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HomeMy WebLinkAboutBLDCI-16-003258-02 IN. t The Commonwealth of Massachusetts it r —_: itl)c � City\Town of s ®Utir - YARMOUTH New and Renewal Certificate of Inspection In accordance with 780 CMR,Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Business Name:HAMPTON INN&SUITES/CAPE COD BLDCI-16-003258-02 Trade Name: HAMPTON INN&SUITES RESTUARANT - Identify property address including street number,name,city or town and county Certificate Expiration Located at 99 ROUTE 28 12/31/2019 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) _ A-2 01st Floor 64 A-2 Nightclub/Restaurant/Bar/Banquet Hall Breakfast Room/Lobby Allowable 01st Floor 150 A-2 Nightclub/Restaurant/Bar/Banquet Hall Nantucket Room-150 Occupant Load Seating/Standing 72-tables&chairs 01st Floor 44 B Business Exterior Pool 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 life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of-the certificate is strictly prohibited Name of Municipal Philip Simonian III Name of Municipal //Clark Grylls /� Date of Fire Chief Building Commissioner __ , / 7 Inspection Ze2—S'/g Signature of Municipal Signature of Municipal y�� j Date of Fire Chief '/�If - •/ i >/� Building Commissioner L....---j/ //�/ /� Issuance /Zrif / , Fee:$150.00 . BLD Certoflnspection.rpt 49;_ _ TOWN O F YARMOUTH BUELEG�TRIG `3IL � GAS 1- ,;NI ,` 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 "":1( =` Telephone(508)398-2231,Ext.1261 —Fax (508)398-0836 PLUMBING SIGNS --_ - - BUILDING DEPARTMENT Inspection and License ReportDate /2/4/1"1/)7-617 �— G/D/9 r Address / P Dori .2 Business Name /4/1"i! TGv7 rjY/t/ Con Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: "gra* U Emergency egress signage Location ❑Emergency egress lighting location1( / l ❑Maintenanceofmits Location ❑Guards/handrails Location onin ❑ Signs Location ❑Parking location ❑ Other Location Mecbairzieaf ❑ Combustion Air Location ❑ Storagein Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents Location Qther Location The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. in order to abate the above violation(s)you must- o Make corrections immediately and contact this office for a follow-up inspection. o Make corrections prior to opening and contact this office for a follow-up inspection. o Make corrections prior to your next annual inspection. o Make corrections within 7 days and contact this office for a follow-up inspection. IoalOffcial/Ins r /� art' at Received By Lf "''' , / Title J Revised 2/8/13 '4 } ,R TOWN OF YARMOUTH _ � BUILDING DEPARTMENT w.* 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 3, 2018 PAYABLE UPON RECEIPT ( Y) Fee Required S150.00 ( ) No Fee Required In accordance with the provisions Sof the Massachusetts State Building Code, Section 110.7, I hereby appl for Certificate of Inspection for the below-named� � premises located at the following address: RECEIVED CE ' vED Street and Number: -`RM0.11p 17T K-I-& 2 d _ NAV 1421118 Name of Premises: _s_ .__ _vi +Y1 +S.A.t C$ (1n po Tel: FITMENT 1 BUILDING UEFA Purpose for which permit is used: _ 1401e1___..___ — License(s) or Pennit(s) required for the premises by other governmental agencies: License or Permit Agency .It CPinEe 11 er nn b Vmktes C� n•�;�i Certificate to be issued to ISvta+asto^I'ta.� Tel: SQg=gg0t0 Address: 9R Ma►n Sit._Rt Owner of Record of Building FAL_fi �13_ '(10',`Pl'�t`,,' Address . ICIS Fall R11RF In-'i I --- . ._--- Present Holder of Certificate Stbit,' .yw y �tS 0 raj • MOS ¢Q M - Si•gnature of person to whom Title Certificate is issued or his agent _ ---_ Date eiYllflaI) Grail Address: Ir -- ''gn1+I ncarc (.Corn Instructions: Make check payable to: Town of Yarmouth 1 146 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 he 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 // ,B�nti=I4-ob3ZSt OZ. Ul/2019-12/31/2019 • e4 1". DARLDEV-01 LBROWN /4.--- CERTIFICATE OF LIABILITY INSURANCE DATE 1 /03/20f7 �_ � 1vo3/zo17 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 CONTNACT Loretta Brown NHO 8 neuro,LLC PHONE FAX 12 128 Dean Street E.M No,Est):(508)824-8666 1240 (ac,Nd): Taunton,MA 02780 ADD fEss: LBrown@fbinsure.com INSURER(S)AFFORDING COVERAGE NAIC A INSURERA:Arbella Protection Ins Co 41360 INSURED INSURER B:Pilgrim Insurance Company 21750 FED Hotels Properties LLC INSURER C:Nat'l Liability& Fire Ins Co 20052 1105 Fall River Ave INSURERD:Ohio Casualty Ins Company 24074 Seekonk,MA 02771 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 ADDL SUeR POLICY EFF POLICY EXP _LIN_ TYPE OF INSURANCE 9NSD Yl/V0 POLICY NUMBER (MMLQ Y LiMMIDP)yyyp LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000'000 CLAIMS-MADE X OCCUR 8500046875 03/31/2017 03/3112018 DAMAGE TORENrarrence)_ S 250,000 MED EXP(Any one person) 5 10,000 PERSONAL&ADV INJURY 5 1.000'000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 2,000,000 POLICY JECpT X LOC PRODUCTS.COMP/OP AGG S Included OTHER, .. Liquor Liab s 1,000,000 B AUTOMOBILE LIABIUTY • COMBINED SINGLE LIMIT 1,000,000 (Ea accident 5 ANY AUTO PRC00001005283 0313112017 03/31/2018 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY X AUTTO(S�WN p BODILY INJURY(Peraccidenl) 5 X AUTOS ONLY X AUOTOS ONLY (Per acccPROEident)AMAGE 5 5 • A X UMBRELLAUAB X OCCUR EACH OCCURRENCE 5 10,000,000 EXCESS LIAB CLAIMS-MADE 4600047384 03/31/2017 03/31/2018 AGGREGATE s 10,000,000 DED X RETENTIONS 10,000 $ C WORKERS COMPENSATION - X PER 0TH. AND EMPLOYERS'LIABIUTY STATUTE ER • ANY PROPRIETOR/PARTNER/EXECUTIVE YIN •V9WC818846 03/31/2017 03/31/2018 1,000,000 ApFFICERR EXCLUDED? NIA E.L.EACH ACCIDENT 5 (MandaloryinNH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 II yes.describe under 1,000,000 _ DFSCRIPTIONOFOPERATIONSbelow El_UISEASE-POLICYLIMIT 5 • D Excess Liability EC01857913907 03/31/2017 03/31/2018 Per Occurrence 10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon space la required) Umbrella Liability and Excess Liability policies/limits extend over the General Liability,Liquor Liability,Automobile Liability,and Workers Compensation policies. Regarding:Hampton Inn 8 Suites,99 Main St(Route 28),West Yarmouth MA 02673. CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 ---__. AUTHORIZED REPRESENTATIVE $ a&X. 2)440-,.., ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD