Loading...
HomeMy WebLinkAboutBLDCI-23-002797 The Commonwealth of Massachusetts ps i 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 Issued to Certificate No. Business Name:S-H Hotel Yarmouth LLC BLDCI-23-002797 Trade Name:Aiden Best Western Identify property address including street number, name,city or town and county Located at Certificate Expiration 476 ROUTE 28 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy P Y Use Group Wither Classifications(s) A-2 02nd Floor 42 A-2 Nightclub/Restaurant/Bar/Banquet Hall 42-Upstair 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 +ewierrlH Name of Municipal Mark G lis Fire Chief ry Date of Cr n S .-,),cs® Building Commissioner � r Inspection l ,� Signature of Municipal Signature of Municipal Fire Chief C2(4,j>„,—' Date of Building Commissioner— 'q.....,, ,„.../-- Issuance / 2 6 tZ Fee:$100.00 BLD_Certofl nspection.rpt BUILDING EPARTMENT 1 146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Aidan by Best Western-Lounge ADDRESS: 476 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 Date Comments Approved for A ,_ License Issuance /�� 2 IMP No Fire Department Rep. Date Comments Approved for Licen e Issuance f , *6 0.4 22 klb 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 • .rnab 4 .11 ,do 6 • ' 4 . ' �'�'c o;. . -,..\�:y} BUaLDING DEPARTMENT ii 1146 Route 28, South Yarmouth, MA 02664508-398-2 ( p V D APPLICATION FOR CERTIFICATE OF INSPECTION NOV 212022 AREN November 16, 2022 PAYABLE U.J• TMT F (X) Fee Require. 00.00 ( )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: 4/7z.4 R 0 /.‘,Jes r ytA/,yhc.2 f./7 Name of Premises:�Q,,,/.- 8e�74-Ge.,ssr xA,/Cs:'` fooLe,,,f Tel:.St —7Z —/scc 0 .11 Purpose for which permit is used: // // ,ke X „,_ hie�„.ww �►'1 - ,C License(s) or Permit(s) required for the premises by other governmental agencies: 1� �a \lY License or Permit Agency r ' LI p_er Ii1/42M Certificate to be issued to $ -hi f/ yjiir.,iec c-t.L Tel: z_, - Address: j/ /N IO T y,�.t..v L, 'i9. e› 26,3 Owner of Record of Building N/as'f, Rate/ Address yl-C ale. 748 €.ae.,.s X-Aptrr a , dl1/a. o�. ,x_g Present Holder of Certificate //rsd, P,9,4( ki). . rCt.)-d ( .I\C_AAck q (,_ eThr--- Signature of person to whom Title Certificate is issued or his agent /05 .2 (' � Cl Date v Email Address: /' ��� C�'Zt'm 0 (,f ► . Co 144 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 # iLJ),C,-- 23.. bta2 7 12/31/2022 to 12/1/2023 -....1 JAMSHOT-01 FQUISPE ,4coRIf) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �— 11/16/2022 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 CONTACT Francis Quispe NAME: Boyd&Boufford Insurance Agency,LLC PHONE FAX 167 S River Road Unit 10 (NC,No,Ext): (A/C,No): Bedford,NH 03110 E-MAIL ADDRESS:Francis@Bouffordins.com E-MAIL _ _ _- INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Technology Insurance Company 42376 INSURED 1 INSURER B: S&H Hotel Yarmouth LLC INSURER c Jamsan Hotel Management Inc. _ 83 Hartwell Ave. INSURER D _ [_ Lexington,MA 02421 INSURER E I INSURER F: I, 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD END POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED T — I I PREMISES(Ea occurrence) $ __ MED EXP(Any one person $ i PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY i JECOT LOC i I I I PRODUCTS-COMP/OP AGG I $ _ OTHER: $ AUTOMOBILE LIABILITY I C(EOMBINED u accident)INGLE LIMIT $ ANY AUTO _BODILY INJURnper person)i $ OWNED SCHEDULED I I AUTOS ONLY AUTOS BODILY INJURYfPer accident) $ HIRED NON-OWNED PROPERTY DAMAGE __ AUTOS ONLY 1 AUTOS ONLY A_Per accident) $ I I I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE AGGREGATE $ I DED RETENTION$ $ A WORKERS COMPENSATION I X PER OTH- AND EMPLOYERS'LIABILITY STATUTE _ ER . TWC4147543 8/1/2022 8/1/2023 1,000,000 I ANY PROPRIETOR/PARTNER/EXECUTIVE vYN.,.1 N/A I I.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under i 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) reference location:476 MA-28 West Yarmouth,MA 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 W-V"-----e_ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD