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HomeMy WebLinkAboutCerticate of Inspection The Commonwealth of Massachusetts }r: I_e& City\Town of _ = ?. 11= - YARMOUTH I 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:CALAMARI, INC BLDCI-16-003267-03 Trade Name: DIPARMA ITALIAN TABLE Identify property address including street number,name,city or town and county Certificate Expiration Located at 175 ROUTE 28 12/31/2020 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 17 A-2 Nightdub/Restaurant/BarBanquet Hall Bar Stools Allowable 01 st Floor 154 A-2 Nightdub/Restaurant/Bar/Banquet Hall 154 persons-tables& chairs 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 �� Fire Chief Building Commissioner .action Signature of Municipal i Signature of Municipal 'ate of Fire Chief ) Bu'Iding Commissioner .�` /` Issuance (2 c/ 57 ANOWr. Fee: I50.00 BLD Certoflnspection.rpt TOWN OF YARMOUTH _ o 0 y BUILDING DEPARTMENT _ — ce\NATTA M e„„_4' a 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: MainStreet and Number: —lS ICs1. Name of Premises: ,f�1(L_ Tel: JCS 1 Purpose for which permit is used ' A-A'GLt License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency I ° OCT 28 2019 BU U .'. NT By ����� Certificate to be issued to •V 2614AlleitA,, Tel: ' 1`1 I r 111 t, Address: 33`c Owner of Record of Building y 'id byts Address k'-i c Y --r\ Present Holder of Certifi e S\Ai e 20 Ifl JL Sig,atur-4f I-rson to whom Title C; fica is issued or his agent 1(�1 t$'I Date Email Address: \10.1 nO h u..i'e$-1z iraivt4 E j(Y1 Z. Lc w1 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# 8 el- /� -00 326 '`°3 12/30/2019-12/30/2020 MM/DD/YYYY CERTIFICATE OF LIABILITY INSURANCE DATE( 10/21n0)9 IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS AATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ,4. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED �ePRESENTATIVE 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 NAME: STANDISH INSURANCE GROUP INC. PHONE 7T4 283.4425 FAX 774.283.4243 303 COURT STREET UNIT 1B _A°.Exti: ( ,Mod ANDYRChSTANDISHINSURANCE.COM PLYMOUTH,MA. 02360 aoDREs___ INSURERS)AFFORDING COVERAGE NAIL A ,INSURER A. BERKSHIRE HATHAWAY GUARD INSURED INSURER B: CALAMARI INC. INSURER C: -- 175 MAIN ST INSURER D: WEST YARMOUTH MA 02675 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. IXP NSR TYPE OF INSURANCE SU9R POLICPOLICY NUMBER (MMID YD/YVYYI (MF M/ODNYYY) LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S L.X _ •.DAMAGE TO RENT D CLAIMS•MADE OCCUR PREMISES(Ea occurrence) $_ --_-J MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE E PRO- _—_._-------- POLICY JECT _ LOC PRODUCTS-COMP/OP AGG $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _(Ea acciden}) ANY AUTO BODILY INJURY(Per person) "$ OWNED SCHEDULED AUTOS ONLY ,.......AUTOS ' BODILY INJURY(Per accident);E HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY - i AUTOS ONLY (Per accident)_ UMBRELLA LIAB : OCCUR EACH OCCURRENCE "$ EXCESS LIAB CLAIMS-MADE'. AGGREGATE $ DED I RETENTIONS $ WORKERS COMPENSATION CAWC078215 PER OTH AND EMPLOYERS'LIABILITY Y/N 6/10/2019 6/20/2020 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE : E L EACH ACCIDENT -$ 500,000 A OFFICER/MEMBER EXCLUDED" N/A ---- - --- ---- (Mandatory In NH) E L DISEASE-EA EMPLOYEE$ 500,QQQ If yes describe under .. DESCRIPTION OF OPERATIONS below - . E L.DISEASE-POLICY LIMIT $ 50000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 ROUTE 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2015 ORD CORPORATION. All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD e_ e