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Home My WebLink AboutBLDCI-17-002475-02 r The Commonwealth of Massachusetts et City\Town of =runts 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 Certificate No. Issued to Business Name:IRISH VILLAGE RESTAURANT&RESORT,LLC BLDCI-17-002475-02 Trade Name:IRISH VILLAGE RESTAURANT&RESORT, LLC Identify property address including street number,name,city or town and county Certificate Expiration Located at 822 ROUTE 28 12/31/2019 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 643 A-2 Nightclub/Restaurant/Bar/Banquet Hall 91 persons-Pub& Function Rms Allowable Function Rm-Bay 164 persons-table/chairs Occupant Load 352 persons-chairs Function Rm-Bass River 36 Tables/chairs 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 Philip Simonian III Name of Municipal Mark Grylls Date of �-7 Fire Chief Building Commissioner Inspection �?// • Signature of Municipal Signature of Municipal / / Date of 6 Fire Chief . Building Commissioner /J� / Issuance - / -/p U' � (27 0 Fee:$150.00 BLD_Certoflnspection.rpt > •YARo TOWN OF YARMOUTH o�` y' -y BUILDING DEPARTMENT H!s-) %- ••%/ 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 3,2018 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: 2SIL MPlitu STtECl S. fjig,Nl0(AT kli MA 0wo4' Name of Premises:CA,E COD TtAS4 lilt_LA(s6 Tel: SOR-314- 12ao Purpose for which permit is used: �E ST A U IR NT License(s)or Permit(s)required for the premises by other governmental agencies: RECEIVED License or Permit Agency ALtopouc. ecuetAc-6 SELEcxMAt-3 OCT 2 2018 Cn nn' V taus tF,girsD Sesitt6 NEALTU QJEPT; BUILDING DEPARTMENT Byt Certificate to be issued toS&tS Ft Utcl- E kSTAuK&T Tel: SO - ' -' S3 00 Address: %it t t%i4) StRC€tS . YA/tit-cov.-R, 1174 Ot.4,(,W1 Owner of Record of Building h1(1CL�-J u-c.1 Address Cad_ M A t s-' STR%Et, Qtaa.Ttr a t S.lfl&pld'cCTO S HA 4512.4 Present Holder of Certificate js — 'LG'4 t'ANAWtNSture of person to whom Title Certificate is issued or his agent '0 IL4I I Z Date Email Address: 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# ULDCI - /7- 00 Pas. -0 7_ 1/1/2019-12/31/2019 • AmTrust Insurance Company of Kansas, Inc. A Stock Insurance Company WORKERS COMPENSATION WC 00 00 01 A , AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Ncci Code:68405 I. Insured: Policy Number: KWC1121153 Maclyn LLC 822 Route 28 South Yarmouth,MA 02664 Individual Partnership Other workplaces not shown above: Corporation X LLC See Extension of Information Page Federal Tax ID: 464699010 Producer: Risk Id: AmTrust North America,Inc. Renewal of. KWC1085464 do HUB International New England,LLC 300 Ballardvale Street Wilmington,MA 01887 2. The policy period is from 3/13/2018 to 3/13/2019 12:01 a.m.at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here:Massachusetts B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: State Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $1,000,000 each accident $1,000,000 policy limit $1,000,000 each employee C. Other States Insurance:Part Three of the policy applies to the states,if any,listed here: All states except ND,OH,WA,WY and State(s)Designated in Item 3A. D. This policy includes these endorsements and schedules: See Extension of Information Page 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans.All information required below is subject to verification and change by audit. See Extension of Information Page TOTAL ESTIMATED ANNUAL PREMIUM 10,627 STATE ASSESSMENT 527 TOTAL ESTIMATED COST 11,154 Minimum Premium 401 Deposit Premium 1,587 Issue Date:2/3/2018 Countersigned by: AmTrust Insurance Company of Kansas, Inc. WC 00 00 01 A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: Maclyn LLC Policy Number: KWC1121153 EXTENSION OF INFORMATION PAGE FOR ITEM#1 ITEM 1: NAMED INSURED and WORKPLACES NAMED INSURED: Maclyn LLC Fein:464699010 WORKPLACES: Location Number 1. 822 Route 28 South Yarmouth, MA 02664 NAMED INSURED: Irish Village Restaurant&Resort LLC Fein:464699010 WORKPLACES: Location Number 2. 822 Route 28 South Yarmouth, MA 02664 , AmTrust Insurance Company of Kansas, Inc. WC 00 00 01 A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: Maclyn LLC Policy Number: KWC1121153 EXTENSION OF INFORMATION PAGE FOR ITEM#3.D ITEM 3.D: ENDORSEMENT SCHEDULE State Form Number Description WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000001A DECLARATIONS PAGE WC000404 PENDING RATE CHANGE ENDORSEMENT WC000406A PREMIUM DISCOUNT ENDORSEMENT WC000414 NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT WC000421D CATASTROPHE(OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT WC000422B TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC000425 EXPERIENCE RATING MODIFICATION FACTOR REVISION ENDORSEMENT MA WC200301 MASSACHUSETTS LIMITS OF LIABILITY ENDORSEMENT MA WC200302 MASSACHUSETTS -ASSESSMENT CHARGE MA WC200303C MASSACHUSETTS NOTICE TO POLICYHOLDER ENDORSEMENT MA WC200401 MASSACHUSETTS PENDING PREMIUM CHANGE ENDORSEMENT MA WC200405 MASSACHUSETTS PREMIUM DUE DATE ENDORSEMENT MA WC200601A MASSACHUSETTS CANCELLATION ENDORSEMENT MA WC200604 MASSACHUSETTS POLICY DEFINITION ENDORSEMENT AmTrust Insurance Company of Kansas, Inc. WC 00 00 01 A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: Maclyn LLC Policy Number: KWC1121153 EXTENSION OF INFORMATION PAGE FOR ITEM #4 ITEM 4: SCHEDULE OF PREMIUMS Premium Basis Rate Per Estimated #of Code Total Est.Annual $100 of Annual Classifications Emps No. Remuneration Remuneration Premium Massachusetts Clerical Office Employees NOC - 0 - 8810 90,000 0.07 63 MA LCM Deviation 0 9037 0.00 -1,769 Hotel—All Other Employees&Salespersons, Drivers 0 9052 440,000 1.80 7,920 Restaurant NOC 0 9079 350,000 1.09 3.815 Manual Premium 10,029 Total Manual Premium 10,029 Premium for Increased Limits Part Two:2% (1000/1000/1000) 9812 201 Total Premium Subject To Experience Modification 10,230 Experience Modification 98% 10,025 Expense Constant 0900 338 Terrorism 9740 264 Total MA Premium 10,627 DIA Assessment 4.56% 9751 527 Total MA Cost 11,154 TOTAL ESTIMATED ANNUAL PREMIUM 10,627 STATE ASSESSMENT 927 TOTAL COST 11,154 oF....% TOWN O F YARMOUTH BUILDING 7 E1T:crwcAl. GAS • ,� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING "li Telephone(508) 398-2231,Ext.1261 —Fax(508) 398-0836 SIGNS BUILDING DEPARTMENT,(. r' T,,\�\ Inspection and License Report nQ Date /A7--45 J�8 / Address �V Rrr To Business Name _ Z1?A /1 Ifi/LQgc Conttn__y j Phone 737 9a-Sr �l During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and//or the Board of Health rules,the following violation(s)were observed: ,EgEU' LI ryPLL Emergenegresss�gnage Location t t'X.v� / /�//tion � "✓ l� L1�� 16 - 1j ❑Emergency egress lighting Location t- c r1i1 1 J - i -.d ST 57h17" c0 , . ❑Maintenance of exits Location 4 7t j kW/ V(9 T ❑Guards/handrails Location rr Zoning ❑Signs Location ❑ Parking Location ❑Other Location Mechanical ❑CombustonAir Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automaticdoordosures on boiler room doors Location ❑ Clothes dryer vents Location Other Location The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. In order to abate the above violation(s)von must: o Make corrections immediately and contact this office for a follow-up inspection. o Make corrections prior to opening and contact this office for a follow-up inspection. o Make corrections prior to your next annual inspection. o Make corrections within t'." days and contact this office for a follow-up inspection. LocalOfficia1ilnspecto 21140 -77/V Airy Received By lkhat CV hl Tide atliv • Revised 2/8/13 SEASIDE ALARMS 1265 ROUTE 28 SOUTH YARMOUTH,MASSACHUSETTS 02664 FIRE PROTECTION TEST REPORT Name of Premises: Irish Village - SSA#5000-1,2 Address: 822 Main Street Route 28 Telephone Number: 508-394-9300 Control Panel Location: Fire panel is by front desk CO panel is in office Date of Service Control Panel: SK-5208 YES OK 4/11/18 Stand-by Battery YES OK 4/11/18 Smoke Detectors 83 OK 4/11/18 ROR Heat Detectors 176 OK 4/11/18 Pull Stations 22 OK 4/11/18, Horn/Strobes . 32 OK 4/11/18 Fixed Panic YES OK 4/11/18 CO Detectors YES OK 4/11/18 Fixed Heat Detectors 3 OK 4/11/18 Door Hold Backs/Mag releases OK 4/11/18 Service Comments: Cleaned and tested smokes,ROR's, pulls, CO's,batteries, horn/strobes,fixed heats: OK. Signals to/from central station: OK I,Shawn Johnson, and I Robert Phillips,inspected Irish Village on 4/11/18 and the above tested items are working according to manufacturer's recommendations. Siu ature Date Sigdti uE re Date, Company Name and Address Seaside Alarms #1317C 1265 Route 28. South Yarmouth MA 02664 • • SEASIDE ALARMS • 1265 Route 28 SOUTH YARMOUTH MASSACHUSETTS 02664 FIRE ALARM TEST REPORT • Name of Premise: Irish Village SSA#5000-1,2 Address: 822 Main Street Route 28 Telephone Number: 508-394-9300 Owner's Name: John Hynes,Jr. Owner's Address: Same Contact Name: Tommy McCormick Contact Phone: 508-394-9300 Night Phone Contact: 508-737-9256 Fire Alarm Company: Seaside Alarms,Inc. Sprinkler Company: N/A Extinguisher Company: Cintas • ITEM Checked On: OK BY: Smoke Detectors 4/11/18 Yes Seaside Alarms ROR Heat Detectors 4/11/18 Yes Seaside Alarms Control Panel 4/11/18 Yes Seaside Alarms Stand By Battery 4/11/18 Yes Seaside Alarms Pull Stations 4/11/18 Yes Seaside Alarms Horn Strobes 4/11/18 Yes Seaside Alarms Fixed Heat Detectors 4/11/18 Yes Seaside Alarms Door Hold Backs 4/11/18 Yes Seaside Alarms CO Detectors 4/11/18 Yes Seaside Alarms Fixed Panic 4/11/18 Yes Seaside Alarms I, as owner/representative, have had all the fire protection systems at my property inspected, and they are in compliance with all laws, codes, rules and regulations that may apply. (2 S gnature at