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HomeMy WebLinkAboutBCOI-24-53 2025 The Commonwealth of Massachusetts Town of I) YARMOUTH P 10f, :OAT = H . t-.co. RATES N„I/ I 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: Ocean Mist Beach Motel Trade Name: Ocean Mist Beach Motel BCOI-24-53 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 73 SOUTH SHORE DR SOUTH YARMOUTH, MA 02664 May 1, 2025 Floor Occupancy_ Use Group Other Other 8 R-1 Hotels, motels, boarding hnuses Front o Bldge 8 Units Use Group Classification(s) etc. Other 14 R-1 Hotels,motels,boarding houses, Middle Bldg 14 Units Allowable Occupant Load etc. 01st Floor 4 R-1 Hotels, motels, boarding houses, 4 Units&Office 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 t I/� Li Commissioner Mark v�u[ :i{p-`�sate of Inspection Signature of Municipal Fire Signature of Municipal Building • Chief Commissioner (."2:4 1111.�/,,, Date of Issuance 7/ r 7 A `Y-_�R7. ` ; TOWN OF YARtiiOUTH a . ' �` BUILDING DEPARTMENT ��..�� �x 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 6 ,L,) fi)11 APPLICATION FOR CERTIFICATE OF INSPECTION April ' 161 2024 01, PAYABLE UPON RECEIPT (X ) Fee Required S 148.00 ( ) 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: 3 -dic 5X%3' i.,<L7, Name of Premises: !C& t 75 :f & C„Tel: fag' 26Y3 Purpose for which permit is used:fo License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency APR 11 2024 BUILDING DEPARTMENT ay Certificate to be issued to t''G'��r $// t- Tel: 9e:V iff/.3'L/)&24) Address: .2A9 .1(-ZG'O e /4 -f " 7 k14t.` )2-% G7�'c)'i-/Z. Owner of Recordpf Building (� i.i-t /724S/ .L L C Address 2Y .4 z-co/v to tV z t , /ma(a'/4' sz-- /e_ 22 7 I/Z \� 91/ Present Holder of Certificate " �� .k a-laia 1,_ ot4 ,/ I-Oh-1 d� cz4'f �c°e1LIt /1-Z,{.5/.LLB' O ,�\k Signature o petnto whom Title Certificate is issued or his agent </75/,�2jl Date Email Address: /L de 1r v/- . C-t!%•`= 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 # , fI 05/01/2024-05'01/2025 !�L C / — . y --; AC�® DATE(MMiU0/YYYY) �, CERTIFICATE OF LIABILITY INSURANCE DATE 023 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 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 GENATT V NAME: PHILIP GINEXI JR. FAX 3333 NEW HYDE PARK RD PHONE Extk 1-516-387-3069 ovc,No); 1-516-869-8765 SUITE 400 E-MAIL inexi enatts cial com NEW HYDE PARK NY 11042 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A : Zurich North America INSURED NEWPHOTE INSURER B : ACE Property & Casualty Insura 20699 Newport Hotel Group LLC, ETAL - — -- - - ---- — 28 Jacome Way INSURER C : Don McCall INSURER 0 : Middletown RI 02842 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 531218037 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES O`' INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1 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 ADDL'S- R --' POUCYEFF POLICY EXP I LTR TYPE OF INSURANCE INSD MD 1 POLICY NUMBER 1MMiDDNYYY) (MM/D12/YYYY1}' LIMITS A COMMERCIAL GENERAL UABIUTY Y Y GL0011456108 4/12/2023 4/12/2024 I EACH OCCURRENCE I $ F _-. 6AWAGlr TO t ENTED CLAIMS MADE I J OCCUR PREMISES_IEII occurrence) $ MED EXP (Any one person) $ PERSONAL&ADV INJURY 1 $ GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO—JECT LOC PRODUCTS-COMP/OP AGG $ X OTHER LIQUOR LIABILITY LIQUOR LIABILITY $$1,000,000 A AUTOMOBILE UABIUTY Y + BAP011657508 r 4/12/2023 4/1212024 ' COMBINED SINGLE LIMIT A - BAP012619005 4/12/2023 4/12/2024 F-La scudenl. $1.QQQ_( ¢___._.�..__ X ' ANY AUTO i BODILY INJURY(Per person) $ ALL OWNED i SCHEDULED f BODILY INJURY(Per accident) $ ! AUTOS i —I AUTOS X HIRED AUTOS 1 X NON-OWNED I PROPERTY DAMAGE $ _ .. AUTOS 1 I Per accident.".. B X I UMBRELLA UAB OCCUR Y Y HL122AG73713134 4/12/2023 4/12/2024 EACH OCCURRENCE $50,000,000 EXCESS LAB CLAIMS-MADE. ' AGGREGATE $50.000,000 DED X I RETENTIONS 10000 $ A W►OR CERS COMPENSATION I VJC014008009 11/15/2023 11/15/2024 i PER OTH- AND EMPLOYERS'LIABILITY Y!N . STATILTL- x ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 000000 OFFICER/MEMBER EXCLUDED' N/A x r .._ (Mandatory in NH) E.L.DISEASE EA EMPLOYEE $1.000.000 if yes, describe under --- .___4 DESCRIPTION OF OPEFATIONS below E L DISEASE -POLICY LIMIT , $1.000,000 I I i I l . DESCRIPTION OF OPERATIONS!LOCATIONS i VEHICLES (ACORD 101,Additional Remarlis Schedule, may be attached If more space is required) LOCATIONS: 2. 213 Ocean Street, Hyannis, MA 02601 Bldg#1 & #2 3. 178-180 Thames Street, Newport, RI 02840 4. 15-13 Kilburn Ct., Newport, RI 02840 5. 82 Mt. Hope Street, N. Attleboro, MA 02670 6. Settlers Green, Rt. 16, North Conway, NH 03860 7. 40 Main Street, Falmouth, MA 02540 See Attached... • i CERTIFICATE HOLDER CANCELLATION i 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1, #. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EVIDENCE OF INSURANCE AUTHORIZED REPRESENTATIVE I ® 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: NEWPHOTE _ LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED GENATT V Newport Hotel Group LLC, ETAL 28 Jacome Way POUCY NUMBER Don McCall Middletown RI 02842 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM: TITLE: CERTIFICATE OF LIABILITY INSURANCE 8. 28 Jacome Way, Middletown, RI 02842 10. 97 South Shore Road, South Yarmouth, MA 02664 Bldgs. #1,2,3 12. 73 South Shore Road, South Yarmouth, MA 02664 Bldgs.#1,2,3,4 13. 38 Purgatory Road, Middletown, RI 02842 Bldgs#1,2 14. 368 Old Post Road, North Attleboro, MA 02760 15. 390 N. Glenwood, Jackson, WY 83001 16. 251,259,267 Thames Street, Bristol, RI 02809 Bldgs#1,2,3,4,5 17. 1 State Street, Bristol, RI 02809 Bldg#6 18. 157 Holly Ridge Road, Conway, NH 03818 19. 235 Ocean Street, Hyannis, MA 02601 20. 120 Palmer Avenue, Falmouth, MA 01930 21. 107-108 Atlantic Road, Gloucester, MA 01930 Bldgs#1,2,3 22. 43 & 45 Hull Shore Drive, Hull, MA 02045 23. 131 Ocean Street, Hyannis, MA 02601 24. 149 Ocean Street, Hyannis, MA 02601 25. 42 Wylie Ct. #14, North Conway, NH 03860 26. 70 Wylie Ct. #26, North Conway, NH 03860 27. 70 Wylie Ct. # 28, North Conway, NH 03860 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD