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HomeMy WebLinkAboutCertificate of Inspection Y The Commonwealth of Massachusetts City\Town=. .." of ,E,. m-v' YARMOUTH I.„.„ I 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: BLDCI-15-004922-03 Trade Name: HUNTERS GREEN MOTEL Identify property address including street number,name,city or town and county Located at Certificate Expiration 553 ROUTE 28 05/19/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Classifications(s) Other R-1 01st Floor 37 R-1 Hotel/Motel/Boarding House/Transient INCLUDES SWIMMING POOL&LOBBY 02nd Floor 38 Allowable R-1 Hotel/Motel/Boarding House/Transient INCLUDES OFFICE Occupant Load 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 Mark Gryl� Date of Building Commissioner Inspection 6_,,g......./7 Signature of Municipal Signature of Municipal Building Commissioner ( 1(. Date of Issuance 67,* - Fee:($292.00 BLD_Certoflnspection.rpt p...... _RoTOWN OF YARMOUTH ou • y BUILDING DEPARTMENT 4. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 10, 2019 PAYABLE UPON RECEIPT (X) Fee Required 292.00 ( ) 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: 5 53 RO tJ'fr -2g Name of Premises: Hui t-e rS' 6re e,r) Tel: 50 8 -'7 75 -5L1 © 0 Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to r l on to vs 6ree.,f) Tel: 50 8 - 7 7 5-3-1-1©a Address: 653 Roo t -.28, act ^/q rmp o/1.., iv1A 02 6 7,3 Owner of Record of Building AM r i S J p fi Address /i /PubnlFPfr /el.0,.._ DV, 6 r9-v8' , , t27O � I E Present Holder of Certificate H i r) et-e vs' . _-._ . D 6 A/L I MAY 23 2019 at e of person to whom Title BUILDING ucHARI MENT Certi icate is issued or his agent o_Sl/ d)1YYq — - ------ r Date Email Address: S h r r 555 YL C0144- 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# 61.4067 -/S- Oa(-0013 - 0 3 5/19/2019-5/19/2020 ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/15/2019 T f S 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. PHONE FAX IA/C.No,Ext): (A/C,No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# ' Roseland NJ 07068 INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: SHRIM INC INSURERC: 553 MAIN ST RTE 28 INSURER D: INSURER E WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 1165638 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 ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 10 REN FED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ • GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE OTH- ER A ANY PROPRIETORPARTNER/EX OFFICER/MEM ER/EXCLUDED?ECUTIVE YNN N/A N SHWC061861 05/01/2019 05/01/2020 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURED COPY AUTHORIZED REPRESENTATIVE 1(.:) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ♦ TOWN OF YARMOUTH BUILDING 1, , 1 �` G GAS . ; 1146 ROUTE 28. SOUTH YARMOUTH MASSACHUSEIIS 02664-4451 ''� PLUMBING Telephone(508)398-2231,Ext.1261 —Fax (508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report Date S /p 47U72537,3 �/� �/Address Business Name /`7C//27'Le.4Z S CT/G'C'/, Contact 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: AVM Emergency egress signage Location ❑Emergency egress lighting Location tt 5('1(-( ❑Maintenance of exits Location ❑Guards/handrails Location ❑Signs Location Parking Location ❑Other Location Mechanical ❑Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑Clothes dryer vents Location Qir 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. Ju 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 /d days and contact this office for a follow-up inspection. Local Official/I 640 -TA/4/C7V Received Title Revised 2/8/13