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HomeMy WebLinkAboutBCOI-24-3 The Commonwealth of Massachusetts Town of 19) YARMOUTH New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code,Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:Bayside Resort Hotel BCOI-24-3 Trade Name:Bayside Resort Hotel Identify property address including street number,name,city or town,and county Certificate Expiration Located at 225 ROUTE 28 WEST YARMOUTH,MA 02673 February 4,2025 Floor Occupancy_ Use Group Other 01st Floor 65 R-1 Hotels,motels,boarding houses, 65 Rooms Use Group Classification(s) etc. Swimming pool,ladies&Men shauna room Allowable Occupant Load 02nd Floor 63 R-1 Hotels,motels,boarding houses, 63 Rooms etc. 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 line safety features.This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned.Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Chief Name of Municipal Building Mark G s D e of Inspection I S'I�t t Commissioner 1 Signature of Municipal Fire Signature of Municipal Building v Y Date of Issuance Chief Commissioner > � Z t* -,-Ced° Y �", TOWN OF YARMOUTI RECEIVED BUILDING DEPARTMENT % gN 10 2024 ATTA � s`y, 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 elxt. 12 kO<n.nca s� i d BUILDING DEPARTMENT By: — APPLICATION FOR CERTIFICATE OF INSPECTION January 1, 2024 PAYABLE UPON RECEIPT (X) Fee Required $457.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number:005 i),U `�e2 itA Name of Premises:?j(K S+ QSU C\ t'tO <,k Tel: 0/-11 S -(D(DG Purpose for which permit is used: H(A LI ChiAOL- License(s)or Permit(s)required for the premises by other governmental agencies: cc.0 --11`t.a,%- l41 q License or Permit Agency Certificate to be issued toR)(1�S\GU-- SUE\ lk)4-(!i Tel: F --as 50,9 Address: �o)S �W ik r.) (A)•ti ..r Pinov}ti,, MA Oc lo i:. • Owner of Record of Building S�0 9 y fA,c+ r\- LLC. . �' Address arc J�j c01-,e cE L .uk(f -mo v-1,1,, YYNC\ ()At 01 ' Present Holder of Certificate t�(u.�g'it V c c\ 0f� � 0 CI Viler "�° J / Signature f person to whom Title Certificate is issued or his agent ..O q.. q Date Email Address:-1-0.$)1 ,6a'Side fesi/I_. Col 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 N CA OT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 0 Cbl-d1/471_-3 02/04/2024-02/04/2025 BAYSYAR-01 FQUISPE AC L DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/12/2023 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). CONTACT Francis Quispe PRODUCER NAME: Boyd&Boufford Insurance Agency,LLC PHONE 603 673-7228 (A/C,No):(603)673-7290 167 S River Road Unit 10 (A/C,No,Ext):( ) Bedford,NH 03110 E-MAIL Francis@Bouffordins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Technology Insurance Company 42376 INSURED INSURER B: Bayside Yarmouth LLC INSURERC: 110 Hartwell Ave Suite 300 INSURERD: Lexington,MA 02421 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. INSR TYPE OF INSURANCE ADDL SUER W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD IMM/DD/YYYYI (MM/DDIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PR PREMISES S l RENTED (Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED den accident) LIMIT ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYpAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN TWC4345600 11/15/2023 11/15/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Y 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 I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) reference location:225 Route 28 West Yarmouth,MA 02673 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD