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HomeMy WebLinkAboutBLDCI-16-001516-05 The Commonwealth of Massachusetts } h City\Town of is YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 wasolo Identify Name of Establishment LCertificate No. Issued to Business Name: SUNFLOWER SCHOOL Unit F B - 1516-05� Trade Name: SUNFLOWER SCHOOL Identify property address including street number, name,city or town and county Certificate Expiration Located at 923 ROUTE 6A UNIT F 07/01/2017 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) E E 01st Floor 19 E Educational School to 12th Grade/Child Care(More than 5) from 2.9 years&older Allowable 01st Floor 13 E Educational School to 12th Grade/Child Care(More than 5) from 2.9 years&older 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 7.--/Jq -' Signature of Municipal Signature of Municipal Date of Building Commissioner ( ° Issuance 7 /9 z/ Fee: $0.00 BLD Certoflnsoection.rot fa-. --A>; TOWN OF YAR1 'IOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION June 1,2021 PAYABLE UPON RECEIPT (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: .9 a3 Po. G 61.411(9r1?)2 Grn Name of Premises: SunFlot.e.c ` zc.. o\ Tel: Sib— — 4 q®- t#t ..F' _ e � Purpose for which permit is used: C...1.11 ��,Q cc,rt. (,��• -�� JUN License(s) or Permit(s) required for the premises by other governmental agencies: 1 �� 2021 8U �y/ Tip ry License or Permit Agency T ©Y _- 1l� 6105qqati G. oc Mara UelV.Oc �� 1611 `V' Certificate to be issued to jt„nc(a,ic, jc-1 1 Tel: 6439 Address: 6)2.3 Rob„lac. &A , �larn,ci,14- O 15— Owner of Record of Building L.41J 13 Re lki 1 i4 Address 14 S►sk.es C..L rd t cia 5- Present Holder of Certificate nc Signa'•'. •erson to w••m Title Certific.1.. -: •r his agent C. "3w ocOt t. Date Email Address: GeG„vgg GunclatjercyACrjoix. . Coin 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# 07/01/2021-07/01/2022 I ACORD DATE(MMDDYVYY)CERTIFICATE OF LIABILITY INSURANCE 06/08/2021 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 policy(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 CONTACT Laura J Murphy HART INSURANCE AGENCY. INC. PHONE 508-759-7326 X207 FAX 243 MAIN STREET (A/C.No.Ext): (Arc.No: PO BOX 700 ADDRESS: Imurphy@hartinsuranceagency.com BUZZARDS BAY, MA 025320700 INSURER(S)AFFORDING COVERAGE NAK:s INSURER A: MARKEL INSURANCE CO INSURED The Sunflower School Corp. INSURERB: 923 Rt 6A Yarmouth Port,MA 02675 INSURER C. INSURER D: INSURER E: 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. ADDL SUBR POLICY EFF POLICY EXP INSR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MWDO/YYYY) (1134/DD/YYYY) LII/IS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ I DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $ POUCY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ''SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS NON-OWNED PROPERTY(Per accident)DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AWC008719-02 12/13/2020 12/13/2021 PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY -— ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ _ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Location: 923 Rt 6A,Yarmouthport, MA.02675 CERTIFICATE HOLDER CANCELLATION Proof of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��"r�lT ,74- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD . w., W #, - f ♦ ri..lt"•. Wig' ..'i['T7,Y. •c, • -. .. - . . c � e ' ''C3 {e a3a t a 4I9 r - - :7T• s • .0 _, ar, • c r , e .. • I4 1 } x � - e �. A.i.t.,-"_alirlilittl'='' '°j5a„ ,, .t„ *sue 4.- • a= ..i .. • • • f,= '3• • •