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Home My WebLink AboutBCOI-23-1789 2025 The Commonwealth of Massachusetts Town of . o,, 0 e YARMOUTH c • y ;y, `MC o.ATEO TES/ 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: Hampton Inn &Suites Trade Name: Hampton Inn &Suites BCOI-23 1789 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 99 ROUTE 28 WEST YARMOUTH, MA 02673 December 31,2025 Floor Occupancy_ Use Group Other 01 st Floor 64 A-2 Restaurants,Night Clubs,or Breakfast Room/Lobby Use Group Classification(s) similar uses 01 st Floor 150 A-2 Restaurants,Night Clubs,or Nantucket Room-150 similar uses Seating/Standing Allowable Occupant Load 72 Tables&Chairs 01st Floor 44 A-2 Restaurants,Night Clubs,or Exterior Pool similar uses 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 Enrique Arrascue Name of Municipal Building Mark G Date of Inspection Commissioner I gg ' I J _ _).: Signature of Municipal Fire ! ,./ 4ignature of Municipal Buildin 47, Date of Issuance ,/ Chief / g,Commissioner E `// ;v4' , yO YAK TOWN OF YARMOUTH Office of the BuildingCommissionei R E, C E L V !�D } I y r� � 1146 Route 28, South Yarmouth, MA 026640CT 2 8 2024 508-398-2231 ext. 1260 Fax 508-398-0836 ` MATTACHEESE � ..r.--- ---' --""' 4, ,b, ; f BUILDING DE N PARTMET RPORATE: ay: APPLICATION FOR CERTIFICATE OF INSPECTION September 23,2024 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: 4 6 RAW n J Name of Premises: n `M n 4-S(,)41 J Tel: . - - — Purpose for which permit is used: hD+e I License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate tQ lie issued to n c( 141'--(i1)'1 CO is() Tel: 3f),c-Z4'1 A--L 16 0 Address: t4 g I 0 Owner of Record of Building Feb t1t k' fl�tit fL C Address 19-11 FP11 -i Uf►C ►�W-e I S LU`► L Zf e v(X)K l rh Oni Present Ho r of rtif e • f 'i co j C• ?it)Si CIPAtri-/C ED Signature of person to whom Title Certificate is issued or his agent 16) 7 01 ZL J Date Email Address: G r)(5r_ Jo dC v I ) 0Oj hol 1J,CQ rn 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# 12/31/2024-12/31/2025 Be O/ .3~/-7,S--- �1 Client#: 144654 DARLIDEV ' ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/04/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Dawn M.Pare,AIS Starkweather&Shepley PHONE 401 435-3600 FAX 401-735-1059 (AIc,No,Ext): (AIC,No: PO Box 549 E-MAIL tom Providence, RI 02901-0549 ADDRESS: d Pare @starshe P• 401 435-3600 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Propty Casualty Co of America 25674 INSURED INSURER B:MemiC Group FED Hotel Properties LLC Firemans Fund Insurance Co 21873 99 Main Street INSURER C West Yarmouth, MA 02673 INSURER D:Chubb Custom Insurance Company 38989 INSURER E:Beazley Insurance Company,Inc. A1340J 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 •H 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. SUBR LTR TYPE OF INSURANCE NSRR ADDL WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y P6308X407200PHX2 03/31/2024 03/31/2025 EACH OCCURRENCE $1,000,000 E CLAIMS-MADE X OCCUR PREMISES(Ea oceu ante) $500,000 X Liquor Liability MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 1XPRO- PRODUCTS-COMP/OPAGG $2,000,000 POLICY JECT LOC OTHER: Per Loc.Agg $$2,000,000 A AUTOMOBILE LIABILITY Y BA8X4225652443G 03/31/2024 03/31/2025 a acciden SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ I AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ $ X AUTOS ONLY X AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR Y CUP7X81574424NF 03/31/2024 03/31/2025 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 _ DED X RETENTION$1 OOOO _ $ i TA B WORKERS COMPENSATION 3102810469 03/31/2024 03/31/2025 X STATUTE IT EORH P AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Excess Liability USC035698242 03/31/2024 03/31/2025 $5,000,000 D Employee Theft BINDER1517316 03/31/2024 03/31/2025 $1,000.000; $10,000 Ded E Cyber Liability B1NDER1517310 103/31/2024 03/31/2025 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured and Waiver of Subrogation per policy terms and conditions as listed above. Umbrella Liability and Excess Liability extend over General Liability, Liquor Liability,Automobile Liability and Employers Liability. RE:Hampton Inn&Suites,99 Main Street,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 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD DMP #S23595151M2336345