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HomeMy WebLinkAboutCertificate of Inspection • The Commonwealth of Massachusetts 3 City\Town of 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-16-003258-03 Trade Name: HAMPTON INN&SUITES RESTAURANT Identify property address including street number,name,city or town and county Certificate Expiration Located at 99 ROUTE 28 12/31/2020 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 64 A-2 Nightdub/Restaurant/Bar/Banquet Hall Breakfast Room/Lobby Allowable 01st Floor 150 A-2 Nightclub/Restaurant/Bar/Banquet Hall Nantucket Room-150 Seating/Standing Occupant Load 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 HI Name of Municipal Mark Grylls Date of /77e3-147Fire Chief Building Commissioner Inspection • Signature of Municipal Signature of Municipal Date of Fire Chief A wilding Commissioner Afra- Issuance ///• J 2 `v9 Fee:$150.00 B LD_Certofi nspectio n.rpt 4- �' 1- TOWN OF YARMOUTH ' c -y BUILDING DEPARTMENT x , r. .'," 1146 Route 28. South Yarmouth. MA 02664 508-398-2231 e\t. 1260 APPLIC'AT1ON FOR CERTIFICATE OF INSPECTION October I.2019 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code. Section I 10.7. I hereby apply for a Certificate of inspection for the below-named premises located at the following address: 7 Street and Number: co Mo-in SF Rciira.. 2 _ Name of Premises: }O + thf _pCQOTel: .. __ 1 Purpose for which permit is used:_iid+1 License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit AAgency R E C E I V E D nal " �'� -- --- OCT 28 2019-1 - - I DEPARTMENT Cenificate to be issued to 1 Q" iWy 1 P.t em s • plO y Address: _°9_.._ 041 r _ q. Owner of Record of Building Ffi0 1A0Vc.15 -1r mat Zit __. Address 1.16,5__V4,11 lk i / ekoAk_ M'IA 0m1 I Present holder of Certificate1.10.0100,31tr, 4.346 ry,p' +Herr • r e( Signal of person to whom Title Certificate is issued or his agent -- 10.25.19 Date 1-m:ill Address. bre nog,.el,. \lanr-onInncaptcc1cam y Instructions: Make check payable to: Town of Yarmouth 1146 Route 2H, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted fir 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. Cenificate of Inspection#74062._A, — CO 3,2<f-p 3 12/30/2019-12/30/2020 h _ �-.•1 DARLDEV-01 LBROWN DATE(MM/DD/YYYY) A �RtJ CERTIFICATE OF LIABILITY INSURANCE 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 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 NApME CT Loretta Brown FBinsure,LLC i PHONE FAX 128 Dean Street (A/C,No,EXt):(508)824-8666 1240 (A/c,No): E-MAIL LBrown@fbinsure.com Taunton,MA 02780 ADDRESS: @ INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:Arbella Protection Ins Co 141360 INSURED INSURER B:Mapfre Insurance Company _ ,23876 FED Hotels Properties LLC L INSURER c:AIM Mutual Insurance Company 33758 1105 Fall River Ave ;INSURER o:Ohio Casualty Ins Com_pany 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 TYPE OF INSURANCE '.ADDL•SUBR' POLICY NUMBER ' POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMMIDD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -- DAMAGE TO RENTED 250,000 CLAIMS-MADE X OCCUR 8500068374 3/31/2019 3/31/2020 PREMISES(Ea_oCCurrence) $ MED EXP(Any one person) $ _ 10,000 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: ; GENERAL AGGREGATE $ 2'000'000 POLICY pi, X LOG PRODUCTS-COMP/OP AGG $ Included OTHER: , ,Liquor Liab $ 1,000,000 B AUTOMOBILE LIABILITY COMBINED e81 accident) SINGLE LIMIT $ 1,000,000 •ANY AUTO I 1BHVZZT 3/31/2019 3/31/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X_ AUTOS .BODILY INJURY(Per accident),$ X WWNNEE PROPERTY acc dent DAMAGE $ • AUTOS ONLY X AUOTO ONLDY A X UMBRELLA LIAB X OCCUR ,EACH OCCURRENCE $ 10,000,000 EXCESS LIAB • CLAIMS-MADE 4600068388 3/31/2019 • 3/31/2020 AGGREGATE $ 10,000,000 DED X RETENTION$ r $ 10 000 C WORKERS COMPENSATION X STATUTE EORH _ AND EMPLOYERS'LIABILITY YIN WMZ8008007249 3/31/2019 3/31/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $ _ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory inNH) _ E.L.DISEASE-EA EMPLOYEE,$ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Excess Liability ' 1EC057913907 3/31/2019 3/31/2020 Per Occurrence 10,000,000 • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Umbrella Liability and Excess Liability policies/limits extend over the General Liability,Liquor Liability,Automobile Liability,and Workers Compensation policies. Regarding:Hampton Inn&Suites,99 Main St(Route 28),West Yarmouth MA 02673. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 — AUTHORIZED REPRESENTATIVE i0,4, .X. t3O-No ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD