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HomeMy WebLinkAboutBLDCI-16-003258-05 The Commonwealth of Massachusetts City\Town of i F .t,i YARMOUTH J 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-16-003258-05 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 12/31/2022 WEST YARMOUTH, MA 02673 I Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 64 A-2 Nightclub/Restaurant/Bar/Banquet Hall Breakfast Room/Lobby 01st Floor 150 A-2 Nightclub/Restaurant/Bar/Banquet Hall Nantucket Room-150 Allowable Occupant Load Seating/Standing 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 / Fire Chief Building Commissionerspection -a Signature of Municipal Signature of Municipal ate of Fire Chief i Building Commissioner Issuance ,r2 - Q f , i‘' Fee:$150.00 BLDCertofl nspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: El Mariachi Family Restaurant ADDRESS: 1329 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 Re . Date Comments Approved for Lice ssuance , Yes No Fire Department Rep. Date Comments Approved for -nse Issuance 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 11/23/2021 10 : 51 From : 5093633919 Anderson Lampe, PS Wehfax Page : 1/1 AC� DATE(MMIDDOYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/23/2021 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 o^such endorsement(s). PRODUCER CONTACT Debbie Kleponis NAME: Brown&Brown of Massachusetts,LLC PHONE (781)455-6664 FAX (A/C,No,EM): (AIC,No). 980 Washington Street E-MAIL dkle onis rodmanins.com ADDRESS: p Suite 325 INSURER(S)AFFORDING COVERAGE NAIC Dedham MA 02026 INSURER : Twin City Fire Insurance Company 29459 INSURED INSURERB: Wesco Insurance Company 25011 LaPlaya dba El Mariachi&Nogales Inc INSURER C: 1506 N Washington Street INSURER D: INSURER E Spokane WA 99201 INSURER F COVERAGES CERTIFICATE NUMBER: CL21112368626 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 ADEL SUBR POLICY EFF POLICY EXP LTRINSD AND POLICY NUMBER (MMIDDIYYYY) (MMIDWYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 DAMAGE I0 RENTED 1,000,000 �,;,=n,•q;r PREMISES(Ea occurrence) $ X Liquor Liability MEDEXP(Any one person) $ 5,000 A 08SBMAD4757 06/18/2021 06/18/2022 PERSONAL&ADVINJURY $ 1,000,000 nrl�ll 4�1pprnlrrIIIIlT inn lrnnrn nrtrnII InnnrnITT m Z14941449 AUTOMOBILE LIABILITY COMBNED SINGLE LIMIT $ (Ea accident) ANY AUTO BIDOLY INJURY(Per person) $ - OWNED SCHEDULED BODLY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED — NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE - EXCESS UAB CLAIMS-MADE AGGREGATE _ LED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N 1 A WWC3542564 08/15/2021 08/15/2022 E L.EACH ACCIDE,iT { 500.000 OFFICER/MEMBER EXCLUDED' (Mandatory In NH) E L DISEASE-EA EMPLOYEE { 50D.000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS be m E L DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of West Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE West Yarmouth MA ©1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f cad a.�',� TOWN OF YARMOUTH 1 ."" ' a�- c" BUILDING DEPARTMENT ,-"sue 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2021 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 paddress: Street and Number: 11 Up P O U-k a g .)tS� y 01Y IMU�l� fI) 1k 0 a b 1- Name of Premises: e L. (Ai-mini I'\ck I(An T�1M,\%1 ole _ Tel: GJ Off{- if -11 Purpose for which permit is used: UgUOV "1 Ger15{.. License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency F. A NOV �,n, 2 4 9921 tAq vor A&v R BU."01 ,1 , NT Certificate to be issued to Et- Mav tactA, t \Qk1(I ;m1h1 Qe,t,Tel: 5 a- %x3-"I-(4.(6, Address: li(le (Zook aSS West 'tarwno- , Mp 010- Owner of Record of Building 1))16 'tt hsnbi(q Address `alb Rook a, W 4prm-,-4^, rvhn cza 64.5 Present Holder of Certificate bc,,\c d A', I,.9C2 OUllr1-CY Sig re of person to whom Title Certificate is issued or his a gent (1-.23-21 Date Email Address: dlnpe25111 g) Yghoo. Cori-' 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# ,e(( /--17 b/,23-S-9'(o—Lu" 12/31/21-12/31/2022