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HomeMy WebLinkAboutCertificate of inspection The Commonwealth of Massachusetts ' / City\Town of YARMOUTH • � u 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: RYAN FAMILY AMUSEMENTS BLDCI-16-003546-02 Trade Name: RYAN FAMILY AMUSEMENTS Identify property address including street number,name,city or town and county Certificate Expiration Located at 1067 ROUTE 28 12/31/2020 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 300 A-3 Amusement/Church/Gym/Library/Museum Allowable Occupant Load 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 Date of //� Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Building Commissioner i+ Issuance ((.(bi/Fee:;150.00 B LD_Certofl nspection.rpt �Q ;` 41.YgR TOWN OF YARMOUTH /t--y� - y BUILDING DEPARTMENT • � A MTTACn CSC xo.,a••„o•-0 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2019 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) 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: LOG 7 fto,, -e 2 Name of Premises: tR,D, t---c,,,,,,,t j 11-c,^,d ,e hy,,N 1' Tel: '�C� 4 'SO Li Purpose for which permit is used: PJo t,;Au) Pt(C L'y�u. ( License(s) or Permit(s) required for the premises�by other gov)ernmetftal agencies: License or Permit Agency l)l , ,r ,_i 1.....:01 i J J, Certificate to be issued to '�•1" t o'-w•. Av„u, ,,,,«„f Tel: Address: lb l Rc„k Z$ 46.1-14,4),tl.. yAk G, Gc,ci Owner of Record of Building t2i,i r •I'- f .t.w Address Present Holder of Certificate F,A, CkkoAA C,OA Signature of person to whom Title Certificate is issued or his agent i o-`l -(9 Date Email Address: ie_Ve. Co•,v,Ca Si"_ N 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# BCD ea- r(,- 0 3 -A-aid 12/3 0/2019-12/3 0/2020 AC RE CERTIFICATE OF LIABILITY INSURANCE BATE(MMIDD/YYYY) 5/6/2019 .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). PRODUCER CONTACT John McLaughlin Agy PHONE FAX 828 Lynn Fells Pkwy CNC.Lo.Ext):781-665-2775 (A/C,No):781-665-0295 Melrose MA 02176 ADDRESS: info@mclaughlinins.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Commerce Insurance Company 34754 INSURED RYANF-1 INSURER B:StarStone National Ins.Co. Ryan Family Amusements, Inc. Attn: Mike Crowley INSURER C:Guard Insurance Group 116 Waterhouse Road INSURER D:Everest National Insurance Corn Boume MA 02532-3867 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:687557958 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 UNITS LTR INSD WVD POUCY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) D X COMMERCIAL GENERAL UABILITY R/O SI8ML01505-181 5/1/2019 5/1/2020 EACH OCCURRENCE $1,000,000 GE TO CLAIMS-MADE X OCCUR PRREM SES(EaENTED occurrence) $100,000 X LIQUOR LIAB MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Liquor $1 m/1 m A AUTOMOBILE LIABILITY BDPRLQ 4/10/2019 4/10/2020 COMBINED SINGLE LIMIT $ (Ea accident) 1.000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED x SCHEDULED BODILY INJURY(Per accident) $ AUTO AUTOS PROPERTY X HIRED AUTOSX TO AUSWNED Perry cidentDAMAGE R D $ B X UMBRELLA UAB X OCCUR 70531N183ALI 5/1/2019 5/1/2020 EACH OCCURRENCE $2,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$10 000 $ c WORKERS CO PMST'r"' RYWC995289 12/312018 12/312019 PER OTH- AINYEMPLOTERS'LUU IUTY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (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 D Property R/O SI8ML01505-181 5/1/2019 5/1/2020 Building $2,732,400 Bus.Pers.Prop. $250,000 I, Bus.Inc. $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall 1146 Route 28 AUTHORIZED REPRESENTATIVE ATIVE So.Yarmouth MA 02664 4g 20 4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Worker's Compensation and Employer's Liability