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HomeMy WebLinkAboutBldci-16-003258-04 The Commonwealth of Massachusetts City\Town of I 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-16-003258-04 Trade Name: HAMPTON INN&SUITES/CAPE COD Identify property address including street number, name,city or town and county Certificate Expiration Located at 12/31/2021 99 ROUTE 28 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 64 A-2 Nightclub/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 Ill Name of Municipal Mark Grylls Date of � �O Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal ] ,7 '�ate of Fire Chief 2g, , e Building Commissioner Issuance iiiepie,...Sap Fee: $150.00 QI rl Cs.rtnflncnortinn rnt ' l LNG , DEPARTMENT 146 Route 28, ` ruuth Yarmouth, NI \ 02664 508-398-2231 ex t. 1260 Fax 508-398-08 6 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Hampton Inn-Assembly ADDRESS: 99 Rte 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for License Issuance f/:—/a771.© j No Fire Department Rep. Date Comments Approved for C Rrr. tl�-1 (l License Issuance � 'es No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 oi.YzR • ,$1--)o TOWN-OF—YARMOUTH u y. BUILDING DEPARTMENT M,,.___ ___. ' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2020 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: 909 6.(1a R4.- 0 Name of Premises: gapil+Yk(-InfA * 86\EZCam't Tel: Purpose for which permit is used: +-e_ License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to n 4 5 t Tel: 5E-��a ct 0(0 Address: Mawl aFt�� �,� Owner of Record of B 'lding (q) a l: "t ()cult e,�-E Address it 05 FallNye(' ,,,,� MA pa I f �r�" l Present Holder of Certificate 'Z�z1-1-3„t14t _e_ei_i4.54444,4„,1- i)re4si 6+ COtICN3a'10 Signature of person to whom Titl Certificate is issued or his agent 10 al pap Da Email Address: bce°nC10..Dia 11100d1nn cx r C � 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# B U C/-/&-- vy's..._ iZ -ti_-Df 12/31/2020—12/31/2021 DARLDEV-01 LBROWN ACOREP L— DATE(MMIDD/YYYY) �-- CERTIFICATE OF LIABILITY INSURANCE 5/12/2020 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 FBinsure,LLC NAME;__ PHONE FAX 128 Dean Street (A/c,No,Eat):(508)824-8666 N o)1508)880.4142 '; Taunton,MA 02780 E-MAIL mfo insure.com ADDRESS: INSURERtSJ AFFORDING COVERAGE 'MAC S ---- — INSURER A:ArbeilaProtection Ins Co 41360_-- INSURED j_INSURERB:Commerce Insurance Company _ -__ _34754 FED Hotel Properties LLC essuRER c:New Hampshire Employers Ins Co_ 13083__ 99 Main St INSURER 0 Ohio Casualty Ins Company 24074_ 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 EFF POLICY EXP LTR INSD,yyyp POLICY NUMBER (MMIDD/YYYY) (MMIDD/YY1el1 LIMITS A X ;COMMERCIAL GENERAL 11ABILn Y EACH OCCURRENCE 1+000+000 — CLAIMS-MADE X:OCCUR 8500068374 3/31/2020 3/31/2021 ,PDR^eI a r ) $ 250,000 10680 MEDEXP-(Mime perk _ _ ' —_-- 1,000 000 PERSONAL 8 ADV INJURY --_--_ ' GENT AGGREGATE LIMIT APPLIES PER: 2 000 000 GENERAL AGGREGATE _$ + + POLICY X 1 LOC PRODUCTS-COMP/OP AGG;$ 2,000,000 OTHER: Liquor Liabi 1,000,000 COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE UABIUTY ._(Eaaakdann ___ ---.$ ANY AUTO BHVZZT 3/31/2020 3/31/2021 BODILY INJURY(Per personZ_ $ AU OS ONLY ,NED X; SCHEDULEBODILY D _ e r )( HIRES �( No�.pyyNEp PPROOPERTY DAMAGE URY(per aoddenu;¢ AUTOS ONLY AUTOS ONLY - $ - '$ A X UMBRELLA LIAR X OCCUR 10,000,000 _EACH OCCURRENCE -_- _-�$- EXCESS LIAB CLAIMS-MADE 4620092990 3/31/2020 3/31/2021 AGGREGATE $ 10'000,000 DED X RETENTIONS 10,000 ~ S - C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY • _ STATUTE ER.,__ - Y/N ECC600400099S' 3/31/2020 3/31/2021 EL EACH ACCIDENT_ $ ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A1,000,Qp0 (Mandatory In NH) E L.DISEASE-EA EMPLOYEES Y If yes.describe under - — 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Excess Liability EC057913907 3/31/2020 ' 3/31/2021 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 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 ,Y, .X gam,., ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • . V> `