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HomeMy WebLinkAboutBCOI-24-38 pool/spa The Commonwealth of Massachuse ,-, , Town of ,,. , *. YARMOUTH F`t` 1 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 BCOI-24-38 Trade Name:The Cove at Yarmouth-Pool/Spa Identify property address including street number,name,city or town,and county Certificate Expiration Located at 183 ROUTE 28 April 15,2025 WEST YARMOUTH,MA 02673 Floor Occupancy.. Use Group Other Basement/Lower 100 A-3 Lecture halls,dance halls, HealthClub churches and places of religious Use Group Classification(s) worship,recreational centers, terminals,etc. Allowable Occupant Load 01st Floor 406 A-3 Lecture halls,dance halls, Pool&Spa churches and places of religious worship,recreational centers, terminals,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 G^ ■ate of Inspection q''S*j� [-f Commissioner /� /�j Signature of Municipal Fire Signature of Municipal Building (/A Arer/Zb/ / Chief Commissioner /iv`,� Date of Issuance r TOWN OF YARMOUTH o -jy BUILDING DEPARTMENT \reMATTACF+ :E '� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 �p+vapaiiLOS G J.r r APPLICATION FOR CERTIFICATE OF INSPECTION March 1 , 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 Certificate of Inspection for the below-named premises located at the following address: Street and Number: /73 c'✓' sir Name of Premises: , Coo Yet-rie). 004'11 Tel: 5JF, 77/ - 3 h Purpose for which permit is used: Pop Sp_ License(s) or Permit(s) required for the premises by other governmental agencies: R E C I V E D License or Permit Agency MAR 112024 So/ poz:) , L.-ryt)A-si 30H �',�;?y s h ye8.3/--/ BUILDING DEPARTMENT By: �'� . -? 7 ! - 3 0\4L Certificate to be issued to ) 1k, Co► �- ya.r, :t Tel:tr� `,�� 6,6 (O Address: Owner of Record of Building Address Present Holder of Certificate Sign ture of son to whom Title g Cert i Icate is issued or his agent 3/ L 2JLi-I Date Email Address: { s C o vc 4 _ co c 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 04/15/2024-04/15/2025 r AC CERTIFICATE OF LIABILITY INSURANCE DATE 45MJDDD/202 ) 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(les)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 RogersGray,Inc.-Kingston Branch PHONE Fax 63 Smith Lane we No Fee.508-746-3311 I re c.NM:877-818-2156 Kingston MA 02364 E-MAIL mail@rogersgray.com INSURERS)AFFORDING COVERAGE NAIL INSURER A:Cincinnati Specialty Underwrit 13037 INSURED The ove at Yarmouth Resort Hotel Owners Association,Inc. ATM 1 INSURER B:Allied World Insurance Company 22730 The Cove at Yarmouth Resort Hotel Homeowners Association,Inc. INSURER C:Massachusetts Retail Merchants 183 Main Street INSURER D:The Commerce Insurance Company 34754 West Yarmouth MA 02673 INSURERS: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. *MR EX ADDL SUER POLICY EFF POLICY P TYPE OF INSURANCE LTR INMO WWI POLICY NUMBER IMM/OD/YYYY) IMMND/YYYYI DMRS A X COMMERCIAL GENERAL LIABILITY CSU0185688 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO ICLAIMS-MADE E OCCUR PREM SES(EaEoNavurrence) $100,000 _ MEDEXP(Any one person) $0 PERSONAL a ADV INJURY $1,000,00D GEM.AGGREGATE UMITAPPLIES PEA GENERAL AGGREGATE $2,000,000 X POLICY[11 1.2c9f O LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: D AUTOMOBILELNBIUTY BJGMTM 4/1/2023 4/1/2024 COMBINED ISINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $20,000 —OWNED SCHEDULED BODILY INJURY(Peracdderd)$40,000 AUTOS ONLY AUTOS )( HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per ao/de^t) B X UMBRELLAUAB OCCUR PRE BILL 4/1/2023 4/1/2024 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE 55,000,000 DED I X 1 RETENTION$n $ C WORKERS COMPENSATION 014005035505123 1/1/2023 1/1/2024 I STATUTE I I ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECU IVE Y� NIA EL EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED9 (Mandatory in NH) EL DISEASE-EA EMPLOYEE$1.000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000 E Boller a Machinery 7033730991 4/1/2023 4/1/2024 41.745,275 Commercial Property BlmkNBBi4and own 35,470,275 Blanket Contents 175,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 1S1,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 DREPRESENTATIVE South Yarmouth MA 02664 � • 745 ! m 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#: A ® 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 NAIC 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 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD