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HomeMy WebLinkAboutBCOI-24-10- • The Commonwealth of Mas h etts 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:Holly Tree condominium Trust BCOI-24-10 Trade Name:Holly Tree Motel Identify property address including street number,name,city or town,and county Certificate Expiration Located at 412 ROUTE 28 February 16,2025 WEST YARMOUTH,MA 02673 Floor Occupancy_ Use Group Other Otst Floor 8 8 UNITS 160-167 76 UNITS MAIN BLDG Use Group Classification(s) 02nd Floor 76 R-1 Hotels,motels,boarding houses, 76 UNITS BLDG etc. Allowable Occupant Load 01st Floor 48 R-1 Hotels,motels,boarding houses, MANAGERS OFFICE&LOBBY etc. SWIMMING POOL SQUASH COURT-10 BREAKFAST ROOM-36 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 Building Mark s to of Inspection Name of Municipal Chief Commissioner ^-.., 3 I JaD 2-if Signature of Municipal Fire Signature of Municipal Building Date of Issuance 37i V/Z Chief Commissioner " ' TOWN OF YARMOUTH I lob BUILDING DEPARTMENT 1� ,. 5// -/--1/ le: 1y1 " —"`" '� o 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 h Ser APPLICATION FOR CERTIFICATE OF INSPECTION January I, 2024 PAYABLE UPON RECEIPT (X) Fee Required $325.00 ( ) No Pee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, 1 hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Ala- h 4:014 45).-- 177 Name of Premises: 4.#1b11 IT-44,-, Tel: ( 6 Purpose for which permit is used: Pitirc405\ .^ License(s)or Permits) required for the premises by other governmental agencies: RECEIVED License or Permit Agency _ JAN 2 2 2024 BUILDING DEPARTMENT By- -------_- Certificate to e issued to `1..ko\A '% or't Tel: 11 t Co 4 1' " Address: ..-. loo • _..._. ,.._ 0 ci1- ,Owner of Record of Bgildin Cor .•/ Address Present Holder of Certificate 3 CotD 0 6.°01\•, Sig a ire of person to whom Title if i Certificate is issued or his agent (00 ( 2°°' %If Date Email Address: 13)1Zdj°7101/4N tf\-.14 tit'KA@C7141k. 1:10.10". CO INr.***.- 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 CANI IQ,T:.1 SUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# IOL'V/T2 C/-'/O 02/16/2024-02/16/2025 ACCFIRCP CERTIFICATE OF LIABILITY INSURANCE DA�zMsDD/Y" 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 Diane Camlain NAME: The Armstrong Company Insurance Consultants PHONE Ertl: (310) (AIC(310)530-0099 FA%,No): (310)530.0098 (NC No. 2780 Skypark Dr,Ste 440 AoDRESS: dcarmain@armstronginsco.com INSURERS)AFFORDING COVERAGE NAIC Torrance CA 90505 INSURERA: Employers Preferred Insurance Company 10346 INSURED INSURER B: Holly Tree Condominium Trust INSURER C 412 Main Street,Route 28 INSURER D: INSURER E: West Yarmouth MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 23/24 WC 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 AODL SUER POLICY NUMBER POLICYEFF POLICY EXP UMRS LTRINSD WVD (MM/DD/YYY1') (MMIDDIrYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE IO REN PLO CLAIMS-MADE 0 OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jEIT 0 LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _AUTOS ONLY _AUTOS HIRED NON-OWNED PROPERTY DAMAGE _AUTOS ONLY _AUTOS ONLY (Per acdden) UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE DED I I RETENTION$ WORKERS COMPENSATION XI STATUTE I I ER OTH AND EMPLOYERS'LIABILITY YIN A OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE N/A EIG494051401 04I01/2023 04/01/2024 E.L.EACH ACCIDENT E 1,000,000 OFFICEREMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S N yea,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace la required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth Health Department-Hazmat Ren AUTHORIZED REPRESENTATIVE 1146 Route 28 �_ � South Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) - The ACORD name-and logo are registered marks of ACORD