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HomeMy WebLinkAboutBCOI-24-57 2025 The Commonwealth of Massachusetts UIFTown of `og..YA. • 3i O YARMOUTH 3 , - •,,, Oda -= y: 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: Seaside Cottages Trade Name: Seaside Cottages BCOI-24-57 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 135-135 SOUTH SHORE DR April 24, 2025 SOUTH YARMOUTH, MA 02664 Use Group Classification(s) Floor Occupancy Use Group Other 01st Floor 40 R-1 Hotels, motels,boarding houses, 39 Units(16)Building&Lobby etc. Allowable Occupant Load Managers Apt No Occupancy 10/21-11/30 each year 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 1�i, Name of Municipal Chief Mark Gryl : Date of Inspection (/ _Commissioner Signature of Municipal Fire Signature of Municipal Building gate of Issuance Chief Commissioner '� ��� 7 ' 4:- TOWN OF YARMOUTH BUILDING DEPARTMENT ,N ML.— =c 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 $205.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a A Certificate of Inspection for the below-named premises located at the following address: N Street and Number: i 35 N-4\-\ C.A,Ity\DJA\ , ma 0 a 4(,..LI , • ) ;INA' ' 3 \()11 Name of Premises: S�S i , � CL) � Tel: �(;� , 39 -JS � Purpose for which permit is used: -O ( \\ ' d2. v� License(s) or Permit(s) required for the premises by her o ernmental agencies: License or Permit Agency Certificate to be issued o ` Tel: 0 ' �c 3 ^ Address: /V1 Owner of Reco of�$uildin Cs1 '� .t'1" Ca t p )[-,'e Ray) (� Address t,9)-) JC(1/ Sr�(JLA �,N y S ��Wu 1l�l - �' Present Holder of Certificate 1111 // C.. ft .4 0 .Ake. Ii _nature of person to whom iii Tit , 1 ,_ -- ificate is issued or his agent Da APR 222024 �O �� @raJ \ , CC DEPARTMEmail Address: \ \(>\C�(1 S��S� G By 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# £(20/ 2(71-4-7 04/24/2024-04/24/2 02 5 DATE(MM/DINYYTY) 4, /R� ERTIFICATE OF LIABILITY INSURANCE 04/18/2024 V 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: Automatic Data Processing Insurance Agency,Inc. NE 1-800-524-7024 AX Automatic Data Processing Insurance Agency,Inc. PHONE No,Ext►: F I (A/C,No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC A Roseland NJ 07068 INSURER A: FirstComp Insurance Company 27626 INSURED Four Kids Property Management LLC INSURER B: INSURER C: 214 Pleasant Lake Ave INSURER D: INSURER E: South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 3586492 REVISION NUMBER: THIS IS TO PERIO INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR PECT TOTHELICY 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 ADDL SUBR POLICY EFF POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS LICY EXP LTR TYPE OF INSURANCE INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES(Ea occurrence) $ - CLAIMS-MADE OCCUR MED EXP(Any one person) $ — — PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ _ POLICY JEC LOC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY(Per person) $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON OWNED PROPERTY DAMAGE $ (Per accident) AUTOS ONLY AUTOS ONLY $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR - EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ I >< STATUTE WORKERS COMPENSATION I I FAH - AND EMPLOYERS'LIABILITY E L.EACH ACCIDENT $ 1,000,000 ANYCERIMEMBPROPRIETOR/PARTNER/EXECUTIVE YYN N/A N WCO234560-1 03/24/2024 03/24/2025 1,000,000 A (MandatoryaR/MEMNH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ i in and 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 st AUTHORIZED REPRESENTATIVE Yarmouth MA 02664 --)} }1t )'t"`' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD