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Home My WebLink AboutBLDCI-17-006521-04 The Common ,/ealp of Massachusetts } . ity, own of �n er _ a�_�,' •%' OUTH .: .:�, 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: COLONIAL ACRES RESORT BLDCI-17-006521-04 Trade Name: COLONIAL ACRES RESORT Identify property address including street number, name,city or town and county Certificate Expiration Located at 114 STANDISH WAY 06/16/2022 II WES I YARMOU T H, MA 02673 I Use Group Floor Occupancy Use Group Other Classifications(s) 01st Floor 24 R-1 Hotel/Motel/BoardingHouse/Transient R-1 BLDG. 1 -12 UNITS BLDG.2-12 UNITS Other 10 R-1 Hotel/Motel/Boarding House/Transient 10 SINGLE COTTAGES Allowable Occupant Load Other 2 R-1 Hotel/Motel/Boarding House/Transient 2 DUPLEX COTTAGES 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 MM Building Commissioner Inspection (�`da�l Signature of Municipal Signature of Municipal Date of Building Commissioner nuance /Z. z. Z ' Fee: $184.00 3 .,"`'1.`YRR;; TOW OFYARMOUTH RECEIVED 1o, �: BUILDING DEPARTMENT � �„ ,�� .4/ c T 2 8 2021 - ., �-s 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 c t. 2 BUILDING DEPARTMENT By:APPLICATION FOR CERTIFICATE OF INSPECTION ___________ October 25,2021 PAYABLE UPON RECEIPT (X)Fee Required 184.00 ( )No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-name premises located at the following address: Street and Number: \\A S-.r-a►.+�t S scV rtr-. tr.,All-- Name of Premises: R:.1/4.,___ , A.,41...J tbk cet S `��,v Tel: SOS.'1'I 5-- Uei( S Purpose for which permit is used:e—rvr"N4, `' w'1$, L 0l License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to Ub.,-.....� NJi.5 Tel:'S'b - s"c v c Address: k\Nok ' r -�•,Lr V......, \.1 .\ttativ- -r\._ y•"-/ . Owner of Record of Building Address Present Holder of rtificate C,\.,.,..L A ,,,,_s ---- --17---%-__ Signature of person to whom Titl Certificate is issued or his agent -2-1 \\ Date Email Address:��`� S �1 ', Q �j i C 0,""1 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 CERTIFI ATE OF INSPECTION. Certificate of Inspection# 6 iY J�/7-'� �I I.ZS" 6/16/21-6/16/2022 • • i 14.1 t!. A ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/13/2021 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 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 Gloria Smith HART INSURANCE NAME: PHONE 508-781-7326 I FAX 243 MAINS STREET AGENCY, INC. (A/c,No,Ext) ( No): PO BOX 700 ADDRess: gsmith@hartinsuranceagency.com BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: UND @LLOYDS 32727 INSURED Colonial Acres Resort Association INSURER e: AMGUARD INSURANCE COMPANY 42390 114 Standish Way West Yarmouth, MA 02673 INSURER C INSURER D: INSURER E: ( INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD,WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A ' V COMMERCIAL GENERAL LIABILITY XSZ168474 01/01/2021 01/01/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ _.._ MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- 1,000,000 V POLICY _ JECT LOC PRODUCTS-COMP/OP AGG $ ,OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _.. ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOS --- HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ , DED l RETENTION$ $ B WORKERS COMPENSATION • COWC281509 08/01/2021 08/01/2022 PER STATUTE ER H I AND EMPLOYERS'LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 1 OFFICER/MEMBER EXCLUDED? N/A 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ J I j 1 I I I 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) _CERTIFICATE HOLDER CANCELLATION Fax#:(508)398-0836 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 MAIN STREET South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 77r'.4.4. 1 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1