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HomeMy WebLinkAboutBCOI-24-27 The Commonwealth of Massachusetts .4;YA.. Town of ,o` YARMOUTH '0 r,�4 y ,F 4,: 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:Town'N Country Motor Lodge BC0I-24-27 Trade Name:Town'N Country Motor Lodge Identify property address including street number,name,city or town,and county Certificate Expiration Located at 452 ROUTE 28 March 7,2025 WEST YARMOUTH,MA 02673 Floor Occupancy_ Use Group Other Use Group Classification(s) Other 143 R-1 Hotels,motels,boarding houses, 4 Buildings 1st&2nd floors totaling etc. 143 Rooms Allowable Occupant Load For Seasonal Housing 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 J Ma, Date of Inspection f Name of Municipal Chief Commissioner 1 r'`t y Signature of Municipal Fire Signature of Municipal Building ;/ Date of Issuance ('O////z Chief Commissioner iii�/ 1 (.136i44- -Y TOWN OF YARMOUTH .��i . ' r: it BUILDING DEPARTMENT `•� -MATTACM St•�' 9/ '/1 ;�,...o.,,to*.0 G,..,.. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 / et ni lo APPLICATION FOR CERTIFICATE OF INSPECTION February 28, 2024 _ PAYABLE UPON RECEIPT `i o(,,.D,A A ) C��t,\J 1- Y (X) Fee Required 526.00 �,",, 1 L, -2—. 2 Y ) No Fee Required z;1 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: LI S Z ,k=~-' 2 PCCF Name of Premises: (1/4-)-. k) N (.6-AAJi-r1 Tel: 9 1 e 8 ��- (9 1 Purpose for which permit is used: Mc-) k t / S e-A Si") A I N0�s i•*Qc") License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency 1 FEB 28 2024 BUIL...L[ I V&. By: Certificate to be issued to Ironer'' t`-) ti -r'kk1 Tel: ci -1 (6 - 6 - S. ' ( G (2' 1 4 Address: k ht:.c,(c/YAI Goa t< 5 L A A)-(' ilk A S t-A *-rr MA C 2(.4 y Owner of Record of Building A w ko t, 'I t--I c is `ili44..' ) ��j t l Z tV��#-�. i2 Q:>v st --i 3(.,v� PlA i23 �7 s'e•s" 2. 'i V d eV✓ 6)9 " ° "`1 Address L s gas , �� .� Present Holder of CertificateSNJ 4s po\ A 17 / / ?"‘ S:.L'esj /Cr S'dit./1 !I 1 . g / Signature` f person to whom Title i'? ri 419 fir Certificat is issued or his agent Z 4 Date ' �1 , - 1. Email Address: -N tM4l kl 4 T el L. L C S 414-I cc--4') l , Instructions: Make check payable to: Town of Yarmouth 4 �, : 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 pa thereof to be certified. Application must be received before the certificate will be issued. The building off' 'al shall be notified within ten (10) days of any change in the above information. //I PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH T APPLICATION OR WE CANNOT S WE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection # YA l —d'7 3/7/2024-3/7/2025 • ACC RE)® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/28/2024 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 Julie Lapointe NAME: p CHOICE INSURANCE AGENCY INC (A/C No.Extl: (978)343-4853 FAX No): E-MAIL IPnte@ la oi choice-insurance.com ADDRESS: 376 SUMMER ST INSURER(S)AFFORDING COVERAGE NAIC# FITCHBURG MA 01420 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: AMERIBOUND INC INSURERC: INSURER D: C 0 PATRICK MALONE 1 HIDDEN OAKS LN INSURER E: MASHPEE MA 02649 INSURER F: COVERAGES CERTIFICATE NUMBER: 982052 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(a occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A 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 N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY OTH- X STATUTE ER A OFFICER/MEMBEREXCLUDED?ECUTIVE N/A N/A N/A 6S60UB0W42709724 02/22/2024 02/22/2025 E.L.EACH ACCIDENT $ 1,000,000 (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 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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 Main Street AUTHORIZED REPRESENTATIVE Yarnmouth MA 02664 Daniel M.Croy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts ILV Town of ° 8 YARMOUTH ` 11 '~'+CO � RPO RAT0, 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: Town' N Country Motor Lodge BCOI-24-27 Trade Name: Town' N Country Motor Lodge Identify property address including street number, name, city or town, and county Certificate Expiration Located at 452 ROUTE 28 WEST YARMOUTH, MA 02673 March 7, 2025 Floor Occupancy_ Use Group Other 01st Floor 76 BId 1-40 units Use Group Classification(s) Mangers Apt-Office&Playroom BLD 2-24 Units BLD 3-12 Units Allowable Occupant Load 02nd Floor 76 A-2 Restaurants, Night Clubs,or BLD 1-40 Units similar uses 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 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 Building I to of Inspection C� p Commissioner ry ���S 1 Signature of Municipal Fire Signature of Municipal Building (-_-_16M;rk l` Date of Issuance / l '2Chief Commissioner6./e