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HomeMy WebLinkAboutBLDCI-17-002519-04 The Co m wealth of Massachusetts ► ` .� City\Town of cmp A i} 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: PLANET FITNESS BLDCI-17-002519-04 Trade Name: PLANET FITNESS Identify property address including street number, name, city or town and county Certificate Expiration Located at 7 LONG POND DR 10/01/2022 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 186 A-3 Amusement/Church/Gym/Library/Museum AEROBICS RM-49 EXERCISE AREAS-137 Allowable Other 15 A-3 Amusement/Church/Gym/Library/Museum 15-MEZZANINE 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 /e3W 1 Signature of Municipal Signature of Municipal / Date of Building Commissioner Issuance /4,40/ 0.00 BLD_Certofl nspection.rpt °`. Ary TOWN OF YARMOUTH o' q `,�' '`\O 1 ` '41 .� BUILDING DEPARTMENT \�N..': ` " 1146 Route 28, South Yarmouth, MA 02664 508-398-22. .(1 ' RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION SEP 3 1021 September 1,2021 PAYABLE UPON RE• (X) Fee Require, (� G DEPARTMENT ( ) 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 following1 address: W Street and Number: 11 Y) r d �A 1/L V B u ' �l.r ino D.-t t0 1 Name of Premises: 1 la n C4' (411c.1) Tel: S d r- 7b O Purpose for which permit is used: h1S.) Ceryk" License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency 1 ann b1 rvri Certificate to be issued to a( 1 Ian Cr Tel: 1)4 536 a s71 Address: !11 D Owner of Record of Bur ing IN , r n i J ` r� Address �j Present Holder of Certi rcate l a n • iAf_1 U94 0 QC L Si-0 atu"A f person to f om Title' ") , Certificate is issued or his agent Date Email Address• bd a e Ift441 of p+ �i"�O e '�11�'tr,4(„14L•C-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# e Czc,I- h--OD J(- 10/01/2020-10/01/2021 /U///a D.)/— /D///a .d-- • A�R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDYYY1� 6/1/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CETIFIATE DOES NOT BELOWC AFFIRMATIVELYNEGATIVELYCOVERAGE AFFORDED THIS CERTIFICATE CATE INSURANCE OF 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 riLhts to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Jenn Garibay HAUSER PHONE 513-745-9200 FAX Not:513-745 9219 5905 E.Galbraith Rd,Ste 9000 (ac,Ne,Ex1): E-MAIL Cincinnati OH 45236 ADDRESS: igaribay(a�thehausergroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Jnsurance Company 31325 INSURED PLANFIT-01 INSURER a:Union Insurance Company 25844 CDM Fitness Holdings,LLC 2 Hampshire Street INSURER C:Liberty Insurance Corporation 42404 Foxboro MA 02035-3171 INSURER D_Fireman"s Fund Insurance Co _ 21873 INSURER S: INSURER F: COVERAGES CERTIFICATE NUMBER:434762143 REVISION NUMBER: THIS IS TO ERTIFY THAT THE ND CATED.TNOTW NOTWITHSTANDING ANY IREQUI EMENT,TERM OR CONDITIONVOF ANY CONTRACT E BEEN ISSUED TOR O THE ITHER DOCUMENT WINSURED NAMED TH POLICY FOR THE 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 SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDO/YYYY) (MMIDD/VYYYI A X I COMMERCIAL GENERAL LIABILITY 1 CPA5468597 2/3/2021 2/3/2022 EACH OCCURRENCE I$1,000,000 DAMAGE TO RENTED CLAIMS-MADE I X 1 OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGG $3,000,000 X POLICY JEC I I LOG $ OTHER: COMBINED SINGLE LIMIT 8 AUTOMOBILE LIABILITY Y MAA5468538 2/3/2021 2/3/2022 (Ea a I ED1) $1,000,000 BODILY INJURY(Per person) $ ANY AUTO OWNED X SCHEDULED BODILY INJURY(Per acadent) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ X HIRED X NON-OWNED (Per accident)AUTOS ONLY __AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR Y CUA5468539 2/3/2021 2/3/2022 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 $ DED RETENTION$ pER OTH- ER WORKERS COMPENSATION WC5-Z91-472621-041 2/3/2021 2/3/2022 X STATUTE ER AND EMPLOYERS'LIABILITY YIN EL.EACH ACCIDENT $1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBEREXCLUDED7 E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 -DESCRIPTION OF OPERATIONS below Y USL002648202 10/21/2020 10/21/2021 OCCURRENCE 5,000,000 D Excess Uability AGGREGATE 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks;ichedule,may he attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Information Only AUTHORIZED REPRESENTATIVE 9. I ©1980-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD cmitchell@fitearth.com From: Jennifer Littlefield <jlittlefield@fitearth.com> Sent: Thursday, September 9, 2021 2:57 PM To: cmitchell@fitearth.com Cc: Lane Milliken;Jennifer Littlefield Subject: CHECK REQUEST: South Yarmouth Building Inspection Attachments: [Untitled].pdf HI Chris- Please issue a check in the amount of$100.00 made payable to the Town of Yarmouth for the 2021-2022 building inspection permit. Mailing Address Town of Yarmouth Building Inspectors Office 1146 Route 28 South Yarmouth, MA 02664 Thanks, Jen Jennifer S. Littlefield Business Solutions Specialist Core Development and Management an independent franchisee of Planet Fitness® 508-570-8966 I jlittlefield@fitearth.com 2 Hampshire Street,Suite#302 Foxborough, MA 02035 Customers first* Optimism * Respect and Kindness * Excellence CDM proudly supports Original Message From: Scanned by Core Development& Management<scans@fitearth.com> Sent:Thursday, September 9, 2021 3:02 PM To:Jennifer<jLittlefield@fitearth.com> Subject: 150147 Scanned Message