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HomeMy WebLinkAboutBCOI-24-52 2026 • The Commonwealth of Massachusetts Town of og Y9 . * Ko YARMOUTH � 3�'I O `:�yy': U r else- 4 r i'',Me0RP0R-- ',-, ,� 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, 2026 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st 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. Chief Name of Municipal Building Name of Municipalja Commissioner Mark Gryl Date of Inspection i lj `�3 � , Signature of Municipal Fire Signature of Municipal Building Chief Commissioner ate of Issuance 7,4y S ., RECEIVED s"'Azt8 APR 24 2025 tt464 f TOWN OF YARMOUTH ce of the Building Commissioner BUILDING DEPA R ute 28 South Yarmouth, MA 02664 By. 47 503" 8-2231 ext. 1260 Fax 508-398-0836 APPLICATION FOR CERTIFICATE OF INSPECTION April 01,2025 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 tiir the below-named premises located at the following address: Street and Number: 9 5.6,16.7t. 5447"-- Name of Premises: 1ceezfi ic-4741/( //afe'Ver .5-46,4/6 Purpose for which permit is used: 1:241.- License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to &' 7/115 ,L-C, Tel: 9)7--1"‘"T-- ej700 Address: 2,:e „rheame Pite e <44-z-7 AL O ner of Record of Building A-low:-L / Address_Ze /41e0/779- frvezy.„ /772:etd/e t ,e., Present Holder of Certificate h" i /4-474-7 A- 4-aq 07fraVej17t //-4.57///e . aii‘-c-fixAt el„- neeeatt-h.Signature ce-y9e-P- 11S6)‹.- or person to whom Certificate is issued or his agent ate Emil Address: inktierf/iyeA/eS CVM 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 he notified ithin ten(10)days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATM INSURANCE FORM WITH THIS APPLICATION OR 'WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection 4. BCOI-24-52 t)I 2015-05 01 'Olo +-R A�`� DATE(MM/DD!FYYY) w �,,.. CERTIFICATE OF LIABILITY INSURANCE 11/20/2024 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 GENATT V NAME: PHILIP GINEXI JR. PHONE 3333 NEW HYDE PARK RD _ ,€sti 1 516-387-3069 =.tNcj :1:516 869-8765 SUITE 400 Aoonss Inexi enatts is corn P9 S�9 t nY --- NEW HYDE PARK NY 11042 INSURERM AFFORDING COVERAGE NAIGe NE_ INSURER A,Zurich American Insurance Company 18535 Newport Hotel Group LLC, Etal INSURED — vw*IUTE Y INSURER B:"ACE Property&Casualty Insurance Company 20699 28 Jacome Way INSURER C: Don McCall iNSURER D Middletown RI 02842 INSURER E: . — INSURER F: 1 COVERAGES CERTIFICATE NUMBER:1087423044 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. _ iNSR 1 TYPE OF INSURANCE ..'.�ADDL SUBRI POLICY NUMBER _. POLICY EFF_—POLICY E7(R LIMITS LTR� 11NSD.WVD. €tMM/D0IYYYYi iMM@D/YYrn A _ X COMMERCIAL GENERAL LIABILITY Y Y i GL0011456109 4/12,2024 4/12/2025 i EACH OCCURRENCE I S 1,000,000 j CLAIMS-MADE XOCCUR = "b '(St2EfTfiE'S �..�.�. 1 I 1 PREMISESIEa occurrence S 1,000,000 — I— I s f MED EXP(Arty one person) $10,000 I PERSONAL&ADV INJURY S 1,000 000 GEM.AGGREGATE LIMIT APPLIES PER: 1(GENERAL AGGREGATE L$2.000,000 I POLICY ,ECT I j LOG '. PRODUCTS-COMP/OP AGO 1,$2.000.000 _.. X OTHER: LIQUOR LIABILITY _ t i i LIQUOR LIABILITY !$51,000,000 A AUTOMOBILE LIABILITY Y BAP011657509 4/12/2024 4,12/2025 I COMBINED SINGLE LIMIT $1,000,000 I(Ea accdant�_....__ A s----- BAP012619007 4//212024 4/12/2025 t' X ARV AUTO E BODILY INJURY(Per Pin) j$ ; I OWNED I I SCHEDULED . AUTOS ONLY i 'AUTOS i ' BODILY INJURY(Pet*cadent) S X 1 HIRED l X' NON-OWNED PROPERTY DAMAGE s —. .__.,AUTOS ONLY 3 AUTOS ONLY i per amderff,)._.._.....__.�..�_-.____ , S B !X I UMBRELLA LAB X OCCUR Y ? Y I HL123AG73922653 4112/2024 4/12/2025 1 EACH OCCURRENCE S 50.000,000 EXCESS LIAR I CLAIMS-MADE! i{ )AGGREGATE $50,000.000 "-- I `DEO 'X 1 RETENTIONS to Mn I I t 3 $ !WORKERS!WORKERS COMPENSATION j WC014008010 11/15/2024 11/15/2025 i$ATU7E i i ER 9,AND EMPLOYERS'LIABIUTY YIN 1 t ANYPROPRIETORJPARTNER/EXECUTIVEJM i E.L.EACH ACCIDENT $1,000,000 I .OFFICEREMSER EXCLUDED? NIA` (, . -- (Mandatory in NH) i i E.t.OtSEASE-EA EMPLOYEE'$1,000,000 (if if yos desalt*under + . I DESCRIPTION OF OPERATIONS below _ I i i E.L.DISEASE-POLICY LIMIT :$1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) LOCATIONS: 2.213 Ocean Street,Hyannis,MA 02601 BIdg#1&#2 3. 178-180 Thames Street,Newport,RI 0284 4. 15-13 Kilburn Ct..Newport,RI 02840 5.82 Mt,Hope Street,N.Attleboro,MA 02670 6.72 Common Court,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 POUCY PROVISIONS. EVIDENCE OF INSURANCE AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: NEWPHOTE LOC#: ACCORD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY I NAMED INSURED GENATT V Newport Hotel Group LLC,Etat 28 Jacome Way POUCY NUMBER Don McCall Middletown RI 02842 CARRIER 1 NAM 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 Road,Middletown,RI 02842 Bldgs#1,2 14.368 Old Post Road,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 8 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