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HomeMy WebLinkAboutBCOI-24-67 2025 The Commonwealth of Massachusetts • Town of ;'og..Y96. g) YARMOUTH .,3 a! `.,eo.PO RA.,0,i' • I New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Super 8 Motel BCOI-24-67 Trade Name: Super 8 Motel Identify property address including street number, name, city or town, and county Certificate Expiration Located at 41 ROUTE 28 WEST YARMOUTH, MA 02673 May 15, 2025 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 20 R-1 Hotels, motels,boarding houses, 20 Units etc. Lobby Allowable Occupant Load 02nd Floor 20 R-1 Hotels,motels,boarding houses, 20 Units etc. Managers Apt 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 line safety features. This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Chief Name of Municipal Building ns Mark G s ate of Inspection 7 f 9 J"1 V/tea L Commissioner p I � Signature of Municipal Fire Signature of Municipal Building Chief Commissioner Date of Issuance / f� -�Q TOWN OF YARMOUTH BUILDING DEPARTMENT MATT�tnVt47211146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION April 01, 2024 PAYABLE UPON RECEIPT (X) Fee Required $190.00 ( ) 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 thepp below-named premises located at the following address: Street and Number: I FT 2_ S' 4 6-5r Y,4�C )(p U i k M A 0 ?3 Name of Premises: S)F R S MOT-EL Tel: S0 S 7 -]S 0 q Purpose for which permit is used: Ake,1 E l— License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency MAY 10 2024 e PboL W -D of 14-P1- .rH BUI I Ep T By Certificate to be issued to SU P&R $ !'irTE I, Tel: S )$ ?7 5 c 16Z Address: E f-T 2 g W ST 164 v'rO Not- (ylb?3 Owner of Record of Building A-iV IL i!),4T b-L Address 3 A-LGoNi)'iT,j pk Lv& ry iv(1'dw MA Ot sU3 Present Holder of Certificate S c 2-E i frlo I'&L Z.: gnature of person Title Certificate is issued or his agent $ 7 'r/2'( Date Email Address: 4U/tA k VA-0-d , (0 tit 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# 13cp 10N- 6,7 05/15/2024-05/15/2025 AC� ATE(MM/DD/YYYY) ® D �� CERTIFICATE OF LIABILITY INSURANCE 03/28/2024 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 DOWLING &O'NEIL INSURANCE AGENCY PHONE FAX 973 Iyannough Road (A/C No.EMI: /C (A ,No): E-MAIL P.O. Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# --- — - --_ _.— INSURERA: NorGUARD Insurance Company 31470 INSURED --- — - AUM Corporation INSURERB: DBA/TA Super 8 Motel INSURERC: 3 Algonquin Dr INSURERD: Burlington, MA 01803-3601 INSURERS: 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 -- -- LTR TYPE OF INSURANCE ADDLISUBRI POLICY EFF POLICY EXP --- INSD I WVD I POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 0 1 CLAIMS-MADE OCCUR DAMAGE TO RENTED 0 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 POLICY I PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 0 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y!N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 A OFFICER/M EM BER EXCLUDED? N NIA AUWC455443 10/21/2023 10/21/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS;/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Employees: Full Time: 1; Part Time: 1 Governing Class Description: HOTEL- ALL OTHER EMPLOYEES 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 Rt 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE: I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD