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Home My WebLink AboutBLDCI-16-006080-07 The Co once ealth of Massachusetts -ter •_ City\Town of YARMOUTH 111. 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: MAYFLOWER INN BLDCI-16-006080-07 Trade Name: MAYFLOWER INN Identify property address including street number,name,city or town and county Certificate Expiration Located at 504 ROUTE 28 04/15/2024 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 20 R-1 Hotel/MoteUBoarding House/Transient BLDG. 1 -16 UNITS BLDG.2-4 UNITS Allowable 02nd Floor 5 R-1 Hotel/MoteUBoarding 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 Signature of Municipal Signature of Municipal Date of Building Commissioner oer . Issuance c Z f v. Fee:$0.00 BLD_Certofl nspection.rpt s0PR�,a �� : � TOWN OF YARMOUTH ig,,/, -alrt--1$1 BUILDING DEPARTMENT K " TT"`" �`;, � 1146 Route 28, South Yarmouth MA 02664 508-39 1 c/E1IC0 D APPLICATION FOR CERTIFICATE OF INSPECTIO v MAR 312023 March 1, 2023 PAYABLE UPON RECEIP'UUILDING DEPARTMENT (X) eleYe - ( ) 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: S d -1 j(Y ,50 h ' T Ci-1 a Name of Premises: N\(y ‘OW-fa_ Tel: ►i 7 S�' 7 S — S L. Purpose for which permit is used: 11, OTC 1, L t c e k C- License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to SG+n fl llA I W 61 'I C Tel: 171 — 3 7 S— 5 4 a Address: S \ k IM qk S r VA) -e so t it 4 /A o J.G 7 Owner of Record of Building C 1--6\d,\h Address 5 t ) ‘ S`r W ►S 6 (4 2vv,o v 14t, /►SA- CY G 73 Present Holder of Certificate hy------ 0 LU0Pa-, Sig Lure of erson to whom Title J C ificate is issued or his agent 3/ 30( J 3 Date Email Address: ,, e ® M f4 c c C, 1Mo\ Et-) G m a, L, Co V`'` 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# g( 16--� �jk) 04/21/2023-04/21/2024 � `2'�7 • • • • • • • • �_.. _ —.tee- � _.-_ _ .•+' _ -.- - "_ • • • • • • • • • • • • • • • • Ott t • �l\- '•414t} ,�irsisy..,ur�T r"r,��a•wx r.+�+.r.--.. - ._ _.- -<-. __ r .- - :: -• x....r.Wp.€00. • ^ • Y es AC.7 R12) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `'. ."` 11/14/22 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(les)must have ADDITIONAL INSURED provisions or be endorsed. tf 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 NA : Brian Allaln Choice Insurance Agency PHONE 978-343-4853 1(NCC,Nei: 978-345-1007 376 Summer Street -- Fitchburg,MA 01420 ADDRESS: balialn@chotce-Insurance.com INSURER(S)AFFORDING COVERAGE NAIC I —- ---- INSURER A: AmGuard Ins Co 42390 INSURED INSURER 8: Sandbar Management Inc/Sandbar Holdings LLC INSURER C: Cape Cod Inflatable Park/Shark Bites Cafe INSURER O: 100 Wood Ave S,Suite 209 Iselin,NJ 08830 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELDW 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. INSP. — LTR TYPE OF INSURANCE '(POLICY YYYUMM/DD/YY Y) UNITS IN$D WVO POLICY NUMBER COMMERCIAL GENERAL LUBIUTY EACH OCCURRENCE S DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ r MED EXP(My one person) S I PERSONAL&ADV INJURY S GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY ri, f n LOC PRODUCTS-COMPIOP AGG S OTHER S I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S I (Ea accident) ANY AUTO BODILY INJURY(Per person) S —OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per auJdent) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY —AUTOS ONLY (Per accident) S UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE - AGGREGATE S DED i RETENTION SI $ WORKERS COMPENSATION AND EMPLOYERS'UHY AITY Y I N STATUTE I XI ER ANY PROPRIETORJPARTNER/EXECUTIVEn E.L.EACH ACCIDENT S _ 1,000,000 A OFFICERMEMBEREXCLUDED? NIA SAWC374351 10/01/22 10/01/23 (My In NH) E.L.DISEASE.EA EMPLOYEE S 1,000,000 k y�s dwabe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION Of OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Opeatlons of Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sandbar Management,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 409 Iselin,NJ 08830 AUTHORIZED REPRESENTATIVE 1 (?)M `?r- Cam`^^ 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD