The URL can be used to link to this page

Home My WebLink AboutBLDCI-16-003258-06 The Commonwealth of Massachusetts ' -- City\Town of =' 'lam YARMOUTH _s: 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-16-003258-06 Trade Name: HAMPTON INN&SUITES/CAPE COD Identify property address including street number, name,city or town and county Certificate Expiration I Located at 99 ROUTE 28 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other _ -Classifications s 01st Floor 64 A-2 Nightclub/Restaurant/Bar/Banquet Hall Breakfast Room/Lobby A-2 01st Floor 150 A-2 Nightclub/Restaurant/Bar/Banquet Hall Nantucket Room-150 Allowable 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 Name of Municipal Mark Grylls Date of _/�� Fire Chief �o y 5 Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner `` Issuance 1270 t Fee: $150.00 BLD_Certoflnspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 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 R Date Comments Approved for ter, License Issuance .4/ /2—/2.L AMP No Fire Department Rep. Date Comments Approved for Li - Issuance /- /74/%(-12— r 42-6 -2--e__ di 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 (*%. `7.'s •• "'"". '` TOWN OF YARMOUTH rif, BUILDING DEPARTMENT .,k,MATT 1146 Route 28, South Yarmouth, MA 02664508-398-2231 ext. 1260 ^r�,m APPLICATION FOR CERTIFICATE OF INSPECTION September 16, 2022 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: q"! r 'VDU Tf• a 1 G e_m0(A') Name of Premises: Ho plon.to y d- teJ Tel: RECEIVED Purpose for which permit is used: tVi I NOV 14 2022 License(s) or Permit(s)required for the premises by other governmental agencies: _ BUILDING DEPARTMENT License or Permit Agency sy: Onnu cl I L C ii cc Lis nJ_e- Certificate to be issued to V >1 1 Tel: 5 b a-ak Address: r'Icl \hut g ,Y1un urt Owner of Record of Building F e e e:11-05 Address 1105 FCI f l 1vev pry n Ue r-e yLor L1 M14- Qe� Present Holder of Certificate m r\ Ifl IA co J., -- ) ( Cp )e ea •Poshri Signature of person to whAn Titl Certificate is issued or his agent 1 11 1 I O�a Date Email Address aiicA Y\ 1 O do iz t 1 ryd J_ c e IJ .0 Orn 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# & i�((®� 5 i ge-h 1/01/2023— 12/31/2023 3 I, -- _ :0""-1 �—..4, DARLDEV-01 LBROWN "et CCORL/ DATE(MM/DD/YYYY) kis.-- 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 CONTACT Loretta Brown FBinsure,LLC 128 Dean Street (A/C,No,Ext):(508)824-8666 FAX No):(508)880-0142 Taunton, MA 02780 E-MAIL DRESS:loretta@fbinsure.com INSVRER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Ins Co .41360 INSURED INSURER B:New Hampshire Employers Ins Co 13083 FED Hotel Properties LLC INSURER C:Ohio Casualty Ins Company 24074 99 Main St INSURERD: 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 POLICY EFF POLICY EXP LIMITS _LTR INSD WVD IMM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500068374 3/31/2022 3/31/2023 DAMAGETORENTED $ 250,000 PREMISES.(Ea_occur_[ence) MED EXP(Any one person) ,_$ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,000 POLICY JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Liquor Liab $ 1,000,000 - - - - COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO 1020096475 3/31/2022 3/31/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED J AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-(e NED PROPERTY DAMAGE .AUTOS ONLY AUTOS ONLY (Per accident) .$ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _$ 10,000,000 EXCESS LIAR CLAIMS-MADE 4620092990 3/31/2022 3/31/2023 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ B AND EMPLOYCOMPENSATION RS'LIA TILTY _- _- - _-- - -- - -_-- - X STATUTE EERH- Y/N ECC6004000999 3/31/2022 3/31/2023 1,000,000' ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N I A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C 'Excess Liability EC057913907 ' 3/31/2022 3/31/2023 'Per Occurrence 10,000,000 DESCRIPTION OF OPERATIONS/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 REPRESENTATIVETArTI� i a.X• 23M ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD