HomeMy WebLinkAboutBLDCI-16-003692-02The Commonwealth of Massachusetts
r City\Town of
' 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 BLDCI-16-003692-02
Business Name: RED FACE JACKS INC.
Trade Name: RED FACE JACKS
Identify property address including street number, name, city or town and county
Certificate Expiration
Located at
- 585 ROUTE 28 12131/2019
WEST YARMOUTH, MA 02673
_ Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 299 _ A-2 NightdublRestauranUBarBanquel Hall 95 Persons -
Bar/Lounge
154 Persons - Main
Allowable Dining Room
Occupant Load TOTAL SEATS -248
seats
TOTAL OCCUPANCY -
299Persons
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
Fire Chief -
Building Commissioner
- pection
Signature of Municipal
Signature of Municipal
Date of
Fire Chief
Building Commissioner
Issuance
/z
BLD_Certofl nspecfion.rpt
October 3, 2018
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
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:
NameofPremises: Tel: 5bV-77(-S5-d.i
Purpose for which permit is used: 'o
License(s) or Permit(s) required for th�p�enb�o�� �v�u ental agencies:
License or Permit OCT 2 9 2018 Agency
BUILDING DEPARTME
0v'
Certificate to be issued to Pace.Jet6ts ly,c Tel:
Address: 51t!s-, `fav-kL ag
Owner of Record of Building �4vangf ,lo— z rr.te). c sAq me- IZ,ea"41
Address
Present Holder of Certific ^'
Signature n to whom Title
Certifca is i sued or his agent
Date
Email Address: �0� 26k- Gor1
Instructions: Make check payable to:
Return this application to:
Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
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# -A.� �qa-pa
1/1/2019-12/31/2019
'AC a CERTIFICATE OF LIABILITY INSURANCE
°ATE,MM� 612016
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.
H 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 endorsements .
PRODUCER
STANDISH INSURANCE GROUP INC.
303 COURT STREET UNIT i6
PLYMOUTH, MA. 02360
CONTACT
NAME:
PHONE 774:Z83:442:) -- FAx-774383-4243—
AID,No.Eal)' —L 1AIC,Mo)_
ADDRE
ADDRESS: ANOYR STANDISHINSURANCE.COM
s 1,00_0,()_0_0
f 50,000
INSURER(S)AFFORDING COVERAGE_
N_AICf
INSURER A: GUARD INSURANCE GROUP
INSURED -
INSURER 8-GLTABB
RED FACE JACK'S INC
INSURER C:ATiD-- �
D/B/A RED FACE JACKS
INSURER °:
585 ROUTE 28
WEST YARMOUTH MA 02673
INSURER E:
GEN'. AGGREGATE LIMIT APPLIES PER -.
--
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.
LTR TYPEOFINSURANCE �ADOC3UBR, POLICY NUMBER IMM`DryEFF FOLExp-
TR YP1 LIMITS
LTR
Ix I COMMERCIAL GENERAL UABIUTY
CLAIMS -MADE 19 OCCUR
RESP994034
8/12/2018
8/12/2019
EACH OCCURRENCE
DAhRCETO RENTED
PREMISE§.(EaommePn)
s 1,00_0,()_0_0
f 50,000
MED EXP (Any one Fetzf
5000
, 1,0001000
' RSONAL A ADV INANf
GEN'. AGGREGATE LIMIT APPLIES PER -.
GEN
3 2,000,0 00
POLICY I]jEC EILOC
PRODUCTS - COMP/OP AGG
f -_2 000
..000
OTHER'
S
AUTOMOBILE LIABILITY
OMDINED SINGLE LIMA
LEe.acaPenl
S
3
ANY AUTO
BODILY INJURY(Perparson)
OWNED 6CHEDULED
AUTOS ONLY AUTOS
HIRED No"WNED
AUTOS ONLY HAUTOS ONLY
BODILY INJURY (Per scaaem)
PROPERTY DAMAGE
1PH A-XJ6 R
S
3
f
UMBRELLA UAR
OCCUR
EACH OCCURRENCE
3
EXCESS UAB
CLAIMS -MADE
AGGREGATE
�'—_�
f --
RIONS
DFD ETENT
S
B IANY
WORKERS COMPENSATIONCHUBB
ANDEMPLOYERS'LWBRJTY YIN
PROPRIETORMARTNERIEXECUTNEE.L.
OFFICERIMEMDER EXCLUDED? F
NIA
5116/2018
5/1612019
R t4
—LSTATVTE_ €
EACH ACCIDENT
S _500,000
E. L DISEASE_ EA EMPLOYE
(Mandatory In NH)
S SM000
DE6CRIPTION OF OPERATIONS treioN
NIMyeC IPTION OF O
S nn nan
EL DISEASE -POLICY LIMB
LIQUOR LIABILITY
REOP994034
8112/2018
8/12/2019
$1,000,000 PER OCC
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$2,000.000AGGREGA
E
DESCWTK)N OF OPERATIONS I LOCAT*NS I VEHICLES (ACOR0101, AdditionalRemarks SCAsduN, mar W aeatMd tl more spsee ngWrcd)
LOCATION 1 585 ROUTE 28 WEST YARMOUTH MA
BUILDING 1 YEAR ROUND RESTAURANT
10 DAYS NOTICE OF CANCELLATION
TOWN OF YARMOUTH
1146 RTE 28
SOUTH YARMOUTH MA 02664
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
I
TOWN OF YARMOUTH BEL; ELECTRICAL
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 026644451 GAS
p1UMBING
Telephone (508) 398-2231, Ext.1261 - Fax (508) 398-0836
SIGNS
BUILDING DEPARTMENT
Inspection and License ReportaO
_ Date
�y
�J� t
Address S /�OG-re Business Name S
Cont Phone
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
❑ Emergency egress signage
❑
Emergency egress lighting
❑ Maintenanceofexits
❑ Guards/handrails
� nirr
❑ Signs
❑ PWdng "
❑ Other
Mechanical
❑ Combustion Air
❑ Storage in Boiler Room
❑ Vents
❑ Automadedoorelosures
onbollerroomdoors
Location
Location v
Location
Location
Location
Location
Location
Location
Location
Location
Location
❑ Clothes dryer vents Location
32that Location
The State Building Code, Section 10013 - 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) you 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_days
//ddaa�ys an act this office for a follow-up inspection.
Received ByTitle
,411
Revised 218/13