Loading...
HomeMy WebLinkAboutBLDCI-17-006521-05 The nwealth of Massachusetts . W City\Town of • ,_tii- YARMOUTH 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:COLONIAL ACRES RESORT BLDCI-17-006521-05 Trade Name:COLONIAL ACRES RESORT Identify property address including street number,name,city or town and county Certificate Expiration Located at 114 STANDISH WAY 07/14/2023 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 24 R-1 Hotel/MoteVBoarding House/Transient BLDG.1-12 UNITS BLDG.2-12 UNITS Allowable Other 10 R-1 Hotel/MoteVBoarding House/Transient 10 SINGLE COTTAGES Occupant Load 1 Other 2 R-1 Hotel/MoteVBoarding House/Transient 2 DUPLEX COTTAGES 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 fun 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 �/ .f Building Commissioner Inspection / "�9 in Signature of Municipal Signature of Municipal Date of Building Commissioner ✓/w Issuance 0/1.7 } Fee:$184.00 BLD_Certofl nspection.rpt x �r-� .0 .,,\ , TOWN OF A.R O TH �. - BUILDING 1'-"ys MATTp_. „s�,-7,�, 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 ' et:t „-j,s�` flRA C APPLICATION FOR CERTIFICATE OF INSPECTION June 1, 2022 PAYABLE UPON RECEIPT (X) Fee Required $184.00 ( ) 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: \ . �*a.-Al L \,... ,,i :ort..L, (.-., 3. A enST-, b ‘ Name of Premises: � � �r' • Z W1.4., Tel: S Purpose for which permit is used: ,e't. .,• License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to Tel: Address: Owner of Record of Building Address Present Ho er o ertificate ,------... --\\ Signature of person to whom Ti 1c o At Certificate isissuedor his �"Ce cate agent Date -10 Email Address: 47----k-\: / ._6a (C,4./\ 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 # (3tf)C /— /7-01)66-o; 46-t93 07/14/2022-07/14/2023 1 AC CERTIFICATE OF LIABILITY INSURANCE DATE 11/O2/2022 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 Erica H.O'Connor HART INSURANCE AGENCY, INC. NAME' PHONE FAX 243 MAIN STREET (ac.No.Ext): (NC,No): PO BOX 700 AIL ADDRESS: eoconnor@hartinsuranceagency.com BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: UND @LLOYDS 32727 INSURED Colonial Acres Resort Association INSURER B: AMGUARD INSURANCE COMPANY 42390 114 Standish Way West Yarmouth,MA 02673 INSURER c: INSURER D: 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 SUBR POLICY EFF POLICY EXP W LIMITS LTR _INSD VD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) A J COMMERCIAL GENERAL LIABILITY XSZ186960 01/01/2022 01/01/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENE CLAIMS-MADE OCCUR PREMISES(Ea occur ence) $ 50'000 v l MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 VPOLICY JECT PRO- LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ Nn B WORKERS COMPENSATION COWC358830 08/01/2022 08/01/2023 I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 l DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION Fax#:(508)398-0836 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 MAIN STREET South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 7.74,4(.....44. ©1988-2015 ACORD CORPORATION. All rights reserved. - ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD