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HomeMy WebLinkAboutBLDCI-18-004981-05 The Commonwealth of Massachusetts } = ,= 9, City\Town of IMM la`' I = YARMOUTH or :; ; 4- #... 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: SUNFLOWER SCHOOL BLDCI-18-004981-05 Trade Name: SUNFLOWER SCHOOL i Identify property address including street number, name,city or town and county Certificate Expiration Located at 923 ROUTE 6A UNIT G 7/1/2023 YARM01_1TH PORT MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) E E 01 st Floor 30 E Educational School to 12th Grade/Child Care(More than 5) 30 persons-age 2.9& over 02nd Floor 38 E Educational School to 12th Grade/Child Care(More than 5) 38 persons-age 2.9& Allowable over 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 7—ag AR Signature of Municipal Signature of Municipal Date of 7:2k Building Commissioner j Issuance 7/L t �� F e: ;100.00 DI n n,..i,.a 4,,......4 Ghc�.k# 3�6� TOWN OF YARMOUTH \aN BUILDING DEPARTMENT vt$.1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION June 1, 2022 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ( ) 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: g023 v. c L (Un 1/ 3 Name of Premises: 6u,r clove c 5! Tel: 604-31a,2—4100 Purpose for which permit is used: G V►L)PC.ccre, C / License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to G tr-I c c,j-Noo 1 Tel: - 36) -54 Address: CV 3 you CiA , tani� G , `lc rrrvv l4-4p,,rd-, y'{1:A OW)T Owner of Record of Building Li -*..1 Address G1Li 6ck-c 61tk, err Igod- , mfl 0.2121 S Present Holder of Certificate1��,,,,,F(�We� Scl RECEIVED •APIPIPIP OLJnohl JUL 07 2022 Signature o'erso. to whom Title sU i t M E Nl" Certificate •... -. . • .tent Ob BY. Date Email Address: ,,,, c, ��,,��ra�ea/oY)L Ne - 6oro 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# Cl- 98-/-4.e6-oS 07/01/2022-07/01/2023 CORE)® DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 07i07i2022 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 NAME: Christy Schneider McShea Insurance Agency, Inc �n"/c°NNo Ext): ($OB)420-9011 (A/C,No):FAX (508)420-9010 1645 Falmouth Road, Rt 28 BLDG D AIL ADDRESS: christy@mcsheainsurance.com Centerville, MA 02632 INSURER(S)AFFORDING COVERAGE NAIC INSURER A: Quaker Special Risk INSURED INSURER B: The Fairway Agency The Sunflower School Corp INSURERC: 923 Route 6A INSURER D: Yarmouth Port, MA 02675-2159 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00011664-0 REVISION NUMBER: 1 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 f - ___ _ - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NLMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A ' X COMMERCIAL GENERAL LIABILITY 01-C-PK-P20058633-0 06/26/2022 06/26/2023 EACH OCCURRENCE $ 1,000,000 _ _-- DAMAGE TO RENTED 1 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEM-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 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 I RETENTIONS $ B WORKERS COMPENSATION AWC0008719-03 12/13/2021 12/13/2022 X AND EMPLOYERS'LIABILITY STATUTE OTH- ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (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 I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth Buillding Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE 0Th (CMS) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CMS on 07/07/2022 at 10:21AM