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7 LORING HILLS AVE - BUILDING INSPECTION (7) t i The Commonwealth of Massachusetts W Department of Public Safety Massachusetts State Building Code(780 CNIR) Building Permit Application for any Building other than aOne-or Two-Fam' Di Ilin (This Section For Official Use Onl ) Budding Permit Number. Date Applied: Building Offici.il:'� SECTION 1: LOCATION(Please indicate Block k and Lot k for locations for which a str not available) d¢ve 5a(ew 0070 _l�osvea©r-VParL,,-J ', No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 1 PROPOSED WORK Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration ❑ 1 addition❑ 1 Demolition ❑ (Please fill out and submit Appendix I) Change of Use ❑ 1 Change of Occupancy ❑ Other pecify: /CLW Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No —/ Is an Independent Structural Engineering Peer Review required? \ r Yes ❑ No l3 Brief Description of Proposed Work:")"uo t9 rc �GI X �(� l p n 4- J 4 P`rlf vP Fndc,4 , SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA"LION,ADDCC[ON,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CIOR 34) ❑ Existing Use Gruup(s): Proposed Use Grou pis): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)8r AreHPer Fffoor(sq, t.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-{❑ A-5❑ r B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ HA❑ FI-5❑ L• Institutional M ❑ 1-2❑ 1-3❑ 1-4❑ Ni: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-I ❑ S-2❑ U; Utility❑ Special Use❑and please describe below: Special Use At;' ' SECTION 6:CONSTRUCTION TYPE(Check as a Iicable) 'IB O — - IIA O 1IB ❑ IIL\ ❑ nIB ❑ IV 17 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CiNIR 111.0 for details on each item) 1 Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: PP Y❑ Check if outside Flood Zone❑ Indicate nuu,icipal❑ A trench will not be Licensed Disposal Site❑❑ or indcntify Zoue uron site system❑ required❑or trench orspecify: permit is enclosed❑ road right-of-way: hazards to Air Navigation: \I-\I l t < mi v n I eie�ot Applicable❑ Is Structure withinoirportapproach area? Is their review completed? nt to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑SECTION 8:CONTENTOF CERTIFICATE OFOCCUPANCY ode Use Gnmp(s): 'Type Of Construction: Occupant Load per Floorilding contain an Sprinkler System?: Special Stipulations:_ t } SECTION 9: rROPCR'!Y OWNER AUl1[ORIZATION Name and r\,ldress of /P/r�operty Owner ,,n c /- q,7(2 I/ev[OT J-6/(�/ / hDr,u� 14,715 /f7ye JQ(t l.Ll �Z .. Name(Print),i{/fp-5t`r.�Nowe No.and Street City/Town Zip Property Owner Contact/Information: - 7,1d 'Title -� Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereb authorizes �Z w Name Street Address City/row State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building ermit a lication. SECTION 10:CONSTfiUCI'ION CONTROL(Please fill out Appendix 2) If buildin&is less than 35,OI111 cu.ft.of enclosed space and or nut under Construction Control then check here O and skip Section 111.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No, e-nail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Na//me // ? Name of Person Responsible for Construction c� // License No. and Type if�jA,/p Applicable �e L-1 �-o c.t2P �. PeG✓✓d�N- &—Y Street Address City/To%vry State Zip -535 S UDC' Telephone No. business Telephone No. cell a-mail address SECTION 11:k�'ii:?I_I:Httti'CC.-IAiP13NS,\IICAV INtiIJK:\ C4::\P!'ll)�\\I r M.G.L.c.152. 