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HomeMy WebLinkAboutBLDCI-16-005193.-04 The Commonwealth of Massachusetts I=_ ! '� City\Town of • = YARMOUTH L - 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 COVE AT YARMOUTH BLDCI-16-005193-04 Trade Name:TENNIS, RACQUET&SQUASH COURTS Identify property address including street number, name,city or town and county Certificate Expiration Located at 183 ROUTE 28 04/15/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 124 A-3 Amusement/Church/Gym/Library/Museum Reception&Lounge Allowable 02nd Floor 100 A-3 Amusement/Church/Gym/Library/Museum Lounge 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 a Date of Building Commissioner Issuance ��'2� y. Fee: $100.00 AN � � Q\ TOWN OF YARMOUTH QW a °tBUILDING DEPARTMENT �6),`s�,.,,:«m, 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION March 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: /93 fl'Jcyn ...Si- Name of Premises: 771 (p v_. a-F Yet,f—m0 -4-h Tel: 5U2 - 7 -) I . 36>“, Purpose for which permit is used: -frr ,-1,'S COL.rf S r-a cl t.-t-4 G.r)a) S1 v 4.TRIECEIVED License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency MAR 2 4 2022 Ciw i tJsem.tAl+ B U I C N E RT . Certificate to be issued to i►u Co .„c. ,-t Yei,,-rv»L`1.in Tel: SO2 ---)1 1,36.z, Address: Owner of Record of Building Address Present Holder of Certificate Q Sign re of p son to whom Title Certificate is issued or his agent 3/ 7/l O' .2 Date Email Address: {'Y)td I.va.4•o1S Cove-1-ja4,-ry);JL-1-1-1 , co inn 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# / /( S/9.�-g—�/l_Dy 04/15/2022-04/15/2023 1111k 011111. LI "/ f‘ Loo 1/400 ACCPRd CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 04/06/2021 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 Diane Carmain NAME: The Armstrong Company Insurance Consultants (A/C,No,Ext): (310)530-0099 FAX No): (310)530-0098 2780 Skypark Dr,Ste 440 E-MAIL dcarmain@armstronginsco.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Torrance CA 90505 INSURER A: Philadelphia Indemnity Ins Co 18058 INSURED INSURER B: StarStone National Insurance Co 25496 Cove at Yarmouth Resort Hotel Owners Association INSURER C: Ohio Casualty Insurance Co 24074 183 Main Street INSURER D: Westchester Surplus Lines Insurance Co. 10172 INSURER E: West Yarmouth MA 02673-4653 INSURER F: COVERAGES CERTIFICATE NUMBER: 21/22 Liability&Prop 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 LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 1 , 00 00 A PHPK2253671 04/01/2021 04/01/2022 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PHPK2253671 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 25,000,000 B EXCESSLIAB CLAIMS-MADE 073781212ALI 04/01/2021 04/01/2022 AGGREGATE $ 25,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA XW057710689 04/01/2021 04/01/2022 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below —Primary DISEASE-POLICY LIMIT $ Primary Limit: $10,000,000 Property-Special Form,RC D Including Named Storm D37406107 04/01/2021 04/01/2022 Deductible: $5,000 Named Storm Deductible 1% DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is hereby named Additional Insured with respects to the property and general liability located at:183 Main Street,Route 28,West Yarmouth,MA 02673-4653 but only as their interest may appear. 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. Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD