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HomeMy WebLinkAboutBLDCI-17-004341-05 , The Commonwealth of Massachusetts h1 City\Town of ., YARMOUTH 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:CAPE COD&ISLAND ASSOCIATION OF REALTORS BLDCI-17-000431-05 Trade Name: CAPE COD& ISLAND ASSOCIATION OF REALTORS Identify property address including street number, name,city or town and county Certificate Expiration Located at 22 MID-TECH DR 08/18/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 170 A-3 Amusement/Church/Gym/Library/Museum Meeting Room 1 - Concentrated-170 Allowable 01st Floor 80 R-3 Single Family/Duplex Residence/Child Care 5 or Less/Congregate Living 'Meeting Room 2- - Unconcentrated(table& Occupant Load chairs)80 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 Commissioner7:2" , Issuance 972,%t Fe FFee: $100.00 BLD Certoflnspection.rpt TOWN OF YARMOUTH a;f �� lya BUILDING DEPARTMENT "<T'`" � 1 146 Route 28, South Yarmouth, MA 02664 508-39 APPLICATION FOR CERTIFICATE OF INSPECTIO UILDING DEPARTMENT July 1, 2022 PAYABLE UPON RECEI TY (X) 'Fee Kequire' ( ) 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: (9 oc I vk 0\ 1TC,k ' IJ \V L) (A), \70J YD4 a v Name of Premises: CC d- I Y-f S5Or, 0 c ' / e0.1f6 cS Te(SOS) 957- 1130 0 Purpose for which permit is used: Cu rv, 0 rr. Ui.s License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to CC/a- I Assoc . u t- (R .A r Tel: <-\i)9c7- t'I3C:53 Address: OVVVA 1 Owner of Record of Build S 0, s. v\$ d CA' k- o(S Address oZ o. 6 A e c 1)it , W, arw. tA.A O a to-73 Present Holder of Certificate (LI Ce-eANsis lA6`Ca + ( Si nature of person to whom Title ertificate is issued or his agent 1 gig°.2.� Date Email Address: cc(1,l C Cam)0..Or, Cori, 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# n 08/18/2022-08/18/2023 a ACCt CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VVVY) 07/15/2022 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 CONTACT Caitlin Regan NAME: Dowling&O'Neil Insurance Agency PHOACNE Ext1: (800)640-1620 FAX (AC,No): 973 lyannough Road n-MAIL cregan@hilbgroup.com INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02E01 INSURER A Twin City Fire Insurance Company 29459 INSURED INSURER B: Cape Cod&Islands Associationof Realtors,Inc. INSURER C: 22 Mid Tech Drive INSURER D: INSURER E West Yarmouth MA 02673 INSURER F COVERAGES CERTIFICATE NUMBER: CL2271520069 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD,WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE I RENTED CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 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$ $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N 500 000 A ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA 08WECNJ2677 11/30/2021 11/30/2022 ( E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in 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) Insurance coverage is limited to the terms,conditions,exclusions,other limitatiors,and endorsements.Nothing contained in the Certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions 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. 1146 Rt 28 ---- - AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 /r _ I a1lll�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD