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HomeMy WebLinkAboutBLDCI-22-006193 \ The Commonwealth of Massa etts R City\Town of , ) p YARMOUTH 24. New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Issued to Identify Name of Establishment Certificate No. Business Name:Ocean Mist Beach Hotel&Suite BLDCI-22-006193 Trade Name: Identify property address including street number,name,city or town and county Certificate Expiration Located at 97 SOUTH SHORE DR UNIT 101 5/1/20 SOUTH YARMOUTH, MA 02664 ` Use Group Floor Occupancy Use Group Other Classifications(s) 01st Floor 63 R-1 Hotel/Motel/Boarding House/Transient EAST WING-34 UNITS R-1 WEST WING-29 UNITS • MANGERS APARTMENT Allowable r' 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 /S Building Commissioner Inspection "Sig a Signature of Municipal Date of Building Commissioner Signature of Municipal � �/ Issuance Z y/zL Fee: $259.00 BLD Certoflnspection.rpt e dO�aR ( TOWN OF YARMOUTH r BUILDING DEPARTMENT 1146 Route 28,South Yarmouth, NIA 02664 508-398-2231 eft. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION April 1,2022 PAYABLE UPON RECEIPT (X) Fee Required $259.00 ( ) 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. 97 South Shore Drive Name of Premises: Ocean Mist Beach Hotel&Suites Tel: 508-398-2633 Purpose for which permit is used: RECEIVED License(s)or Permit(s)required for the premises by other governmental agencies: -- License or Permit Agency APR 2 2 2022 BUILDING DEPARTMENT BY. --- Certificate to be issued to Ocean Mist LLD Tel: Qo1-aas-osno Address: sR Jaenm t W yr)AlddIatawn.RI 1142 Owner of Record of Building Ocean matt LC_ Address 28 Jecome Way Middletown,RI,02842 Present Holder of Certificate YY rose )4 St-4/l.t. 4 oic 0 ,.,,m,sr��-C �,02 / ,.._- Signature o person t Title Certificate is issued or his agent 4/11/7) Date Email Address: susenpanewparthotelproup.ccm Instructions: Make check payable to: Town of Yarmouth 1146 Route 28,South Yarmouth,MA 02664 Return this application to: Building Inspector's Office PIease 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# 05/01/2022-05/01/2 023 A D CERTIFICATE OF LIABILITY INSURANCE DATE(MVdODrYYY) 11/22/2021 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 poilcy(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 NAME cT PHILIP GINEXI JR. GENATT V PHONE 3333 NEW HYDE PARK RD INC.No-Ertl:516-387-3069 I FAX — ____ SUITE 400 gpprm,g5; pginexi@genattspecIalty.com NEW HYDE PARK NY 11042 INSURER(S)AFFORDING COVERAGE NAIL C INSURER A:Zurich North America INSUR Newport Hotel Group LLC,ETAL NElnrroTe INSURER B: 28 Jacome Way INSURER C Don McCall INSURER D:Middletown RI 02842 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:239126613 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. NOTIMTHSTANDING 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. Ip1 L TYPE OF INSURANCE SD IWVD POUCY NUMBER POLICY EFF POLICY EXP f MNUPpIYYYYI lMM1DDIYYYYI UNITS COMMERCIAL GENERAL LIAGIU1Y EACH OCCURRENCE E CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Arty one pomp) $ PERSONAL IL ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE S POLICY—JECT LOC — PRODUCTS-COMP/OPAGO I S OTHER; I I$ AUTOMOBILE LIABILITY COMBINED SINGLE OMIT s IEa=Went) ANY AUTO BODILY INJURY(Per person) S ALL OWNED . —SCHEDULED AUTOS AUTOS BODILY INJURY(Per atddent} S NON-OWNED PROPERTY DAMAGE — ._,AUTOS (Per occident) S HIRED AUTOS S UMBRELLA LJAB OCCUR EACH OCCURRENCE S EXCESSUABCLAIMS-MADE AGGREGATE S OED RETENTIONS S A WORKERS COMPENSATION WC01400ac07 11113I2021 11/15l2022 I STATUTE I( X 1 ERH.AND EMPLOYERS'LIABIUTY YIN ..—._. ANY PROPRIETOR/PARTNERiEXECUTIVE E.L.EACH ACCIDENT S 1,000;000 OFFICER/MEMBER EXCLUDED'? C N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E 1,000.000 If yypstt describe under OESCRIP710N OF OPERATIONS Maw describe DISEASE-POLICY LIMIT I E 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional R►marka Schedule,may be attached II more apace la required) LOCATIONS: 1))1 WAVE AVENUE,MIDDLETOWN,RI 02842 2)213 OCEAN STREET,HYANNIS,MA 02601 3 178-180 THAMES STREET,NEWPORT,RI 02840 4 13-15 KILBURN CT.,NEWPORT.RI 02840 5,82 MT.HOPE STREET,NORTH ATTLEBORO,MA 02760 6 20 WAVE AVENUE,MIDDLETOWN,RI 02842 7)40 N.MAIN STREET,FALMOUTH,MA 02540 See Attached... 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. EVIDENCE OF INSURANCE AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: NEWPHOTE LOC#: ACCIRD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY GENATT V NAMED INSURED Newport Hotel Group LLC.ETAL POLICY NUMBER --. 28 Jacome Way Don McCall Middletown RI 02842 CARRIER 1 NAM CODE— EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 8 28 JACOME WAY,MIDDLETOWN,RI 02842 9 84 SEA STREET,HYANNIS,MA 02601 1 385 JONES RD.,FALMOUTH,MA 02540 11 97 S.SHORE RD.,SOUTH YARMOUTH,MA 02664 12)7710 GRANITE LOOP RD.,TETON VILLAGE,WY 83025 13 3285 MCCOLLISTER DR.,TETON,WY 83025 14 73 S.SHORE RD.,SOUTH YARMOUTH,MA 02664 15 390 N.GLENWOOD STREET,JACKSON,WY 83001 16 259,251.267 THAMES ST&1 STATE STREET,BRISTOL,RI 02809 17 368 OLD POST RD.,NORTH ATTLEBORO,MA 02760 18 38 PURGATORY RD.,MIDDLETOWN,RI 02842 19)157 HOLLY RIDGE LANE,CONWAY,NH 03818 20)235 OCEAN STREET,HYANNIS,MA 0260 21)120 PALMER AVE„FALMOUTH,MA 02540 22)107 ATLANTIC RD.,GLOUCESTER,MA 01930 23)108 ATLANTIC RD.,GLOUCESTER,MA 01930 24)43&45 HULL SHORE DRIVE,HULL,MA 02045 25)132 PROSPECT AVE.,MIDDLETOWN,RI 02842 26)116 PROSPECT AVE.,MIDDLETOWN,RI 02842 27)131 OCEAN STREET,HYANNIS,MA 02601 28)149 OCEAN STREET,HYANNIS,MA 02601 ACORD 101(2008/01) ®2008 ACORD CORPORATION. All rights reserved. The ACORD name and Togo are registered marks of ACORD