25C 6 A Workers'Compensation Insumncc Affidavit from the MA Department of Industrial Accidents must be completed;Intl submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 'S G)= t. Building S d w Building Permit Fee-Total Construction Cost s_(Insert here 2. Electrical 5 appropriate municipal factor)=S 3. Plumbing act nw lily Note: ivlinimum fee cont =$ (.t. \lechanical (FIVAC) $ 5. Mechanical Other $ e Enclose check payable to � G.Total Cost S I-led. 00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering illy name below, [hereby attest under the pains and penalties of perjury that all of the information continued in this application is true and accurate to the b It f illy knuWledge and understanding. ee �/ 12 Ce � k/G(,w49 � r 'f�$- S3S5��5 c g Please print and sign name 'title Tclepltone No. Date . J6, y Lowel/ S� i'rllp /)a& Street Address City/To vn State -Zip Municipal Inspector to fill out this section upon application approval: Name Date The Cpmmonwealth of Massachusetts kvDepartment oflndustrialAccidents 1: 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): 7�c Address: g1a4 L D we,1l 5f. City/State/Zip: Pea bo XY D l¢&0 Phone#: Are y an employer?Check the appropriate box: Type of project(required): 1. " I art a employer with J. _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand 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.! ❑ g required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their I L Plumbing re❑ g pairs or additions myself..[No workers'comp. right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12.E❑.,Roof repairs employees. [No workers' 13.E Vther %pWJ comp.insurance required.] *Any applicant that checks box tQ must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. !Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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 that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: IJt^/`Cl — 4AAA-e6k C&f. 5 U/6e WGN !7 Policy#or Self-ins. Lic. 9:: 192C-570 -2a - 3S -O� Expiration Date: `/1�D/�(� Job Site Address: � 4 o r&'c& />r c/5 f4t/e City/State/Zip: rJa IL'y/ t 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 D1A for insurance coverage verification. I do hereby certify undertree pains and penalties of perjury that the information provided above is true and correct. Sign , Date: Phone#: Official use only. Do not write in this area,to be completed by city or town 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#: l I Information and Instructions 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 licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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 compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be 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' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. 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 in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/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 the affidavit that 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. A new affidavit must be 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-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia I ACC>Rd CERTIFICATE OF LIABILITY INSURANCE 03125/20 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: H the Certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions;of the policy,certain policies may require an erWorsemem. A sfe6emern on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER NAME: CT Tom Honan do Hays Companies of NEW England eidPRo� . 617 723-7775 'F Na: 617 723-5155 133 Federal Street ---- Second Floor JODFSI' - -- Boston,MA02110 HiSUM481 AFFORDING COVERAGE NAICf NsuRER A: Zurich-American Insurance Compny——--�16.535 —— nssuaED — Allegiant Management Corp. -----'"------ -- ------ 300 Lafayette Rd. _— Rye,NH 03871-000 0: — — -- - eawRer E: :. ei51E/JR F COVERAGES CERTIFICATE NUMBER:12NHOO2780696 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 PAW CLAIMS. TYPE Oi WBYRANCE POLICY MISBER POLkY 6f POLICY E%P IAART3 OENETtAL uAeluTY I 1 EACH OCCURRENCE S COMMERGALGENERALLI.4BILITY �T—:'CWMSUADE 1OCCUR '_MEOEXP(.An Me ) Is --_— :PERSONAL.&ADVMJUR GENERAL AGGREGATE IE GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPR1P Ari6 ys POLICY! PR6 LOC ABTOYO&LE LIABILITY EaaWtlsll 1 'L ANY AUTO _ SOOILYINJURYIPer Pasco) I S --.— T -__T_ �,_�AUTOS OWNED ' AUTOS ULEO BODILY INXJRY(Per arvJaert) S . NON-OWNED PROPERTY DAMAGE I__ HIREDAUTOS _I AUTOS (Paremslenry__ � 1 5 UMBRELLA UAD OCCUR I 1 EACH OCCURRENCE S —L.—�--' 'CWMS-MADE AGGREGATE OED gETE1�ITgNS �I _ _-_-_ $ WORKERS COMPENSATION 1 WCSTATU- 0T AND EMPLOYERS'UABUJTY YIN.I X!TORY�AUTC 1 ER ANY PROPRIETORMARTNER(EXECUTIVE EA EP,CN ACCIDENTS 1,000,000 A lOFFICERIMEASiER EXCLUDED? CiNfAi WC W90-735-04 - 111101/2012 �,11101120131� — — (1AWWMorylnNNl - EL DISEASE-EA EMPLOYEE S. 1,000,000 H yym,describe urea DESCRIPTKNI OF OPERATIONS dabw -E.l DISEASE-POLICY LIAal E 1,000,000 � I I Localise Coverall P~. 11/012012 111012013, ClienO 821 DESCrtBnON OF OPFAAl10M9/LOCATMINS f VEIRCLE8(AtteW ACORD ter.AIY➢CarM ReaYee SAtNd1110.V rnu.epere is reRldre4l Coverage is provided for North Shore Rental,Inc.dba:Events for Rem only those employees 464 Lowell St leased to but not Peabody MA 01960 subcontractors of: CERTIFICATE HOLDER CANCELLATION North Shore Rental,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE dba:Events for Rent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 464 Lowell St ACCORDANCE WITH THE POLICY PROVISIONS. Peabody,MA 01960 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I c ¢ y1i A.x d 'rye9h`h'i�.1! v v7 �4!� ,lk r...slt"' s 9} a N.L1�Yi W W � ck e oee Alame eses ancePAGE 1 s F70=3/24/2010 tured AZTEC TENTS `' '` 2665 EC TENTS COLUM IA ST TNV NUMBER: 0179791 1 '' TORRANCE, CA 90503 P.O. NUMBER: (800) 228-3687 CUSTOMER NO: EVEN019 This is to certify that the materials described below have been flame retardant ` 11"t- treated (or are inherently flame retardant). I Allied Financial Solutions u,,'a." '°• Events for Rent =,.,a,Fao^6 F9002 - 7303 Turfway Rd Ste.306 o•F ,a,2.ga 1 s,ol _V, Florence, KY 41042 464 Lowell Street o.F ea oz r7 ea Peabody, MA 01960 .' °" `°` »m„ r llk. Fm2n Recmtrun:17 OB v : ., OIii11i0s Te idles Mil Tfi Vner F-.-Ol .MYYry w Te<n. oero co<e rvelon so°.oi f F, s^ra.r w.aena�.o vl oa: y, r.na6.os F� Certification is hereby made that the-anTVEs d SCf1'bed below hereof are maw T�vamaee HE from a flame-retardant fabric or material registered and approved by the T^1a^1a,.California State Fire Marshal for such use. The fabric has been tested and *^�.^ase Fvss.mrsao. : Yvs3 passes NFPA 701 Large Scale. See chart to right for trade name of x t +"1 flame-resistant fabric or material used and additionally referenced on the label 7 of the fabric panel e . THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING 1t �. David Bradley General Manager-Manufacturing � 4 a otluct on superintendent s` L[le of A 1¢a[or or Pr u i t Name of ApPI¢ato or Protluctlon Supnrintentlent pp -yx i ITEMS MANUFACTURED TYPE PRODUCED 15x15 Ipc Festival TOP UW S 1 w/ Rope Tensioners & Flag with secondary valance 15x15x8 Festival Frame Only S 1 15x30 1pc Festival TOP UW S 1 w/ Rope Tensioners & Flag with secondary valance 1Sx30x8 Festival Frame.Only S 1 (2Peak) 20x2O 1pc Festival Top UW S 1 w/ Ratchet Tensioners&Flag with secondary valance 20x2Ox8 Festival Frame Only S 1 20x30 Ipc Festival Top UW S 1 w/ Ratchet Tensioners & Flag with secondary valance 20x3Ox8 Festival Frame Only S 1 (2Peak) 20x4O ipc Festival Top UW S 1 w/ Ratchet Tensioners&Flag with secondary valance 20x4Ox8 Festival Frame Only S 1 (2Peak) NORTt" OP ID: DES CERTIFICATE OF LIABILITY INSURANCE °"""N10V2019"'° 013 O THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FOLDER. 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 ISWNG INSURER(% AUT140MYED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: if itte carOftm hwldar is an ADORIONAL INSURED,thfr pobcyiws)ff"T he anderaed. If SUBROGATION IS WANED,subject to the terms and Condition,or the polley.certain posdes nay spoke an C 4wwmerrL A rNrowwre on the mr6 icele do"not conhr rights to the certifrate holder in lieu of such erWorsmle Si FROPucm Phone:8174 Ann4Rarie Kaharrow= DPS Insurance Grow.Inc. Fax:6174MOT81 608-628 52DD SOS-520.6914 500 0mnite Awt. Sud!3 INdton,REA 11 aka jrlsurancs.can Daniel P SWfivan i 6FPGRprla IC b affivleal A:St Paul Fire✓I,Marine Mts.Co. wEVeSO No ore a nt. a,Safety Insurance Company Chris Leblanc 464 Lowell SL Ohio Ca%Lm iA..IDarty Agency Peabody,MA 01980 COVERAGES CERTIFICATE NUMBER: P REVISION NUMBER= THIS IS TO CERTIFY TIWT THE POLICIES IE OF INSURANCE LISTED BELOW HAVE BEEN LSStIED TO T INSURED NAMED ABOVE.FOR THE POLICY PERIOD INDICATED. N M 1THSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTTER.DOCUMENT VATH RESPECT TO VA9CH THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.L:•MITS SMOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ TYPE OF RISVRANC POLY LRfIS GENERAL liAellm aam EASP y:.:JPP.'NCE I 1rDDD,88 A CK00223359 04i01120131 0N01)2014 i PRENIS£S.Er` t t00. 1 C,AiNS WDC �J JC_JR it,EC e%P S fjn erd Leon` 15 1 1 PiA&/NA:SAN INJ6RY 5 11000,94 __ �ENcR4 nCOP's<+ATE S 2,000.00 IQ L>WRE� E.M 7AR"iIES PER °P.LY -E-CJNPA?A•�G i 1,000,000 (?C Y _ t,000. 'ALROMOBIL!wNNTT 6>.e�be'T B x AN'AUTO6217a80 W0112013 040U204 BODILY MAIR•:P Pr, r, e +',_C'Y&E, F SC`!=3VLE0 BDJI rN;JRY iAar6wwvrl)-.S AL-CS r.—AL-O., LnO r I H'FEC,alTCS Al'CS X ileWR6ta uA6 X CG:LR EACh OCCJRFMNCE T 1,000.00 nt�cBas�una I SAMS—MADE NU0135508"26 04MI12013104VII 18'AOOREGA- S t,000 D O A fl NT!ON 10,000 At S4 Ia vaoanlas cmrPrdlsAnoNITO Imm I Ar�ES�LnYsse!'walLm Y,N I =•. ; Acmm I I ANY PRCPR1ET00.'?APrwEC;EkeCUTW2 jN.A I iman0st"I"BER u..OdFJ4E-EP EMP„OYE;I 0. ItIa M W. ' F� .jGftlfD!uIYJP I i - p COTic Of CPERA'gN6 -Imit tSE.,'!'3u^' •MI' 'S 001 A 'EgWpment Floater I0.1002m1610 04/Otl20'13'py01/2018 UIRk T00. i I jD9d. 6,00 �elEatlamow OP OP6RAT,naa:LOCATONB!VEM4LE6 WtrrhAr�eo rPf,A.a..�ela>°.r+o aPe.m.Aama.a..sa*�I 4 ip"ty Goods Rental I i CERTIFICATE HOLDER CANCELLATION NORTHSM SHOULD ANY IO THE ATE T DESCRIBED D FnCr W BE C9L 06 R"BEFORE THE EXPIRATION DATE THEREOF, XOTiCE wR.l BE a6LIVERET) M North Shore Rental Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 464 Lowell Street Peabody,NIA 01960 AUTIreP68P RFsrRtlNr►RNE 01905-2010 AC.ORD CORPORAYION. All rights reserved. ACDRD 25(2010/08) The ACORD name and logo are re owed marks of ACORD