (ft) �— Y'urJ tilde YarJ% Roar Sard 1-runt '— Required PruwdrJ _. Required ProNded Required I PI,,,iJcd i 1.6 Water Supply: CM G L c -4Q 4 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zunc: Outside Rood Zone' I PubL•c ❑ Pn rate❑ Check if yo❑ l Municipal ❑ th, .Ile Jupu Sal ,rvrin ❑ IN SECTION 2: PROPERTY OWNNER�SHI�Pt 1p F 2.1 Ow^ert of Record: "-- /N_�_ Lr�r� /�IRrUG Prat, Address fur Service: Sienutere Tclephunr �\ r SF..CTION 3: DESCRIPTION OF PROPOSED WORK' Ichrck all that apply) — I \yJ\ —� 71:r..v Gurdructiun ❑ Existing Building ❑ Ossner-Occupied ❑ Rep:nrsu,) ❑ :\Itecul,.nl s) ❑ ,\Jdin,m ! Demul:!Iel ❑ Accessory Bldg. ❑ Number of Units_ I Other Zspecjfy Bn:a Cescripuun o(Pmp(isrJ Work": Se. 1<� qQ, Y _ — 1 SF.CTiON J: ES"fiMATED CONSTRUCTION COSTS ----- Fsurnated Cl,sts: OMcial Use Only J Vern ILahurandMaterials) I L17—ulJing '� --- 1. Building Permit Fie: g___ Indicate fits„ lec Is Jele,mined. ❑ Sclndard City/Town :Application Fee _t. Flectncal _JI ❑ rota: Project Cost I Item 6) < multiplier _ s LNI,�Iechanical _t. Other Fees: S_ 1l IHS'ACI 5 IFirefltel :\IlFces: S - —� ('heck No ('heck .\m,lunr (�.nh \in„unl o i'ola) Project Cost 5 -- ��e S� 0 Paid In Full 0 OutsLu,Jnl_, 13,11,111,e Due -- SEC-1 ION 5: CONSTRUCTION SFR% ICES G.I I.icensvdt'oiistructiosiStipenisorIC'SLJ, SI, IIA&I is f Ho, 1c I cph'-fic wal 5.2 Registered I I o me I trip ro v nient Contractor i I I I t I HIC G)1111%111s Name of HIC Rcgistjjiit Name \Jdre,, Stptatwe Icieph"Fle SECTION 6: WORKERS' COM PENSA TION INSURANCEAFFIDAVIT iM.G.L. c. 152. § 2506)) Workers Compensation Insurance affidj%jl must be completed and uhrotited with this applio-at,mi F,Ilklle tl' 111111111c this atfida%it will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ILY" No , 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Lt-j, iflcw as Ow ner of th� jnojpeity hereby D 4 auth'.''ze y?.c-'r -- to act t"! InY he bait, II .ill IT)a I lees to lorke.11 trued by this building permitappli�ation. Slk.IllatdrC tit Ossrier Date SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLARATION as Owner cir .Authmi/ed \I,ern hetch) declare that the statements and information on the toregoinc ipplicatromaie true and accurate. to the best or m), knowledge JIILJ behalf. Print Name SILIlatUri!0I Ownerol-Authmi/colAgent Date LI Stened under the pairs and penalties tit perjuryi NOTES: 1. An Owner who ohiams a building permit it, do his/her own \kotk. uran owner %%ht) hues in unreui,tcled r, 1111AL(I-I I not registered in the florne [nipo)sernern Contractor (FI10 Program). will nw ha,.e access to Theai hill Ali, 11 program or guaranty tund under M.G.L. c 142A Other important information tinthe HI(' Constiuclion Supervisor Licensmg WSI.) can he found in "i 0 %IR Regulation,; I M R6 and 1 11) Rs, When uhmantiAl work IN planned, po)%ide the inf(irmantin below 1,oal Ill-ors area ,Sq. H.i iincludirig garage. tirij,hed Ieck.s ,,r area lsq. A I Habitable :,,unf Nuinherct beep LacesN111rher A becro,-in, N,imhcf of hathn,mi, Number of fi.ilt Ispe ,ltheating ,l,iern 1 \Ile -I "'ohne Icm Lit,Ik lCd =j i I o rPcPrJ�rJ�[Pr�rPr IMPORTANT D O C U M E NTRuPLPL PJ�LLPLPL -pd-3'�'�' ° 5 Certificate of Flan-N Resistance 5 5 ` ISSUED BY Date of Shipment 5 5 5 REGISTRATION �� s RR9 4i312007 5 NUMBER INDUSTflIE51NC. 5 Tent Identification 5 EVANSVILLE, INDIANA 47725 5 MANUFACTURERS OF THE FINISHED 04457947 5 ._ 5 F121 a 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: 5 692825 5 5 RICE RENTAL CENTER 5 5 115 CABOT ST 5 BEVERLY MA 19155108 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 # 8045300C(3) r, 5 Description of Item certified: FIESTA PLUS CATENARY MIDDLE 5 5 40WX20 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 JOHN BOYLE STATESVILLE NC Signed: 5 I Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 o rJrPrJ��nrJ�rJ�rJ�rJrJ�u�u�r��nrPrJ�rJ�u�r�cnrJ�rJ�cPrJ�rlr��nrSr��Pu�r�rJ�rlrJ�rJ�r�rPrJ�rPr�rJ�rPrS�nr��Pr��nr�r�rPrS�rrPrSrSrJ�cnrJ�r nrJ�rJ�rJ�rJr�rJQ�r�rPr�rJ��Ps o °P9Muu92Q2MRQKM 1 M PO RTANT DOCUMENT o 5 Certificate of Flame Resistaice 5 5 ISSUED BY 5 REGISTRATION Date of Shipment 5 5 NUMBER is NpCNon® 4J3J20075 EVANSVILLE, INDIANA 47725 Tent Identification 5 SF121.4 MANUFACTURERS OF THE FINISHED 04457947 Ij 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 692825 5 5 5 RICE RENTAL CENTER fj 115 CABOT ST 5 5 5 BEVERLY MA 19155108 5 5 5 5 5 5 S SCertification is hereby made that: S 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# 8045900C III 5 5 5 Description of item Certified: FIESTA PLUS CATENARY LOOP END 5 40WX20 WHITE VINYL 5 SFlame Retardant Process Used Will Not Be Removed By S 5 Washing And Is Effective For The Life Of The Fabric 5 JOHN BOYLE STATESVILLE NC Signed: — --� � � A 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. A rJ�rJ�cPrJrJ@PcPtPrJ�cPrJ�rJ@PcPrJ�rJ�cPrJ��P�P�P[PrJ�cPr�rJ@PrJ@PcPrJ@PrJ�rJ�rJ@P�PcPrJ�rJ�rJcPcPrJ@PcJ@PrJ�cPrJ@E! 31: 11:31 rPL3rL3rJ@PcPrJ�cPrJ�rJ�rJ�cP�PcPrJ�rJr� O o cP�P�P�PrP�P�PrP�Prl�PcPr PrJ@PrlJr11 M PO RTA NT D O C U M E NTa'�'uP'�PLPL'�uuPL'��PLpd 5 o to Corm icatle of t�art Flan?e Resisce Is 5 5 Date of Shipment 5 5 REGISTRATION 4!3/2007 is SS NUMBER rj 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 C5 F121.4 MANUFACTURERS OF THE FINISHED 04457947 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: 5j 5 692825 1 �j 5 RICE RENTAL ENTER 15 CABOT ST 1 S 5 5 rj BEVERLY MA 19155108 5 5 S 5 S 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# 5045600C(I) S 5 Description of item Certified: FIESTA PLUS CATENARY HOLE END 5 5 40WX20 WHITE VINYL 5 5 Flame Retardant Process Used Will Not Be Removed By 5 rS Washing And Is Effective For The Life Of The Fabric �a7 C5 JOHN BOYLE STATESVILLE NC Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 O rJ�rJ�rJ@P�PcPr Pc PrRPLPLj-cPr 3j[!! [filPrPcPcrcPcPcPrJrJ@PcPcPcPr PrJ@PcPcPrJ�rJ�cPrJ�cPcPcPr PcPrJ�cPrJ@PrPrJ�rrl�cPrJ�cPLrL3PLPcPLPLr rL3Pr r PLFEP�PrJ�r�cPcPcP�P O IMPORTANT DOCUMENT u�u�cruu�uu�u�u��u�u��u�u�su�u�rssu�u��n�u�r� o 5 IrCertificate Of ff la e Rot'5taurp rj REGISTERED 1 ISSUED BY 5 5 v R. Date of Manufacture APPLICATION 5 5 NUMBER k*11[1=JSTRIES INC. 02/19/01 EVANSVILLE. INDIANA 47711 Order Number Li 5 MANUFACTURERS OF THE FINISHED 333649 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 692825 5 5 5 RICE RENTAL CENTER TAYLOR RENTAL CENTER 115 CABOT STREET 5 t7 BEVERLY MA 01915-5108 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 Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method of the FR chemical application is: 55 5 Serial #: 5 (J 6020560C(4) 5 Description of item certified: TENT WAL 6'[OX40'VL W W W/4CA 5 S _ Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric (5 •JOFIN BOYLE STATESVILLE NC Signed: _2 _ fS` 5 Name If Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. r CPf�CP[P[PCP[P[PCI�C.I�[PC.I�LI�L(Cn[PCPC.IaC.F 11 i:PCn[PCPCPCPf�C.I]I�C.IE.([?[1:![.1[PG)7LI�CPC.([PC�C�f�CPCn[PCP[PGPCPCPC�f�CPCP[PCP[P[PC)7[PC�f�CPCn[ 0E9rJJ 00[2[P[PC.IPrPCPCPC.Pc P[P[_f� B • j t E FRMM9��1 M P O RTA NT DOCUMENT ��LPLP� 5 Ceruf leave of Flange Resis"ee 5 5 REGISTRATION ISSUED BY 5 Date of Manufacture 5 APPLICATION v uu 5 5 NUMBER s NDUSTflIES ING.® 05/08/03 5 EVANSVILLE, INDIANA 47725 Order Number 5 5 FI2La �'� �� ° MANUFACTURERS OFTHE FINISHED 368094 55 TENT PRODUCTS DESCRIBED HEREIN 55 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 692825 5 5 RICE RENTAL CENTER 5 5 TAYLOR RENTAL CENTER#14978-4 115 CABOT STREET 5 5 BEVERLY MA 019155108 5 5 5 • 5 5 5Certification 5 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 S Fire Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. 5 5 The method.of the FR chemical application is: 5 5 Serial # 8020560C(4) 5 5 certified: Description of item cert 5 5 TENT WAL 6'10"X40'VL WH14/CA MIA JOHN BOYLE STATESVILLE N.0 I 5 5 5 5 Flame Retardant Process Used Will Not Be Removed By 5 S Washing And Is Effective For The Life Of The Fabric rS 5 JOHN BOYLE STATESVILLE NC Signed: d' S 5 Name of Applicator of Flame Resistant Finish TENT DEPARTh1ENT-ANCHOR INDUST,RIES INC. �° ChLPC-h[PC-nC1�CCPChCP'�[J�CPChC�`CPCrL'rL"�LhCJ�CPCJ LICJ�CJ'I[][JCJU�LI�Li LI�C-)—CJC'J^":J[JiJCJL�?CJ[�u"�'J Ci e�C�Ci LILICJ�L1JfJ LiC�!7_i��f_'(fJC'�f-'JfJL'JCILI L;ULit_!L31' °"� " °°"""' .4CC7RD,� CERTIFICATE OF LIABILITY INSURANCE 7raprzflDs PFTIGUDER THIS CERTIFICATE M ISSUED AS A MATTER OF INFORMATION Whofesal% rRetail'Suppliaa Compensation ONLY AND CONFERS NO RIGHT$UPON THE CER, ICATE. �COrpOfafian HOLDER.THIS CER WIGA7 .00ES.NQT AMEND,EXTEND OR DO,Hox 84.5933 ALTER THE COVERAGE AF BY THE.POLICIES BELOW. . 6oston MA 022845S33 INSURERS AFFORDING.COVERAGE "Cs wbuReD Rice Renlal'Center,Inc., R761/RERk WHOLESALE(RETAIL SUPPLIERS 'Gt:2n0-RQlilal Station NaeVRER 6: _...__ .......w._v._.__—._............... _._._....._...... . .11=�Cahot'S(reaq' .Bey¢riy' MA' 01915 1 NaBVREXO; INSURER III . . COVERAGIEs THE POLIES OF INSURANCE LIPTED.BELOW HAVE BEEN ISSUED TOTNE INSURED NAMED AOOVE FOR.THE.POlICY PER1001NDICATED.NOTWITHSTANDING. ANY REWIREMENT,.TERM OR.CONDITION OF ANY.CONTRACT OR D THER DOCUMENT WITH.RESPECT TD WhICH'rMIS.CERTIMCATE'MAY BE ISSUED OR MqY PERTAIN.THE IN8URANCE AFFORDED BY T'FIE POLICIES DESCRIBED HEREW IS SUBJECT TO ALL tEit.TERMS.ESCCLUSIONS AND CONDITIONS OF SVFJ! POUCIE&AGGREGATE UMIYB SHOWN MAY HAVE s=N RLDuomaY PAID CLAItay4. OiSR -_._ _..__ LT 'TYPE LIIF NWNeNDE' POIiC NUNBEB .....11aOLICY.EFFEC E POLN:Y PIRATNBI .. . —I ........ ,.J DA .�Nm T __WRITS GENERAL LN9ILITi' EACHOCcm9ENCE s .._. CIAJMS MADE ,OCCUR! N „_. (''�' PRE S Ee rc_ S L ' L G GE L I[RY I PERSONALSADV Ik1URV' S — — rn � 'GENERAL AOOREGATE $ ..... PGNi AGGREGATE LIMTAPr�P�Li—E'�6 PFR PriODU •CDNIP/DP'ACG s ..._. '.A�1ITONOBAE LIABILRY j 1 co LIMIT i i 1 —AUTO ! IEP Pagenit ALL OWNED AUTOS - BQDM1Y NLDRY s NII✓EOAIH06 GOOIIY IWURY � NDWOWNECANID$ (Pb BENUsnit g 1.. _...... ....._ ....,. .-.�....--•......� -�, PROPERTYDANtAOE'; �)Per aeaam}) 5 GARAOE.LIAGIUTY AITOOIa.Y -CAACOOENT $ i .....,i,ANY AUTO OTNERTLY, EA AtY.Ib .......... ....._.._.___.. I ! AUTOON[Y: EACE68R&19RELIA WRILfIY EACH OCCURRENCE 6 OCCUR CLAIMS'L140E AGGREGATE $ . . . i9 OEOUCTI&P. RETENTIONS $ � is .... A 1YORRBRSCONPENEATION"0 � —��_.•�� _.- X , STATU- OTN ' lHPLOYEG$11ABRJLY VVC 000475-08 D1A972008 Ot/01/2009 ANY PAOPRMRMARTNGWCFCDUME Off1CCR!MEMBCR ExCLWFnT. ..__. EL DISEASE Ed EMPLOYEQ°s S. 100,000 .. . .... E L OI$EASF,,.POLICY ivaT 6 500,0p0" aascneY,ma«' '' I I OESCR�OF OPERAOON9 ILOCATpTHB)vE1aCLE&I FxCLU$bNSA00ED 0V ENDDR6ENENi/SPECIAL PNOVIEIdS CER`rIFtCATE HOLDER CANCELLATION eIRIULO ANY OP TNE.AEOVE DESCRIBED POLICIES SE GANCELLe6 BEPORE THE E%PRATWN City Of S61CIT1 DATE THEREOF,THE ISSUING WSUC "4 ENDEAVOR TONAL 30 (1A-rkwpnTEN NORVE To TUW�CEaTIFICATE.NOIBEA NANED TO TI{E LEFT.BUT FAILURE TOM So.EHAL4 WIM/IO OlIMATHON'OR LNIRE.RY OP ANY'RRID UPON TIE Wut;RER.RB,AGENTE OR IlEPRES�NTATIYEB.TM�� ...___ .,_ . AiRrIp1G�'FFPREaeNTATIVE ACORD 25(2001108) ® - RPORi[T10N 1 888 IMPORTANT If the certificate holder is an ADDITIONAL IN..SURED,the:poicy(ies)must be endorsed.A statement .onthis certgloete does not confer rights to the certificate holder.in:lisu-of such,endoraeroent(y). if SUBROGATION lS-WAIVED, sulboct to the tarms.and cantlieons of the policy,certain pclices?nay require an endorsement.A atatement on this cerliffc@te does not confenrights to.the oertftcate holder in lieu of such endbmement(s). D IS CLAMER The Cortificate of Insurance on fhe raveia'a'side of thisfcrm does'not constitute a contract between' the issuing Insiirert5),evthor¢ed represomtative orprdducer,and the canificate"der,nor does it. afflrtnapvaly or negatively a mend,extend or alter the coverage affnroed by the'policies listed the"h. AOR0 21(200t,f0$) J