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HomeMy WebLinkAboutCertificate of Inspection The Commonwealth of Massachusetts City\Town of ra 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:AIDEN BY BEST WESTERN BLDCI-20-002587 Trade Name:AIDEN BY BEST WESTERN-LOUNGE Identify property address including street number,name,city or town and county Certificate Expiration Located at 476 ROUTE 28 12/31/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 02nd Floor 42 A-2 Nightclub/Restaurant/Bar/Banquet Hall 42-UPSTAIRS LOUNGE Allowable 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 Philip Simonian Ill Name of Municipal Mark Gryll Date of Fire Chief Building Commissioner ,��Inspection / 5'2/7 Signature of Municipal G[ Signature of Municipal Date of Fire Chief Building Commissioner Issuance //9 aI Fee:$100.00 BLD_Certoflnspection.rpt _ o TOWN OF*YARMOUTH ' -y BUILDING DEPARTMENT N MATTAc. CSE 4. .<..,. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2019 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) 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: 4'/G /?Od77 A G�' YJ7ie,i A 047, Name of Premises: frept,0 3 Y T U 13.7 ,4-' 64GAUT Tel: ��;? ' " /' ,� Purpose for which permit is used: 1./Q� � ,���lY"�l�� . ;� Y� License(s) or Permit(s) required for the premises by other governmental agencies: {{ OLT '3 .1. IO1 i BUILDWG DEPARTMENT License or Permit Agency 3y.R D Lig'(49''fir-- 61 r lbw ((taw() '-r9--/ — Certificate to be issued to 54' Neorez I " ('N '- Tel: 5 7'7 6 r0 Address: it/(o 72-13 Owner of Record of Building Address 5' 4e ` __ y z Present Holder of Certificate —* ./1*/ Signature of person to whom Title C Certificate is issued or his agent m/ 7ZO f //'' �,�` �'l Date Email Address: C.('A (Q)4 ) t if�+�d� -CO 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# C 0tO ' 7 Awe, 12/3 0/2019-12/3 0/2020 ,,._-�...4 JAMSHOT-01 JHOGAN ACORO` DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/1/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Roblin Insurance Agency PHONE 781 455-0700 FPX No):(781)449-8976 144 Gould Street Suite 100 (A/C,No,Est):( ) (A/C, Needham,MA 02494 MI6,certificates@roblininsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance Company 23043 INSURED INSURER B:Liberty Mutual Fire Insurance Co. S&H Yarmouth Hotel LLC INSURER C:Chubb Group of Insurance 41386 Cape Point Hotel 476 Main Street INSURER D:AIM Mutual Insurance Co 33758 West Yarmouth,MA 02673 INSURER E:Travelers Casualty and Surety Company of America 31194 INSURER F:ACE American Insurance Co. 22667 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR TB2-Z11-261917-018 8/1/2018 10/1/2019 DAMAGE TO RENTED 500,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20'000'000 X POLICY PRO- X JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ COMBINED B AUTOMOBILE LIABILITY (Ea acccdent)SINGLE LIMIT $ 1,000,000 ANY AUTO X AS2-Z11-261917-058 8/1/2018 10/1/2019 BODILY INJURY(Per person) $ OWNED x SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PR tDAMAGE $ AUTOS ONLY AUTOS ONLY X Collision X Comprehensive Deductibles $ 500 C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25,000,000 EXCESS LIAB CLAIMS-MADE X 78187751 8/1/2018 10/1/2019 AGGREGATE $ 25,000,000 DED X RETENTION$ 10,000 $ D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WMZ-800-8006935-2019A 8/1/2019 8/1/2020 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBERt EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Crime 106110926 8/1/2018 10/1/2019 Crime 100,000 F Cyber Liability X EON G29006076 8/1/2019 8/1/2020 Cyber Liability 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Location#22070:Aiden by Best Western @ Cape Point,476 Main Street,West Yarmouth,MA 02673 Best Western International,Inc.is listed as an endorsed additional insured in all of the above policies.Assault and battery and abuse and molestation are not specifically excluded in any of the above policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Best Western International,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 8201 N.24th Parkway Phoenix,AZ 85016 AUTHORIZEDTH REPRESENTATIVE L I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r r °F TOWN OF YA R M O U T H ELFLDI GI. 'l ' GAS ` r,A, "� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 __ C`'"' _' PLUMBING ,� Telephone(508)398-2231,Ext.4261-Fax(508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report / �� Date 7,7 -�7 • Address lt� A?o fc 2 9 Business Name //�G4'/7 re-e) Conran 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 Bo Health rules,the following violation(s)were observed: EiXal Q Emer'gencyegress signage Location 4.' i/`e - '.,//A.- 90 �i�'7l�, /'R r 4/i/G ❑Emcgency egress lighting Location ❑Maintenance of exits Location ,Z7/LeirC%t (-)( ❑Guards/handrails Location Zoning Signs f Location 0 Parking Location ❑ Other Location Mitheifikai 0 Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures , on boiler room doors Location - d 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. IA 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 r7,�7 dad contact this office for a follow-up inspection. Local Off:. . - ,.r //' /' 1( �f' V Received By 60A) Title (441 • Revised 2/8/13