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HomeMy WebLinkAboutBHOU-24-19 2024 ^ � von --�- ppr ue�- cJ/) 3jf( �'"I� Office Use Only '� Permit# 1 1;+ o I / crREIV � FEE $50.00 MATTACn CS[,� nuN �� �� �wro.. C� Map BUILDIAENT Lot By —` fifj/ 3t4JC MANAGER /SEASONAL EMPLOYEE HOUSING PERMIT APPLICATION TOWN OF YARMOU"I'I I Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 APPLICATION FOR: MANAGER UNIT(S) / SEASONAL EMPLOYEE HOUSING HOTEL/MOTEL ADDRESS: 3 SQ 2�'.4.-e V 141 4i� 4- A SPECIFY STREET• AND NAME OWNER: J►,a4,e-514.L s_D G `c LL- C--- ,54P —740v 'i214- NAME LEGAL ADDRESS TEL. # MANAGER: ,(d,r_104 /4 / c Sod` 7.g ' 'f NAME LEGAL ADDRESS TEL.*/ ON SITE PROCTOR •J{/i ivs e M,Gn-DqO / 14 L 7✓5"- S iG?3 NAME ROOM NUMBER CELL# EMAIL CONTACT j il/ )1..ie.1 c WY f) .q n,e_ .( _.?Al*/I•Co/. TOTAL NUMBER OF LICENSED ROOMS: �� NUMBER OF MANAGER/OWNER UNITS ROOM NUMBERS NUMBER OF SEASONAL HOUSING UNITS: isi (APRIL 1st—OCTOBER 31") 15% MAX ROOM NUMBERS: C+ 9 1 cl C/`J C, 'let I ) I IAL I will comply with all applicable Town of Yarmouth Zoning Bylaws and all other applicable laws. Seasonal employee housing shall be used solely by employees and shall not include family members or non-employees. )141 I understand that any false statement(s)will be just cause for denial or revocation of my permit and may result in the town taking further legal action. I declare under penalties of perjury that the statements herein contained are true and correct. Applicant's Signature: 9i' Date: GO L / 1 / Owner's Signature(or attachment) Date: 4 G iP/ ?-4/ Approved By: Date: Building Commissioner(or designee) Updated 3/24 SHORPRO-04 LISAEDMUND ACORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �.� 5/6/2024 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 NAMIACT Meg Kudla NFP Property & Casualty Services, Inc. (aH�c°,No,Ext): (617) 405-1534 FAX No): 141 Longwater Drive Suite 101pD' SS: meg.kudla@nfp.com Norwell, MA 02061 INSURER(}AFFORDING COVERAGE NAIC tt INSURER A:Associated Employers Insurance Company 11104 INSURED INSURER B: Shoreside Properties, LLC INSURER C: PO Box 714 INSURER D: South Yarmouth, MA 02664 �y 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 TYPE OF INSURANCE ADDL SUBR POUCY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (11MIDDIYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ --- GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY , JECOT LOC PRODUCTS-COMP/OP AGG OTHER: , $ AUTOMOBILE UABIUTY WCO pcciden SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ i , $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION I v PER H AND EMPLOYERS'UABILITY ^ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N IWCC-500-5027012-2024A 5/4/2024 5/4/2025 E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L DISEASE- EA EMPLOYEE $ 500,000 If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Excluded Officers: Jack Hynes CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Rte 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE :4/244;q ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD