The URL can be used to link to this page

Home My WebLink AboutBLDCI-19-005389-03 The Commonwealth of Massachusetts City\Town of :.'iTil YARMOUTH *� Sr:1� 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: HEATHERWOOD AT KINGSWAY BLDCI-19-005389-03 Trade Name: HEATHERWOOD AT KINGSWAY-COMMUNITY Identify property address including street number,name,city or town and county Certificate Expiration Located at ` 1101-5232 HEATHERWOOD 04/06/2023 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) Basement/Lower 49 A-3 Amusement/Church/Gym/Library/Museum exercise room-49 A-3 Allowable 01st Floor 442 A-3 Amusement/Church/Gym/Library/Museum club room-67,meeting room-71, Occupant Load library-39,parlor-42, lounge-56,dining room -135,private dining- 32 Total persons:491 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 Issuance 6/3/z Z .1 Fee: $100.00 PI rl (`crfnflncncrtinn rnt ro � o, TOWN OF YARMOUTH t ',t BUILDINGDEPARTMENTRECEIvED ,Mf1TTACrl yT 1146 Route 28, South Yarmouth, MA 02664 508-398-223[ ext. 126MAR 0 2022 APPLICATION FOR CERTIFICATE OF INSPECTION BU I L M NT By March 1, 2022 PAYABLE UPON RECEIPT (X) Fee Require $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: fob //FA -# 1' Name of Premises: 44 j f L' 14N74,it Tel: Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to /47{-/Q a4,1L Tel: 50 Address: /*//e/I--gQ/,-/yo0 dZ 0,4, y4 h 0„4 i m'4 4,4,7, Owner of Record of Building /`tgif(AA bpi",c4- ap,06, -3r ' i Address Present Hol r of Certificate FX Re.-v D,i.(Z.• nature of person to whom Title Certificate is issued or his agent ,3- Z Date Email Address: 51nCCIf 1104-1e Leocci tncj�t,�r,�i.0 v 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# B LOCI -tq-O0S- 3ej-0 3 04/06/2022-04/06/2023 ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/01/2021 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 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: Zoe Hellwig BALDWIN KRYSTYN SHERMAN PARTNERS LLC (NC.No.Ext): (508)790-4417 FAX No): E-MAIL ill zhew ro ers ra ADDRESS: g@ 9 9 Y.com 4211 West Boy Scout Blvd Suite 800 INSURER(S)AFFORDING COVERAGE NAIC# Tampa FL 33607 INSURER A: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: HEATHERWOOD AT KINGS WAY CONDO TRUST INSURERC: INSURER D: 100 HEATHERWOOD INSURERE: _ YARMOUTH PORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 721277 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 ADDLINSD WVD SUER POLICPOLICY NUMBER (MMIDDY EFF POLICY EXP LTR INSD TYPE OF INSURANCE /YYYY) (MM/DD//YYYY) LIMITS LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ N/A 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) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION x/ PER AND EMPLOYERS'LIABILITY o'NSTATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A WCV01253206 10/26/2021 10/26/2022 (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 • N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i