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HomeMy WebLinkAboutBCOI-24-24 2026 'y^ _ TOWN OF YAROUTH /• �� YA . M %* a40.tr Office of the Building Commissioner _ 1146 Route 28, South Yarmouth, MA 02664 -_ ' - y' 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHECSC 41,c, ORATEO,b�p� APPLICATION FOR CERTIFICATE OF INSPECTION January 23, 2026 PAYABLE UPON RECEIPT (X) Fee Required$150.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 2\ Pt Y V t r1 G) 3(-0 n .6 k Name of Premises: -r\l 0�b Q cA 5 Tel: g d$- ?j(01 - —1"-If ig Purpose for which permit is used: Se aS,91 a1 L 1 1 tik re LU Cer License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to 1 'C b60({ Z amb t 15 Tel: S 6$ -3(y 1 • 7ll(o Address: 2L RYVk ►nod k Oh S • t E'S 1 y a 0-4.oufir\ Owner of Record of Building INV)O j p kYic \'C ar bo r 1 h C.• Q A- Address 2\ Po( \n y'r0'n S'r W cs\- ki A Y Y•r•O U'syn 62(013 Present Holder of Certifi . e f 0 r� l 1 S MPNa(jEe Signature of pers•n t.w� Title Certificate is is• el o r his agent 21 2(p jeoVo Date 1 f ' r Email Addres.• -cf'd@-cm y boat C A ee COok • COrr FEB 2 6 2026 i 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 chan_e in the above information. aa , , � r Certificate of'Inspection#_BCOI-24-24_ 04/0 1/2026-11/30/2026 v • �AC �� DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/15/25 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(les)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). CACT PRODUCER NAAME: PAUL SCHLEGEL WORLD INSURANCE ASSOCIATES LLC P �O No. ): 508-771-8381 (AA/C (�H ,No): 508-771-0663 34 Main Street -eV L West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: AMERICAN AUTOMOBILE INS CO INSURED INSURER B: GUARD INSURANCE ABOVE THE HARBOR,INC. DBA INSURER C: ARBELLA TUGBOATS INSURER D: NAUTILUS INS COMPANY 21 ARLINGTON ST WEST YARMOUTH,MA 02673 INSURER E: 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 ADDLBUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDIYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO D CLAIMS-MADE X OCCUR PREMISES Ea Eoccurrence) $ 100,000 MED EXP(Any one person) $ 1,000 A A OSU1011142-00 06/17/25 06/17/26 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JPERO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY n OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ C OWNED SCHEDULED A 10222627687 06/25/25 06/25/26 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) , $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 D X EXCESS LIAB CLAIMS-MADE A AN1351878 06/17/25 06/17/26 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N • STATUTE ER B OFFICER/MEM ANY ER EXCTNER/EXLUDED?ECUTIVE N N/A ABWC657282 06/08/25 06/08/26 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 LIQUOR LIABILITY EACH OCC 1,000,000 A A OSU1011142-00 06/17/24 06/17/25 POLICY LIMIT 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) LISTED AS ADDITIONAL INSURED ON GENERAL LIABILITY AND LIQUOR LIABILITY: HYANNIS MARINA,HYANNIS MARINE SERVICE REALTY TRUST,S&L REALTY TRUST,MARINE REALTY TRUST, 146 LEWIS BAY ROAD REALTY TRUST,162 LEWIS BAY ROAD REALTY TRUST,OCEAN REALTY TRUST,WAYNE KURKER,HABOUR CLUB,INC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Hyannis Marina ACCORDANCE WITH THE POLICY PROVISIONS. 1 Willow Street Hyannis MA 02601 AUTHSV,INZED REP NTATI 1 .) I ‘::c ©1988-2 5 ACORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD