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HomeMy WebLinkAboutBCOI-24-73 2026 The Commonwealth of Massachusetts Town of ,a�'.YA7�._ * O YARMOUTH , � rf 'i \'1NP.RATO 0"/ 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: Sandbar MGT INC dba Wicked Waves Trade Name: Cape Cod Inflatable&Water Park BCOI-24-73 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 518 ROUTE 28 WEST YARMOUTH, MA 02673 April 15,2026 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 2,200 A Special amusment buildings or 2200 Total for both Inflatable and portions thereof Water Park Allowable Occupant Load (240 for Shark Bites, 100 for Arcade, 1860 parks) 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 Name of Municipal Chief Mark G Date of Inspection Commissioner �' J��/�J - Signature of Municipal Fire Signature of Municipal Buildi , Chief Commissioner Date of Issuance 1/2 r. 2 k+ .' TOWN OF YARMOUTH oe 0 - 4t4 BUILDING DEPARTMENT �.,,.1,�o•�'� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 l r)acd-c btu (- APPLICATION FOR CERTIFICATE OF INSPECTION February 28, 2024 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) 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: SS �C pnet..e, 7 Name of Premises: 59/aki'Q a#atn/M ve eyk Tel: ,7V-3 5 ,5-1/0.? cape 0067,fr Purpose for which permit is use • .,/~Tf}t k . a. ' Gt Te2 [ RECEIVED License(s) or Permit(s) required he remises by other govern agencies: HR 14 2024 License or Permit Agency BUILDING DEPARTMENT By ----- -- CEO- Certificate to be issued to ~�6 aftaZQ C#' l 0 t], �1die,M.P.CTel: -,315 561O.Z Address: Jr/s Route ' ' Owner of Record Af Building 501464.,Q 1Qahag nI//e Address 51.2 ,mAte oZ8 Present Holder of Certificate 9/Ate MIA crane,Ave 14a. Cloe COc/Ar-entifieC/0 ' S. nature of person to whom Title/ / Certificate is issued or his agent ?/Pi( ZY Date Email Address: OW £,'a,eetikf z C671V)1•af 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# v 7 re i 4/i5/2024-4/15/2025 ~A CF ' I' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/20/23 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: Brian Allain Choice Insurance Agency PHONE 978-343-4853 FAX No): 978-345-1007 376 Summer Street E-MAIL ADDRESS: ballain@choice-insurance.com Fitchburg, MA 01420 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company INSURED INSURER B : Guard Insurance Sandbar Management Inc INSURER C : P.O. Box 481 INSURER D : West Yarmouth, MA 02673 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 CONDITICN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 13SUED 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 I-AVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL 3UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY S 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 S $ WORKERS COMPENSATION PER STATUTE X OTRH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? N/A SAWC187858 10/01/23 10/01/24 1,000,000 (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,000 $ Aggregate 2,000,000 Liquor Liability A CPS7362638 06/26/23 06/26/24 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations of Insured 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 Route 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE r ? CYL-Qjjars © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD og YA TOWN OF YARMOUTH Office of the Building Commissioner 4. I I 4 1146 Route 28, South Yarmouth, MA 02664 `p y: 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESE ! COgP0RAte''' APPLICATION FOR CERTIFICATE OF INSPECTION March 04,2025 PAYABLE UPON RECEIPT (X) Fee Required$750.00 ( ) 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: 57i Rou i 2 Name of Premises: /Cktebif}L6/e 4c7'47F-Mi a 0417t 1p t9,,' Tel: .}I7-375-5yO.Z Purpose for which permit is used: 4/497::62/if'/Z .SP,4i 21706 Bt/3741_ License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency RECEIVEDi Certificate to be issued to f,vd/ !//, e j/6,p�/ djwh'J Tel: 8-37 -51/j7 I MAR 27 2025 Address: 5/.? , a(S,4/15 Y%'/,L10Y1 ,U , Od6�3 � z Owner of Record of Building 54,vda4e 11197/4/C Bu y I lectaRlet, Address 3K �OLTQ o Lf/lSt Y Q ioUi9/ If,Q &6 '3 Present older of Certi care . NAiMR UL7 `Sign re of person to whom Ti le Certificate is issued or his agent 34).7/a J Date Email Address: 7Df•/townlig Gn a,it• Caw 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#BCOI-24-73 04/15/2025-04/15/2026 DATE(MM/DD/YYYY) AGORO' CERTIFICATE OF LIABILITY INSURANCE 03/25/25 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT: HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), •UTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisio s 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 CON EACT NAME: Brian Allain Choice Insurance Agency PHONE A/C,No,Ext): 978-343-4853 FAX o): 978-345-1007 376 Summer Street E-MAIL Fitchburg,MA 01420 ADDRESS: ballain@choice-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Scottsdale Insurance Company INSURED INSURER B: Ace American Insurance Company Sandbar Management Inc INSURER C: P.O.Box 481 INSURER D West Yarmouth,MA 02673 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 P• ICY 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 T E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) ITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE $ CLAIMS-MADE OCCUR PREMISESO(Eaoccu RENTED $ MED EXP(Any one person) $ PERSONAL&ADV INJUR $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AS G $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per perso ) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accid nt) $ 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 OT AND EMPLOYERS'LIABILITY Y/NANY STATUTE ER I.; OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVEEXCLUDED? N/A 6562UB1W17748324 10/01/24 10/01/25 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NI-I) E.L.DISEASE-EA EMPLO EE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LI -T $ 1,000,000 Liquor Liability Aggregate 2,000,000 A CPS7362638 06/26/24 06/26/25 Each Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations of Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8: CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DE IVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATIO . All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD