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Home My WebLink AboutBLDCI-22-006782 The/to monwealth of Massachusetts k Fp= t City\Town of YARMOUTH It .41 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:The Ocean Club BLDCI-22-006782 Trade Name:The Ocean Club on Smugglers Beach Identify property address including street number,name,city or town and county Certificate Expiration Located at 329 SOUTH SHORE DR 06/07/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 32 R-1 Hotel/Motel/Boarding House/Transient 32 Rooms,Function room,Enclosed Swimming Pool Allowable 02nd Floor 31 R-1 Hotel/Motel/Boarding House/Transient 31 Rooms,Function Occupant Load Room Basement/Lower R-1 Hotel/Motel/Boarding House/Transient Exercise Room,2 Offices, 1 Storage Room Other 15 R-1 Hotel/Motel/Boarding House/Transient 15 Permanent Efficiency 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 Date of / .t Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Building Commissioner ^ Issuance �b ee:;304.00 BLDCertofl nspection.rpt IMF•Yq_. ./. R` y TOWN OF YARMOUTH ` • '' .221 BUILDING DEPARTMENT ceqsMATTCMUJv 11.46 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Q..a_a�t<'� rc. m APPLICATION FOR CERTIFICATE OF INSPECTION May 1, 2022 PAYABLE UPON RECEIPT (X)Fee Required $304.00 ( ) 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: V-e Street andl� Number:�/\ //�y�//e//y� (//\� 1 Name of P Vim✓vs. T v V 1- L ��u b Tel: 6b 8 `3q 2 ' b-. Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: RECFIVEDI License or Permit Agency MAY 1 9 2022 BUILD y• NT Certificate to be issued to Th CXP v C(K-6 Tel: 6 — O c/S-( ,5 Address: 9a.29 �aL,44-\ Shore_ 1Dt^l V-e--- Owner of Record of Building Address Present Holder of Certificate Th c )C tvi CJtib 4100 171/11061 . ri4 &eileail I i larl62 Signature of person to whom Title ,•�/l Certificate is issued or hisauen+__ �J Date , (,, Email Address: 11 Cdt 1Q(di� ' L1416iUC��IYl l "�-""LY)` cbr 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# 6(,1)C I-.2d- bO 7 . 06/07/2022-06/07/2023 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. WCC-500-5021374-2022A PRIOR NO. WCC-500-5021374-2021A ITEM 1. The Insured: Ocean Club Home Owners Association DBA: Mailing address: 329 South Shore Drive FEIN:**-***5454 S Yarmouth, MA 02664 Legal Entity Type: Assoc, Labor Union, Relig.Org Other workplaces not shown above: 2. The policy period is from 01/01/2022 to 01/01/2023 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 001190676 INTER SEE CLASS CODE SCHEDULE Minimum Premium $276 Total Estimated Annual Premium $7,830 GOV GOV Deposit Premium $2,034 STATE CLASS MA 9052 State Assessments/Surcharges $7,234.00 x 4.1800% $302 This policy, including all endorsements, is hereby countersigned by '�` �' 12/16/2021 Authorized Signature Date Service Office: HUB International New England LLC 54 Third Avenue PO Box 696 Burlington MA 01803 Wilmington, MA 01887 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission.