Loading...
HomeMy WebLinkAboutBLDCI-20-005598 The Commonwealthk tassachusetts may, rp=Lam: t City\Town of 13 YARMOUTH 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: CITIZENS BANK BLDCI-20-005598 Trade Name: CITIZENTS BANK Identify property address including street number, name,city or town and county Certificate Expiration Located at 1106 ROUTE 28 09/29/2022 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor A-3 Amusement/Church/Gym/Library/Museum Meeting room 72 person Allowable 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 /10 2C Signature of Municipal Signature of Municipal / ' � Date of Building Commissioner Issuance fQ �j�f� , V '- Fee:;100.00 BLD Certotinspection.rpt "lag '�`i b TOWN OF YARMOUTH li : . 11t t i .� BUILDING DEPARTMENT ,.; v 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION August 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: nu, & ag so, Ve,.4,,vla >14- C12c6 T Name of Premises: (;1f z e 1A5 6 K oi_jiati4Tel: .sO Er- 3 - 03?/ Purpose for which permit is used: ,L;�-ek,S-e keg ( i C.1.1411 ri RECEIVED License(s)or Permit(s)required for the premises by other governmental agencies: r- -•- - License or Permit Agency AUG 2 3 2021 BUILDING DEPA12T Fiji T Certificate to be issued to �C 1t r t ?.ei.1 Sea el: vS0 ir-�cl O3/ Address: Y Owner of Record of Build Building y . k� 5Sc4e tU°a 66 Address gO njcsr'41 g-1a14 •S-1- YGrr�-144,4-i.,/ 1f1 0266? ! Present Holder of Certificate C it(-i 7_..u1 s ,570,14, t -gnature o perso to whom T. e ,' rtificate is issued or his agent '-/ - .I _ Date � 'f f-:mail Address: _.�et-yyt mac,+, , i_ t,„ Q ,C..',4..1._?-,,4,-ieei_rtK'w<L.Uv►ti 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 # BC!)C/-df)--ObSS-,8- 09/29/2021-09/29/2022 TOWN OF YARMOUTH o; . c?, BUILDING. DEPARTMENT 1146 Route 28, South Yarmouth, IA 02664 508-398-2231 ext. 1260 August 1,2021 Citizens Bank of Massachusetts 1116 Route 28 South Yarmouth,MA 02664 Re: Inspection Date—09/29/2021-09/29/2022 Fee$100.00 Pursuant to the provisions of the Massachusetts State Building Code 780 CMR, Section 110.7 and Table 110,you are required to apply for a Certificate of Inspection for the building located at 1116 Route 28, South Yarmouth, MA 02664 D/B/A Citizens Bank of Massachusetts. Please complete the enclosed application and return it with the appropriate fee payment to the Town of Yarmouth Building Department, 1146 Route 28,South Yarmouth,MA 02664. Checks should be made payable to the Town of Yarmouth. Please note that as of September 15,2008,a revised fee schedule has been instituted. The new fee schedule includes re-inspection fees. IMPORTANT: One (1) re-inspection to confirm the abatement of any violations listed during the initial inspection will be included in the initial fee if the abatement is completed during the time period(typically 10 days)listed on the Inspection Report, Additional re-inspections will cost$80 each, which is payable in advance of the re- inspections. Unless otherwise requested, inspections will be performed unannounced. Typically the following elements/systems are inspected: fire protection equipment, means of egress, including emergency lights, exit signs, egress doors c&hardware, clear path of travel, adequate lighting and occupancy total. Also, the building shall be maintained and adequate housekeeping provided to insure public safety. Rooms such as basements and attics are included. Violation details will be provided in the form of a Violation Notice and may delay the issuance of your certificate and/or license, if applicable. Note: After receivin our a lication a minimum of 3 weeks' notice is require for an insection, Finally, applications and fees must be received within ten (10) days of receipt of this letter. Failure to comply may jeopardize your license where applicable, and/or the occupancy of the building. ) Pft71Y Your ark A. G " * Building Commissioner Page 1 of 2 A CERTIFICATE OF LIABILITY INSURANCE °8/MIDDFV2) 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE FAX c/o 26 Century Blvd (NC.No.EMI: 1-877-945-7378 (NC,No): 1-888-467-2378 IL P.O. Box 305191 ARE ADSS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAICN INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED INSURERS: LM Insurance Corporation 33600 Citizens Financial Group, Inc. Liberty Insurance Corporation 42404 Citizens Bank, N.A. INSURERC: One Citizens Bank Way INSURERD: Mailstop: JCCL45 INSURER E: Johnston, RI 02919 INSURER F: COVERAGES CERTIFICATE NUMBER:W21811721 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 1,000,000 A MED EXP(Any one person) $ 0 TB2-611-004526-031 03/31/2021 03/31/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I 1 PRaJECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _ 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 RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N 1,000,000 /M B ANYPROPRIETORIPARTNER/EXECUTIVE No NIA WAS-61D-004526-101 03/31/2021 03/31/2022 E.L.EACH ACCIDENT $ OFFICEREMBEREXCLUDED7 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Workers Compensation and WC5-611-004526-151 03/31/2021 03/31/2022 EL-Each Accident $1,000,000 Employers Liability EL-Disease-Pol. Limit$1,000,000 Work Comp: Per Statute EL-Disease Each Emp. $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 03/30/2021 WITH ID: W20500911. All terms and coverages evidenced on this certificate will only apply to the extent of the requirements within the written agreement or lease. 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. AUTHORIZED REPRESENTATIVE ?�/ emu,Tl.'t90A .v3--- Evidence Only ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21462136 BATCH: 2200045 AGENCY CUSTOMER ID: LOC#: A�RL ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Citizens Financial Group, Inc. Willis Towers Watson Northeast, Inc. Citizens Bank, N.A. POLICY NUMBER One Citizens Bank Way See Page 1 Mailstop: JCCL45 Johnston, RI 02919 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: Liberty Insurance Corporation NAIC#: 42404 POLICY NUMBER: WA7-61D-004526-171 EFF DATE: 03/31/2021 EXP DATE: 03/31/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL-Each Accident $1,000,000 Employers Liability EL-Disease-Pol. Limit $1,000,000 Work Comp: Per Statute EL-Disease Each Emp. $1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 21462196 BATCH: 2200045 CERT: W21811721