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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: SUPER 8 MOTEL BLDCI-16-007004-03 Trade Name: SUPER 8 MOTEL Identify property address including street number,name,city or town and county Certificate Expiration Located at 41 ROUTE 28 05/15/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 20 R-1 Hotel/Motel/Boarding House/Transient 20 UNITS LOBBY Allowable 02nd Floor 20 R-1 Hotel/Motel/Boarding House/Transient 20 UNITS Occupant Load MANAGER'S APARTMENT 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 Grylls Date of '� Building Commissioner ection / '5Q Signature of Municipal Signature of Municipal . Date of Building Commissioner Issuance /],_�� `� Fee:$190.00 B LD_Certofl nspection.rpt • � o TOWN OF YARMOUTH o - -y BUILDING DEPARTMENT MATTA A SE^ �, �.o..,o� � 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION June 11, 2019 PAYABLE UPON RECEIPT (X) Fee Required .070Q lClL .CS0 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby app,ty for a • Certificate of Inspection for the below-named premises located at the following address: CcA Spe C, Street and Number: 1t c-A-5.r & (.(s li q q - a' L-10 Name of Premises: $C 2 2 8 Tel: 1 cc,S, `1 ') 'S^ 09 Purpose for which permit is used: �— License(s)or Permit(s)required for the premises by other governmental agencies: z ; ,=1 License or Permit AgencyJUN .I �U(� 0-'ht `f) Certificate to be issued to SUP r- S Tel: 1 COS C°e1___ Address: Li f C- t2-r 2-er to •Neprrr.urvri am,,; 2 Owner of Record of Building 1--t s tc.l Address S , --Qa7 PC,in3 exit RIAJALQI-t-zi,4 tG1-,8-14 c1 Present Holder of Certificate S o -�- Signature of person to whom Title Certificate is issued or his agent jriy* 4i �" , 411 Date Email Address: �`D-UM P lg1 yMtcy0, coin 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 ISSU YQ IFICATE OF INSPECTION. Certificate of Inspection# - / w 7/28/2019-7/28/2020 • Client#: 16866 2SUPER8M0 DATE(MMIDD/Yr Y) ACORDr. CERTIFICATE OF LIABILITY INSURANCE 06/12/2019 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 FAX 5087781218 (A/C,No,Ex* _.. (A/C,N9): Dowling&O'Neil Insurance Agy E-MAIL ADDRESS: P.O.Box 1990 INSURER(S)AFFORDING COVERAGE NAIL# Hyannis,MA 02601 Lloyds London LLOYDS s o INSURER A: Y INSURED INSURER B:Scottsdale Insurance Company 41297 Kishor K.Patel A/O Kiran K Patel NO NorGuard Insurance Company 31470 INSURER C: P Y AUM Corp. dba Super 8 Motel INSURER D: 3 Algonquin Drive INSURER E: Burlington,MA 01803 i 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 jADDL SUER POLICY EFF POLICY EXP i LIMITS LTR TYPE OF INSURANCE 'IN D/ SR WVD POLICY NUMBER (MM/DD/YYYY)!(MM/DYYYY); A XI.COMMERCIAL GENERAL LIABILITY I XSZ116300 08/26/2018108/26/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X.,OCCUR II P EpREMISESgEaoccurrence). $50,000 X BI/PD Ded:500 MED EXP(My one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: �, GENERAL AGGREGATE $2,000,000 X POLICY JECOT LOC PRODUCTS-COMP/OPAGG $Included I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ Ii AUTOS ONLY I AUTOS I : HIRED I NON-OWNED i PROPERTY DAMAGE $ AUTOS ONLY j AUTOS ONLY I (Per accident) I $ B �iI X!UMBRELLA LIAB XOCCUR I XBS0093763 08/26/2018 1 08/26/201 EACH OCCURRENCE $3,000,000 , EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 I DED X RETENTION$O $ C STATUTE ERH I AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE—' i E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N.;NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under ' I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below l it DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Rt 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 -- AUTHORIZED REPRESENTATIVE —1✓/.0-- '-''? .'—=:'moo,. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S237091/M237088 RPCH1 ,f. a OF Ye-- = TOWN OF YARMOUTH ELECTRIC. ~ 1,6 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 GAS ,t ~" II _ Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836 PLUMBING '' SIGNS BUILDING DEPARTMENT Inspection and License Report 7 :3�''/ Date •• / Address / " Xe �2� Business Name Sc'1 U Tic 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: 11` Egress .I / ZCIC2/ )//❑ Emergency egress signage Location (5-Of �P G C� ❑ Emergency egress lighting Location ' s`e k` '" ❑Maintenance of exits Location ❑ Guards/handrails Location Zoning ❑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 Other 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 da s and contact this office for a follow-up inspection. Local Official/Inspector I3�q' ''v -"Z.."(' I Received By Title Revised 2/8/13