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HomeMy WebLinkAboutBCOI-24-36 motel 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:The Cove at Yarmouth Trade Name:The Cove at Yarmouth Motel BCOI-24-36 Identify property address including street number,name,city or town,and county Certificate Expiration Located at 183 ROUTE 28 WEST YARMOUTH,MA 02673 April 15,2025 Floor Occupancy_ Use Group Other 01st Floor 76 R-1 Hotels,motels,boarding houses, Bld A-8 Units Bld B-14 Units Use Group Classification(s) etc. Bld C-18 Units Bld D-12 Units Bld E-18 Units Bld F-6 Units Allowable Occupant Load 02nd Floor 153 R-1 Hotels,motels,boarding houses, Bld A-16 Units Bld B-28 Units etc. Bld C-26 Units Bld D-4 Units Bld E-37 Units Bld F-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 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 BuildingMark II to of Inspection JI /. Commissioner Signature of Municipal Fire Signature of Municipal Building Date of Issuance [I/?�/Z Chief Commissioner 7` °f RHO TOWN OF YARMOUTH - BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION March 1, 2024 PAYABLE UPON RECEIPT (X) Fee Required $757.00 ( ) 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: /Q3 /rW✓) S4,_-/ 4 Vii Name of Premises: 1� Co, cc/ yo..rrno,"fli Tel: 509- 7-/ 1.314,fo Purpose for which permit is used: Lod i1 1 /fY1c�/ License(s) or Permit(s) required for the prmis6s by other governmental agencies: RECEIVED License or Permit Agency Ps i -t sp Yu,rmo c7 L \( ^N MAR 112024 -Gvfni.S 6,1 q 11�'V`J L` '� BUILDING DEPARTMENT By Certifinte to be issued to t - C2.rG 4 •-,-- In Tel: Sd E. 7-7 1• 36,6( ( V U 4 4C / Address: Owner of Record of Building Address Present Holder of Certificate ?LeG4,--etP i'v)u.r, Sign ture of person to whom Title Certificate is issued or his agent J( L, /7 o 29 Date Email Address: ',Inc 4 UJ ez Gotrr .-}y G,✓rrtov�[�, �y„� 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 # 6C,D/--,3 q-3(o 04/15/2024-04/15/2025 -41 A°R D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/5/2023 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 NAME: RogersGray, Inc.-Kingston Branch PHONE FAX 63 Smith Lane IA/C,No.Extl: 508-746-3311 (Arc,No):877-816-2156 Kingston MA 02364 E-MAILDSS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwrit 13037 INSURED COVEATY-01 INSURER B:Allied World Insurance Company 22730 The Cove at Yarmouth Resort Hotel Owners Association, Inc. INSURER c:Massachusetts Retail Merchants The Cove at Yarmouth Resort Hotel Homeowner's Association, Inc. 183 Main Street INSURER D:The Commerce Insurance Company 34754 West Yarmouth MA 02673 INSURER E: CNA Insurance Co 35289 INSURER F: COVERAGES CERTIFICATE NUMBER:1378413616 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 LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY CSU0185688 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $0 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY X Ter- l X 1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ D AUTOMOBILE LIABILITY BJGMTM 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $20,000 OWNED SCHEDULED BODILY INJURY(Per accident) $40,000 AUTOS ONLY AUTOS x HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) B X UMBRELLA LIAB OCCUR PRE BILL 4/1/2023 4/1/2024 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n C WORKERS COMPENSATION 014005035505123 1/1/2023 1/1/2024 PER ERH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE YNN E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 E Boiler& Machinery 7033730991 4/1/2023 4/1/2024 Limit Per Breakdown 41,745,275 Commercial Property Blanket Building 35,470,275 Blanket Contents 175,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 229 Total Units Replacement Cost coverage applies Special Form Building Deductible$50,000 Building Wind/Hail Deductible-$50,000 per Occurrence Ordinance or Law Coverage-Coverage A Included,B&C Limit$5,000,000 Blanket Business Income$6,100,000 Business Income Waiting Period 72 Hours See Attached... 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 Route 28 AU ED REPRESENTATIVE South Yarmouth MA 02664 I ` x ours") 7, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:COVEATY-01 LOC#: AR Oe ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED RogersGray,Inc.-Kingston Branch The Cove at Yarmouth Resort Hotel Owners Association,Inc. The Cove at Yarmouth Resort Hotel Homeowner's Association,Inc. POLICY NUMBER 183 Main Street West Yarmouth MA 02673 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Carrier Subscription $5M of Primary$10M Endurance American Specialty Insurance Company $5M of Primary$10M AXIS Surplus Insurance Company $15M Excess of$10M Mt Hawley Insurance Company $8,372,638 of$16.7M Excess of$25M Landmark American Insurance Company $8,372,638 of$16.7M Excess of$25M James River Insurance Company Policy Numbers-To Be Determined When Required by Written Contract,the Following Applies General Liability-Additional Insured Ongoing(CG 20 04 11/85)Primary and Non-Contributory Basis(CG 20 01 12/19),Waiver of Subrogation(CSGA4087 12/12) ACORD 101(2006/01) 02008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD