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HomeMy WebLinkAboutBLDCI-22-004471 The C I' . i onwealth of Massachusetts r fr, City\Town of _ ia= T YARMOUTH 'limp 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:Two Families Inc BLDCI-22-004471 Trade Name:Cape Sands Inn Identify property address including street number,name,city or town and county Certificate Expiration Located at 151 ROUTE 28 3/12/2023 IWEST YARMOUTH, MA 02673 I Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 32 R-2 Apartment/Non-Transient Hotel/Convent/Fratemity Mangers,Apartment& Lobby Allowable 02nd Floor 28 R-1 Hotel/Motel/Boarding House/Transient 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 Gryl Date of Z Building Commissioner Inspection ✓�� Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance 7%7/2 Z Fee: $'74.00 ,�o� YaR TOWN OF YARMOUTH bo, BUILDING DEPARTMENT MATTA�'N SS/_ 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION February 1, 2022 PAYABLE UPON RECEIPT (X) Fee Required$274.00 ( ) 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: 147 /92 $ ; s / /G r 1.N. «/ /17, d 73 Name of Premises: es p,0 e5 Tel: 777 - j X 2 212 - SSA 7713 (�//� ✓ Purpose for which permit is used: Zo License(s) or Permit(s) required for the prez4sy other governmental agencies: ! RECEIVED ! License or Permit Agency FEB 10 20221 Br Certificate to be issued to Cep e Sc., c✓s Tel: Address: / /7,4 2 it Ares 7J4.," / AM /2 67 3 Owner of Record of Building /i/o ci s h c `s Address / , z;) w�,�.,1 u-co o�/ � r'cy,i,y, /0/7 02a Present Holder of Certificate vsr✓ ,r s Signature of person to whom Title Certificate is issued or his agent 6 2/ d 7/,& Xct_5" Date Email Address: P s�o ) �.. / ( o- 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 I— —( (ici-7/ .03/12/2022-03/12/2023 A� ® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/09/2022 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 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). CONTACT William Rohr PRODUCER NAME: Morse Insurance Agency,Inc. PHONEt Extl: (508)238-0056 FAX No): (508)230-8367 285 Washington Street E-MAIL billrohr@morseins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# North Easton MA 02356 INSURER A: Vermont Mutual Insurance Co. 26018 INSURED INSURER B: Associated Employers Ins.Company TWO FAMILIES INC DBA CAPE SANDS INN INSURER C: 149 RTE 28 INSURER D: INSURER E: WEST YARMOUTH MA 02673-4653 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 Master 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,000 DAMAGE 1 O REN TED 50,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A BP11058627 01/27/2022 01/27/2023 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' 2,000,000 PRO- LOC PRODUCTS-COMP/OP AGG $ X POLICY JECT $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accdent) BODILY INJURY(Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY ROP r colde�d)ERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (P $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE CU11005271 01/27/2022 01/27/2023 AGGREGATE $ 2,000,000 DED RETENTION$ OT - WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N NIA WCC-500-5026341-2022A 01I27I2022 01/27/2023 —E 1,000,000 .L.DISEASE-EA EMPLOYEE $ (Mandatory In andNH) 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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. EVIDENCE OF COVERAGE AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. -ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Ca onwealth of Massachusetts Coaonw }4 rtritirpMIMM _ grl City\Town of � '! YARMOUTH *� •=as 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: Two Families Inc BLDCI-22-004471 Trade Name: Cape Sands Inn Identify property address including street number, name,city or town and county Certificate Expiration Located at 151 ROUTE 28 3/12/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01 st Floor 32 R-2 Apartment/Non-Transient Hotel/Convent/Fratemity Mangers,Apartment& Lobby Allowable 02nd Floor 28 R-1 Hotel/Motel/Boarding House/Transient 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 Gryl Date of Q�,e�� Building Commissioner Inspection "� pG/�( Signature of Municipal Signature of Municipal ;' Date of Building Commissioner Issuance y7/7/7 2- Fee:5'14.00