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HomeMy WebLinkAboutBCOI-23-1775 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:Colonial Acres Resort BCOI-23-1775 Trade Name:Colonial Acres Resort Identify property address including street number,name,city or town,and county Certificate Expiration Located at 114 STANDISH WAY WEST YARMOUTH,MA 02673 July 14,2024 Floor Occupancy Use Group Other 01st Floor 24 R-1 Hotels,motels,boarding houses, BLDG 1-12 UNITS etc. BLDG 2-12 UNITS Use Group Classification(s) Allowable Occupant Load Other 10 R-1 Hotels,motels,boarding houses, 10 SINGLE COTTAGES etc. Other 2 R-1 Hotels,motels,boarding houses, 2 DUPLEX COTTAGE 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 Date of Inspection a.0, Ia I Commissioner Signature of Municipal Fire Signature of Municipal Building ///Date of Issuance T/z// Chief Commissioner / /% p TOWN OF YARMOUTH "got BUILDING DEPARTMENT `� 1146 Route 28, South Yarmouth, MA 02664 508-398-2 RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION OCT 18 2023 June 1, 2023 PAYABLE UPON RECEIPT BUILDING DEPARTMENT (X) Fee - ( ) 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 pr mises located at the following address: Street and Number: ``\k7--4zkY<\ U'1 Name of Premises: :> •-�. v1/4L �t� ,►�� Tel: S(A, � "c\--)c Purpose for which permit is used: c\tA+�4- License(s) or Permit(s) required for the premises by other governmental agencies:License or Permit Agency ( )---°13(sr-21) 10 Certificate to be issued to Q)% a ,.,j v w{J Tel: �b �1S-Address: \\`A � Owner of Record of Building Address `` Present Holder of Certificate �` n.,• ,;L S � \,�►-�_ \1/4-` Signature of person to whom Title Certificate is issued or his agent Z+1�-,Z Date Email Address �' S C-\\` " k 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# C C. b/-a 3_/ 07/14/202 3-07/14/2024 '' G® t vGERTIFIGATE OF LIABILITY " "01123 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS AMEND, EXTEND R ALTER THE AGE AFFORDED BY THE POLICIES OR Y CERTIFICATE OCATHIS CERTIFICATE F CATEFAT OFN INSURANCEDOES NOTLCONSTITUTE A CONTTR CT BETWEEN THEISSUINGINSURER(S), AUTHOR ZED BELOW. 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). ONTACT PRODUCER NAME: Erica H.O'Connor AX HART INSURANCE AGENCY,INC. PHONE (FAIC,No): (A/C.No.EA 243 MAIN STREET E-MAIL enc eoconnor@hartinsuranceag y .com PO BOX 700 ADDRESS: NAIL# BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE INSURER A: GREAT AMERICAN INSURANCE CO 16691 42390 114S INSURER B: AMGUARD INSURANCE COMPANY INSURED Colonial Acres Resort Association 18058 114 Standish Way INSURER c: PHILADELPHIA INDEMNITY INS CO West Yarmouth,MA 02673 INSURER D: — INSURER E: _ — — -- -- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO THAT THETHE PE R ND CATED.CNOTTWITHSTANDINGOES ANYIREQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH REOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEOSPECT TOLICY WHICHTIHIS 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 REDUPOCED CvD BY PAID C EFF LAIMS. LIMITS ADDL SUBR POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) 1'000'000 XP INSR TYPE OF INSURANCE INSD WVD LTRAES123069300 01/01/2023 01/01/2024 EACH OCCURRENCE $ A COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE OCCUR 1 OO,000 - PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 I PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:POLICY JEC PRODUCTS-COMP/OP AGG $ 2,000,000 Fir LOC $ ' OTHER: COMBINED SINGLE LIMIT $ (Ea accident) AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AULTOOBODILY INJURY(Per accident) $ OWNED 'SCHEDULED H ONLY AUTOSPROPERTY DAMAGE $ — HIRED IRED NON-OON-OWNED (Per accident) AUTOS ONLY `AUTOS ONLY $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR I AGGREGATE $ --- EXCESS LIAB CLAIMS-MADE $ DED RETENTION$ -.PER OTH- B WORKERS COMPENSATION COWC418752 08/01/2023 08/01/2024 ✓ STATUTE ER AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ 500,000 A(Mandatory RIin NH) ARTNER/EXECUTIVE N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 OFFICER/MEMBER EXCLUDED? I N (Mandatory in NH) 500,000 DIf ESs,RIPTIONunder E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1�QUO,UOU C DIRECTORS&OFFICERS PCAP032842-0222 02/18/2023 02/18/2024 Liability Limit 15,000 Retention I 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 Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �,,/ mil! ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD