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Home My WebLink AboutBCOI-23-1710 The Commonwealth of Massachusetts ;'g Y4 Town ofU :''''t • � o\ YARMOUTH `3z� y'�;Q' t�,�-CORPORATE-,,.>/, 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:The Ocean Club Trade Name:The Ocean Club on Smugglers Beach BCOI 23 1710 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 329 SOUTH SHORE DR SOUTH YARMOUTH, MA 02664 June 7, 2025 I \\IVIV V 111, IYI VL V Floor Occupancy_ Use Group Other 01 st Floor 32 R-1 Hotels,motels,boarding houses, 32 room,Function room Enclosed Use Group Classification(s) etc. Swimming Pool 02nd Floor 31 R-1 Hotels,motels,boarding houses, 31 Rooms-Function Room Allowable Occupant Load etc. Basement/Lower 2 R-1 Hotels,motels,boarding houses, Exercise Room-2 offices-1 Storage etc. Room 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 I I Name of Municipal Chief Commissioner Mark I Date of Inspection Signature of Municipal Fire Signature of Municipal Buildin , Date of Issuance Chief Commissioner Z Z .:94 TOWN OF YARMOUTH Q; �;$ 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 RECEIPT (X) Fee Required $304.00 ( ) 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: 2 i i Q_ D Name of Premise (7, (t.A1 Tel:e55?:: Purpose for which permit is used: ' l(/►e_SV a-V '-- License(s)or Permit(s) required for the premises by other governmental agencies: _ IREEIVE License or Permit Agency -C D JUN 21 2024 BUI I EP-- (kY Certificate to be issued to \ CI �0 Tel: 13-3CM'CA55- Address: 3,9 S_ 5 r - Owner of Record of Building Address Present Holder of Certificate ®C A 4'\ G-111 ignature of person to whom Title Certificate is issued or his agent )\5—(2'Y Date Email Address: ‘- ece_cun cSuto smugkr-c C6 f./.V_ 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# g/ b��p� 3 _ 17/D 06/07/2024-06/07/2025 41.• ttSOS i. (. , '. { l (Policy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: SEE ATTACHED ENDORSEMENT t TUE A'' NCCI Company Number: 10448 ��ARTFORD Company Code:9 Suffix LARS RENEWAL POLICY NUMBER: 22 WBC AROHOR 5 Previous Policy Number: 22 WBC AROHOR 1. 'Named Insured and Mailing Address: RESORT MANAGEMENT&CONSULTING GROUP LLC (No., Street,Town,State,Zip Code) 742 MINK AVE STE 224 MURRELLS INLET SC 29576 FEIN Number: 83-1075760 State Identification Number(s): Refer to the EXTENSION OF THE INFORMATION PAGE-WC990365. The Named Insured is: LLC Business of Named Insured: Hotels(except Casino Hotels)and Motels Other workplaces not shown above: See Endorsement-WC990366 2. Policy Period: From 02/01/24 To 02/01/25 ANNUAL 12:01 arn., Standard time at the insured's mailing address. Producer's Name: SOUTHEASTERN INS CONSULTANTS LLC PO BOX 1396 IRMO SC 29063 Producer's Code: 22293049 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (866)467-8730 Total Estimated Annual Premium: $49,745 Deposit Premium: Policy Minimum Premium: $612 NC(Includes Increased Limit Min.Prem.) Audit Period: ANNUAL Installment Term: Twelve Pay(8.33%Down+11@8.33%) The policy is not binding unless countersigned by our authorized representative. Countersigned by 61'4- o � 12/23/23 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 12/23/23 Policy Expiration Date: 02/01/25 Y • INFORMATION PAGE (Continued) Policy Number:22 WBC AROHOR 3.A.Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: NC (SPO) SEE ENDORSEMENT-WC 99 03 67 B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO,V►1ASHINGTON,WYOMING,U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A.OF THE INFORMATION PAGE. D.This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 41. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $48,619 Premium Discount -$1,887 Expense Constant $338 Terrorism Risk insurance.Program Reauthorization Act Disclosure Endorsement $461 Catastrophe (Other Than Certified Acts Of Terrorism) $309 Other Miscellaneous State Premiums $1,390 Estimated Annual Premium(before Surcharges) $49,230 Total Estimated Surcharges $515 *See the attached Schedule(s)of Operations for Location and State.Level Premium Information Total Estimated Annual Premium: $49,745 Deposit Premium: Policy Minimum Premium: $612 NC(Includes Increased Limit Min.Prem.) Interstate/Intrastate identification Number: Refer to Schedule of Operations NAICS:721110 Labor Contractors Policy Number: SIC: 7011 /Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 12/23/23 Policy Expiration Date: 02/01/25 EXTENSION OF THE INFORMATION PAGE - ITEM I - OTHER WORKPLACES rJ Policy Number:22 WBC AROHOR Endorsement Number: Effective Date: 02/01/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Resort Management&Consulting Group LLC 742 MINK AVE STE 224 MURRELLS INLET SC 29576 Item 1 of the Information Page is completed to include other workplaces of the named insured: 329 South Shore Drive, South Yarmouth, MA 02664 742 Mink Ave, Murrells Inlet,SC 29576 2108 N Ocean Blvd, Myrtle Beach, SC 29577 8 Wimbledon Court, Hilton Head Isl,SC 29928 1110 S Virginia Dare Trail, Kill Devil Hills, NC 27948 4724 N CROATAN HWY,KITTY HAWK,NC 27949-8911 1307 S OCEAN BLVD, MYRTLE BEACH,SC 29577-4541 100 N WACCAMAW DR, MURRELLS INLET,SC 29576 1 7 Form WC 99 03.66 Printed in U.S.A. Process Date: 12/23/23 Policy Expiration.Date:02/01/25 " EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED Policy Number: 22 WBC AROHOR Endorsement Number: Effective Date: 02/01/24 Effective hour is the same as stated on the information Page of the policy. Named Insured and Address: Resort Management&Consulting Group LLC 742 MINK AVE STE 224 MURRELLS INLET SC 29576. Item 3.A. of the Information Page is completed to include the following states: North Carolina NC(SPO) South Carolina SC(SPO) Massachusetts MA(SPO) Form WC 99 03 67 Printed in U.S.A. Process Date: 12/23/23 Policy Expiration Date:02/01/25