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Home My WebLink AboutCertificate of Inspection The Commonwealth of Massachusetts ` — ert City\Town of =.77.710_ YARMOUTH err�� w 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:SKIPPY'S PIER 1 BLDCI-17-002511-03 Trade Name: SKIPPY'S PIER 1 RESTAURANT Identify property address including street number,name,city or town and county Certificate Expiration Located at 17 NEPTUNE LN 12/31/2020 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01 st Floor 252 A-2 Nightdub/Restaurant/Bar/Banquet Hall 68-2 SM.DINING 142-MAIN DINING 422SM Allowable DINING-OPPOSITE Occupant Load BAR 1ST FLOOR TOTAL- 252 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 Ill Name of Municipal Mark Grylls Date of Fire Chief Building Commissioner Inspection / /7"-47 Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance /f•/5 r/Q Fee:$150.00 BLD_Certofinspection.rpt n`sra1 a o TOWN OF YARMOUTH . o -y BUILDING DEPARTMENT MATTA M ESE <�.o..t o�* 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2019 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: f 1 kV-6C La/or Name of Premises: 5 °h 5 CI.- Tel: 94 3 6 v 15 3' Purpose for which permit is used: I e5+w1/4-t rtt vl License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to 5 h Y \ L LC Tel: 5-1) 3?c 1 57, Address: I 44-kae Laxr 5-far li- 6_2..c0(. 1 Owner of Record of Building kkP.1-W1, L L C Address t `) tUr0 y(� N \-16f d1.�.' 1 Oh' yRECEIVED Present Holder of Certificate S �P 011 L. L C OCT 22 2019 1 /GI/0'4P- qI ' D NT Signature of person to whom Title g BYe.�(� Certificate is issued or his agent Date Email Address: SpaShUV' a) CC 0 I i C OY 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# B tb 1 - /7-"V.4.S/J-0 3 12/30/2019-12/30/2020 A MI DATE(MDD(YYYY) •. �.--- CERTIFICATE OF LIABILITY INSURANCE 101/08/2019 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 be endorsed. If SUBROGATIONIS 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 NAME: THE OCEANSIDE INSURANCE GROUP 08084400 PHONE (866)467-8730 FAX (888)443-6112 (NC,No,Ext): (A/C,No): 411 ROUTE 28 E-MAIL ADDRESS: • W YARMOUTH MA 02673 INSURERS)AFFORDING COVERAGE NA CS • INSURER A: Hartford Accident and Indemnity Company 22357 INSURED INSURER B: SKP1M,LLC.,731 MAIN STREET LLC,277 S.SHORE INSURER C: DRIVE LLC DBA SKIPPY'S PIER 1 PO BOX 370 INSURER D: SOUTH YARMOUTH MA 02664-0370 INSURER E: 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 TYPE OF INSURANCE ADDL SUER POUCY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR ,WVD (MM/DDIYYYY) _ (MMIDDIY YYYI COMMERCIAL GENERALRA LIABILITY EACH OCCURRENCE CLAIMS-MADE I I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO I I JECT LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS _AUTOS (Per accident) _ UMBRELLA LABOCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS- MADE AGGREGATE PED RETENTION$ WORKERS COMPENSATION PER x OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY YM E.L.EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNERIEXECUTWE N/A 08 WEC AD1A4A 05/30/2019 05/30/2020 OFFICER/MEMBER EXCLUDED? C E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION 731 Main Street,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Tavern 731 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Sandra M DiGiovanni IN ACCORDANCE WITH THE POUCY PROVISIONS. PO Box 370 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 /Vf, ' C, ®1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD s � ' °r Yq TOWN OF YARMOUTH BUILDING GAS 1 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 ,'l' Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836 PLUMBING SIGNS BUILDING DEPARTMENT Inspection and License Report //V/ �7 D Address /7 ,/4 Pfifi ZN Business Name s�/,< /4-2. Contact 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: Egress ❑Emergency egress signage Location ❑ Emergency egress lighti•ng Location ❑Maintenance of exits Location a Guards/handrails Location Zoning ❑ Signs Location ❑Parking Location ❑ Other Location Mechanical ❑Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location Li Automatic door dosures on boiler room doors Location ❑ Clothes dryer vents Location r 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)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 and contact this office for a follow-up inspection. Local Official/Inspector •U(J mo Received By t. r (` 1 tLL Title Revised 2/8/13