Loading...
HomeMy WebLinkAbout3040 FALMOUTH ROAD/RTE 28 - HOTELS/MOTELS t J+'1 t i r° _,f rt t :r, :«f ,. aa,. ,i •+1':r d ! 17 41 , v • H r, , C.x. 1!. i. � .... ,.. t t u, .t;... ,: I�•t e�,t .rt.:'ss 's: 'Sa• �'.. S .'.a 1} : tf rR...i` ,''{'••I.1 J �' el n�r '� � - ! . : a. }' 4 ,n.if 1t1+ .. r L 1 � « a r i t' S 'iC)a ufi" '7: L `�' f e� 4 ... x .. +�,"• t� u .. .. �,�. r . r 'tx , , , '.1:.. a - , - « 1r• st 4 � a:1. ' '• ,.. o , s !- ♦T...} a„ x: _ y J' �. it' �� - tk#;� ! .:ti.. i i:, �i. l.. ,t a,P�e s't Y>tt t!"` it'� i�.y + it ;_as t.' .y .. Af Ji p ,t::. �! ,'A ' , • ll r 4 Ea; :i • ;t' �C.. � .b n ,. .. itt" � ,e;- 41.3� � 04 } ;' p�:::,+ ,n1 ,: .•, - ',A' „ . �� .;'. .CY. .,.. l..i' r. -3 x �tb: Fi •t Y' s "3.`4 +C ,•• `rF ` J, r ,'a, yr. ., ` V. t1E 'FW..,;•.: L,,t' `� 'i��f Yl,�"n; ", st -°`G ... g t p +� i.1.., ...J,•AVA ,Nr a 't. a1`.r -, f.'!. ", a .'T' ^` _ - n t.,: , , ., r f�^ , lit "+>r x) ! ,,. t'R +k�c�' 'tirr G ii!( •'2;sr.,� t4 � `���.•. t r ft ', a, z -. } t',.'ah, rt r ', .x, ' rr'F• r»t.: � yc' r ,- r':' � � -t :s _ w. y}�" r .1 - r T•i.. ,.1;, Y'�"`�InSM -e! "i`� +���F � r TIC, rt'' '+a,.; t .a •, T .. :."' ,,R ¢'"'t r� �9 s � rr.. ;.�: .c w 3 e, r .. - .. a :r , . 4 - �f :r c 1 _ __ _ .. . : .: a.. '�. ��. �. � .; .. e .. , •.,: .. '. s' :. ,• � . ,n e � _+: .. • 1 k. t � �, � � � - ��•, �.. .. .: ,1 i .. n+i ., ... ..e �• e .o '+ ,- .. . C _ _ r,• ` i� .�P • . a , x .�_ a �. +. s �. �' - vie .. \ .,. ..r, v, .. ., f i • j: � � t �� J� /' . 1� ::� r �. 1; - � ... + _ .. ,.. li t' �„ .. k, _ e r'. . .. � , �Y A c ' ;. . ,. ,, .. b • ,_ � r r. .... .. ,\ ,. ,., [. ,�« ,. .. ._, S a ` r`' �. ., ., �:, , '- ., .' 4 q.' .fir .. � � .. .. '.:� ) . .S� � '- � a ,.. ,.. .• ,; x s � _ , �' � • .. • '. x c : . i .. .. w. �.., � °^ .. ,. .._ _ . � ,. . �. �. .. _ �.. � �S .• K. K�Y'. F �r .• u.. �� :5 _. '� tax ` 't. ,ig 9`. J 1. ' S � � ql , � .. t .: .. .. .. � M '� J \ / i Yrr ' tl YSl'r - 2 - � • •. _ j C ` � n F • • �� .. .. •,! . x � �e u.' . a' S ..• • t. ...7. �.. . .. t _ � � .. .. ' �:i�. .. - r S i i' > v -_, r � , �. ,. :.x + � ,, a - :. _ ., !. _ �1 ti � _ - _ - 4 i �o► �00 CJI (o�� APPLICATION FOR A PERMIT TO OPERATE A SWIMMING POOL Application is hereby made for a permit to operate a public or semi-public swimming pool. This pool is to be operated in accordance with 105 CMR 435.00:Minimum standards for swimming pools(State Sanitary Code: Chapter V)and the Town of Barnstable Code. so OWNER: rn 11IP ng5 EMAIL: PHONE: .rZ POOL LOCATION ADDRESS: 3C,% MAILING ADDRESS:'2.- 121 AIA66 _ 0:1 MAIN CONTACT NAME: cw5j, ':btj2 n Ole PHONE: POOL TYPE:(circle one) INDOOR POOL OUTDOOR POO SPECIAL PURPOSE(ie.hot tub) SAUNA SKETCH:Please attach a le ' le detailed,sketchwith dimensions,depths and detailed pool volume calculations SIZE: Swimming area(>5'deep) sq.ft. Non-Swimming area(<or=5') sq.ft. MAXIMUM BATHER LOAD:Swimming area: people. Non-Swimming area: people Bather load calcs per 105 CMR 435.27: 15 sq.ft of surface area per person for non-swimming area 20 sq.ft.of surface area per person for swimming area 10 sq.ft.of surface area per person for special purpose pools POOL SUPERVISION: (circle) Lifeguard Qualified Swimmer" Lifeguard