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HomeMy WebLinkAboutBCOI-23-1733 2025 The Commonwealth of Massachusetts Town ofk.,g) YARMOUTH ,y �aRPaw.,Ea. 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:Bass River Sports World BCOI-23-1733 Trade Name:Bass River Sports World Identify property address including street number,name,city or town,and county Certificate Expiration Located at 932&940 ROUTE 28 SOUTH YARMOUTH,MA 02664 August 13,2025 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 150 A-3 Lecture halls,dance halls, 150 PERSONS churches and places of religious Allowable Occupant Load 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 Markpor Pate of Inspection S'/74 Commissioner !!! [ Signature of Municipal Fire Signature of Municipal Buildir}E //i , Chief Commissioner jI��, Date of Issuance •. :-sird4, \. TOWN OF YARMOUTH Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 H , ►. 508-398-2231 ext. 1260 Fax 508-398-0836 \MATTATTACHEESE /4-c-RpaRAfEV \b�q ,. APPLICATION FOR CERTIFICATE OF INSPECTION July 01 , 2024 PAYABLE UPON RECEIPT (X) Fee Required S 100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 1 10.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: ('R Street and Number: 9 s 00TC 12, Name of Premises: *1S 7 2-1VC(2Se 0 W 0 �--L� Tel: ` 5 v ' 1 - (.oO1O Purpose for which permit is used: A '2C 67 E License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to ZAS 5 Zfe-{Z. Sohn 13o .Q-i--b Tel: LD , -Address: 94 l20 i=� oc 'l --t--4 ,��z ''t0 V � � ail ?o � �� S�� y MA 0/2_6 b� Owner of Record of Building 3 pkSS Address ( (3 ?L 6s4t --r Si-, Soyrtt '- 42.1.10UT1+ HA O 2(c.L4 Pres t Hold f Ce 'fica e ' S 5 2 'L Spo s O C— nature of person to whom III Title, Certificate is issued or his agent 3o 0 Date Email Address: 1 + '� fCK1 �1 O t RECEIVED JUL 3 0 2024 BUILDING DEPARTMENT By'-- -- — 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 # 08/13/2024-08/13/2025 iif / 3 f-23 3 A COR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYYY) 07/22/2024 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 CONTACT NAME: Lydia Power BALDWIN KRYSTYN SHERMAN PARTNERS LLC INC No.Extt: (508)760-4604 FAXX,Not_ E-MDRAILESSya.power@ gers ra I di ro com AD : g y• 4211 West Boy Scout Blvd Suite 800 INSURER(S)AFFORDING COVERAGE NAIC# Tampa FL 33607 INSURER A: ACE AMERICAN INSURANCE CO _ 22667 INSURED INSURER B BASS RIVER SPORTS WORLD INC INSURERC: INSURER D PO BOX 183 INSURER E SOUTH YARMOUTH MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 1028525 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. INSRFF POLICY EXP i TYPE OF INSURANCE IN SD S WVD POLICY NUMBER J.MM DDUBR Y E/YYYY)-_(MMDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I OCCUR DAMAGE TO RENTED I PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ _ POLICY JECT I LOC PRODUCTS-COMP/OP AGG $ OTHER: _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ , (Ea accident) ANY AUTO I BODILY INJURY(Per person) $ ~ OWNED SCHEDULED N/A • BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — HIRED NON-OWNED PROPERTY DAMAGE $ II AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH i AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 AI OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6S62U61K68658924 01/01/2024 01/01/2025 (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 $ N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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. Town of Yarmouth 1146 MA-28 South Yarmouth MA 02664 AUTHORIZED REPRESENTATIVE ) Daniel M.Crowl@y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD