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Home My WebLink AboutBCOI-23-1740 2026 '" �'Y0 TOWN OF YARMOUTH 0 A_�j ,� t =:�,� 0, Office of the Building Commissioner } 1146 Route 28, South Yarmouth, MA 02664 = y 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESE ,, O i\ORPORATEO. '• "'` "' APPLICATION FOR CERTIFICATE OF INSPECTION July 01, 2025 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ( ) 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: 42V-N k,k " l -1,, - )r- Name of Premises: CC— 1- ( 14 S S6C, d 1 w-\+or'S Te(5 )1' ?57- L(300 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 4- \ tA5 S 6L. !• Telel 5 - Ud Address:oC� M:ok \ ec� 'T r• L L a-v o `. 1�\l� c�2 (.7? Owner of Record of Building S c.A,.t, ) Address Present older of Certificate co. -'-� • / .1-2c.\ ?I o-S Co er\ • S• nature of person to whom Title ertificate is issued or his agent Date Email Address: f C41,'11Oi- C_G 1 ao r' , (.,o w\. d RECEIVED JUL 0 9 2025 -a Li oviwirv� uCVi-\N i MtN I Instructions: Make check payable to: Town of Yarmouth By _�� 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-23-1740 08/18/2025-08/18/2026 ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DDMYYY) 07/07/2025 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. N 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 Carolyn Milano NAME: The Hilb Group New England,LLC PHONE (800)640-1620 I FAX IA/C.No.EMI: WC,No): E-MAIL cmilano@hilbgroup.com ADDRESS: 973 Iyannough Road INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: Safety Indemnity Insurance Co 33618 INSURED INSURER B: Twin City Fire Insurance Co 29459 Cape Cod&Islands Association of Realtors,Inc. INSURER C: 22 Mid Tech Drive INSURER D: INSURER E: West Yarmouth MA 02673 INSURERF: 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 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 ADDLSOBR POLICYEFF POLICYEXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MMIDD/YYYYI (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE 1O RENTED 100,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MEDEXP(Any one person) $ 10.000 A BMA0024156 09/04/2024 09/04/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY❑PRO- ❑ 4,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY OMBItlEDDlSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY yen accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DES I I RETENTION$ $ WORKERS COMPENSATION XI STATUTE I I W- AND EMPLOYERS'LIABILITY Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE I N I NIA OSWECNJ2677 11/30/2024 11/30/2025 E.L.EACH ACCIDENT $ 500,000 OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 U yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations,and endorsements.Nothing contained in the Certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cape Cod&Islands Association of Realtors Inc ACCORDANCE WITH THE POLICY PROVISIONS. 22 Mid Tech Drive AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 G 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD