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Home My WebLink AboutBLDCI-16-006080-05 The Com o wealth of Massachusetts tr--1" ;ity\Town of .1.,t„. 4 F t. YARMOUTH I 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: CAPE COD FAMILY RESORT BLDCI-16-006080-05 Trade Name: MAYFLOWER INN Identify property address including street number, name,city or town and county Certificate Expiration Located at 504 ROUTE 28 04/21/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 20 R-1 Hotel/Motel/Boarding House/Transient BLDG. 1 - 16 UNITS BLDG.2-4 UNITS Allowable 02nd Floor 5 R-1 Hotel/Motel/Boarding House/Transient BLDG. 1 -MANGRS. APT.&OFFICE Occupant Load BLDG.2-5 UNITS 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 a --„:75---c 1 Signature of Municipal Signature of Municipal Date of Building Commissioner ' (- --2 6)417 Issuance ;7'07q Fee:$145.00 BLD_Certofl nspection.rpt r0 F�L� ®® r OF YA a #O v ; �,' � , BUIL* NG DEPARTMENT • 1146 Route 289 South Yarmouth,MA 02664 50 -S 395-2231 ext. 1260 • APPLICATION FOR CERTIFICATE OF INSPECTION March 3,202i PAYABLE UPON RECEIPT (X) Fee Required 145.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7,I hereb a Certificate of Inspection for the below-named premises located at the following address: Y PP1Y for a Street and Number: o FD Name of Premises:l�t�V C'�®t.zgg s�►e•°�xi Tel: i " Purpose for which permit is used: License(s)or Permit(s) �°� �— MAR 1? 2i021 t( )required for the premises by other governmental agencies: License or Permit (Jfi r Agency Certificate to be issued to_Sgatifkft , Address: P O t M 'r' tit______:Tel: Owner of Record of Building Address S a Present Holder of Certificate R� t Signa of person to whom Certificate is issued or his agent Title Email Address: Date r.) Instructions: Make check payable to: Town of Yarmouth Return application to: 1146 Route 28, South Yarmouth,MA 02664 Building Inspector's Office Please note: Application form with accompanying to a Application fee must be submitted for each buildingor structure t notified certified must be received before the certificate will be issued. The sh ten(10)days of any change in the above info building official shall or behereof PLEASE SEND US A COPY OF YOUR WORKER'Sinformation. APPLICATION R WE CANNOT Y ISSUE COMPENSATION Certificate of InspectionYOUR CERTIFICATE OF INSPECTION.INSURANCE FORM WITHS # A. ''' 'iz�'� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) I 12/14/20 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 NAME: Brian Allain Choice Insurance Agency PHONE (A/C.Na.Ext): 978-343-4853 FAX No): 978-345-1007 376 Summer Street Fitchburg,MA 01420 E-MAILDSS: ballain@choice-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company INSURED _ INSURER B: Guard Insurance Sandbar Management Inc INSURER C P.O.Box 481 West Yarmouth,MA 02673 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. INSRL TYPE OF INSURANCE ADDLBUBR POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE El OCCURDAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CPS7208009 06/26/20 06/26/21 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY pi JECT 7 LOC GENERAL AGGREGATE $ 2,000,000 OTHER PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LAB $ _ OCCUR EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I STATUTE I XI ER B (Mandatory OFFICER/MEMBER EXCLUDED? ❑ N/A SAWC187858 E.L.EACH ACCIDENT (Mandatory in NH) 10/01/20 10/01/21 $ 1,000,000 DESCRIPTIO under OPERATIONS below EL.DISEASE-EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Liquor Liability Aggregate CPS7208009 2,000,000 06/26/20 06/26/21 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addit(anal Remarks Schedule,may be attached if more space is required) Operations of Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE Brian Allain ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered mars of ACORD