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HomeMy WebLinkAboutBCOI-24-39 The Commonwealth of Massachusetts 7.lg.YA gp Town ofo, YARMOUTH •� � `,q :O -- H: \'',cORPORATEO�," 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 Inflatable Park BCOI-24-39 Trade Name:Arcade — Identify property address including street number, name, city or town, and county Certificate Expiration Located at 518 ROUTE 28 WEST YARMOUTH, MA 02673 April 15, 2025 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 100 A-3 Lecture halls,dance halls, ARCADE ONLY churches and places of religious Allowable Occupant Load 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 Mark GryDate of Inspection ' )ALt Name of Municipal Chief Commissioner p 1 , ) Signature of Municipal Fire Signature of Municipal Building �/ Jy Chief Commissioner ate of Issuance [ �� / if 'I TOWN OF YARMOUTH � ;� ) BUILDING DEPARTMENT ` 'i";r"s! re- t�n, MAT £3[%� 1146 Route 28, South Yarmouth, MA 02664 508-3 R E C t. D E �-t APPLICATION FOR CERTIFICATE OF INSPECTIO MAR 3 1 2023 March 1, 2023 PAYABLE UPON RECE P 'EDING DEPARTMENT (X) • ( ) 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 f~or the below-named premises located at the following address: �- Street and Number: `� I' \N\C,T1^ Name of Premises: C.G I'(� D-( �,� v). Tel: 9 76- p �t PIvA Purpose for which permit is used: i ( I' a-\ License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to S 11) 14-N V ) V'C., Tel( 57�� 3 )r--SL,o )- Address: S' J W1aIh cfi W 1 a,2V"� c� v �'1�, tAA Owner of Record of Building S Gtn Q a•(' 14o1 1" (S Address S 1/M ci t r, -[St `6 G Q'Y`N r1 q d d 6 7? Present Holder of Certificate S G r\ G,2 y/Vt G r T► . G 0‘ \/CCii S' nature f person to whom Title 3 ertificate is issued or his agent J 3 I �. Date Email Address: .J © �9 PAGi 41 CM Q i L c G trv- 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# 04/15/2023-04/15/2024 /9 fr ( (Ai\ e • ACcf oN CERTIFICATE OF LIABILITY INSURANCE DATE NN D° ErPER �.^ 1111422 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:tt the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. H 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 Allele Choice Insurance Agency PHONE 978'+eg ARRi reit,NN: PS3404007 Ew. 376 Summer Street IYfuL Fitchburg,MA 01420 ADDREss: baliain@choles4NquFales.eom NeuRER(S)AFFORDING COVERAGE NAIDC INSURER A:AmGuard Iris Co 42390 INSURED MEURERs: Sandbar Management Inc/Sandbar Holdings LLC INSURER C: Cape Cod Inflatable Park/Shark Bites Cafe NsuREao: 100 Wood Ave S,Suite 209 Iselin,NJ 08830 INSURER E: SOURER 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 CERTFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY NE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REIN IrED BY PAID CLAIMS. 1N5R AGDLEUeR POLICY Err PODCYEOP AIR TYPE OF INSURANCE lNSD HOD POLICY NUMIER ParamorrWl1 dammoWYYI urn COMMERCIAL GENERAL LIANLrTY EACH OCCURRENCE f DAMAGE TO RENTED Ft A.,MADE OCCUR PREMISES IEaoaonanCM f MED DIP(Any one pre en) S PERSONAL a ADV INJURY S GEHL AGGREGATE MOT APPLIES PER: GENERAL AGGREGATE f _.POLICY❑,EL LOC PRODUCTS-COWIGP AGG f OTHER _ S AUTOMOBILE Y IEOMmodal)NgLE LIMIT S ANYAUTO BODILY INJURY(Pr hereon) $ —OWNED —SCHEDULED BODILY INJURY(Per accidre) $ _AUTOS ONLY _AUTOS AUTOS ONLY AUTOS OMY Per acoSenti W LIN OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MX AGGREGATE f _ DEO I I RETENTIONSWORKERS COMPENSATION pEp 77 pp Alm EMPLOYERS.LSROY YIN $TAME I xl ER IA ANY PROPRJTORAARTNEILEIIECUTIVE EL EACH ACCEENT f 1,000,000 A OFFICERALEMBER EXCLUDEDT ❑NIA 3AYVC374351 10/01/22 10f01/23 IMrra.mry M NH) EL DISEASE-EA EMPLOYEE$ 1,000,000 N yy..ea.�aavts DESCRIPrgNurdr GF OPERATIONS below EL DISEASE-POLICY LIMIT f 1,000,000 o6scNITIoe OF OPERATIONSI LOCATIONS I VEHICLES(AGGRO tot,Additional RRmerks Schedule. may M MbNRd I mom pace I.meted) Opeatlons of Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED N Sandbar Management,Inc. ACCORDANCE WITH THE POUCY PROVISIONS. P.O.Box 409 Iselin,NJ 08830 AUTHORIZED REPRESENTATIVE m 1988.2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo ere registered marks of ACORD Cs