Loading...
HomeMy WebLinkAboutBCOI-23-1789 2026 � 0 YA4\, TOWN OF YARMOUTH 1. _ �. Office of the Building Commissioner � y;4 44. 1146 Route 28, South Yarmouth, MA 02664 'co7k-4 - _ -, 1 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESC 96'P0RAlE\ aIEI6AEIb RTIFICATE OF INSPECTION August 15,2025 _ SEP 08 2025 PAYABLE UPON RECEIPT (X) Fee Required$150.00 ou o - ;- ( ) No Fee Required By 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: g9 1-(al i'j LAT. 1L e. O 10 Name of Premises: , n 117n ,-F.L�({I�C.S 0o l �lTh Tel: j pdk - c� G,2 - 96/(J Purpose for which permit is used: N 1' / License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency 417)(,vii 4/Ql or l--) 42_0SQ... Certificate to be issued to 11/S SC( N I/Q s; 7/4a,v/G),a inn Tel: 56 g-- ,?(0.) - 90/D Address: 99 )14r, /r) `S . L. 'e 2 S -,,-.-t c iites Owner of Record of Building FED it-/n,1e js +- ()rt rI/rrc�J, -e_ve/Cp/'YLt rri-' Address /7 2-1 -/0,(/ P 1 I:P( /9-(,'e -Ex_c 1/4i h 3 $/,r/ � goc2. f'CC?r?-, )-' v - ) Present Holder of Certificate (vn f7-kon 1 n n c&L,(l-i.,S n_,A pe OW .: e‘"j 0&44'Le2 Treii 40" Signature of person to who Title Certificate is issued or his agent SPa Cl 1 2 Date Email Address: -e f)a('h i006) c/arl//?1 h(I'(/5 .writ 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-23-1789_ 12/1/2025-12/31/2026 Client#: 144654 DARLIDEV ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)9/02/2025 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lauren Luke E: Starkweather&Shepley PHONE 401 435-3600 FAx 401-735-1059 PO Box 549 E-u"I IESS: Iluke@starshep.com Iluke starshe com MI6 Providence, RI 02901-0549 INSURER(S)AFFORDING COVERAGE NAIC# 401 435-3600 INSURER A:Travelers Propty Casualty Co of America 25674 INSURED INSURER B:Memic Group 14164 FED Hotel Properties LLC INSURER Firemans Fund Insurance Co 21873 _ 99 Main Street Chubb Custom Insurance Company38989 INSURER D: West Yarmouth, MA 02673 Underwriters at Llo d s London 1122 INSURER E: Y 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 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 TYPE OF INSURANCE IINDSRL y VD POLICY NUMBER (MM/DDY/YYYY) (MM/LDCY DIIYYYY) LIMITS A X COMMERCIAL GENERALUABILITY X X P6308X407200PHX2 03/31/2025 03/31/2026 EACH OCCURRENCE $1,000,000 E CLAIMS-MADE X OCCUR PREMISES(EaEocccurrence) $500,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I JJEECT X I LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X BA8X4225652543G 03/31/2025 03/31/2026 paMalgdEeDneNGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ X AUTOS ONLY X ANON-OWNED ONLY (Per accident) A X UMBRELLA LIAB X OCCUR X CUP7X81574425NF 03/31/2025 03/31/2026 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION 3102810469 03/31/2025 03/31/2026 X PERATUTE OTH- AND EMPLOYERS'LIABILITY ST ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under i DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $1,000,000 C Excess Liability USC035698252 03/31/2025 03/31/2026 $5,000,000 D Employee Theft J06600384 03/31/2025 03/31/2026 $1,000,000; $10,000 Ded E Cyber Liability D23B6E250801 03/31/2025 03/31/2026 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured and Waiver of Subrogation per policy terms and conditions as listed above. Umbrella Liability and Excess Liability extend over General Liability, Liquor Liability,Automobile Liability and Employers Liability. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are,registered marks of ACORD #S2681143/M2587250 PAT2