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Home My WebLink AboutBLDCI-23-004892 The Commonwea\ of i assachusetts 1=i____ - City\To� • '�'}4'— YARMOUTH .; .Irmo ..-ate 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 Sands Inn BLDCI-23-004892 Trade Name: Cape Sands Inn Identify property address including street number,name,city or town and county Certificate Expiration Located at 3/12/2023 151 ROUTE 28 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 Gist Floor 32 R-2 Apartment/Non-Transient Hotel/Convent/Fraternity Managers,Apartment& Lobby 02nd Floor 28 R-1 Hotel/Motel/Boarding House/Transient 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 Its Date of Building Commissioner Inspection 9 7s —'3 Signature of Municipal Signature of Municipal Date of Building Commissioner C� Issuance 0/701- $274.00 BLD_Certofl nspection.rpt v BUILDING DEPARTMENT 4 • \ rT <ii SC_ .,, J \,- :" 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 REICEE APPLICATION FOR CERTIFICATE OF INSPECTION , ' V E D March 1, 2023 PAYABLE UPON REC IPFEB 2 7 1023 (X) Fee Require 41109ING ( ) No Fee Requ - yip T In accordance with the provisions of the Massachusetts State Building Code, Section 1 10.7, I hereby apply for a 2.--1 Certificate of Inspection for t� below-named premises� located at the followingol address:dd Street and Number: -/¢7 f�.'„ $Tree T, 1'17Ps/ /may- u�7h, /77, OZG-73 Name of Premises:�y-po S�^W /hip Tel: 50S - 775 - 35 / /y� z '2 ese - 7 4-3 (c) �� Purpose for which permit is used: L e, , j.,. / / /o�e License(s) or Permit(s) required for the premi(s'esother governmental agencies: License or Permit Agency /a Certificate to be issued to (- i=ie . ma's -/hn Tel: �Ui" ./7f- 3Y2-.3- Address: / '`, - fr7•-7;, $f.,r/ . /. yam,,,,z,,,.. /1/9 a G/3 �, 5' s n / 'Tw0 tiM,'/,es /e. Owner of Record of Building C' c✓ � 7 /� Address i'1 7 /YIA/9 $ ie 71 Present Holder of Certificate C.:j2 sue,,, 4 , / /wo A,, -•/,r 'C //;(. . Pi•t-,Pe/t Signature of person to whom Title Certificate is issued or his agent p2-7/23/2.3 Date Email Address: �GtS`i emnd e -, ,7„ 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 # 3Uj /-. 2,.3_- opt s--9c)._ 3/12/2023 to 3/12/2023 �' DATE(MMIDDIYYYY) A�!�® CERTIFICATE OF LIABILITY INSURANCE 02/02/2023MMIDD 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 William Rohr NAME: Morse Insurance Agency,Inc. PHONE (508)238-0056 FAX (508)No): (508)230-8367 (A/C,No,Ext): 285 Washington Street E-MAIL billrohr@morseins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 North Easton MA 02356 INSURER A: Vermont Mutual Insurance Co. 26018 INSURED INSURER B: Associated Employers Ins.Company TWO FAMILIES INC DBA CAPE SANDS INN INSURER C: C/O NAUSHAD KASHEM INSURER D: 1 DOWNINGWOOD DR INSURERS: FRANKLIN MA 02038-2767 iNSURERF: . i r COVERAGES CERTIFICATE NUMBER: 23-24 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 SUI:ik POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE _INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA10 RENT CLAIMS-MADE X OCCUR PREMISES(Ea occEence) $ 50,000 MED EXP(Any one person) $ 5,000 A BP11058627 01/27/2023 01/27/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 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) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE CU11005271 01/27/2023 01/27/2024 AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE OTH- ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? Y N/A WCC-500-5026341-2023A 01/27/2023 01/27/2024 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-FvUCY!JU iT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF COVERAGE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD