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HomeMy WebLinkAboutBCOI-24-70 2025 The Commonwealth of Massachusetts 19) Town of :og.•YA YARMOUTH 0i `;°4 4•'�C.!poRAT:!:;„, . 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 Collaborative Trade Name: Cape Cod Collaborative BCOI-24-70 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 1175 ROUTE 28 SOUTH YARMOUTH, MA 02664 May 1, 2025 Floor Occupancy_ Use Group Other 01st Floor 689 A-3 Lecture halls,dance halls, 689 Use Group Classification(s) churches and places of religious Gym 358 worship,recreational centers, Cafeteria 207 terminals,etc. Allowable Occupant Load 02nd Floor 395 A-3 Lecture halls,dance halls, Classroon 395 churches and places of religious 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 Chief Name of Municipal Building r7 id- 10,g1 Commissioner Mark ate of Inspection Signature of Municipal Fire Signature of Municipal Building Chief Commissioner Date of Issuance f /Z, k.° 'YgRo TOWN OF YARMOUTH 0 . Ncc" BUILDING DEPARTMENT }...,,.,�o•�'� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 01, 2024 PAYABLE UPON (X) Fee Required $200.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: ((`J S R . 2g 5jc u-!'<n clCt,Ynvu-tfi Name of Premises: _ !/g7/0/;I1 4QoIG y Tel: 5og-Liao-oqj x II Sb �/' Purpose for which permit is used: 5 I or, ( License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency at e- COe W c Alam.'// "l24'f,frV/ f- Certificate to be issued to ,e' l/;L Tel: SD$-4,20—iog50 Address: "`— `• -` Owner of Record of Building RECEIVED Address A� Present Holder of Certificate MAY 2' 1 n^ BUILDING DEPARTM�N`�' # 2/V1ILL, al4e1AAL ignature of person to whom Title Certificate is issued or his agent 5/lifZy Date Email Address: ,), OQ.t'e(n?S !Ctkpecootcollaborq-hve,o(3 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# Ol —c,Z,q„7(') fi �6/01/2024-0b/01/2025 r.-3 5- �RG�► DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 6/29/2023 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: Darla Duckwitz CCMSI PHONE FAX C/OCannon Cochran Management Services,Inc. tAlC.No. IL ExtI:(217)-444-1186E-M (Alc No):(217)-444-6669 55 Walkers Brook Drive ADDRESS: dduckwitz@ccrosLcom Suite 402 INSURER(S)AFFORDING COVERAGE NAIC# Reading,MA 01867 INSURER A;MEGA PROPERTY B CASUALTY GROUP INC. INSURED INSURER B: CAPE COD COLLABORATIVE 418 BUMPS RIVER ROAD INSURER C: OSTERVILLE,MA 02655 INSURER D: 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. I EFF POLICY EXP NSR ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS LTR INSD YdW 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 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 RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 1,000 000 A OFFICER/MEMBER ECUTNE ri N/A WCX3405240023 7/1/2023 7/1/2024 E.L.EACH ACCIDENT $ (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 $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION CAPE COD COLLABORATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:PATRICK MURPHY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 418 BUMPS RIVER ROAD ACCORDANCE WITH THE POLICY PROVISIONS. OSTERVILLE,MA 02655 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CertReclD:621674 PRID:330280213 AGENCY CUSTOMER ID: LOC#: ACORL) ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED CAPE COD COLLABORATIVE 418 BUMPS RIVER ROAD POLICY NUMBER OSTERVILLE,MA 02655 WCX3405240023 CARRIER NAIC CODE EFFECTIVE DATE: 7/1/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acord 25 FORM TITLE: Certificate of Liability Insurance Schedule of Named Insureds and Locations 01 CAPE COD COLLABORATIVE CAPE COD COLL-418 BUMPS RIVER 418 BUMPS RIVER ROAD OSTERVILLE MA 02655 06 CAPE COD COLLABORATIVE CAPE COD COLLABORATIVE-78R ELD 78R ELDREDGE PARKWAY ORLEANS MA 02653 07 CAPE COD COLLABORATIVE CAPE COD COLL-24 CANDLEWOOD LN 24 CANDLEWOOD LANE DENNIS PORT MA 02639 08 CAPE COD COLLABORATIVE CAPE COD COLLABORATIVE-YARMOUTH 1175 ROUTE 28 S YARMOUTH MA 02664 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD