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Home My WebLink AboutBCOI-23-1710 ro, - dYA4 TOWN OF YARMOUTH �`�' Office of the BuildingCommissioner � 1146 Route 28, South Yarmouth, MA 02664 ii 1N -,.r 508-398-2231 ext. 1260 Fax 508-398-0836 MATTAEHEESE A ' "CoRFs'oRA1E%�''r �`" " APPLICATION FOR CERTIFICATE OF INSPECTION June 1, 2026 PAYABLE UPON RECEIPT (X) Fee Required$304.00 ( ) 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: -3 2,q OU ( \ y g Y I-°ire x v 42— Name of Premises: 'Mc, '_Qn C.-ki b Tel: `gib b F---(°45`) ,------ Purpose for which permit is used: I /me SA P—_--- License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency RECEIVED l' MAY 15 2026 Certificate to be issued to ill,ille Ocecul Ciu� Tel: BUILDING DEPARTMENT Address: er Owner of Record of Building Address Present Holder of Certificate /14/beilall4e( doictik c::, /iv? ignature of person to whom Title ' / Certificate is issued or his agent /I G�L� n^ 0ceQh .oS Date Email Address: �v l �lG( {�t'�Gl, �erf�Pc LOV 1 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-23-1710 06/07/2026-06/07/2027 Eastern Alliance Insurance Company 25 Race Avenue PO Box 83777 Lancaster, PA 17608-3777 WORKERS' COMPENSATION and EMPLOYERS' LIABILITY INSURANCE POLICY In Witness Whereof we have caused this policy to be executed and attested and if required by state law this policy shall not be valid unless countersigned by our authorized representative. !i Kevin M.Shook Kathryn A.Neville President Secretary If you need to report a claim, please call the following telephone number: 1-800-336-3658 Questions or concerns about your policy should be directed to your producer. If you need further assistance, contact us at 1-855-533-3444 or at the following address: Underwriting --Policy Information P.O. Box 83777 Lancaster, PA 17608 WC 99 06 00(11108) Insurer: Eastern Alliance Insurance Company Policy Number:001-0000618838-2026A Previous Policy:001-0000618838-2025A Workers Compensation and Employers Liability Policy Information Page (1 ) Name and Mailing Address of the Insured: Agency: Gregory & Appel, Inc. Resort Management & Consulting Group, LLC, 1402 N. Capitol Avenue 783 Sandy Lane Suite 400 Surfside Beach, SC 29575 Indianapolis, IN 46202 Agency Code: 8550 See Named Insureds — Extension of Information Page Fed ID Number: 83-1075760 Legal Entity: Limited Liability Company (LLC) Bureau ID Number: 914813557 NCCI Company Number: 42997 Other workplaces: See Additional Locations — Extension of Information Page (2) Policy Period: From 2/1/2026 to 2/1/2027, 12:01 a.m. standard time at the insured's mailing address. (3) Coverage: A. Workers Compensation Insurance: Part One of this policy applies to the Workers Compensation Law of the following states: MA, NC, SC, VA B. Employers Liability Insurance: Part Two of this policy applies to work in each of the states listed in item (3)A. The limits of our liability under Part Two are as follows: Bodily Injury by Accident - each accident $1 ,000,000 Bodily Injury by Disease - policy limit $1 ,000,000 Bodily Injury by Disease - each employee $1 ,000,000 C. Other States' Insurance: Part Three of this policy applies to the states, if any, listed here: ALL STATES EXCEPT ND, OH, WA, WY and the states designated in 3.A. of the information page. D. This policy includes the following forms and endorsements: See Listing of Endorsements — Extension of Information Page (4) The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. False See Schedule of Operations — Extension of Information Page Minimum Premium $720 Total Estimated Annual Premium $66,189 Expense Constant $338 Countersigned by: (,44 / AY 11(r/4— WC 00 00 01 A Insurer: EASTERN ALLIANCE INSURANCE COMPANY Policy Number: 001-0000618838-2026A Extension of Information Page Additional Locations Other work place locations not listed on Page 1,Item 1: 0001Ttesort Management&Consulting Group,LLC 329 South Shore Drive South Yarmouth,MA 0266 0002 Resor anagement onsultingc5roup,LLC 1110 S.Virginia Dare Trail Kill Devil-Hills,NC 27948 0003 Resort Management&Consulting Group,LLC 4724 N.Croatan Hwy Kitty Hawk,NC 27949 0004 Resort Management&Consulting Group,LLC 2108 N.Ocean Blvd Myrtle Beach,SC 29577 0005 Resort Management&Consulting Group,LLC 8 Wimbledon Court Hilton Head Island,SC 29928 0006 Resort Management&Consulting Group,LLC 1307 S.Ocean Blvd Myrtle Beach,SC 29577 0007 Resort Management&Consulting Group,LLC 100 N.Waccamaw Dr Murrells Inlet,SC 29576 0008 Resort Management&Consulting Group,LLC 215 Atlantic Avenue Murrells Inlet,SC 29576 0009 Resort Management&Consulting Group,LLC 783 Sandy Lane Surfside Beach,SC 29575 0010 Resort Management&Consulting Group,LLC 1301 Atlantic Avenue Virginia Beach,VA 23451 WC 00 00 01 A