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25C-251 (128) 0V- &v --1:55 City of Northampton r •'tr I Massachusetts A DEPARTMENT OF BUILDING INSPECTIONS y � 212 Main Street • Municipal Building Northampton, MA 01060 a �cj .� �5� I -- EGTENT PERMIT APPLICATION JUL :71VD (For Tents over 120 square feet) A ;50 I! Permit Fee: $30.00 Check # r FST O�F.UI_DIN(,INSPECTIONS n;OPTNAmr,ON.MA 01060 PLEASE TYPE OR PRINT ALL INFORMATION 1 1. Name of Applicant: 6� \ r� ` �� 3C��t -7 LOS—Address: \75 Crl�l��_� R�V7�_ _�tUT, IX -PJ��1(4elephone: 2. Owner of Property: S Address: v Y '� Telephone: 3. Status of Applicant: Owner SContractor 4. Tent Location Address): / F1� st- Nc)Ai x!LM �t � mc�lien Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: 6. Description of Tent: Size: :)0Ix qylJ`) Occupant Capacity: C) / �` , Dates of Use: -7 Z _ e U� 7/)0)0 OTt-cy 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: APPLICANT'S SIGNATURE NOTE: Issuance of a permit does not relieve an applicant's burden to comply wi/all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities. City of Northampton Massachusetts t DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060YyF: �1kti TENT PERMIT APPLICATION (For Tents over 120 square feet) ( �>o Permit Fee: $30.00 Check # 1-4�- PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: �U ASI V C y-b k3 tLn— 1'CI,(SIC?� Address ��S � � V�_ �t C_ �U[� H) �elephone: �j F)b t /Z � 2. Owner of Property: l/ Address �/I Telephone: ( �"�S 2Z� 3. Status of Applicant: ,/�Owner Contractor 4. Tent Location Address): Parcel iD_ Zoni ngg Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: 6. Description of Tent: \I Size: C:)l Occupant Capacity: 1,S—D LL Dates of Use: 7 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: APPLICANT'S SIGNATURE NOTE: Issuance of a permit does not relieve an applicant's bur en to compl 4th all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities. ot lame ISSUED 6Y: EUREKA! TENTS I a div. of Johnson Outdoors Gear LLC BINGHAMTON, NEW YORK 13902 ' Manufacturers of the Finest �� ;5 A, Tent Products Described Herein s Pi's �F asiat� DEALER NAME: Northampton Rental Center, Inc ADDRESS: 59 Service Center Rd CITY: Northampton STATE/ZIP: Mass. 01060 This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical that was tested and passed the following codes:California State Fire Marshal Code, NFPA-701, Underwriters Laboratory of Canada(ULC-S109-M87)and(ULC-S109-2003). Description of item certified: 30'x40'x18'White Tent Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric TENT DEPARTMENT,JOHNSON NO O/ 00 S GEAR LLC ot Flame ISSUED BY: ' EUREKA! TENTS I a div. of Johnson Outdoors Gear LLC BINGHAMTON, NEW YORK 13902 Manufacturers of the Finest ¢� ;5EQFO Tent Products Described Herein 9 f1kE M� F RgtP� DEALER NAME: Northampton Rental Center, Inc ADDRESS: 59 Service Center Rd CITY: Northampton STATE/ZIP: Mass. 01060 O ♦ O This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical that was tested and passed the following codes:California State Fire Marshal Code, NFPA-701,Underwriters Laboratory of Canada (ULC-5109-M87)and(ULC-5109-2003). Description of item certified: 30'x40'xl 8'White Tent Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric TENT DEPARTMENT,JOHNSON 0 OO S GEAR LLC mow,n �® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/18/2019 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). PRODUCERNTA T NAME: Christina Barrett Aquadro 6 Associates PHONE (413)586-7373 FAx UVC.No.Extie N : (413)584-0859 355 Bridge St. , P. O. Box 357 E-MAIL -christina@aquadroinsurance.com INSURERS AFFORDING COVERAGE NAIC 01 Northampton MA 01061 INSURERA:NAUTILUS INSURANCE CO INSURED INSURED INSURER B AIM MUTUAL INS CO 40959 Northampton Rental Center Inc. INSURERC:NATIONAL GRANGE MUTUAL 14788 59 Service Center Road INSURER D: INSURER E Northampton MA 01060-0000 INSURERF: COVERAGES CERTIFICATE NUMBER:CL175808074 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 LTR TYPE OF INSURANCE A POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 AX CLAIMS�dADE OCCUR PREMISES Ea occurrence $ 100,000 1172729 MED EXP(Any one person) S 5,000 5/1/2018 5/1/2019 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE E 2,000,000 POLICY F7 PRO- JECT F7LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER a C AUTOMOBILE LIABILITY MIS40BIR 12-16-2018 12-16-2019 MEIN D L LI $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE S -DED7 1 RETENTION9 WORKERS COMPENSATION E H- AND EMPLOYERS'LIABILITY W,I N X TAT TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICERIMEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT S 100,000 (Mandatory In NH) WCC500-5006728-2019 1/1/2019 1/1/2020 E.L DISEASE-EA EMPLOYEE I 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mare 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Aquadro/HOLLIF. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) --- I f i I i � � I l w ♦ 4 I � � I�__--_ -_' ------'•- _(�-��_••�` A .�/ .' - � 'ley ,�, }..-_..�•-•","- -'; -- �: - ;J t fie,