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HomeMy WebLinkAboutCertificate of Inspection The Commonwealth of Massachusetts City\Town of YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: HAMPTON INN&SUITES CAPE COD BLDCI-16-006844-03 Trade Name: HAMPTON INN&SUITES CAPE COD Identify property address including street number,name,city or town and county Certificate Expiration Located at 99 ROUTE 28 06/01/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 26 R-1 Hotel/Motel/Boarding House/Transient Allowable 02nd Floor . 54 R-1 Hotel/Motel/Boarding House/Transient Occupant Load 03rd Floor 56 R-1 Hotel/Motel/Boarding House/Transient 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 Name of Municipal P Mark Grylls Date of � Building Commissioner Inspection - Signature of Municipal Signature of Municipal z Date of Building Commissioner Issuance / y Fee:$478.00 BLD_Certoflnspection.rpt _., ,..xY4R ;' , . TOWN OF YARMOUTH t, it 4i•tit.. c a .� - BUILDINGDEPARTMENT Yt "" "'' 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 3,2019 PAYABLE UPON RECEIPT (X) Fee Required 478.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 1 10.7,1 hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: '99 Main ...1- __._r'STC: rdsE — —.__._-_ Name of Premises: -0111 ,SA,e_i4ic,S Car ColTel: Purpose for which permit is used: e_i License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit RECEIVED Agency . . .0l c .1r ►se- MAY 20 2019 ____ _ BUILDING DEPARTMENT _ Certificate to be issued to Cm. ,r r t Address: era A�_._ {,,� .i __ Owner of Record of Building - _,.. 1Lr `Dz`e°109 ark Address ...w • __ Present Holder of Certificate m*__ti _ -—_-� --t—r - '" . ,., nature of person whom Title Certificate is issued his agent Date ______--- _ Email Address: . Ai..: Ati,.. to 0,;.'r11^.I'Ll Ca.f:12r'a Instructions: Make check payable to: Town of Yarmouth 1, 1146 Route 28,South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submi b issued.for a The building structure official or part t thereof to be certified. Application must be received before the certificate will e notified within ten(10)days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION TIOF INSPECT ANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE Certificate of Inspection#3 4 :--4- 00 by(y -0-3 6/1i2019-6/1/2020 t, j-"„a, DARLDEV-01 LBROWN 4CO'RI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/10/2019 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 POUCIES 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 certHicate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Novi cpt,lecr Loretta Brown FBirreure,LLC 'PHONE j A FAX No) - 11 128 Dean Street ( ,No,Eat):(508 824-86661240) Taunton,MA 02780 _Efts,;LBrown@ffbinsure.com_ INSURER(S)AFFORDING COVERAGE NAIC I CoINSURER - 41360_ _ -_ INSURED wsURERB_Mapfre Insurance Company - - __ _23876 FED Hotels Properties LLC INSURER C AIM Mutual_Insurance Company - .33758 1105 Fall River Ave INSURER D:Ohio Casualtyjns Company - .24074 Seekonk,MA 02771 ;INSURERS:-- — _. — 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. POLICY EFF POLICY EXP INSR ADOL;SUBR POUCY NUMBER IMM►DO/MY) IMMIDDIYYYY) OMITS LTR` TYPE OF INSURANCE INSD)NVD_ A X COMMERCIAL GENERAL umuuTY EACH OCCURRENCE S 1,000,000 . _ -_ CIJIIMS MADE X OCCUR 8500068374 DAMAGE TO RENTED 3/31/2019 3131/2020 PREMISES1EI Olxu once) ;-$ 250,000 -- 10,OOb I I MED EXP(MY one Person) S - 4 1,000,000 • PERSONAL&ADV INJURY S _ _ — 2,000,000 GENL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE i,_- POLICY X ;LOC PRODUCTS-COMP/OP AGGS Included — Liquor Liab 1,000,000 $ OTHER: 'COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LU191LITY (Ea accident)_ S_ ANY AUTO BHVZZT 3/31/2019 3/31/2020 BODILY INJURY(Per person) .t --- OWNED X AUTOS LED BODILY INJURY(Per aoridef*) S ---- -_ AUTOS ONLY .- I :PROPERTY DAMAGE Fq��p i(PeracadenU X AUTOS ONLY 'X I AUTOS ONLY '_f I $ A X UMBRELLA UAB X OCCUR , I .EACH OCCURRENCE S 10,000,000 4600088388 3/31/2019 3/31/2020 10,000,000' EXCESS LIAR CLAIMS MADE. AGGREGATE __-_ :___ . DED X i RETENTIONS 10,000 S C WORKERS COIM'ENSATION . X PER ATUTE ERA AND EMPLOYERS'LIABaJTY v 1 N 1NMZ8008007249 3/31/2019 3/3112020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE CUTIVE . El.EACH ACCIDENT __S- �1FeIsH► N NIA 1,000,000 E.L.DISEASE EA EMPLOYEE S_ If yes,describe under E.L.DISEASE-POLICY LIMIT S pExcesxcess Liability abllity 1,000,000 DESCRIPTION OPERATIONS below EC057913907 3131/2019 3/31/2020 Per Occurrence 10,000,000 il DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 701,Additional Remarks Schedlde be aaaehed I more space N regccired► Umbrella Liability and Excess Liability policmaiimits extend over the General Uabil ,Liquor Liability,Automobile Liability,and Workers Compensation policies. Regarding:Hampton Inn&Suites,99 Main St(Route 28),West Yarmouth MA 02673. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE RDAH DATE THE POLICYPROVISIONS.E , NOTICE IE WILL BE DELIVERED IN ACCORDANCE w 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE liu, ,o`'�. 3 n.. ©1968-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD OF - BUILDING a =le 111 r TOWN OF YARMOUTH ELECTRICAL GAS di 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING .It Telephone(508)398-2231,Ext.1261 -Fax(508) 398-0836 „ .. i+'' ,,,.'` SIGNS BUILDING DEPARTMENT Inspection and License Report Date Address / 7��d� O�C.J Business Name �/��7e3,, -Z 4/ Conti 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: Agog ❑Emergencyegresssignage Location ❑Emergency egress lighting Location ❑Maintenance ofexits Location °°61: ❑Guards/handrails Location Zoning 0 Signs Location ❑Parking Location ' ❑ Other Location "terhanica,( 0 Combustion Air Location 1 ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents Location 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 /5— days and contact this office for a follow-up inspection. Local Official/I /42 Received By ° 3 Title , Revised 2/8/13