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Home My WebLink AboutBLDCI-16-006476-06 motel The Comm n vealth of Massachusetts assachusetts 1_IM y\Town of_ I= 1. 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:CAPE COD FAMILY RESORT BLDCI-16-006476-06 Trade Name:TOWN'N COUNTRY FAMILY RESORT Identify property address including street number,name,city or town and county Certificate Expiration Located at 452 ROUTE 28 03/07/2023 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 76 R-1 Hotel/Motel/Boarding House/Transient BLD 1-40 UNITS, MNGRS.APT.,OFFICE Allowable &PLAYROOM Occupant Load BLD 2-24 UNITS BLD 3-12 UNITS 02nd Floor 76 R-1 HoteVMotel/Boarding House/Transient BLD 1-40 UNITS BLD 2-24 UNITS BLD 3-12 UNITS 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 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 ry Date of U �7 Building Commissioner Inspection /" Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance //. t/a if'L Fee:$526.00 �,`,,t• �a‘� TOWN OF YARMOUTH : ' \O _ • rt - ,fw BUILDING ILDING DEPARTMENT kA" h;t i'; ;? 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 zt f. APPLICATION FOR CERTIFICATE OF INSPECTION I C16447aC EC F VF D February 1, 2022 PAYABLE UPON R1Ed IPT . . _-" ------. (X) Fee Requireii $15 02 4 2022 ( . ) No Fee iRefluired BUILDING DEPARTMENT 'In accordance with the provisions of the Massachusetts State Building Code, Section 110. ,' Certificate of Inspection for the below-named premises located at the following address: Street and Number: LI S ) `,j(Yl c-i i v% P I �/ - � T )( 4`R6-\ ovrel i- aoZG7i Name of Premises: T d W v1 1~ C 0 v h $V 1M klieli Q to Sas(2, Purpose for which permit is used: 1,--1 CPS, .S License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency L kc-orke • . ,(- ---rc:.,..„, , (, ,, , I._,Certificate to be issued to5ck\A f,k 1mo c-cu v %\IAscT 1: 1 7 3 75 4 0 cL, Address: Owner of Rec rd of Building ,1 k C i \-i o \ 1 vl 5 5 7 h Address k-IU (� v AAA- O A-G Present Holder of Certificate S c, 1. c, l' S p 'TR, LA) in. C G ,,J 0 r �"`` y f2 ' 5`'1s) . 7 12—‘ -___ 6 LA, i4 e rt_ gnature of person to whom Title Certificate is issued or his agent ,a X Lj a k Date Email Address: 4a A. YY1 R q_-_,)t- G NrieN ct IL i ( v \c/N- 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 # 13 Ctc,1 /(o--�ocf 7 -DE 03/07/2022-03/07/2023 ACORD DATE(MMIDDf/YYY)CERTIFICATE OF LIABILITY INSURANCE 12W01/21 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 NAME:E'AM C Brian Allain Choice Insurance Agency INC.No.Eat): 978-343-0853 {uc,Ro), 978.345-1007 376 Summer Street E-MAIL ADDRESS: ballain@choice-insurance.com Fitchburg,MA 01420 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:AmGuard Insurance Company INSURED INSURER B Sandbar Management Inc INSURER C Cape Cod Inflatable Park INSURER 0( P.O.Box 481 West Yarmouth,MA 02673 INSURERE: 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 MAYBE 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. INBR TYPE OF INSURANCE AODLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR NOD WVD IMMIDDIYYYY),(MM/DDIYYYY) COMMERCIAL GENERAL LIABILfTY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR❑ PREMISES(Ea occurrence) $ MED EA,(Any one person) $ PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PROT u LOC PRODUCTS-COMP/OP AUG $ JEC OTOBLAUTOMOBILE LIABILITY COMBINEDE t)SINGLE LIMIT 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) UMBRELLAUAB _OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE I $ DEO RETENTION$ $ WORKERS:;OMPENSATION STATUTE I XI ERH AND EMP_DYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE[71 NIA E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED, SAWC283178 10/01/21 12101/22 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 1,000,000 I(yyee $coLr,Lo a tar DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace le required) Operations of Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sandbar Management,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 481 West Yarmouth,MA 02673 AUTHORIZED REPRESENTATIVE MA198 O 8-2015 ACORD RDRATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD