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25C-251 (141) BP-2022-0350 54 FAIR ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-251-002 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-2022-0350 PERMISSION IS HEREBY GRANTED TO: Project# TENTS Contractor: License: Est. Cost: MICHAEL'S PARTY RENTALS INC. Const.Class: Exp. Date: Use Group: Owner: HAMPDEN HAMPSHIRE FRANKLIN & Lot Size (sq.ft.) Zoning: URB Applicant: MICHAEL'S PARTY RENTALS INC Applicant Address Phone: Insurance: 1221 SOUTH MAIN ST (413)589-7368 014005034819121 PALMER, MA 01069 ISSUED ON:04/07/2022 TO PERFORM THE FOLLOWING WORK: 80X100 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $30.00 212 Main Street, Phone(41 3)587-1240,Fax:(413)587-1272 Office of the Building Commissioner City of Northampton CDEPA,- jj Massachusetts -_ ,.• .— ,i RTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �� i, J 4 Northampton, MA 01060 fSNh, .0 3, ‘'�`�C APR - 7 2022 ji TENT PERMIT APPLICATION / x F� ; (For Tents over 120 square feet) T" " ` '" r.ino oTI"J Permit Fee: $30.00 Check # ( fo()) t PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: M I Ckl(.R f S pCo -( 12 evi f t c Address: ii-2I ,Snlll-In ML1I/1 SI-, Palryie(1 M4 D/O69 ,Telephone: (L.113) q- 7-368 2. Owner of Property: HOvvi SItiiVfi Fiati i"tl? et +-laVY7pd k/7 4917Y6 //vicd LSOoet-y Address: PO box 305 NoIH-lil(XV 1pl-nn/Ath 0/06I Telephone: (//3) 581.-ti - 2237 3. Status of Applicant: Owner 4 Contractor 4. Tent Location Address): l,--ec Co UP)fj Fair'r'.K / i/'),Z!/r)dr 51 ra -S/ A/o(/-1 k0 /7/-0K? A44 el(>60 Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Residential: Commercial: >Q 6. Description of Tent: Size: HO' X 160 / Occupant Capacity: 5-0 Dates of Use: UI//ll/L2 6Lf/ie/o2 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. ���- b_01v DATE: 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. Client#: 1740037 MICHAPAR6 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/06/2021 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 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 413-750.4407x 711WC,N ' )E.Main Street uuc,No):454.652-5167 ADDRESS: michelle.arsenault@usl.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 Palmer, MA 01069 INSURER o: 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. tTR TYPE OF INSURANCE IN8RL 8MUIBDR POLICY NUMBER (MNIDDYD/YYYY) (FF MM/DD/YYY1) LIMITS COMMERCIAL GENERAL LU1BILI Y EACH OCCURRENCE CLAIMS-MADE C OCCUR pAEMETMEMre ne $ $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COEa aBINEen SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS AUTOS ONLY _ AUTOS ONLY (Per PROPERTY $ ) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED , RETENTION$ $ A WORKERS COMPENSATION 014005034819121 01/01/2021 01/01/2022 X STATUTE EOT AND EMPLOYERS'LIABILITY ANY FIM EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y I N NIA E.L.EACH ACCIDENT :500,000 (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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Michael's PartyRentals Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1221 S Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Palmer, MA 01069 AUTHORIZED REPRESENTATIVE O 1960-2015 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 This page has been left blank intentionally. DATE(MM/DD/YYYY) A`R D 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 IA/c.No.Ext):800 821 6580 (A/C ,_No):816-474-1931 Kansas City MO 64150 ADDRESS: Kbarton@arainsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:AXIS Insurance Company 37273 INSURED MIMA002 INSURER B Michael's Party Rentals, Inc. wsuRERc: 1221 South Main Street Palmer MA 01069 INSURER D: 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 SUER ' POLICY EFF POLICY EXP LIMITS LTR INS]] WVD POLICY NUMBER (MM/DD/YYYY) IMM/DDIYYYYI A X COMMERCIAL GENERAL LIABILITY Al MIMA002-029336-08 4/15/2021 4/15/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT 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) $ AUTOS AUTOS NO OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) X HC Col$1000 X HC OTC$100 $ A UMBRELLA LIAB X OCCUR A5MIMA002-029339-08 4/15/2021 4/15/2022 EACH OCCURRENCE y$1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE S DED ; RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (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 Al MIMA002-029336-08 4/15/2021 4/15/2022 Actual Loss Sustained Special Form/Theft Deductible 2,500 DESCRIPTION OF OPERATIONS 1 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 The Commonwealth of Massachusetts i. i► Department of Industrial Accidents IA Office of Investigations =y. MIk` . Lafayette City Center + ty 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 I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 l 2.❑ 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. #: 014005034819121 Expiration Date: 1/1/2022 Job Site Address: City/State/Zip: 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 pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 413-589-7368 Official use only. Do not write in this area,to be completed by city or towli official. City or Town: Permit/License # Issuing Authority(check one): l❑Board of Health 20 Building Department 3.00ity/Town Clerk 4.0 Electrical Inspector 5E1'lumbing Inspector 6.0Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617) 727-4900 or 1-877-MASSAFE Revised 7-2019 Fax (617) 727-7749 www.mass.gov/dia IMPORTANT DOCUMENT Certificate of Flame Wesistance ISSUED BY Date of Shipment 04/09/2019 Registration NumberSales Order# F-14001.01 r111,... C. SO-665735 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 71445 MICHAELS PARTY RENTALS 1221 SOUTH MAIN ST. PALMER, MA 01069 USA OF ALi• 'yir ,-��7' r 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, ULC 109. Serial# 8147000C (1) Description of item certified: CENTURY END 80WX20 HOLE SNYDER WHITE VL 10' SPACING W/MAXI GRIP Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC IMPORTANT DOCUMENT Certificate of Efame lesistance ISSUED BY Date of Shipment 04/09/2019 Registration Number Sales Order# F-14001.01 ''`INDUSTRIES INC.OMR SO-665735 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 71445 MICHAELS PARTY RENTALS 1221 SOUTH MAIN ST. PALMER, MA 01069 USA of AL1 • r�Q << T .a 44AVE . 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, ULC 109. Serial# 8147000C(1) Description of item certified: CENTURY END 80WX20 LOOP SNYDER WHITE VL 10'SPACING W/MAXI GRIP Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC IMPORTANT DOCUMENT Certificate of Flame Resistance ISSUED BY Date of Shipment 04/09/2019 Registration Number F-14001.01 ! ID! TI!E0RS INC. Sales Order# SO-665735 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 71445 MICHAELS PARTY RENTALS 1221 SOUTH MAIN ST. PALMER, MA 01069 USA --OF CALikO,, • .L ' 99'E'P/RE MPQS Q. Elltd 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, ULC 109. Serial# 8147010C (3) Description of item certified: CENTURY MIDDLE 80WX30 SNYDER WHITE VL 10' SPACING W/MAXI GRIP Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric "4.t, SNYDER MFG Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC IMPORTANT DOCUMENT Cert cate of Flame 1csistance ISSUED BY Date of Shipment 03/28/12 Registration Number �INDUST Q Tent Identification F444.19 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 OF .p� '�O `-"ral• e•.9>. ' .Ls'1l4 ohs.=r -pQ, -7 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# 8108986C (2) Description of item certified: CENTURY MATE EXPANDABLE END 40WX20#602 FERRARI WHITE VL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric 602 FERRARI MFG FRANCE Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC