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Home My WebLink AboutCertificate of Inspection The Commonwealth of Massachusetts A ri 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 Business Name:THE OPTIMIST CAFE BLDCI-19-002913-01 Trade Name:THE OPTIMIST CAFE Identify property address including street number,name,city or town and county Certificate Expiration Located at 134 ROUTE 6A 12/31/2020 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 80 A-2 Nightdub/Restaurant/Bar/Banquet Hall 80 PERSONS Allowable Occupant Load 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 ��+ f/7� Fire Chief Building Commissioner Inspection Signature of Municipal '� Signature of Municipal Date of Fire Chief / Building Commissioner Issuance 77 ,,041064 Fee:;100.00 B LD_Certofl nspection.rpt Ait TOWN OF YARMOUTH u y BUILDING DEPARTMENT c MATTA n CSE 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 100.00 ( ) 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: y3 ao-kth (0 , Wom N L Name of Premises: O 41j 9- Tel: —j )0A Purpose for which permit is used: LeCLUA O, License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit RECEIVE fD Agency OCT CT 12019 BUILDING DEPARTMENT BY - Certificate to be issued to Un Tel: 5 9—j(c d—t C) Address: 12,4 A- '/afm( 1,1 P�g-! Owner of Record of Building &LdL tic AAA .Q/) L( t" Address �Q�vvL Present Holder of Certificate twLe›( 0 WYLIA' Sig ture of person to whom Title Certificate is issued or his agent j U J 0-# 9' Date Email Address: JLr`Yun.9Wgs p (acctioo 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# /f—0, .Q 3 O/ 12/30/2019-12/30/2020 .. l , Pblicy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER:The Hartford Insurance Co of the Midwest ONE HARTFORD PLAZA HARTFORD CT 06155 ' THE H HARTFORD NCCI Company Number. 20605 Company Code: G • Suffix LARS RENEWAL POLICY NUMBER: 08 WEC CL8815 6 Previous Policy Number: 08 WEC CL8815 1. Named Insured and Mailing Address: KRISTINA'S KITCHEN, INC. (No., Street,Town, State,Zip Code) 134 ROUTE 6A YARMOUTH PORT MA 02675 FEIN Number: 38-3892174 State Identification Number(s): The Named Insured is: Corporation Business of Named Insured: Full-Service Restaurants Other workplaces not shown above: 134 ROUTE 6A YARMOUTH PORT MA 02675 2. Policy Period: From 02/01/19 To 02/01/20 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: DOWLING&O'NEIL INS AGENCY/PHS PO BOX 1990 HYANNIS MA 02601 Producer's Code: 08088233 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (866)467-8730 Total Estimated Annual Premium: $977 Deposit Premium: Policy Minimum Premium: $265 MA(Includes Increased Limit Min. Prem.) Audit Period:ANNUAL Installment Term: Four Pay(30%Down+2@25%+1 @20%) The policy is not binding unless countersigned by our authorized representative. Countersigned by d' -, 12/23/18 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 12/23/18 Policy Expiration Date: 02/01/20 INFORMATION PAGE (Continued) Policy Number: 08 WEC CL8815 3.A.Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: MA 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: Bodily injury by Accident $500,000 each accident Bodily injury by Disease $500,000 policy limit Bodily injury by Disease $500,000 each employee C.Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO WASHINGTON,WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D.This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 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. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $665 Expense Constant $250 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsemeht $34 Estimated Annual Premium (before Surcharges) $949 Total Estimated Surcharges $28 *See the attached Schedule(s)of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $977 Deposit Premium: Policy Minimum Premium: $265 MA(Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS:722110 Labor Contractors Policy Number: SIC: Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 12/23/18 ` Policy Expiration Date: 02/01/20 rf Is o ..__Y TOWN OF YA R M O U T H BUILDING RICAL C 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 GAS j�: PLUMBING Telephone(508)398-2231,Ext.4261 —Fax(508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report p / Date Address //y/aGT( (a•1 Business Name 72,' ef:5171..,"!i'ir c '2 Conran 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: Egreil 0 ergency egress signaage Location I ❑Emergency egress lighting Location ❑Maintenance ofexits Location d Guards/handrails Location o—/ 6-xo' Zoning Signs Location CI Parka . Location U Other Location Afichissical ❑Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location d Automatic door closures on boiler room doors Location ❑Clothes dryer vents Location 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 next7 annual inspection. o Make corrections within / ' �diay contact this office for a follow-up inspection. Official/Inspector Local )/=/ 2[/rALe` � Received ByIA ;i • t` ._.,_ ,v Title • Revised 2/8/13 1