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HomeMy WebLinkAboutBCOI-24-25 2024 The Commonwealth of Massachusetts Town of 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:Blue Rock Club,Inc BCOI-24-25 Trade Name:Blue Rock Club,Inc Identify property address including street number,name,city or town,and county Certificate Expiration Located at 48 TODD RD November 30,2024 SOUTH YARMOUTH,MA 02664 Use Group Classification(s) Floor Occupancy_ Use Group Other 01st Floor 48 A-2 Restaurants,Night Clubs,or Club House Allowable Occupant Load similar uses 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 Enrique Arrascue Name of Municipal Building Mar Date of Inspection 3I/1121 D,31`f' Commissioner /� 'L Signature of Municipal Fire - /.,,.t . �--�Commisnature of Municipal Building Date of Issuance �j2/2 T Chief -� --�/// \ Commissioner ` • '1 °� YR`� TOWN OF YARMOUTH o t . y BUILDING DEPARTMENT MATTACM s1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 �vl �MORATCC� L.. APPLICATION FOR CERTIFICATE OF INSPECTION February 28, 2024 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) 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: 41 i /c1 /OCR Name of Premises: //ot wick C( i aulo Tel: cog 3 /V -3 ?ci I Purpose for which permit is used: SeG S o•-•4I 11 A/Cc,l,v%Z A tuafc,,, it? 6) License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Gcc - .� m Certificate to be issu d toat na k Outi h�. Tel: Cos' 3/4/--;, 1 I Address: S Tail k Ci <>AL 1c,rA- � MA O 0V Owner of Record of Building D4vg-.10,,r4 ic' t fiy '%i ) Address 2c) Nd4--- emu,et S�i�lf ra %ysc, MA a 11 V Present Holder of Certificate I3/,;r !2o( CUiv 1�(_ D P,A . &/t 6.f Clivb Signature of person to whom Title Certificate is issued or his agent 1- a r �y Dat Email Address: (L%vertpo4 7%- cl4v co'''"/oc'-,'" • c'w` 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 # 4/1/2024-11/3 0/2024 ga> ACC D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ��. 6/1/2024 2/28/2024 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. 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 Lockton Companies CONTACT: 1185 Avenue of the Americas,Suite 2010 PHONE FAX (A/C,No.Extl: (A/C,No): New York NY 10036 E-MAIL ADDRESS: 646-572-7300 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Mount Vernon Fire Insurance Company 26522 INSURED Blue Rock Club Inc. INSURER B: 1498770 48 Todd Road INSURER C: South Yarmouth MA 02664 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 17838583 REVISION NUMBER: XXXXXXX THIS IS TO THAT THEPERIO ND CATED.CERTIFY NOTWITHSTANDING ANY POLICIES REQUIREMENT,TERM OR CONDIOF INSUNCE LISTED BELOTION OF ANY CO THAVE BEENERACTT OR OTHER DOCUMENT WITH RESPECT TOTO THE INSURED NAMED ABOVE FOR THELICY 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 SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ XXXXXXX MED EXP(Any one person) $ XXXXXXX PERSONAL&ADV INJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX POLICY ECT LOC PRODUCTS-COMP/OP AGG $ XXXXXXX $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY NOT APPLICABLE CO CO BINEDt) $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY accident) ) DAMAGE $ XXXXXXX AUTOS ONLY _. AUTOS ONLY (Pe $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ OTH- ER $ XXXXXXX WORKERS COMPENSATION NOT APPLICABLE PER STATUTE AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ XXXXXXX ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N/A (Mandatory In NH) OFFICE ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ XXXXXXX In If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX A Liquor Liability N N LQ20043 12B 6/1/2023 6/1/2024 Per Person Limit:$1M Per Accident Limit:$I M Aggregate Limit:$2M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 17838583 ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth Route 28 AUTHORIZED REPR ii I\,, .,, , i A IVE South Yarmouth,MA 02664 1 i` ,F- „,,_ „.. . , .A ,Vt. .<1 ` ©1988-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD