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HomeMy WebLinkAboutBldci-16-003446-03 The Commonwealth of Massachusetts ► : ,_ City\Town of —91''= YARMOUTH 1 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: SONS OF ERIN CAPE COD, INC. BLDCI-16-003446-03 Trade Name: SONS OF ERIN Identify property address including street number,name,city or town and county Certificate Expiration Located at 633 ROUTE 28 12/31/2020 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 160 A-2 Nightclub/Restaurant/Bar/Banquet Hall 160 PERSONS TOTAL 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 Ill Name of Municipal Mark G Is Date of Fire Chief Building Commissioner Inspection 4( l02� Signature of Municipal Signature of Municipal Date of /411, Fire Chief ` B 'ding Commissionerie1 Issuance Fee:$150.00 B LD_Certofl nspection.rpt F` Ro TOWN OF YARMOUTH o ti -y BUILDING DEPARTMENT MATTA M CSE ,'4.•,..ro�r 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2019 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: &33 k- 2E7,wc4y4,,, ,i4,,wiA1 0 7._tejl Name of Premises: SOti$ C'f E-�'''4 Car- I Ju t, _Tel: `1 O3 -Cie,nn 13 I Purpose for which permit is used: ✓ Gta.&C-tv. License(s) or Permit(s)required for the premises by other governmental agencies: Z E C E I V E D License or Permit Agency 7 19 L I B J l Ir0P ~ rUlafr- Certificate to be issued to tYMIS Le-A, , '`‘" Tel: 50i6'i M Address: (Q`; 31( -k ? j 1,J, excer Owner of Record of Building "pep cpci _L v-r aro% Cep Address £3s f�k 26 ' tC�v-rr��i4t.. Present Holder of Certificate Se Oi,.r o2. C Wtw.e / Signature of pers to whom Title Certificate is issued or his agent fO-ZZ-,� a �( Date Email Address: tCeK ` A,L�� �-,7 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# TaLUGj.-a,v oTS 12/30/2019-12/30/2020 VDAC CHUBB® WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-4705P92-8-19) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER$100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 8641 NAICS: 813990 STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 575 PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 250 TERRORISM 20 TOTAL ESTIMATED PREMIUM 845 TAXES AND SURCHARGES 22 DEPOSIT AMOUNT DUE 867 A/R (WCIP) # Minimum Premium: $ 211 ST ASSIGN: MA DATE OF ISSUE: 07-18-19 WC OFFICE: RMD CHUBB 24M PRODUCER: BRYDEN & SULLIVAN INS 75BKG Ir Y VAV C 1-i U B B® WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6562UB-4705P92-8-19) RENEWAL OF (6562UB-4705P92-8-18) INSURER: ACE AMERICAN INSURANCE COMPANY NCCI CO CODE: 12165 1. INSURED: PRODUCER: SONS OF ERIN CAPE COD INC BRYDEN & SULLIVAN INS PO BOX 403 PO BOX 1497 SOUTH YARMOUTH MA 02664 SOUTH DENNIS MA 02660 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-02-19 to 08-02-20 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 state(s) 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: 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. MIME DATE OF ISSUE: 07-18-19 WC ST ASSIGN: MA OFFICE: RMD CHUBB 24M PRODUCER: BRYDEN & SULLIVAN INS 75BKG 109183 ,70 a °F ` = TOWN OF YARMOUTH BUILDING 14 . 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 GAS PLUMBING I� Telephone(508)398-2231,Ext.4261—Fax(508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report liL/�/�' Date . �t Address 3 Aare Ai, Business Name Y © T € Af 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 t)f Board of Health rules,the following violation(s)were observed:Agraf Try, Emergency egress signage Location ,9/57i49rei U Emergency egress lighting Location alMaintenanceofexirs Location 1• � t/�`i 7. .G'/y"i/ ❑Guards/handrails Location ailing Sa Signs Location L:.✓if�� /& T d e � y 4 ❑Parking Location ❑ Other Location ❑CombustionAir Location Li Storage in Boiler Room Location • ❑Vents Location • ❑Automatic door dosures on boiler room doors Location I 0 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. Irk order to abate the above violations)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 Of i j Official/Inspector _.Z;CI.Lda! Received By 4tf , Tide ce5,40e ,4 Q-ez , Revised 2/8/13