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Home My WebLink AboutBLDCI-18-002561-05 The Comm ealth of Massachusetts ty\Town of worm YARMOUTH tk AM. 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 BLDCI-18-002561-05 Business Name: PARKERS RIVER RESORT, LLC Trade Name: PARKERS RIVER RESORT Identify property address including street number, name,city or town and county Certificate Expiration Located at 759 ROUTE 28 UNIT 1 06/26/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 24 R-1 Hotel/Motel/Boarding House/Transient 24 UNITS 1 LAUNDRY ROOM MANGRS.APT. 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 _3 Building Commissioner Inspection Zt Signature of Municipal Signature of Municipal7'41° Date of Building Commissioner Issuance 1(. Fee:$142.00 BLD Certoflnspection.rpt ii'YgR . o TOWN OF YARMOUTH O! ,$ BUILDING DEPARTMENT"�Tfi' � 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 r --APPL t✓'ATION O CERTIFICATE OF INSPECTION March 15, 2022, MAR 15 2022 PAYABLE UPON RECEIPT ..-j ' (X) Fee Required 142.00 a u i �Tnn E ry i By ( )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: 1 56\ �� G'LJ Name of Premises Ttir F-±✓ T-'l.vt, CA i l..\-c_. ' Tel: 5 g2,s3gFC/71 7 e-762. ) Purpose for which permit is used: `(`c\err- �� License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to TA r\vasV} 'z- 0k - Tel: 5 € 3.18 j'--T—t y-iciq"l02 v Address: " Pt �'1T j 1/41-M� c -t \ . Mot. O'ztdo+ Owner of Record of Building '(Ll.�� (.3 ►'sr---S1s•V y Address -)X 'S l Zb--1- Present Holder of Certificate1( L7-WkIs . vaa1i L.0 _ U )--9\C, p c>JeJ--IZ • ature of person to whom Title _ Certificate is issued or his agent �i - 1c5' -- Date Email Address: 1)4,117—Vc-c•;�5 --1q�1Z V2--“Ort c, cc-e0Q 1►Er 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# S I& I f 8.DUa6Zo/ /del—0 6/26/2022-6/26/2023 Or3 •-• ' • - • VERMONT MUTUAL GROUP BUSINESSOWNERS POLICY DECLARATIONS 89 State Street, PO Box 188 1�C1 Montpelier,VT 05601-0188 To report a claim call your Agent or the Company at 800-435-0397 Policy Number: BP21042734 - RENEWAL POLICY Type of Billing:DIRECT BILL TO INSURED Named Insured/Address Agency/Address PARKERS RIVER RESORT LLC DOWLING & O'NEIL INS. AGENCY LEWIS BAY PROPERTIES INC 973 IYANNOUGH ROAD PO BOX 753 HYANNIS, MA 02601 -1869 WEST YARMOUTH, MA 02673-0753 (508) 775-1620 POLICY PERIOD From 07/21/2021 To 07/21/2022 at 12:01 A.M.' *Standard Time at your mailing address shown above. INSURANCE PROVIDED BY: NORTHERN SECURITY INS CO. TOTAL POLICY PREMIUM at inception is: $9,573 and at each anniversary. IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. BUSINESS DESCRIPTION Form of Business: LIMITED LIABILITY COMPANY DESCRIBED PREMISES Prem. No. Blda. No. Location/Occupancv Mortgaaeholder Name and Address 001 001 25 UNIT MOTEL/MANAGER APT (See Schedule of Mortgageholder(s) - 759 ROUTE 28 BPDEC5 - If Applicable) UNITS 1 -25 SOUTH YARMOUTH, MA 02664 PROPERTY-Limits of Insurance for BUILDINGS $ 1 ,434,457 • Actual Cash Value - Buildings Option (Y/N) _ N • Automatic Increase - Building Limit (pct.) 4% BUSINESS PERSONAL PROPERTY $ 85,000 EARTHQUAKE DEDUCTIBLE(pct) DEDUCTIBLE$ 5,000 OPTIONAL COVERAGE/EXTERIOR BUILDING GLASS DEDUCTIBLE$ 250 OPTIONAL COVERAGES-Applicable only if an "X" is shown in the boxes below: Limits of Insurance 1. ❑Outdoor Signs $ per occurrence 2. Tenant's Exterior Building Glass $ 3. Interior Glass ❑ Basement/ground floor level ❑All Floors included 4. ['Employee Dishonesty $ per occurrence .5. ❑Money &Securities (Special Form Only) $ Inside the Premises $ Outside the Premises COVERAGE EXTENSIONS 1. Optional Higher Limits-Accounts Receivable $ 2. Optional Higher Limits-Valuable Papers $ ADDITIONAL COVERAGES Optional Higher Limits-Forgery and Alteration $ LIABILITY AND MEDICAL PAYMENTS Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Paragraph D.4. of the Businessowners Liability Coverage Form. Limits of Insurance 7 Liability and Medical Expenses $ 1 ,000,1)00 �- Medical Expenses $ 5,000 Per person Fire Legal Liability $ 50,000 Any one fire or explosion FORMS/ENDORSEMENTS ATTACHED TO THIS POLICY: (See Schedule of Forms and Endorsements - BPDEC4) COUNTERSIGNED — BY (DATE) (AUTHORIZED REPRESENTATIVE) THESE DECLARATIONS TOGETHER WITH THE COVERAGE FORM(S), COMMON POLICY CONDITIONS, FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREFORE,COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of the Insurance Services Office, Inc. Copyright, Insurance Services Office, Inc., 1997 INSURED COPY 06/22/2021 (JJOP BPDEC1 01/10 WORKERS COMPENSATION AND EMPLOYERS' LIABILTY INSURANCE POLICY----INFORMATION PAGE INSURER: POLICY NO: WE114835A NORFOLK & DEDHAM MUTUAL FIRE INSURANCE COMPANY 222 AMES STREET RENEWAL DEDHAM, MA 02026 NCCI Company No: 21059 Account No: FEIN: 26-1913272 ITEM 1. NAMED INSURED AND MAILING ADDRESS: AGENT NAME AND ADDRESS: PARKERS RIVER RESORT LLC ROGERSGRAY, INC. SOUTH 759 MAIN STREET DENNIS OFFICE SOUTH YARMOUTH, MA 02664 434 ROUTE 134 SOUTH DENNIS, MA 02660 AGENT NO.: 20577 LEGAL ENTITY: LIMITED LIABILITY COMPANY (LLC) OTHER WORKPLACES NOT SHOWN ABOVE: (See Workers Compensation Classification Schedule) ITEM 2. POLICY PERIOD: From: 05/18/2021 To: 05/18/2022 Effective 12:01 A.M. Standard Time at the Insured's mailing address. ITEM 3. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident: $ 500,000 each accident Bodily Injury by Disease: $ 500,000 policy limit Bodily Injury by Disease: $ 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: See Schedule of Forms and Endorsements. ITEM 4. PREMIUM: The premium for this Policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to verification and change by audit. Total Estimated Minimum Premium: $ 226 Annual Premium: $ 524 Audit Period: ANNUAL Additional/Return Premium: Comments : Issued At: Date: 04/08/2021 Countersigned by WC 00 00 01 A Copyright 1987 National Council on Compensation Insurance INSURED COPY a •