Loading...
25A-181 (34) ia l IMPORTANT' DOCUMENT Certificate of me Resistance Date of Shipment ISSUED BY 03/16112 Registration Number jF,;.NCH0R1V) INDUSTRIES INC- Tent Identification )+ 15044552 F140.1 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: MICHAELS PARTY RENTALS 409-A WEST STREET LUDLOW, MA 01056 G15 T. �OF CALlp�9 Q Q' q N N 2Q F" �p�FF'RE MPS q4` R E't P+4 Certification is hereby made that: The articles described on this Certificate have been treated with aflame-retardant approved chemical and that the application of chemical 701 conformance 10gth California Fire Marshall Code. All fabric has been tested and p asses NFPA Serial# 8047000 (2) Description of item certified: NAVITRAC END 40WX20 SNYDER WHITE VINYL W/TENSION STRAPS Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHILADELPHIA OH � Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC Applicant Information Please Print LejZibly Name (Business/Oraanizationf'Individual): Michael's Party Rentals, LLC Address:409A West Street City/State/Zip:Ludlow, MA 01056 Phone t*.413-589-7368 4 Are you an employer? Check the appropriate box: Type of project(required)_ 4. I am a general contractor and I 1.[/. I am a employer with 6. ❑New construction l employees (full and/or part time). have hired the sub-contractors 2-0 I am a sole proprietor or partner- listed on the attached sheet. T ❑Remodeling These sub-contractors have ship and have too employees &. ❑ Demolition working for mein any capacity employees and have workers' 9. F] Building addition [No workers, comp. insurance comp. insurance. � required.] Q oration and its 10.F1 Electrical repairs or additions a. We are a corporation 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plturibina repairs or additions myself [No workers- comp. right of exemption per MGL 12.(Q Roof repairs insurance required.] ; c. 152. §1(4). and �,ve have no Tem ora Tents employees. [Rio workers' I-�-© Other P ry comp. insurance required.] *Any applicant that checks box I must also till out the section below showing their workers compensation policy information. t Homeowners who,submit This at_tdavit indicatinz the%-at,-doing all work and then hire outside contractors must submit a new affidavit indicatinn such. =Contractor that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their xvorkers'comp.policy number. I aiii arz etnplover that is providing workers'conzpezzsatiorz insicratzce for Pziy enzplovees. Below is the policy and job site lgfornzafion. Insurance Company Name:AM Trust Policy m or Self-ins. Lic.9:WWL3089560 Expiration Date:4/7/15 P GQ Job Site Address: ��� I`��illd`��r 1 0.� i-Jf��IQ City/State/Zip::L(41)rx, ��n PA 6 10 Attach a copy of the workers' compensation policy declaration pane(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of 1�4GL 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 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 fonvarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c v it der the pains and penalties ofperjug that the information provided above is trite and correct. Signature: Date: ?J"t-1 Phone 4 Official use on&. Do not write in this area,to be completed by citi,or toms official. City or Town: PermitlLicense 9 Issuing Authority(circle one): 1. Board of Health 2.Buildina Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector i 6. Other Contact Person: Phone(*: xxx*xxxxxSA�PLEx"""xxx�x ._.�. xx'.'*i#-f*Sx*irtxii*i14oMlf**k* AUTHORIZED REPRESE14TATNIE a-rxxxsresxzxrxx-r*xxsxsxxxxxrzx �•}l� _ 19ss-2010 ACORD CORPORATION. All rights reserved. ACORD 25{2010105} The ACORD name and logo are registered marks of ACORD '►0- Do.arry signs exist on the property? YES No IF YES.=descxtbe size,type and location: Are there any proposed changes to or additions of signs intended for the property? YES-NO IF YES. describe size,type and location: 1 t. Will the construction activity QisttRti(clearing,grading, ezravation,or fllinej over 2 aCre or is it part of a common plan of developmeM thOvAll disturb over Z acre? YE5 __ No IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERiW r CAN sE DENIEo DUE To LACK OF INFORMATION ?Lit cold=reserved for use by the Sta7ding MUTSMC PROPOSED Lot Site fro r ge setbacks Front" Side L' R: L F� j_ JL- i2ear Suiiding Height Building Square Footage minus n Space (lot&M& ' - #.of ParkkV Spacxs f of Loading Hacks Fitt: (volume& location) 13. Certification: I hereby certify that thl,iriformation coWined herein is true and accurate to the"best of my knowledge. Bete: T Appac nes S-tg tu,m ./D NOTE:Issuame of a zoninj'perr dt does not relieve aD appliranes burden to coraplymith ail zorass►b regttit erxieaLS and obtain all required pesmits fx oim the Board�of Health,CorservAdon:Coarmimsion. Ffistoric and Archlcectutal Boards.Department ofiP ublic u wJm sad'IT apptirdble permit�T'� authorities. •R.�Dor,,�-,i'•OxAT S"'ori4nsl�L"�>�i-1-��` ^mi+�Pri�°-1 •� 8/41'2004 %ZTL92CTf TV3 6b:ST TTOZ/30/VO y,� �n�1 p p� ';��� 1 IVOit 1(tA � F {U-1 FEE$25,00 /tent File No. Please type or-print aIl information and return tWs.form,to the Bztildin; - Inspector's Uf -ce - {check or money order)gable to the., City of11!ortharrupton Name of Applicant: 11� i 5 . ✓Address: 0-1 A Uk3V JV ts) l 1 -/Telephone: l( L S `] ✓l Omer of Property: Y1 1 rGk, c,'u u 6 ( ' - Address: << nd U S, i c i Telephone:__ 3- Status of Applicant: Owner Contract Purchaser lessee Other(explain) G!/t�✓�Z� N�ff�' r4. Job location: Existing Use of Structure/Property- LIST EVEM 6. Description of Proposed Use/Work/ProjeetJOccupation: (Use additional sheets if necessary): LIST DATES. OF Evaiv. 1 d NO of/SIZES OF TEMS Q WHEN T.F.1= REAQY FOR MPFI! 1M-*. k e C',-N o r, \ ivy Z 10[ -6 7. Attached Plans: Sketch Plan Sit-0 Plan Engineered/Surveyed Plans A. Has a Special PenniVVariance/r`inding ever been issued for/on the site? NO DONT KNOW %/ YES IF YF_5, date issued. IF M: Was the permit recorded at the Registry of Deeds? NO DDNT KNOW YES IF YES: enter Book Page and/or Document# -- 9.Does the site contain a brook, body of water or wetlarOS? NO DONT KNOW YES IF YES, has a permit been or need to be obtained fmm the Conservation Commission? Needs to be optained-- Obtained date Issued: (form Comm)-es On DL her Side) W:\Doa rs':0PY.S,C7 z 2lln dig- a o � --4opli�ion ss*�ador g�anOt?4 -°-°s UZ%9SCTV IVA VV:ST TTOZ/SO/to 115 INDUSTRIAL DR BP-2015-0408 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A- 181 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeory: Tents BUILDING PERMIT Permit# BP-2015-0408 Project# JS-2015-000732 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MICHAEL'S PARTY RENTALS LLC_ Lot Size(sq. ft.): 108900.00 Owner: WAM LLC zoning: GI(100)/ Applicant: MICHAEL'S PARTY RENTALS LLC AT. 115 INDUSTRIAL DR Applicant Address: Phone: Insurance: 409A WEST ST (413) 589-7368 LUDLOWMA01056 ISSUED ON.101712014 0:00:00 TO PERFORM THE FOLLOWING WORK.-ERECT 40 X 40 TENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 10/7/2014 0:00:00 $25.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner MICHA-8 OP ID: SH CERTIFICATE OF LIABILITY INSURANCE D 051 DDI Q5/19f2(314 14 I 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()es)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 Phone:781-247-7800 P1r,1E: Rodman Insurance Agency,Inc. PHOPES I Fax Fax:781.444-0090 AIC Noe : AIC No 145 Rosemary St.,Bldg.A -- Needham,MA 02494-3238 E[RAIL ADDRESS: James N. Rodman ++ INSURER(S)AFFORDING COVERAGE I NAIC a 11,NSUR,RA;ARA Insurance Services INSURED Michael's Patty Rentals INSURER 8:AM Trust Michael B.Linton dba INSURER C: 409H Vilest St. Ludlow, MA 01056 INSURERD: 1ASURER E f INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT LVITH 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.LIMIT S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fNSR TYPE OF INSURANCE I POLICY EFF 1 POLICY XP LTR INSR VND; POLICY NUMBER (MMIDD1YYYYI (MMIDOM.-MI LilAHS I GENERAL LIABILITY t - c 1,000,00 I •AlfAIMA00200431201 04/15/2014;04/15/2015 G F '"`' 100,00 A X cC:Lt t B. =."ALLIS?!Lt SrEa3ccrrencat 1= i y ! C I = 5,000 t CL Il. `hADE Ln OG..Jo E,.P Any„ze Fzr5on,! i Pte: 'JI:-.! F A[,V IPt.i'.IF'{ 1,000,00 2,000,000 L EPt"L AGGREGATE LIMIT APPLIES FER. $ C--MF`OP AGC, 2, 000,00 PRv- f f I i PvitCY AUrOMOBILELIABIL.1TY I c^":EiPt° SttaeLEtJMiT { . 1,000,00 _ I r c erq I L_ e 15/201A xri ALTS AIMr1A00200431201 4 104/1512015 (Pe' srsonl I I ALL o MED SCHED-ULE�) f �.;c AUTOS AUTOS EMILY JR ?. sck I "CAt.'A6E, OrEC ROPER dint)t . f c I HIRED,L TQ X i$1000 Deds X ICom !Cott X ?UMBRELLAL:AB I X j o'CCJP � �E-'C-f O'CrURRErtcE I 1,000,00 A EXCESSLIAB 1 ! LAI,c.3-I,1L_� Al MIHA00200431201 041151201410411512015 C-REC,;T= 1,000,00 I i DED I X i RIE:mod i IC?I 5 ? ! 1= WORKERS COMPHNSATION I ) '"'L$Iii lL r—H ; AND EMPLOYERS'LIABILITY YIN i I I T�.PY, C I -P I B f PROPRI�IOP.,PART R,c� laE I I WWC3089960 ; 04107/2014 f 04/0712015 rE L EACH ACC L` 500,00 r R�Ee3-cR^CLUe D' ;NI-) (Mandatory in NH) = C :__ E.A.EMPLOYEE!g SOQ 00 If�e d -cob-:node: FpL(C"L In:IT _ 500,00 A JEquipment Floater 'Al MIMAD0200431201 04/15/2014 10411512013 iRC 905,000 f $1000 Ded i I r i I I DESCRIPTION OF OPERATTOPZSI LOCATIONS I VEHCLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION BLANK— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ******'`"SAMPLE*********** ACCORDANCE WITH THE POLICY PROVISIONS. ♦'kit-Y it-!A`ISYK•tx'#9':tlti'Y'?*S'.F*1'H't AUTHORIZED REPRESENTATRTE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD