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HomeMy WebLinkAboutBldci-23-003689 The Commonwealth of Massachusetts 9-.v. City\Town of 7. iM iu ! 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: IFAW BLDCI-23-003689 Trade Name: IFAW Identify property address including street number, name,city or town and county Certificate Expiration Located at 1/31/2024 290 SUMMER ST YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 468 A-3 Amusement/Church/Gym/Library/Museum 468 Persons-Standin 93 Persons Tables/Chairs Allowable 200 Persons-Chairs Occupant Load Only 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 - r�? Building Commissioner Inspection J Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance 2/1-7/4 1 Fee:$100.00 BLD Certoflnspection.rpt ;. r TOWN OF YARMOUTH o'. s. J'=a BUILDING DEPARTMENT . v ..rig:;v},,"t , '0' �..,,--� 1146 Route 28, South Yarmouth, MA 02664. 508-398.223:1 e: l -M1= I E' ! Y L p APPLICATION FOR CERTIFICATE OF INSPECTION 1 I JA_t.4,Q 3 2023� December 3,2021 PAYABLE UPON ING DEPARTMENT (X)Fee.Required 1. .i.t i ( ) 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 thefollowing address: Street and Number: 290 c-r rnsf 3\- Name of'.Preniises: FP ) Tel:-. 50 8 -7-I 4— 21.1::!.3 .... Purpose_for which petmit is used:. --yscr•bV License(s) or Permit(s)required for the premises by oilier governmental agencies: License or Permit Agency Certificate to be-issued to S Fet-LO Tel: 50 -7`I Y-)-1 G=3 Address: 2 L) sao—Aryt er \-. -{L,c-'s,vo,.t.}� S,-\vt Owner of Record of Building T Address Z eLU S,)v r - z33- NtCkS- .s\-Z c-/- 01,4t- Present Holder of Certificate Lc"-4 7 ,Z22--12:_e--------// - T--6- ,/,-f,,e (- .rd•n ak,r Signature of person to whom. Title Certificate is issued or his agent i:2ill z'L Date .. Email Address: /eN)tro-c i-,' s �.s �v aI 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:struct tire or part thereof to be certified_ Application must be received before the certificate will be issued. The building offi:ial 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 ofIn ection# ,(31/ /- a3 kF y 1/31/22-1/31/2 g „E Z t • l t ` -_.. ;,, X.• _:,- -' tk,W 1 r- -a ,iN ..,.. ..,ra - - . s _°e* r _„:~ ';£sk i. .. y !;(0,,,y. 3 , _ • . . -.�' , Y 3� i F J '� ® DATE(MM/DDIYYYY) ACCPRD CERTIFICATE OF LIABILITY INSURANCE 12/08/2022 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: Cheryl Woodside HUB INTERNATIONAL NEW ENGLAND LLC (A/cc.No.Est): (978)661-6678 is,No): E-MAIL fY ADDRESS: the I woodside hubinternational.com 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC1! NORWELL MA 02061 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: INTERNATIONAL FUND FOR ANIMAL WELFARE INC INSURER C: INSURER D: 290 SUMMER ST INSURER E: YARMOUTH PORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 842398 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 EFF POLICY EXP T TYPE OF INSURANCE AINSD SVD POLICY NUMBER ,(UBR MM D//DY/YYI Y) (MM R W IDD//YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY X STATUTEE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6HUB5B47942622 06/30/2022 06/30/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 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. Building Department 1145 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 D � Daniel M.Cron y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _____......4, INTEFUN-02 CWOODSIDE '4�co- CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 12/8/2022 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 License#1780862 CONTACT NAME: Sharon Doyle HUB International New England PHONE ,3279 FAx 300 Ballardvale Street (ac,No,Ext):(781)792 (ac,No): _ Wilmington,MA 01887 aI DR1ss:Sharon.Doyle@hubinternational.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B:Federal Insurance Company 20281 International Fund for Animal Welfare Inc. INSURERC: 290 Summer Street INSURERD: Yarmouth Port,MA 02675-1734 INSURER E: r 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMrrS LTR INSD NND (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK2433178 6/30/2022 6/30/2023 PREM SES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO P H P K2433181 6/30/2022 6/30/2023 BODILY INJURY(Per person) $ AUTOS ONLY AUWNED TOS BODILYBODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDT PROPERTY pAMAGE (Per accident) $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE 79869955 6/30/2022 6/30/2023 AGGREGATE $ 15,000,000 DED X RETENTION$ 0 $ OTH- B WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY 71834621 6/30/2022 6/30/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A 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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation policy above covers the following states:CA CO CT DC FL GA KS ME MI NH NJ NY PA TX VT.Massachusetts WC Proof to follow from the carrier if requested. 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. Building Department 1145 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ilA99;" 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD