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Home My WebLink AboutBLDCI-16-003719-06 The Co %I��'i nwealth of Massachusetts ►— ' City\Town of YARMOUTH mh 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: INTERNATIONAL FUND FOR ANIMAL WELFARE, INC. BLDCI-16-003719-06 Trade Name: IFAW Identify property address including street number, name,city or town and county Certificate Expiration Located at 290 SUMMER ST 01/31/2023 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 468 A-3 Amusement/Church/Gym/Library/Museum 468 Persons-Standing 93 Persons- Table/Chairs Allowable 200 Persons-Chairs Occupant Load only 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 TTy pection Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance n . 7 • Fee: $100.00 BLD CertofInsnectinn rnt ..61-:).:----1.,-.4- TOWN OF YARMOUTH /9k r 'ef 4,,,vi • ., .fte...1 7. 14ii BUILDING DEPARTMENT , ,,., 1146 Route 28,South Yarmouth, MA.02664 50$-398-2231 ext. 1260. 7?V-3cR-)-s-qs- APPLICATION FOR CERTIFICATE OF INSPECTION o cd December 3,2021 PAYABLE UPON RECEIPT -TOrl (X).Fee Required 100.00 ( )No Fee Required In accordance with the provisions ofthe 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: 290 .4)&of\rrk et-- Name of Premises: ...11____c et-L1/43 Tel: . 570 g•-7LP-1—2/423 Purpose for which permit is used: fir- cf.'-\ \•-i License(s)or Permit(s)required for the premises by oilier governmental agencies: License or Permit Agency RECEIVED [JAN 062022 . f 41Trgt_T Certificate to be-issued to S Fert-L.) Tel: 50 Tr-"7(--Pi-21 t. . BUIL AlBy Address: 2A c.) f..).:.)o-Arv%.e.r . Lins-c-uNA-kilk'oc* erk Owner of Record of Building Address Z.cio ..c.... firvAcs- 3-N- Nic,co-kr„,..-,*-P- c--\--- (14 Present Holder of Certificate -__c11-4. --) ,,- Signature of person to whom. Title Certificate is issued or his agent 1Z/43/24 Date Email At-dress: 4%/esferr-x---,,rTh 0 t Cco-3 u,r- - - i_ Instructions: Make:check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth,MA 02664 Return this application to: Building Inspectoes Officc 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 is.sued. 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 oflnspection# 1/31/22-1/31/23 _ _ CERTIFICATE OF LIABILITY INSURANCE jDATE(MMIDDIYYYY) Q�� Q 19/13/2021 TMI 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(les}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: I IUB INTERNATIONAL NEW PHONE FAX 300 BALLARDVALE STREET (NC,No,Ext): (NC,No): E-MAIL WILMINGTON,MA 01887 ADDRESS: 2B22J INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA INTERNATIONAL FUND FOR ANIMAL WELFARE INC INSURER B: INSURER C: INSURER D: 290 SUMMER STREET INSURER E: YARMOUTH PORT,MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 4DDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM\DDlYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE n OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER PERSONAL&ADV INJURY $ GENERAL $ AGGREGATOPROJECT nLOC E POLICY PRODUCTS-COMP/OP AGG $ $ A• UTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) BODILY INJURY OWNED SCHEDULE AUTOS $ (Per person) — AUTOS ONLY BODILY INJURY $ HIRED .... NON-OWNED (Per accident) AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) $ . UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE i$ DED RETENTION $ $ W• ORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-5B479426-21 06/30/2021 06/30/2022 • ANY PROPERITOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT ,$ 1,000,000 OFFICER/MEMBER EXCLUDED' (Mandatory in NH) N N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I HIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE BOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1146 ROUTE 28 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +�"f SOUTH YARMOUTH,MA 02644 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 15 ACORD ORPORATION. rights reserved.