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HomeMy WebLinkAboutBLDCI-22-004938 TEMP CI ,. ° rqR=_= TOWN OF YARMOUTH BUILDING DEPARTMENT �° °G Certificate of Occupancy x� i i. MATTACHEEiE J A,ro In accordance with The Commonwealth of Massachusetts Building Code iv0c_‘ _a.),,- °°�c-Permit No. Location -- .---a.---a -kov-►, aa Type of Building -U \)% 1Q('^ ' Has been inspected and occupancy is approved. -__..� Date ` j r°- Building Commissioner ,/� This certificate must be posted in a conspicuous place. (-_-)\` )TQS U - 1 - 1�0` ' vk L,n(AQs- CeJr\S-(cLL 1c.0 °'N ''44+=__ TOWN OF YARMOUTH BUILDING DEPARTMENT Y ' Certificate of Occupancy MATTAc'eEsa I` Y V S !. '•`i.bZ Z ,'o o In accordance with The Commonwealth of Massachusetts Building Code -*;•':• r Z •1 It ',rn Permit No. Location .c,y . ,�1,/ . , - Type of Building _Ef Has been inspected and occupancy is approved. Date j 25" 'L Building Commissioner ef, / This certificate must be posted in a conspicuous place. ,.� .,f... 7rr , , TOWN OF YARMOUTH Jw(a BUILDING DEPARTMENT ,„/4 Yarmouth, 1146 Route 28, South Y MA 02664 .508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION March 1, 2022 PAYABLE UPON RECEIPT (X)Fee Required $150.00 ( ) 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: Si VY\4 5 9S t �( c 2 Irma UYY' ('\ Name of Premises: Co Qz apt �v �q �'c,8 )e Q4 p,� Tel: 1 7,cF 3 25 S 0) Purpose for which permit is used: f)A- 1.C 1-( t' R5,7; R ECEIVED License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency MAR 0 7 2022 aui �i By ✓ Cc z.' C c ) i c �-1 IL PA k ��Certificate to be issued to saa � \MG Tel: �' 7�` S h ; `r S� G C 3 75 ul Address: ,,,N 4v9st Owner of Record of Building S�h j�� tiG S L L Address 5I F W\c �- S. S• (-& vn o v k /2 A Ca(C7,1 Present Holder of Certificate 5 c�,010\2 016 1. J„n C G 1.6)R Cc 0 )r V k �1 k w 4- G ),-In Qr\ Sig ture o person to whom Title rtificate is issued or his agent 11)) '1 )Date - Email Address: t \c �c 4 ' G Vv\ i L ;''\' 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# L L ,/ J - 01)(719. 40 04/15/2022-04/15/2023 tl DATE(MMIDD/YYVY) AC'CPRL CERTIFICATE OF LIABILITY INSURANCE 12/01/21 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 NAMEaCT Brian Allain HONE FAX FAx Choice Insurance Agency P(uC.No.Eat: (Arc,No): 978.345-1 D07 376 Summer Street E-MAIL ADDRESS: ballain@choice-InsuranCe.COm Fitchburg,MA 01420 INSURER(5)AFFORDING COVERAGE NAIC k INSURER A:AmGuard Insurance Company INSURED INSURER B Sandbar Management Inc INSURER C: Cape Cod Inflatable Park INSURERD: P.O.Box 481 West Yarmouth,MA 02673 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. 1NSR AUULSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD NAM POLICY NUMBER (MMISDIYYYY)(MMIDO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE❑OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PROT El PRODUCTS-COMPIOPAGG $ EC OTHER'. $ AUTOMOBILE LIABILITY (EOMaBII tlEESt SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ —OWNED SCHEDULES AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ _ _ AIRED NON-OWNED PROPERTY AGE $ _AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLA LIAB _OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DES I IRETENTION$ $ WORKERS COMPENSATION I STATUTE I XI ERH AND EMPLOYERS'LIABILITY A OFFICER/MEMBER EXCLUANY DEDiECUTIVE Y❑NIA SAWC283178 10/01/21 12/01/22 E.L.EACH ACCIDENT E 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached It more space Is radulred) 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 /�r�/l ,1-/I A(")Mk pun- �". C�( �• ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD