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HomeMy WebLinkAboutBCOI-24-52 2025 The Commonwealth of Massachusetts Town of :° .•Y9 ,.) YARMOUTH ' _ " .: `.4,,o PORATE�•,,.°,/ 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 Hotel Trade Name: Ocean Mist Beach Hotel BCOI-24-52 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 97 SOUTH SHORE DR SOUTH YARMOUTH, MA 02664 May 1, 2025 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 63 R-1 Hotels,motels,boarding houses, East Wing-34 Units etc. West Wing-29 Units Allowable Occupant Load 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 Mur ici al Chief Name of Municipal Building '' p Commissioner Mar S ate of Inspection / ,,i ) Signature of Municipal Fire Signature of Municipal Building (� Chief Commissioner ate of Issuance �� Or taR,G TOW OF YARMOUTH � BUILDING DEPARTMENT +Yre��`:n•s":x� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION April 01, 2024 PAYABLE UPON RECEIPT (X ) Fee Required $259.00 ( ) 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: q $Q(-C 7%_ 5/-t./7 e plee✓e. Name of Premises: 6 i -tt- At:5/ &ad:A4t-=I'el: Purpose for which permit is used: 1/0/6-e-- License(s)or Permit(s) required for the premises by other governmental agencies: RECEIVE D License or Permit AgencyL APR 11 2024 BUILDING DEPARTMENT By __ Certificate to be issued to ke,aft A5/ //�i Tel: yl.�fceyJ --‘9q‘262 Address: 2 A7 fa-eotn e 4 L-c / 'Lc /-e'1�i.�yt �'1 422d'/2 Owner of Record of Building Q 12 f hiss f L L C _ Address 2,' :Ai -0/tie C1/'i- c- /'�iLc / /,�°_ ?r �y� A-L 22-(' '2 .. _ LA) Present Holder of Certificate ,p f/? 026 !t/C vim. f ZC.-5 f L e'e C - Signature of p rson to whom Title 3.j/ Certificate is issued or his agent Vs-/2 / Date Email Address. rota — f �' 0P- i �-L7r.Z2V:), tOil'7 Instructions: Make check payable to: Town of Yarmouth 1 146 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 SENT) US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection # 05/01/2024-05/01/2025 DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE %iewia 12/8/2023 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(les) 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 NAME: PHILIP GINEXI JR, G E NATT V _---__- . 3333 NEW HYDE PARK RD .(Al .ti9,.Eap,_1-516-387-3089 1 FAX ,Not: 1-516-869-8765 ITE 400 E-MAIL SUIT HYDE PARK NY 11042 _ADDRE : Pginexi tgenattspecialty.com_ INSURER(S)AFFORDING COVERAGE NAIC I INSURER A: Zurich North America INSURED NEWPHOTE INSURER 8 w.ACE Property & Casualty Insure 20699 Newport Hotel Group LLC, ETAL — --28 Jacome Way INSURER C: Don McCall INSURER D: Middletown RI 02842 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 531218037 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 it.TR TYPE OF INSURANCE _._ lAt5617ST18I1:1'�_..+_.. ______ F POLICY EFF ` POLICY EXP j------ _ItiSD MD II POUCY NUMBER IMMfDD/YYYY)UMMrDD/YYYY) LIMITS A i COMMERCIAL GENERAL LIABILITY Y 1 Y G1O01 1 4561 08 I 4/12/2023 4/12P1024 EACH OCCURRENCE $ I CLAIMS-MADE ; I OCCUR 4 PRE,MIS_ S.(Ea ocaurrence_i $ ! MED EXP(My one person) : PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE POLICY I . � j�COT- LOC I PRODUCTS.COMP/OP AGG $� I X OTHER: LIQUOR LIABILITY . I LIQUOR LIABILITY ,, $$1.000,000( A AUTOMOBILE LIABILITY Y BAP011657508 4/12/2023 4/12/2024 I COMBINED SINGLE LIMIT A __._ BAP012619005 4/12/2023 4/12/2024 1Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED T— SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ I X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE I _a AUTOS (Per accident) _ I I � S B X I UMBRELLA UAB Y Y OCCUR HLIZ2AG73713i34 ; a/12/2023 4/12/2024 EACH OCCURRENCE 550.000.000 EXCESS LIAR l H. CLAIMS-MADE + AGGREGATE $50.000,000 DED 1 X RETENTIONS 14 ow i A WORKERS COMPENSATION , PER s AND EMPLOYERS'UASIUTY Y/N VVCOta008009 11/1512023 11/15/2024 STATUTE X _ ER ANY PROPRIETOR/PART'NER/EXECUTIVE E.L. EACH ACCIDENT $1,000.000 /M OFFICEREMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE-EA EMPLOYE $1,000.000 If yes, describe under �_. ...__— I DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT 1 $1,000,000 I 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks 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... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EVIDENCE OF INSURANCE AUTHORIZED REPRESENTATIVE m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: NEWPHOTE _ LOC#: '`��RDA 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 I 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 Roac,Middletown,RI 02842 Bldgs#1,2 14.368 Old Post Roac 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 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD