Loading...
23B-015 APPLICATION ON HOLD Nprzik, Pt, File#BP-2021-0610 IMP APPLICANT/CONTACT PERSON MICHAEL'S PARTY RENTALS LLC ADDRESS/PHONE 409A WEST ST LUDLOW (413)589-7368 A /,e;( e r / '� / v PROPERTY LOCATION 6 HATFIELD ST MAP 23B PARCEL 015 001 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST LOSED REQUIRED DATE ZONING FORM FILLED OUT 75 Fee Paid Building Permit Fill-• :. {�, Fee Paid Typeof Constru tion: 20X20 TENT New Constructi i n Non Struc . . •• 'or renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. City of Northampton •f••'`d Massachusetts z * /%* DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building III' ��•.\ /1/ Northampton, MA 01060 i.. Nov /6 FaloF 2Q�0 ENT PERMIT APPLICATION Np„,N,bn ga o,soONs (For Tents over 120 square feet) Permit Fee: $30.00 Check # 1310 (P gp-al- 6l0 PLEASE TYPE OR PRINT ALL INFORMATION � n`�1n� 1< 1. Name of Applicant: 1"\�1� 1 �Q1� ke 1 IS_( (5 l n L Address: � V 1 kC1l/1 ' 0 I ., h UI T Iel phone: "tI.T-c� f" P3VY 2. Owner of Property: '(An S3,-\ }- Ani I l c1 Pied-VA, Address:U 16 [CI " M V^iVr C)lao0Telephone: 3. Status of Applicant: Owner Contractor 4. Tent Location Address): 1 0 �A, \P.t� JI`I Qt \� Nn eArvlp\-Un V\A- o o Parcel ID: Zoning Map# .2313 Parcel#64C District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: 6. Description of Tent: [��, Size: ZO 0.6 'S'r(Imz n� Occupant Capacity: L' Dates of Use: `� 1 — L` 1 7. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 8. Certification: I hereby certify that the information contained here' is true and accurate to the best of my knowledge. DATE: 1 \I I ZU—Z,o APPLICANT'S SIGNATURE 1 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. n LAT'��' r��-r33--r�r�r�r�rLr IMPORTANT DOCUMENT"-. dap Li 5 5 Cieri l'icato or 'Hanle Rcsista_pee REGISTRATION 1-11 : ISSUED BY APPLICATION a '� Date of Manufacture C� 5 CM R 04/11/03 5 NUMBER '`�� 1 ^c C5 v+ 4-t ' yOrder Number 5 EVANSVILLE. INDIANA 47725 5 F121 4 .4, MANUFACTURERS OF THE FINISHED 3/,78 0 TENT PRODUCTS DESCRIBED HEREIN E. This is to certify that the materials described have been flame-retardant treated 5 t (or are inherently noninflammable) and were supplied to: 5 71445 5 MICHAEL'S PARTY RENTALS 199 ELIZABETH DR jLUDLOW MA 01056 5 5 5 5 C ij, '' 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 Marshal Code. All fabric has been tested and passes NFPA 701-99. CPAI 84, ULC 109, The method of the FR chemical application is: 5 Serial # 5 L� 8023000(1) 1 Description of item certified: 5 PI GXP TOP 20W x 20 VL W�V f, 5 Flame Retardant Process Used Will Not Be Removed By 5 Washing And Is Effective For The Life Of The Fabric 5 5 _- in,IN HUVI F STAn:cv111 F NC Signed: 11",�� �C77+�--"'- 55 ,, ENT DEPARTMENT-ANCHOR INDUSTRIES INC. 5J LIP PrPrPt_1-3 rJ�rJ�rPrPtJ�rJ�rsrJ�rJ�r�rJ�rJ�rn�Pr�rJ�rJ�uMPMPu�rJ�r�rPcfc l-rJ�cJ�rJ�cPr�cluaT2.1-J��Pr�chcPJ�cPrTr��PrJ�r=Pr1�PcPC Pr�r PLin ' LPlcPtPr Pr�cf 0 The Commonwealth of Massachusetts Department of Industrial Accidents _; i__ Office of Investigations Lafayette City Center c 'jaw, 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2iblv 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): 1.0 I am a employer with 18 4. ❑ I am a general contractor and I 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 workingfor me in anycapacity. employees and have workers' P tY x 9. ❑Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 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.El 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. Contractors 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.#:014005034819120 Expiration Date: 1/1/2021 Job Site Address: U2 A--AGV' \Q\ S 1'1(J City/State/Zip:\a '\`CA Y\p 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 certi nder t e pains and penalties of perjury that the information provided above is true and correct: Signature: ///fff • \\ `Date: I\ Phone#: l� — 3733 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): lDBoard of Health 20 Building Department 3JJCity/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: Accwci® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/14/2020 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 NAME CT Kerry Barton ARA Insurance Services, Inc. PHONE FAX 102 N.W. Parkway 06,/C.No.at):800-821-6580 (A/C.No):816-474-1931 Kansas City MO 64150 ADDRESS: Kbarton@arainsure.Com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA: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: 1994473034 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL.LIABILITY AIMIMA002-026119-07 4/15/2020 4/15/2021 EACH OCCURRENCE $1,000,000DAMAGE TO _ JCLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $100,000 _ MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A7MIMA002-026120-07 4/15/2020 4/1512021 COMBINED SINGLE LIMIT $ (Ea accident) 1.000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ X HIRED TSAUTOS X NON-OWNED UTOS PROPERTY DAMAGE AUTOS (Per accident) X HC Col$1000 X HC OTC$100 $ A UMBRELLA LIAB X OCCUR A5MIMA002-026121-07 4/15/2020 4/15/2021 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 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 A1MIMA002-026119-07 4/15/2020 4/15/2021 Actual Loss Sustained Special Form/Theft Deductible 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Building Limit$2,081,000 w/$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