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Home My WebLink AboutBLDCI-17-00431-04 The Com ealth of Massachusetts l+ ity\Town of t, lraw. MI�; YARMOUTH sor 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 BLDCI-17-000431-04 Business Name: CAPE COD& ISLAND ASSOCIATION OF REALTORS Trade Name:CAPE COD&ISLAND ASSOCIATION OF REALTORS Identify property address including street number, name,city or town and county Certificate Expiration Located at 22 MID-TECH DR 08/18/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 170 A-3 Amusement/Church/Gym/Library/Museum Meeting Room 1 - Concentrated-170 01st Floor 80 R-3 Single Family/Duplex Residence/Child Care 5 or Less/Congregate Living 'Meeting Room 2- Allowable Unconcentrated(table& Occupant Load chairs)80 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 ?//..Ek/t/ ee: $100.00 B LD_Certofl n spection.rpt Y. t----- 1-* _R TOWN OF YARMOUTH o(Aar{ BUILDING DEPARTMENT k,,,,T K R J 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 JUL 19 2021 APPLICATION FOR CERTIFICATE OF INSPECTION 411y 1,1-1D DEPARTMENT PAYABLE UPON RECEIPT By ¢ -- (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: e,r7?( M, f z r;,\1 (DTI V t, Name of Premises: C C `I- 1 l 5 S v G, A 7/GA-to r3 Tel(D 957- 43 O 0 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 ( i2 C.e. d'\e. Tel(' ( ) 957- L13 UU Address: ga :a."Tat, -rti v�; L-41t '��('ha*. (7 2. 73 Owner of Record of Building � Co 61,i- I S 0 s 'f 15 S ve,:a ,„:, 1( 0�� Address �.a. ►u:(. e� t6.n 'C�,r. .rk, , LP)Q� yorv`.bC r'ti(\ O ot(Q'.3 Present Holder of Certificate ` �t�t,�-.,� r �Gc.�l`l ,�s cov u ,�c- Si ature of person to whom Title ertificate is issued or his agent jy J j Da t Email Address: Jyo O i 11 Gt-r-z\(J CC,1 a.o r, C',orv, Instructions: Make check payable a able 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# 08/18/2021-08/18/2022 DOWLING & _gait O'NEILGROUP December 28, 2020 Cape Cod &Islands Association of Realtors, Inc. 22 Mid Tech Drive West Yarmouth, MA 02673 Re: Twin City Fire Insurance Company, Workers Compensation, Policy# 08WECNJ2677, 11/30/2020 - 11/30/2021. Enclosed is your Workers' Compensation policy with Twin City Fire Insurance Company which is effective 11/30/2020, along with a "Notice to Employees" which is required to be posted in a visible area in your workplace. Your premium is based on an estimate of your payroll during the upcoming policy year. Your actual premium will be calculated at the end of the policy term and any adjustment to your premium will be made at that time. At the time of your audit, you will be required to provide your payroll records as well as Certificates of Insurance for General Liability and Worker's Compensation coverage for any subcontractors that you have paid during the policy year. If these subcontractors are either individuals or partnerships, the Certificate of Insurance must indicate that the individual or partners are covered by the Worker's Compensation policy. Failure to show proof that an individual or partnership has "opted" into the Worker's Compensation coverage could result in their payroll being included in your audit. You will be contacted either by the insurance company or an auditor and requested to have this information available at the appointed time. If there is no certificate of Workers' Compensation insurance for subcontractors, an auditor will include payments to these subcontractors as payroll in each subcontractor classification. The impact on your final premium could be significant. Il you need any assistance with the audit or have questions, please give me a call. If there is a significant difference in reported payrolls, from one policy term to the next, the renewal policy will be endorsed tc reflect the appropriate differences. If you require a Certificate of Insurance you may access our website at www.doins.com and click on "Certificates". Many clients have found this to be a very efficient way to order and track Certificates. If you work in states other than Massachusetts, please notify us immediately prior to work commencing. I appreciate this opportunity to be of assistance to you. Sincerely, • Caitlin D. Regan Phone:(508)957-4220 Email: cregan@doins.com The Hilb Group of New England LLC dba Dowling&O'Neil Insurance Agency 1973 lyannough Roadl P.O. Box 1990 I Hyannis,MA 102601 800.640.1620 I www.doins.com Workers ' Compensation and Employers ' Liability Business Insurance Policy -rum 401. I UI HARTFORD Form WC 99 00 02 (03/14) Page 1 of 1 (Policy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: Twin City Fire Insurance Company ONE HARTFORD PLAZA HARTFORD CT 06155 ` THE ' HARTFORD NCCI Company Number: 14974 Company Code: 7 Suffix LARS RENEWAL POLICY NUMBER: 08 WEC NJ2677 16 Previous Policy Number: 08 WEC NJ2677 1. Named Insured and Mailing Address: CAPE COD & ISLANDS ASSOCIATIONOF REALTORS, INC. (No., Street, Town, State, Zip Code) 22 MID TECH DRIVE WEST YARMOUTH MA 02673 FEIN Number: 04-2315153 State Identification Number(s): The Named Insured is: Corporation Business of Named Insured: Other Activities Related to Real Estate Other workplaces not shown above: 2. Policy Period: From 11/30/20 To 11/30/21 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: DOWLING & O'NEIL INS AGENCY/PHS PO BOX 1990 HYANNIS MA 02601 Producer's Code: 08088233 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (866)467-8730 Total Estimated Annual Premium: $1,127 Deposit Premium: Policy Minimum Premium: $231 MA(Includes Increased Limit Min. Prem.) Audit Period: ANNUAL Installment Term: Eleven Pay (16.7%Down+10@8.33%) The policy is not binding unless countersigned by our authorized representative. Countersigned by d'u�d')o3" �� 10/21/20 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 10/21/20 Policy Expiration Date: 11/30/21 INFORMATION PAGE (Continued) Policy Number: 08 WEC NJ2677 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 our 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: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 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. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $589 Expense Constant $250 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $269 Estimated Annual Premium (before Surcharges) $1,108 Total Estimated Surcharges $19 *See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $1,127 Deposit Premium: Policy Minimum Premium: $231 MA(Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 531390 Labor Contractors Policy Number: SIC: 8621 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 10/21/20 Policy Expiration Date: 11/30/21