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HomeMy WebLinkAboutBLDCI-16-006844-06 The Commonwealth of - ssaee- setts } — City\Town of s:. . = �— YARMOUTH ii, 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-16-006844-06 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 06/29/2023 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 Mark Grylls Date of G.--a3- Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance 7/�O/Z Z Fee:$478.00 RI fl (.arfnflner rfinn rnf o .yq . . t `o11 TOWN OF YARMOUTH ; BUILDING DEPARTMENT ,t,,.� " 1146 Route 28, South Yarmouth, MA 02664 5(18-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 1,2022 PAYABLE UPON RECEIPT (X) Fee Required $478.00 ( ) 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: 1 1 Name of Premises: ihnipitin rape Cbd Tel: Purpose for which permit is used: License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Food Tor.)rn o-P Yoerrwio- h L'9Gb✓' Ci1,4 ^,;IMenf/grnusemen4-1 V Certificate to be issued to /r)^ `1u' s RECEIVED _ F(=� Nofe��iyo�,� eat rQ� Tel: Address: 99 m�ir) .1'� L)eTh ynii»o�>.11� , rYl�l �b7� Owner of Record of Building FE° fiafe/ Proper-1;4.s , LLC _ MAY 20 ZOZz Address //65 Fn// R,ver ,gue Seekonk_ ruff OD-17) Present Holder of Certificate /=CD /4a+e/ //-1r; n Inn t Su; S G T 3y P/esid eni- Signa re of per o whom Title Certificate is issued or his agent 5117/ e cR. Date Email Address: d i QnQ d nr"lin9ho+els • C o•» 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# 8tLr/—/t d,0(p #,_ ODD 06/29/2022-06/29/2023 s I _ ....1 DARLDEV-01 LBROWN ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/17/2022 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 NAME CT Loretta Brown FBinsure,LLC r PHONE Ext 508 824-8666 I FAX No 508 880-0142 128 Dean Street �-' ) ( ) S— , )( ) 42 Taunton,MA 02780 ADDRESS loretta@fbinsure.com INSURES)AFFORDING COVERAGE I NAIC# INSURERA:Arbella Protection Ins Co 41360 INSURED INSURER B:New Hampshire Employers Ins Co _--_ 13083 FED Hotel Properties LLC INSURER C:Ohio Casualtylns Company 24074 99 Main St INSURER D: _±_ West Yarmouth,MA 02673 !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 I POLICY El I POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI IMMIDD/YYYY) 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE -_ - 250,000J CLAIMS-MADE FX OCCUR '8500068374 3/31/2022 3/31/2023 PRMEORENTED c r $ MED EXP An one erson 10,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 1$ 2,000,000 POLICY J Ta X LOC i PRODUCTS-COMP/OP AGG I $ 2,000,000 OTHER: Liquor Liab $ 1,000,000 I COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY I L(Ea.acciden!)— ___-- $ X ANY AUTO 1020096475 3/31/2022 3/31/2023 ! BODILY $_ OWNED 1 SCHEDULED AUTOS ONLY _ AUTOS ' BODILY INJURY(Per accident $HIRED ONLY F�1 NON- ONLY PROPERTY DAMAGE AUTO � NON- WNED (PeraccidentT _- $ A X UMBRELLA LIAB 1 X I OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE 4620092990 3/31/2022 3/31/2023 AGGREGATE 3 10,000,000� 1 DED 1C RETENTION$ 10,000 $ B 1 WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ECC6004000999 3/31/2022 3/31/2023 I 1,000 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? 1N1 N/A 1,000,000 (Mandatory in NH) - I E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS hu!sv E.L.DISEASE-POLICY LIMIT i$ C Excess Liability IEC057913907 3/31/2022 3/31/2023 Per Occurrence 10,000,000 i 1 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE , .X. gam, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD