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Home My WebLink AboutBCOI-23-1715 2026 The Commonwealth of Massachusetts =` Town of og'Y�'-"i7 `. -It YARMOUTH 'o y C • INew and Renewal Certification of Inspection i'ti RRPO RA T IO 04' In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Cape Cod Veranda LTD • Trade Name: Cape Cod Veranda BCOI 23 1715 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 1261 ROUTE 28 SOUTH YARMOI ITH, MA 07564 June 8, 2026 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 22 R-1 Hotels, motels,boarding houses, BLD 1-12 UNITS etc. BLD 2-9 UNITS Allowable Occupant Load MANAGERS APT LOBBY 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 Ma rylls . Date of Inspection Commissioner t) /34R5 Signature of Municipal Fire Signature of Municipal Buildin , Date of Issuance �7 ZJ_ Chief Commissioner / Z ITOWN� OF YARMOUTH :-.- 1*, 0' Office of the BuildingCommissioner `(t 1146 Route 28, South Yarmouth, MA 02664 ♦r' 1 508-398-2231 ext. 1260 Fax 508-39 .11ME I V E D MATTACHEESE `�"tic ys.q �`'" APPLICATION FOR CERTIFICATE OF INSPECTION APR 23 2025 April 23, 2025 PAYAB Jlsl NT (X) Fee required$133.00 ( ) 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 atthe following address: Street and Number: f 6[ c o �(�i�j/7 *War# MI(��6:‘ L Name of Premises:14E01c` CW2C C60 Z.V) Tel: £ - 3 lS 3 1 1 Purpose for which permit is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to VC/WON CQP5 aia Tel: .E-3 -_2 g(/ Address: /,2 eC/ RciM c ` c v(-Gc -/°arrrnoL 6r1 ,2'i d2 ` L Owner of Record of 'Wilding ,y,,ezC �0 Address (.2£( t ,& Scee' j/(:,.,f,1 zoc e( /14:2_ , Present Holder of Certificate OZ- (2z (/ .,e0iw /A ziz Signature of person to whom Title Certificate is issued or his agent Cif -- 23 - .3 i ) Date Email Address: CCUC1 UWQ ��s'GLPZ,C, CV/ _ 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-23-1715 06/08/2025-06/08/2026 INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: Hartford Casualty Insurance Company ONE HARTFORD PLAZA HARTFORD CT 06155 .ts THE HARTFORD NCCI Company Number: 14397 Company Code: 3 Suffix LARS RENEWAL POLICY NUMBER: 76 WEG AN9EET 4 Previous Policy Number: 76 WEG AN9EET 1. Named Insured and Mailing Address: CAPE COD VERANDA LTD. (No., Street, Town, State, Zip Code) 1261 MA# 28 SOUTH YARMOUTH MA 02664 FEIN Number: 83-0907773 State Identification Number(s):• The Named Insured is: S-Corporation Business of Named Insured: Hotels (except Casino Hotels) and Motels Other workplaces not shown above: 1261 MA#28 SOUTH YARMOUTH MA 02664 2. Policy Period: From 10/29/24 To 10/29/25 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: NUTMEG INS AGENCY INC/PHS 8711 UNIVERSITY DRIVE EAST CHARLOTTE NC 28213 Producer's Code: 76210781 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (888) 925-3137 Total Estimated Annual Premium: $670 Deposit Premium: Policy Minimum Premium: $267 MA (Includes Increased Limit Min. Prem.) Audit Period: ANNUAL Installment Term: Full Pay (100%Down) The policy is not binding unless countersigned by our authorized representative. Countersigned by �`�a" CCZD� 09/19/24 _ Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 09/19/24 Policy Expiration Date: 10/29/25 • INFORMATION PAGE (Continued) Policy Number: 76 WEG AN9EET 3.A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: MA 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 $500,000 each accident Bodily injury by Disease $500,000 policy limit Bodily injury by Disease $500,000 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, WASHINGTON, 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 4. 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 $376 Expense Constant $250 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $9 Other Miscellaneous State Premiums $20 Estimated Annual Premium (before Surcharges) $655 Total Estimated Surcharges $15 *See the attached Schedule(s)of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $670 Deposit Premium: Policy Minimum Premium: $267 MA (Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 721110 Labor Contractors Policy Number: SIC: 7011