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HomeMy WebLinkAboutBCOI-23-1702 fel'ir-4_ k TOWN OF YARMOUTH - Office of the Building Commissioner t,,,, ._.,�„ _ Sig , 1146 Route 28, South Yarmouth, MA 02664 i y 508-398-2231 ext. 1260 Fax 508-398-0836 -MATTACHEESE /�cORPORATED�b�q-Y APPLICATION FOR CERTIFICATE OF INSPECTION June 1, 2026 PAYABLE UPON RECEIPT (X) Fee Required$310.00 ( ) 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 1‘ "- 01.k�e 2-2 J 50 w-t 1, ya rlc,b�j1,1 }\ 0 A(,(2y Name of Premises: c>t R 1 CO 11.46 m t h j U Ms' Tel: 502-3c2 -`7 77O Purpose for which permit is used: ?e r r W o,,\ License(s)or Permit(s)required for the premises by other governmental agencies: RECEIVED License or Permit Agency I ...c Toi r, ac• `1c-,tyl i . MAY 19 2026 e-,!, L. -Te)lx7h 45( 601,46 V;i k' r'l. -o1,.)+,I of `-ir,.ACPJ• . BUILDING DEPARTMENT Certificate t�'be issued to �‘et- ' Cate do,y n ;k vv.s Tel: 53 , _7 277 ®)fr Address: 71 I 1 A i N Sh'L¢.-i-—RA- . .3 So t 11. l c v IN,.o,--t \i M ,k Li 21e 4- C C11: S1 Owner of Record of Building ",,to,rt 0 S ic.,k i ,c., Address 11 i p- c, ,r\ Srree,t- -RI.2. Soi,,h„ ` c.t rl.01,, ':.._ AA A; v'�-.��`'( Present Holder of Certificate Cie/lee-Ai MAA4 y Signature of person to whom Title J Certificate is issued or his agent 5//6).?-A r- Date Email Address: CAPe bree-Ze 5 tf tJ a 3 Ma.' I , Co rrr. 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-23-1702 06/30/2026-06/30/2027 INVOICE 0 FIRE EQUIPMENT �1 Ucit A ` INVOICE It:- SIN329446 AAWily INCaRP0RATE0 gh u INVOICE DATE: 03/12/2026 15 DUE DATE: 04/11/2026 Phone: 508-775-3473 Fax: 508-775-6110 www.feinewengland.com hyaservice@feinewengland.com BILUNG ADDRESS: SHIPPING ADDRESS: PIER 7 CONDO PIER 7 CONDO 711 MAIN STREET 711 MAIN STREET SOUTH YARMOUTH,MA02664 SOUTH YARMOUTH,MA 02664 7.2- . ,' ,- WORK PERFORMED Ext.inspec ,.'i'lt. IMER.REKRENCE WORK ORDER NUMBER PURCHASE ORDER WORK COMPLETEI ON. PI ER7CON D WO-00434793 T&M 03/12/2026 — rtrE , "';' * EICT NAME DESCRIPTION NET VALUE UE 1 Portable Fire Extinguisher 1 -Annual-626A-Extinguisher Inspection $0.00 17 Inspection of Fire Inspection of Fire Extinguishers $170.00 Extinguishers 17 Pull Tamper Seals Pull Tamper Seals $37.40 7 5 lb ABC Recharge Fire 5 lb ABC Recharge Fire Extinguisher $280.00 - Extinguisher 7 Hydrotest dry chem Hydrotest dry chem $280.00 7 Service Collar Service Collar $35.00 7 Oring Oring $49.00 - 1 Labor $75.00 NET TOTAL: $926.40 TAX TOTAL: $25.09 INVOICE TOTAL: $951.49 OUTSTANDING TOTAL: $951.49 Pay Now https://live.protectedpayments.net/PMWeb 1?pmRef=11378&pid=al EUb0000000cSL Wire Funds To: FIRE EQUIPMENT INC Mail Checks To: FIRE EQUIPMENT INC Eastern Bank-ABA 011301798 20 Hall Street Account 21591229 Medford, MA 02155 DATE(MMIDDIYYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 11/25/2025 THIS TIFICATE 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). CONTACT Erica O'Connor PRODUCER NAME: HART INSURANCE AGENCY,INC. PHONE I FAX 243 MAIN STREET (A/C.No.Ext): I (A/C,No): PO BOX 700 ADDRESS: eoconnor@hartinsuranceagency.Com BUZZARDS BAY, MA 025320700 INSURER(S)AFFORDING COVERAGE NAIC# - INSURERA: Associated Employers Ins Co. 11104 INSURED Pier 7 Condominium Trust INSURER B: 711 Route 28 INSURER C: South Yarmouth,MA 02664 INSURER D 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. INSRI IADDLISUBRI i POLICY EFF I POLICY EXP LIMITS LTR i p TYPE OF INSURANCE i INSD MD! POLICY NUMBER ;(MMIDD!YYYY)I(MM/DD/YYYY) p COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ f DAMAGE TO RENTED CLAIMS-MMADE OCCUR . PREMISES(Ea occurrence) $ E i MED EXP(Any one person) $ i i PERSONAL&ADV INJURY I $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1 C POLICY i )JEC7 LOC I PRODUCTS-COMP/OP AGG $$ r OTHER: I AUTOMOBILE LIABILITY I ! COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED ?SCHEDULED AUTOS ONLY 'AUTOS BODILY INJURY(Per accident): $ HIRED NON-OWNED ! ! PROPERTY DAMAGE $ }cewa AUTOS ONLY t n,i AUTOS ONLY (Per accident) I ! $ I • :— UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE , AGGREGATE $ _„i DED i RETENTION$ I $ r A WORKERS COMPENSATION WCC50050114672025A 1 11/06/2025 I 11/06/2026 ✓ 'STATUTE -. T ERN AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L I EACH ACCIDENT $ 500,000 OFFlCER/MEMBEREXCLUDED? N N/AI, (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ 500,000 1 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION Fax#:(508)568-9234 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POUCY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD