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HomeMy WebLinkAboutBCOI-24-50- 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:Inn on Main BCOI-24-50 Trade Name:Inn On Main Identify property address including street number,name,city or town,and county Certificate Expiration Located at 186 ROUTE 6A May 9,2025 YARMOUTH PORT,MA 02675 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 1 R-1 Hotels,motels,boarding houses, 1 Bedroom&Sitting Arean/Bath/Office etc. Allowable Occupant Load 02nd Floor 4 R-1 Hotels,motels,boarding houses, 4 Bedrooms/Bath/Owners Apt 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 Building Name of Municipal Chief Mark II Date of Inspection 5// t/ Commissioner I Signature of Municipal Fire Signature of Municipal Building lIp y Date of Issuance c/2/72y Chief Commissioner 1 �Z..trzi+rzJ•t:�: sIVL .y � .." .:°,. ., i :� r� TOWN OF YARMOIJTII OS( ,A, . ' k BUILDING DEPARTMENT �xn " s 1146 Route 28, South 'Yarmouth, MA 02664 18- 98-2231 ext. 1260 rz APPLICATION FOR CERTIFICATE OF INSPECTION April 01, 2024 PAYABLE UPON RECEIPT (X ) Fee Required $100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a 6Certificate of Inspection for the below-named premises located at the following address: j1./911 Street and Number: t V7 it ice_ £ A- Name of Premises: / 1 N O N M fr./A) Tel: 7 7 M E/7 c Purpose for which permit is used: l (2.47,4t f _--r- License(s) or Permit(s) required for the premisesiby other governmental agencies: License or Permit Agency I-0 - Ikbertilk - ziti APR 112024 Certificate to be issued to iN , ) drJ (1ft 4-f•U Tel: ? 7 tf 551 Address: tcz6. ILLJvcf-. 6 1- Atkh D , � BUILDING DEPARTMENT Owner of Record of Building V,g,titvt ,(.„ 1.E-i---c s N.) G- Address 05 6 f 6 (VIA O`er Zf Present Holder of Certificate ,,.) O*v A/1I-L ill i - ON Iv-ER nature of person to whom Title Certificate is issued or his agent dP(l ' .@ , Date (16`A7 I_ Email Address: (' 'trt3 (�V.o.....A,Ae_.6) r✓\- , l9►M 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 # gel? i 1 05/09/2024-05/09/2025 'dab � p~_ . ` � ' HOLDER. �---. ED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTEWL1713 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 DOWLING&O'NEIL INS AGENCY/PHS NAME: 08088233 PHONE (866)467-8730 FAX The Hartford Business Service Center (NC,No,Ext): (NC,No): 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: Hartford Fire Insurance Company 19682 KenneBurn Properties Inc. INSURER B: 6A#186MA YARMOUTH PORT MA 02675 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDD/YYYY) (MM/DD/Y YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) _ MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY LJ PRO- JECT LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) —ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE - DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY x STATUTE I ER ANY Y/N E.L.EACH ACCIDENT $500,000 A PROPRIETOR/PARTNER/EXECUTIVE N/A 08 WEC AX7YBN 05/18/2023 05/18/2024 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 6 A#186 MA BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED YARMOUTH PORT MA 02675 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r