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31C-047 (8) 88 VILLAGE HILL RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1866 Map:Block:Lot:31 C-047- 001 CITY OF NORTHAMPTON Permit: Temp Structure (Tents) PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1866 PERMISSION IS HEREBY GRANTED TO: Project# TENT Contractor: License: Est.Cost: Const.Class: Exp.Date: CONWAY SCHOOL OF LANDSCAPE DESIGN INC Use Group: Owner: UNIT 2G Lot Size(sq.ft.) Zoning: PV Applicant: MICHAELS PARTY RENTALS INC Applicant Address Phone: Insurance: 1221 SOUTH MAIN ST (413)589-7368 PALMER, MA 01069 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: 20X40 TENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I'ndcrground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:4.) Cr-ZI-Z.I kie THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I a r . >2 Fees Paid: $ 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner City of Northampton (!. .4, )1. * . '' Massachusetts DEPARTMENT OF BUILDING INSPECTIONS i 212 Main Street • Municipal Building r,. `Ca Northampton, MA 01060 sNW►� TENT PERMIT APPLICATION %‘ Sep ��0 n�a �' (For Tents over 120 square feet) �\o4Ty6.�"`n/� �0 i c Mn, _ Permit Fee: $30.00 Check # '5`�d O',,,—.° 40T•/ON 7060 S 1 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 1 C V Aa--e S ()Doc- e_Q- /A�* S Address: I ova‘ 'SO I (Y101.1\3 r. p4��It'`QS, m/�i Telephone: tA l3- S g c -7 3 co g 2. Owner of Property: 1-ArN-e Th v\L C.4L e kook Address:4*> V 1\A0. C11 a ( - ! )OWA-�^" 'Telephone: 4( 0 a a 1 1C/_.-S 3. Status of Applicant: Owner Contractor 4. Tent Location Address): p V 1 k. . 'E pr Lt (c0.c 0 d c--1/4-(A0,,,e4-o-, , /Y C (C0(, 0 Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: r(l. 6. Description of Tent: l Size: �oC X H O' -‘C-Gwv•e --\-'---en'k- Occupant Capacity: (0 -1 Dates of Use: 0 Op ' 1 \ 1cl Io1 7. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 8. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. 7- b -10)f Ai_DATE. f APPLICANT'S SIGNATURE NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities. The Commonwealth of Massachusetts 4 Department of Industrial Accidents =_;JJ_'f Office of Investigations _.!«�I k' Lafayette City Center ; 2 Avenue de Lafayette, Boston,MA 02111-1750 — www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Michael's Party Rentals, INC. _ Address: 1221 South Main Street City/State/Zip: Palmer, MA 01069 Phone#:413-589-7369 Are you an employer? Check the appropriate box: Type of project(required): 1.❑� I am a employer with 18 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and 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.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no Tent employees. [No workers' 13.® Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 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: MA Retail Merchants Workers Comp. Group Policy#or Self-ins. Lic. #:014005034819121 Expiration Date: 1/1/2022 Job Site Address: $� V( l la e I4 l I I P1.60,-A City/State/Zip:JJ of v,p -z •. ma of((„C) 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 DIA for insurance coverage verification. I do hereby ce ' under the pains and penalties of pedury that the information provided above is true and correct. -4,___ Signature: Date: Phone#: 413-589-7368 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3111City/Town Clerk 4.0 Electrical Inspector 5❑Plumbing Inspector 6.0Other Contact Person: Phone#: i--� DATE(MMIDDIYYVY) AC CERTIFICATE OF LIABILITY INSURANCE 4/13/2021 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 CONTACT NAME: Kerry Barton ARA Insurance Services, Inc. PHONE FAX 102 N.W. Parkway (Arc.No.Ext):800-821-6580 FAX No):816 474-1931 Kansas City MO 4150 ADDRESS: Kbartonearainsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AXIS Insurance Company 37273 INSURED MIMA002 INSURER B: Michael's Party Rentals, Inc. 1221 South Main Street INSURERC: Palmer MA 01069 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 142433697 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 TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY A1MIMA002-029336-08 4/15/2021 4/15/2022 EACH OCCURRENCE $1,000,000 MAE TO CLAIMS-MADE X OCCUR PR MISES(EaENTED occurrence) $100,000 MED EXP(My one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A7MIMA002-029338-08 4/15/2021 4/15/2022 COMBINED SINGLE LIMIT $ (Ea accident) 1.000.000 _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTOX H R DSAUTOS X NON-OWNED (AUTOS PPROer eERTY DAMAGE $ ccident) X HC Col$1000 X HC OTC$100 $ A UMBRELLA LIAB X OCCUR A5MIMA002-029339-08 4/15/2021 4/15/2022 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y ANY PROPRIETOR/PARTNER/EXECUTIVE 1-1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Rental/Sales Inventory AIMIMA002-029336-08 4/15/2021 4/15/2022 Actual Loss Sustained Special Form/Theft Deductible 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Building Limit$2,081,000 WI$2500 ded BPP$165,424 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. Reference AUTHORIZED REPRESENTATIVE ARA Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Client#: 1740037 MICHAPAR6 YYVY) MM/DD/ ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE 1106/2021 ( M/DDI 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michelle Arsenault USI Insurance Services LLC PHONE 413-750-4407 FAX �A/C,No,Est): (A/C,No): 484�52-5167 711 E. Main Street ADDRESS: michelle.arsenault@usi.com Suite 201 INSURER(S)AFFORDING COVERAGE NAIC# Chicopee, MA 01020 INSURER A:MA Retail Merchants Workers Comp.Group 00000 INSURED INSURER B: Michael's Party Rentals, Inc. INSURER C: 1221 S. Main St INSURER D: Palmer, MA 01069 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTRR TYPE OF INSURANCE INSRL WVD POLICY NUMBER (SUBR MM/DDY/YYYY) (MMIDD/YY�YY) LIMITS COMMERCIAL GENERAL LIABILITY pEAACCHH�OECCCUURRENCE $ CLAIMS-MADE OCCUR PREMISES(EaEoNccurrrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- 1POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ NED AUTOMOBILE LIABILITY (Ea ac cidentSINGLE LIMIT $ ANY AUTO — BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ - EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION 014005034819121 01/01/2021 01/01/2022 X STATUTE OTH- ER , AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Michael's Party Rentals Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1221 S Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Palmer, MA 01069 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S30894399/M30894390 MZACV IMPORTANT DOCUMENT Certificate of c'Came 1esistance ISSUED BY Date of Shipment 03/28/12 p 4 NCIIIOR Registration Number INDUSTRIES• " INC. Tent Identification F-12110 ' 15042462 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 -• T•.a ,C•.;9j� ' Z;Z y�,•Fj� MP.QQ' ETQ'`;` Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701-04, ULC 109. Serial# 8296001 (10) Description of item certified: TENT WALL LAP& SNAP 7'10X22 W/2 CATHEDRAL WINDOWS WHITE VL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric GLEN RAVEN TECHNICAL FABRICS GLEN RAVEN NC Name of Applicator of Flame Resistant Finish _---� Signed: %� (. ANCHOR INDUSTRIES INC Ve 'eiaiii eporeze/ egi,e4/61alv& Ay' 1;: ISSUED BY Manufactured by Date treated or ar i.t Burlan Corporation Fred's Tents&Canopies manufactured I-704-867-3548 7 Tent Lane Stillwater,NY 12170 03/2007 This is to certt&that the materials described below have beenflame-retardant treated(or are inherently nonflammable) FOR Michael's Party Rental 409 A West Street Ludlow,MA 01056 Certification is hereby made that:(Check"a"or"b") a)The articles described below this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used Chem.Reg.No. Method of application x (b)The articles described below are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal for such use. NFPA-701 (large scale) l-- Trade name of flame-resistant fabric or material used _Blockout_ Reg.No. F53501 The Flame-Retardant Process Used WILL NOT Be Removed By Washing Fred's Studio Tents& Canopies, Inc. Plant Supervisor Product Description 20x40 Center Peak Unit Customer invoice li 17719 4xRpq»d " r City p of Northam ton Certificate of Completion This is to certify the work granted under 780 CMR,9th Edition of the Massachusetts state Building Code, allowing the occupancy of use of the premises or Structure or part thereof located at address below as shown on the Assessor's Map. Owner: CONWAY SCHOOL OF LANDSCAPE DESIGN INC UNIT 2G Location: 88 VILLAGE HILL RD Permit#: BP-2021-1866 Construction Type N/A (780 CMR Table 602): Use Group Classification N/A (780 CMR 3): Occupant Load Per Floor N/A (780 CMR Table 1004.1.2): Live Load Per Floor N/A (780 CMR Table 1607.1): Under the following limitations, special stipulations, and/or conditions of the permit: 20x40 Tent Issued on 09/21/2021 Northampton Building Inspector(Name): Kevin Ross /-2Northampton Building Inspector(Signature): This Certificate shall be posted by owner, in a permanent manner and in a visible location,on all floors designated as use group H, S,M,F, or B, in every room where practicable of use group A,I,R-1, or R-2 per the requirement of 780 CRM Section 120.5 Posting Structures.