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32C-345 TENT PERMIT
BP-2023-1649 0 HAMPTON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-345-001 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-2023-1649 PERMISSION IS HEREBY GRANTED TO: Project# TENTS HOT CHOC 2023 Contractor: License: Est. Cost: MICHAEL'S PARTY RENTALS INC Const.Class: Exp.Date: NORTHAMPTON CITY OF MAIL TO:DAVID Use Group: Owner: POMERANTZ Lot Size (sq.ft.) Zoning: CB/WP Applicant: MICHAEL'S PARTY RENTALS INC Applicant Address Phone: Insurance: 1221 SOUTH MAIN ST (413)589-7368 014005034819121 PALMER, MA 01069 ISSUED ON: 11/21/2023 TO PERFORM THE FOLLOWING WORK: 6 TENTS FOR HOT CHOC RUN 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • 591F Fees Paid: $30.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner City of Northampton AMp�,,. r4 } ew Massachusetts• Iw fvalt DEPARTMENT OF BUILDING INSPECTIONS T 212 Main Street • Municipal Building �. Northampton, MA 01060 °4j.v 6P 23- io qq FC TENT PERMIT APPLICATION Nw (For Tents over 120 square feet) ° (20c93Permit Fee: $30.00 Check # 14 25-144 FAT O,c NOpTti U//°/nJ MnTO� ^ISp�CT 44 AO706p0M3 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: M ► (' V1 Gl. S P c(\_iJ (L�1� �'�\S _ Address: J )9 l S o'`,O �-L. mcm.n A-)c)004,Notr, KA Telephone: L'// 2)- 5 cr- 7 3 (p b 2. Owner of Property: (I-t Dt k)tc' c & d✓� Address: D 4d So04A.. SA("&-e. c LOT Telephone: Li' - /0aS 3. Status of Applicant: Owner 4Contractor 4. Tent Location Address): (j \(� -�Ul�- 'tn Sf( 4 ( _1;) T A)014"ka'^ I c` 65.ac.e focssale t46'1- e ko a/a4-e (L o‘A ) Parcel ID: Zoning Map# Parcel# 111 District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: 6. Description of Tent: Size: ,,tat.I) lasla; aOX20 J (a)Ioxa 'JOX3o Occupant Capacity: .6 - 4g0 Dates of Use: l g-I a)2'- 1a/3) 93 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. DATE: I I J�? 1.2c- 3 APPLICANT'S SIGNATURE �,1-t,1I �� 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 Department of Industrial Accidents 111 _;gym.— Office of Investigations �i- ` Lafayette City Center _4- 2 Avenue de Lafayette, Boston, MA 02111-1750 •—� www.mass.gov/dia .. g 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. 0 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. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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. 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. #:014005034819122 Expiration Date:1/1/2024 Job Site Address: o\ is -1 L 54-(-L2.' ' L.o t City/State/Zip:J )r-\j , -pnl YA b(0(LO 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 certify under the ains and penalties of perjury that the information provided above is true and correct Signature: ai - Date: I I )101 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 3ECity/Town Clerk 4.0 Electrical Inspector 5E:Plumbing Inspector 6.❑Other Contact Person: Phone#: Client#: 1740037 MICHAPAR6 ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD!YVVY)1/06/2023 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 pollcy(les)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 Amanda Hanson USI Insurance Services LLC PHONE Est):845 383-5960 FAX (A/C, 610-537-2231 12 Gill Stret,#5500 E-MAILDDE amanda.hanson@usi.com ADDRESS: Woburn, MA 01801 INSURER(S)AFFORDING COVERAGE NAIC* 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 pRpEDcUCED BY PAIDCLAIMS. itirr TYPE OF INSURANCE N$R� POLICY NUMBER (MM/DD Y) (MM/LDD//YYXYY) UNITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR EpApM pEe nce) $ $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPRO- $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 014005034819122 01/01/2023 01/01/2024 X ISTA OTH- ERAND EMPLOYERS'LIABILITY STATUTE ANYIPROPRIETOR/PARTNER/EXECUTIVE ROPRIETOR EXRTNER E ECUTIVE Y/N N/A E.L.EACH ACCIDENT $500,000 OF(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES(ACOR)101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION informational purposes onlySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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 #S38680502/M38680496 UXYZS I I ®A ``(.(/_)RQ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/19/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Daniel McDonald NAME: Brown&Brown of Massachusetts,LLC PHONE (781)455-6664 FAX No: (A/C,No,Ext): ( ) 980 Washington Street E-MAIL s: Daniel.McDonald@bbrown.com ADDRE Suite 325 INSURER(S)AFFORDING COVERAGE NAIC# Dedham MA 02026 INSURER A: AXIS Insurance Company INSURED INSURER B: Michael's Party Rentals,Inc. INSURER C: 1221 South Main Street INSURER D: INSURER E: Palmer MA 01069 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 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. IPOLICY EFF POLICY EXP NSR ADDTYPE OF INSURANCE INSD WVDSUBR POLICY NUMBER MM/DD/YYYY (MM/DD/YYYY) LIMITS LTR INSD WVD ( ) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A Al MIMA00203617910 04/15/2023 04/15/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 0000 POLICY JECT LOC PRODUCTS- OTHER. Network Security& $ 50,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A - OWNED X SCHEDULED A7MIMA00203618110 04/15/2023 04/15/2024 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED N/ NON-OWNED PROPERTY DAMAGE $ X v AUTOS ONLY (Per accident) AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE A5MIMA00203618210 04/15/2023 04/15/2024 AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN 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 $ Equipment Floater A Al MIMA00203617910 04/15/2023 04/15/2024 $1,500,000 $2,500 Ded DESCRIPTION OF OPERATIONS/LOCATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Michael's Party Rentals,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 1221 South Main Street AUTHORIZED REPRESENTATIVEEOft'. Palmer MA 01069h 12�iriuk•w- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Cr1ifttat& of FL -e Re,BY Manufactured by Date treated or •� �G manufactured ,c•'••"... Snyder Manufacturing,Inc. Fred's Tents & Canopies „ ��.`,', _ 3001 Progress Street 420 Hudson River Road r ,,,; a r Dover,OH 44622 Waterford,NY 12188 8/2023 F 140 This is to certify that the materials described below have been flame-retardant treated (or are inherently nonflammable) FOR Michael's Party Rental 1221 South Main Street Palmer,MA 01069 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. x NFPA-701-2015 (large scale) Trade name of flame-resistant fabric or material used White Blockout Reg.No. 140.01 The Flame-Retardant Process Used WILL NOT Be Removed By Washing Fred's Studio Tents & Canopies, Inc. Plant Supervisor Product Description 1 Ox20 Center Peak Buckle Customer Invoice# 53891 Certificate of Flame Resistance •�-3t ISSUED BY Manufactured by Date treated or c & manufactured Snyder Manufacturing,Inc. Fred s Tents Canopies r • ; s.;r 3001 Progress Street 7 Tent Lane ''sc "FT ° Dover,OH 44622 Stillwater,NY 12170 02-2009 F•140 This is to certify that the materials described below have been flame-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. X NFPA-701 (large scale) Trade name of flame-resistant fabric or material used BLOCKOUT Reg.No. 140.01 The Flame-Retardant Process Used WILL NOT Be Removed By Washing Plant Supervisor Fred's Studio Tents & Canopies, Inc. '� (Jh. `� Product Description 10x10 Center Peak Customer Invoice # 21908 ISSUED BY Manufactured by Date treated or manufactured Burlap Corporation Fred's Tents&Canopies 1-704-867-3548 7 Tent Lane Stillwater,NY 12170 03/2007 This is to certify that the materials described below have been flame-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 Staic 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. 1 _ 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) Trade name of flame-resistant fabric or material used _Blockout_ Reg.No. F53501 The Flame-Retardant Process Used WILL NOT Be Removed By Washing dig(64 Fred's Studio Tents& Canopies, Inc. Plant Supervisor Product Description 20x20 Center Peak Una Customer Invoice ii 17719 II } Certificate of Flame Resistance ISSUED BY Manufactured by Date treated or Burlan Corporation Fred's Tents &Canopies manufactured p:pF 1-704-867-3548 7 Tent Lane Stillwater,NY 12170 01/2007 This is to certify that the materials described below have been flame-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) Trade name of flame-resistant fabric or material used _Blockout_ Reg.No. F53501 The Flame-Retardant Process Used WILL NOT Be Removed By Washing Inc. '! do(6" Fred's Studio Tents & Canopies, Plant Supervisor Product Description 20x30 Center Peak Unit Customer Invoice# 17719