Policy berksh i re Hathaway AmGUARD Insurance Company- A Stock CO. 7 Policy Number RYWC995289 � � Renewal of RYWC861112 Companies NCCX No. [21873] Policy Information Page I[1]Nameod Insured and Mailing Address Agency Ryan Family Amusements Inc MACKINAW UNDERWRITERS INC. 116 Waterhouse Road 10 NEW ENGLAND BUS CTR Bourne, MA 02532-3867 SUITE 110 Andover, MA 01810 Agency Code: MATPAA10 s � Federal Employer's ID 04-3541210 Insured is Corporation Risk ID Number 917565287 Locations on Policy See Extension of Information Page Schedule of Locations L2] Policy Period From December 31, 2018 to December 31, 2019, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance- Part One of this policy applies to the Workers'Compensation taw of the following states: Massachusetts, Rhode Island B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item (3]A. The limits of our liability under Part Two are: Bodily Injury by Accident- each accident $500,000 Bodily Injury by Disease -each employee $500,000 Bodily Injury by Disease- policy limit $500,000 C. Other States Insurance- Part Three of this policy applies to all states,except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page- Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by { audit. (Continued on another page) Total Estimated Policy Premium $ 30,087 Total Surcharges/Assessments $ 1,060.00 Total Estimated Cost $ 31,117.00 INTERNAL USE , IX Page-1 - Information Page MGA : RYWC995289 WC 000001A Date : 11/26/2018 MANQTE Issuing Office:P.O.Box A-li, 16 S.River Street,wi8ces-earree,PA 18703-0020•www.guard.com Worker's Compensation and Employer's Liability Policy I/ rk hire Hathaway AmGUARD Insurance Company-A Stock Co. s' T Policy Number RYWC995289 * Insurance' Renewal of RYWC861112 �.. U A R D Companies MCC/ No. [21873] Policy Information Page Extension of Information Page Schedule of Locations (12) 200 Main Street, Buzzards Bay, MA 02532 (12/31/2018 - 12/31/2019) (L3) 441 Main Street, Hyannis, MA 02601 (12/31/2018- 12/31/2019) (L4) 1067 Rte 28 ,South Yarmouth, MA 02664 (12/31/2018- 12/31/2019) (L5) 115 New State Hwy, Raynham, MA 02767 (12/31/2018- 12/31/2019) (L6) 1170 Main Street, Millis, MA 02054(12/31/2018- 12/31/2019) (L8) 23 Town Hall Sq. Falmouth, MA 02540 (12/31/2018 12/31/2019) (L9) 19 Circuit Ave , Oak Bluffs, MA 02557 (12/31/2018- 12/31/2019) (L10) 268 Thames St,Newport, RI 02840 (12/31/2018- 12/31/2019) (L11) 769 Lyannough Road , Hyannis, MA 02601 (12/31/2018 - 12/31/2019) (L12) Cape Cod Inflatable Park, 512 Route 28 ,Yarmouth, MA 02664(12/31/2018- 12/31/2019) (L13) Cape Codder Resort, 1225 Iyannough Road , Hyannis, MA 02601 (12/31/2018- 12/31/2019) , • • INTERNAL USE_XX Page-2- Information Page mGA :RvwC49528+9 wC 000001A Date : 11/26/2018 MANOTE Issuing Office:,P.O.Box A-H, 16 S.River Street,Wilkes-Barre,PA 18703-0020•www.guard.com °r 4= TOWN OF YA R M O U T H HLFCTRICAI. GAS • C 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING Telephone(508) 398-2231,Ext.I261 —Fax(508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report Date 7",v. Address /��• / liE�i v�9 Business Name /f 7 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: ❑Emergency egress signage Location ,ZAFAC, _..i./ / _ // 4 Ii,s 11 ❑Emergency egresslightmg Location • ❑Maintenance of exits Location • ❑Guards/handrails Location Zoning ❑Signs Locationf Parking Location ❑ Other Location ilfecketticei ❑Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location a Clothes dryer vents abir 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 next annual inspection. o Make corrections within days contact this office for a follow-up inspection. Local() r , /t,p��%` ``may Received By �' Title Revised 2/8/13