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HomeMy WebLinkAboutBCOI-23-1733 2026 The Commonwealth of Massachusetts .. g Yq * , Town of �' � YARMOUTH ��� '..- " �� id 'HC 6�9 °RPp R AI ` INew 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, 2026 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 Building Name of Municipal Chief Mark Gryl Date of Inspection Commissioner f/ ) )<. Signature of Municipal Fire Signature of Municipal BuildingC - Chief Commissioner �' ate of Issuance //Z /Ll. 1 YA TOWN OF YARMOUTH 01 H Iff.* Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 y: 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESE- I /y:RPORATEO� :. .:<--- 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: 9 3 1 OTC O, Name of Premises: 'jc.SS {%\ea_ cq a 12-1 s 00 ,) Tel: 5 og- 3 b-Lc,Q 41 O Purpose for which permit is used: V4 C,Yr i)l�- License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to--giciSSIZVetl_. )Pots, t,.) 042.-L,> Tel: SO4,- 3C(q-(0 0`I 0 Address: Q3H (lotxrc .(23,1 ?o 3 o x \? t Sov ttt krAYIY�'IoUT-I-{-t M�1- (-)2-(0 to Owner of Recor of Building BASS 2 ‘v'evL IE4L-r L_L-C Address 1 t3 lt\5 - STI Sov-t-t+ y w.2(v)p -f'i+ M,1q_ O 9, toot Op 3 o.0 I 3 s.kr Lt6 Pr ent Hol of rtificate ASS flie--il- o(a rc l.)• o42—L- i .00 L g1F ,W2-E 0 'gnature o erson to whom Title Certificate is issued or his agent g \ I 0 `;_ ` ate Email Address: I . fl t C k 1 n-e.( \ o J c@ C.D c 06-\--, lie_-t-- RECEIVED 1 JUL 10 2025 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#BCOI-23-1733 08/13/2025-08/13/2026 ACC)RC) . CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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. 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 Erin Brigham NAME: g BALDWIN KRYSTYN SHERMAN PARTNERS LLC (A/O No. Ext): (800) 553-1801 (F AA/c, No): -MAIL A erin.bri ham ro ers ra com ADDRESS: g � g 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 INSURER C : INSURER D : PO BOX 183 INSURER E : SOUTH YARMOUTH MA 02664 INSURER F : COVERAGES CERTIFICATE NUMBER: 1132596 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 !ADDLISUBR! ' POLICY EFF POLICY EXP LTR , TYPE OF INSURANCE INSD WVD . POLICY NUMBER 1MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY i I EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ N/A PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY PRO-JECT LOC PRODUCTS - COMP/OP AGG $ ' I I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED N/A BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY Oaccident)PDAMAGE $ AUTOS ONLY , AUTOS ONLY I (Per UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB ! CLAIMS-MADE ! N/A AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION STATUTE ' ERH AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A j 6S62UB1K68658925 01/01/2025 j 01/01 /2026 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes. describe under 500 000 I DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 � N/A DESCRIPTION OF OPERATIONS ( LOCATIONS /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 The Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE l South Yarmouth MA 02664 Daniel M. Crowley, 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