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HomeMy WebLinkAboutCI-17-189-02 f. '; o N C O` �� V. es 2 O LL 'Z o 4 N% o ` U+ o as cs v) Q� 1 O o CO o O a. 0 F _ y m U Z W Z a) U y I L � Q -0 is C 0 U V es i O w U m o U o C O 3 N 0 N Ca N N N to 0, a •Q C R O Ca) "Oc 2 0 •'' ...6\\\\\ R III C) i rdn CFn O °' °) ca. G U M.ly 2 �_` R R o s Z m d enen1 r O 4.4 rr O o = = ti c15z yW a m0 a) Q c c 0; o 0 `1 G� O Z N o E g ,� L C� i Cc")) w U 0 ti U = WI- ca m m ti a� m co 0R ti o O +�' N d a E 0 E C c m° rn O 0 � H m z � CO Coo) r H ma o � o� Cis R a) O c y :E N 3 Q z' 0 d O v d' a E. s., C Si .� y = X) s'". a.) N = w >, :s 8 o .� y orr O a� c w C 0 ti a) >N 0..) y ~ 0 U • as W R co o y R o 0 fl OJd r R+.J 4 0 O o N w, �■ee:�601111111"lri o 0 a i-0 R0 co ,r # c z . a TOWN A UU zt:I., UILDING DEPARTMENT MATTAGM egGy 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 �A.Oa.iCO` APPLICATION FOR CERTIFICATE OF INSPECTION May 3, 2019 PAYABLE UPON RECEIPT (X) Fee Required 310.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: CV 07,.\ p � '�\ Name of Premises: Q� ;�� ®W \Y�\U � Tel �> c Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency AEcElvyy t" Certificate to be issued to V vq--�. Tel: 'Siz, Address: "AA\ \k`Pet,.vrN,iM `A ;ss PART.0' N- Owner of Record of Building 3. Address Present Holder of Ce ificate �-- - c ��_ Cam• Signature of person to whom Title Certificate is issued or his agent _ o Date Email Address: eft i-VC1 aiv‘1n\ATMS C0(`1 Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten (10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 861)6/ —/7® 000/ d L 6/30/2019-6/30/2020 A 9RO® CERTIFICATE OF LIABILITY INSURANCE DATE 13/2019YY) 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 CONTNAME:ACT Laura J Murphy HART INSURANCE AGENCY, INC. PHONE (508)759 7326 FAX 243 MAIN STREET (NC.No.Exu: (NC,No):(508)759-7366 PO BOX 700 ADDRESS: Imurphy@hartinsuranceagency.com BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Associated Employers INSURED Pier 7 Condominium Trust INSURER B: 711 Route 28 INSURER c South Yarmouth,MA 02664 INSURER D: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEa 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 5011467012018 08/01/2018 08/01/2019 VI PER ER OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations as performed by Terms&Conditions in the policy CERTIFICATE HOLDER CANCELLATION Town of Yarmouth 1146 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE South Yarmouth,Ma.02664 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 77. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD E o ..._.ygq TOWN OF YARMQUTH BUILDING ELECTRICAL ..1, -13 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 _ PLUMBING ----ill Telephone(508) 398-2231,Ext.I261 —Fax(508) 398-0836 - e SIGNS BUILDING DEPARTMENT Inspection and License Report ea Date Address ' ,`,;' " /'f i ,, „ 8 Business Name ) .01 1.iZ ? CC"eore:{0 f....r .. Contact Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: Egress ❑Emergency egress signage Location ; ID Emergency egress lighting Locanon0°4ince of exits Location 3file !� Q`�"� s` ❑ Guards/handrails Location Zoning C:1‘1, dt (I/47 / 4 CI Signs Location to t '/ '� 4 ❑ Parking Location ra Other • Location Mechanical CI Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location - ❑ Clothes dryer vents Location ,> Other Location "'° The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. In order to abate the above violation(s)you must: o Make corrections immediately and contact this office for a follow-up inspection. • o Make corrections prior to opening and contact this office for a follow-up inspection. o Make corrections prior to your nex nnual inspection. o Make corrections within s and c ntact this office for a follow-up inspection. y�} ,. � LocalOfLicial/Inspector 1 1I 0;) !•~"a° t Received By "=., '`' -* Tide Revised 2/8/13