Exemption*** *See Page 2,Box 1 **See instructions on page 2,box 2 and agreement form on page 3. ***See instructions on page 2,box 3 and agreement form on page 4. CERTIFIED POOL OPERATOR: ()rpnA.S���(321,5 (attach copy of CPO certificate) DISINFECTION(type of chemical,method,capacity,etc.) -rf I Lb FILTRATION(type,size,etc) —71'% 'Sc ~ NUMBER OF MAIN DRA1N(S):—4-If>1,drain cover centers at least 3'apart? ADDITIONAL SYSTEMiDEVICE FOR ANTI-ENTRAPMENT: r' -r-n-LE I&6: Vs 0'(`5 Vk5 P P ANSI ASME At 12.19.8 COMPLIANT DRAIN COVERS? <5 (unblockable drains exempt if they are at least 18"X 23"or at least 29"diagonal measurement) SPECIAL NOTES: DATE: SIGNED: *NOTE: You must file a separate appli on for each swimmiuglspecial purpose pool. INCOMPLETE APPLICATIONS WILL NOT BE ISSUED A PERMIT FEES: Swimming pools,special purpose pools(ie.hot tubs,whirlpools),wading pools=$100 Saunas=$30 Motels=$50 Q-kAppWdw Foffo-AP01 Ap toetcon Revised _.... ........ . ......_.... .__.. ............ .... .. . . .... _ _.... _. ._. .. _. ._. _ _....... ....... ......... ...... _.. ._. ..... ....... _..... ......... _. .._. .. ...._...._ ..__............. _....... ........ ....................... ...... _ _ ......... ......... .. _.. .. ....__.._. .. .... ._.. ._.. . .. . .. . .. .... __ .. . ......... ....._....._........ .............. ............---. . ._. _............_. . . .._.... .. _......... ........ ............. .._..... _....... .. . ._.. ................... . . _.... ....................... ....... . _..... .....__. . .... . ._.. _........ __.... _.. _...... _.. _... _ _. ...... ......... ......__.._ .._. _. .._. ...._._. _. ..... _. ... _. _. ..... _. ...... _.... ........ YEAR: _.. ........ ........ ... _.... .. . .... .... _.. _ _ . .. ._ .._._._.._........... _. QUALIFIED SWIMM A_ R �_�M THIS FORM IS INTENDED FOR SEMI-PUBLIC SWIMMING POOL OWNERSIOPERATORS WHO HAVE ALREADY BEEN BEFORE THE BOARD OF HEALTH AND HAVE BEEN GRANTED THEIR INITIAL LIFEGUARD MODIFICATION VARIANCE,ALLOWING-QUALIFIED SWIMMER(S)'IN LIEU OF THE REQUIREMENT TO EMPLOY FULLY CERTIFIED LIFEGUARDS. ._.. ...... ........................ . THIS FORM IS REQUIRED FOR RENEWAL OF THE VARIANCE ALLOWING UALIFIED SWIMMERS. .. _. The following requirements shall be sWedy adhered to by the owner/operator of the swimming pool: _.. _.... ....... .......: .......... • QUALIFIED SWIMMERS)shall be in constant attendance at the pool site at all times whenever the pool is open. • CPR CERTIFICATION: The qualified swimmer(s)shall be 16 years of age or older holding a current American Heart Association or American Red Cross CPR certificate with training in child,adult,and pediatric CPR. • FAMILIARITY WITH FIRST AID: The qualified swimmer(s) must demonstrate familiarity with lifesaving equipment,including rescue procedures and administering first aid. • GENERAL SWIM TEST REQUIREMENTS: The owner/operator of the pool shall administer a swimming test for each qualified swimmer to ensure he/she is able to: -Swim 2 lengths of pool; Tread Water for 5 minutes-,and Retrieve an object fromthe bottom of the pool .:: CERTIFIED POOL QPERATOR :The owner/operator of the swimming pool shall provide the Health Diivtston a - copy of the current:Certified:Pool:Opemtor:(CPQ):certificete in use: g p p p _.. • LIABILITY INSURANCE• The owner/operator of the swimmin pool shall provide the Health Division a COPY o the general liability insurance policy of the pool which must name the Town as co-insured in the amount of $1,000,000. Suggested wording: "Town of Barnstable is additional insured under General Liability with respect to the swimming pool." _..... ....... __ ........ _.... ...... . . . ......_ .._..... ............_. . . ___....... _ _........... ._. _..._...... _..... . _.. _. _._. ......... . __ _.. _... ................ _... INSURANCE:CERTMICATE:HOLDER Town ofBarnstable 200 Main Street.._ _ _ . Hyannis,MA 02601 ......... _.._.... _...... ......... ........ _. VWEAR w T11All uahfidswimmers:while ondutY.:shall wear an:orangehatorvsr with ord W ..... .... taillimrter(5/8 mch)bhtdc colored lettering on afire fonttof the haL • POOL CAPACITY: The maximum capacity at the swimming pool site Is restricted not to exceed 19 persons. I agree to comply with the above requirements and submit the documents listed above(4e., CPR certificates for qual led swimmers,certbled pool operator certificate,and general liability insurance certiftate): _:: �. d^�c:\tom � rVt��e Pr>es (C7c�da=i�ynic,t Na►ne Facrlt Address .. ....... ... . ........ . .. �� L . .. . .... ne(Stgnature) Date.... Name(Print " Positipn Title(t a motel owner, eert fed pool operator) QAApplication FonnslPool Application Revised 09-1 t-I B.doe r �,. AC40Rf> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/20/2021 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 of such endorsement(s). PRODUCER CONTACT ROSEMARIE GILLARD Eastern Insurance Group LLC PHONE FAX 233 West Central St ac No Ext:800 333 7234 Opt.3 Alc Noy 781-586-8244 Natick MA 01760 ADDRESS: seleetwork@easterninsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:NORFOLK&DEDHAM MUT FIRE INS CO 23965 INSURED OSTEPIN-01 INSURERB:LIBERTY INS UNDERWRITERS INC 19917 Osterville Pines Condominium Trust c/o The South Cape Associates INSURERC: PO BOX 671 INSURER D: Mashpee MA 02649 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1905252697 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. ILTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM DDPOLICY IYYYY MMIDD EFF EXP LIMITS A X COMMERCIAL GENERAL LIABILITY R0644425A 1/1/2021 1/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR - - DAMAGE TO RENTED PREMISES Ea ocwrrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POUCY❑jE O- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLA LIAB OCCUR MCREA701504 1/1/2021 1/1/2022 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MMADE - AGGREGATE $5,000,000 DED I X I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y N STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) LOCATION:3040 FALMOUTH ROAD(ROUTE 28),OSTERALLE,MA 02655(43 UNIT RESIDENTIAL CONDOS) Town of Barnstable is additional insured for General Liability where required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable 367 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD f 05/26/2017 01:05 5084204347 THESOUTHCAPEASSOC PAGE 02/03 05/22/201? 10:21 5084329244 OCEANSIDE POOLS PAGE 01/02 0\ a 71 u . 1