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HomeMy WebLinkAboutCertificate of Inspection (2) _) . ; , di _ The Commonwealth of Massachusetts eft City\Town of 11 = YARMOUTH t., {tip, New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:TOWN N COUNTRY FAMILY RESORT BLDCI-16-006476-03 Trade Name:TOWN N COUNTRY FAMILY RESORT • Identify property address including street number,name,city or town and coun Located at tY Certificate Expiration 452 ROUTE 28 03/07/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy p Y Use Group Other Classifications(s) R-1 01st Floor 76 R-1 Hotel/Motel/Boarding House/Transient BLD 1 -40 UNITS, MNGRS.APT.,OFFICE Allowable &PLAYROOM Occupant Load BLD 2-24 UNITS 02nd Floor 76 R-1 Hotel/Motel/Boarding House/Transient BLD 3-12 UNITS BLD 1 -40 UNITS BLD 2-24 UNITS BLD 3-12 UNITS This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Grylls rY Date of �_7— / BuildingCommissioner Inspection Signature of Municipal Signature of Municipal % / Date of Building Commissioner Issuance 4 Fee:0 26.00 BLD_Certofl nspection.rpt °i'YAk TOWN OF YARMOUTH BUILDING DEPARTMENT N "try : 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION February 7, 2019 PAYABLE UPON RECEIPT (X) Fee Required 526.00 ( ) 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: L5 Z a.. 2.8- Name of Premises: l mul n f coal,tit/ i h1 & Tel: 5.o&-77/ -0 24 Z Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: - -- License or Permit Agency r 1 FEB 222019 I U Certificate to be issued to 5ethaii Arst,t f c Tel: 9 7 e- ,a0tewT Address: Po 41.0,6 s'p7 dv. Owner of Recgrd of Building ' �4 R— G . Address 1�d �. �j b-/ (,�, ` , . -7"" Present Holder of Certificate I k� 611^-04,4,01. Signa e of person to whom Title Certificate is issued or his agent -92-47 Date Email Address: j Q{ , ®61,6J. 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# ,gLfk.-/b-a 6 y24, -0-5 3/7/2019-3/7/2020 ®•4 09/18 Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYrrY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11 THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES 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 poiicy(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 CUN IAc,r NAME: Brian Allain PHONE 800 Choice insurance Agency,Inc. 649 4853 37B Summer Street iaMADDRESS:da•Ext)• jAAic,No): 978-345-1007 Fitchburg,MA 01420 ballain@choice-insurance.corn INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: Guard Insurance Co INSURER e: Certain Underwriters @ Lloyds London Sandbar Management Inc INSURER C: Cape Cod inflatable Park P.O.Box 481 INSURER D: West Yarmouth,MA 02673 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 )LTR TYPE OF INSURANCE iIODL- - POUCYEFF POLICY EXP INSD wVD POLICY NUMBER (MMJDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIMS-MADE I I OCCUR UAMA{,E I U NEN I EU PREMISES(Ea occurrences S 50,000 B MED EXP(Any one person) S 5,000 ZISMB028802 03/24/18 03/24/19 PERSONAL a ADV INJURY $ 1,000,000 GEN1 AGGREGATE LIMIT APPLIESPER. GENERAL AGGREGATE S 2,000,000 1 POLICY I I PRO- n JECT I LOC OTHER. PRODUCTS-COMP/OP AGG 5 1,000,000 AUTOMOBILE UABIUTY S COMBINED SINGLE LIMIT S ANY AUTO IEa accident) OWNED SCHEDULED BODILY INJURY(Per person) S HIRES ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS AUTOS ONLY NONOS ONLD Y PROPERTY DAMAGE (Peracodent) S UMBRELLA LIAB 1_ OCCUR S EXCESS UAB EACH OCCURRENCE S CLAIMS-MADE AGGREGATE DEC I I RETENTIONS S WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH- NY PROPRIETOR/PARTNER/EXECUTIVE Y J N I STATUTE I XJ ER A OFFICERIMEMBER EXCLUDED/ I I Ni A SAWC477816 10/01/18 10/01/19 E L EACH ACCIDENT s 1,000,000 I{Mandatory In NH) Hies descnbe once E L-DISEASE•EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 B Liquor Liability 1,000,000 2,000,000 CPS2440505 03/24/18 03/24/19 DESCRIPTION OF OPERATIONS J LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is p required) Operations of Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPTION DATE THEREOF,NOTICE WIL Town of Yarmouth ACCORDANCE WITH THE POLICY PROVIISIONSL BE DELIVERED IN Route 28 P\ Yarmouth,MA 02664 AUTHORIZED REPRESENTATIV I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD °' 'n_ TOWN OF YA R M O U T H . • O r GAS 1,1:i 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUS1:11, 02664-4451 it Telephone(508) 398-2231,Ext.1261—Fax (508) 398-0836 PLUMBING SIGNS _ BUILDING DEPARTMENT Inspection and License Report Date ,J — /j Address 9 Business Name /e dk7 ' t2 U1177 J rT Contact Phone During the Annual Inspection of your premises,performed i accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the B and of Health rules,the following violation(s)were observed: agrof Ca agencY egress signage Location frit'4 ' Zya ,&V U Emergency egress lighting Location ,1).// i-KGi'S-L" L. /`(1/� , !!SQ ❑Maintenance ofexits Location ( [G' r� $- ,/irJr� z i 4- C-�Wii.. (' 7 f.� 4/77 U Guards/handrails Location - C ' 1.24-7---07-- te.70T.5-4 �G{�s Zoning ;, Signs Location ?..2, i - !% LP• l"' % ccii e l]Pads Location �/'7 12r�4 v/'t ,q"/ict(c�3 7'" IDOther Location / 6CM 12 C�'/ , --e f/ /7 /e2 c'c©/. ZC..!1 7 ' // Mechanical ❑CombustionAir Location / .' 7r ❑Storage in Boiler Room Coati:: f,f�� / / ❑Vents Location �"'�' f7�r.-/ /6 y./f ". 7*r/ 2 )--7 /'7 y j ❑Automaticboiler room door closures C•-• / 5� , ... A-_-_7 ', b'1 of,--A, 17O on boiler room doors Location �j "Cl❑Clothes dryer vents Location C 'f! " J flax 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(sl 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 next, ^-�annual inspection. J o Make corrections within / days and contact this office for a follow-up inspection. Local Ofcial/Inspector L /�/Ita Received By (1 ` Title J Revised 2/8/13