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HomeMy WebLinkAboutBCOI-24-40 The Commonwealth of Massachusetts g Y Town of x° '' �, YARMOUTH oi ` '`'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:Cape Cod Family Resort BCOI-24-40 Trade Name:Cape Cod Family Resort Identify property address including street number,name,city or town,and county Certificate Expiration Located at 512 ROUTE 28 April 15,2025 WEST YARMOUTH,MA 02673 Floor Occupancy_ Use Group Other 01st Floor 34 R-1 Hotels,motels,boarding houses, 33 Rooms etc. 1 Manager's Apt Use Group Classification(s) Indoor Pool&Office Allowable Occupant Load 02nd Floor 35 R-1 Hotels,motels,boarding houses, 34 Rooms etc. 1 Owners Apt 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 Mark G ate of Inspection �y/� Name of Municipal Chief Enrique Arrascue Commissioner Signature of Municipal Fire Signature of Municipal Building Date of Issuance /(/Z/ Chief Commissioner .;0 • •YgR- TOWN OF YARMOUTH o i i . y: BUILDING DEPARTMENT " ;; s`� .:L�' 4. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 ---- '---:,:-#:•; .-'"' C5-,;Li ._ Cv0Lr-I-e,( 1r\ i 1 ui R-e Surf- APPLICATION FOR CERTIFICATE OF INSPECTION February 28, 2024 ' s A :LE UPON REC :I.r( ) e q X F e Re uired 334.0 C. ( ) No Fee Require. / In accordance with the provisions of the Massachusetts State Building Code, ection 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 5IA MtXf1 6Tat Name of Premises:54AR li /NC da- Cbt/E/4 Tel: g7F-373---5-1/04 S Purpose for which permit is used: t6e/te( License(s) or Permit(s) required for the premises by other governmental agencies: r RECEIVED License or Permit Agency 14 MAR By:_� 4Pfal , vc cr �i Certificate to be issued tog"a�6a,,e41 a.Gi 641/4l u e.SORe Tel: Off-3 5'590 5/Address: . Rain 57-R.CC t Owner of Record of Building 5 Vpea-te Ll6r-%IYG Address 5/4 kftVm sm•te t ` Present Holder of Certificate 5#A,aI/( 't2 /tier d6 z COAX rQ4u` ,elfo lie'S/dm zi- gnature of person to whom Titl9 / Certificate is issued or his agent 31 1 `f 1 Z g `/ Date Email Address: .70e. VORlQhtlui4 Onaoit• COM 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 Y UR CERTIFICATE OF INSPECTION. Certificate of Inspection # 4/15/2024-4/15/2025 ?-1-C-SC)Tri-. et0i-cA �'- '�. v u r. -,. �>>,, ,;,,r� DATE(MWDDIYYYY) C ,� CERTIFICATE OF LIABILITY INSURANCE 11/20/23 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: Brian Allain PHONE AX Choice Insurance Agency (A/c No,Ext): 978-343-4853 (AIC,No): 978-345-1007 376 Summer Street E-MAIL Fitchburg, MA 01420 ADDRESS: ballain@choice-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company INSURED INSURER B : Guard Insurance Sandbar Management Inc INSURER C : P.O. Box 481 INSURER D: 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. INSR ADDTYPE OF INSURANCE INSD WVDR POLICY NUMBER MMIDD/YYYY)POLICY EFF LIMITS LICY EXP LTR INSD WVD ( (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY — r— COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED 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 AGGREGATE $ DED I l RETENTION$ $ WORKERS COMPENSATION PER X O AND EMPLOYERS'LIABILITY I STATUTE I I ERTH- B ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y/N NIA SAWC187858 10/01/23 10/01/24 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Aggregate 2,000,000 Liquor Liability A CPS7362638 06/26/23 06/26/24 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. 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