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HomeMy WebLinkAboutBldci-17-003375-02 The Commonwealth of Massachusetts h — —t►r City\Town of _ r " YARMOUTH •+Ya.— 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 LOFT BLDCI-17-003375-02 Trade Name:THE LOFT RESTAURANT Identify property address including street number,name,city or town and county Certificate Expiration Located at 183 ROUTE 28 12/31/2020 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 02nd Floor 194 A-2 Nightclub/Restaurant/Bar/Banquet Hall 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 Gry Date of l ���� Fire Chief Building Commissioner Inspection .` Z Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance /,75- 5 Fee:$150.00 BLD_Certofl nspection.rpt F • °f ` _ TOWN OF YARMOUTH BUILDINELECTRG E _ GAS"C 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING 1i Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836 _- SIGNS BUILDING DEPARTMENT Inspection and License Report Date / j.2 3 -/9- Address `83 /7oO 1 &e .7. Business Name r/YC G-0�� 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)(s were observed: Egressf/y S xc/ /47/ lam " ❑Emergency egress stgnage location i� �.J �3 ��j'rrl�1 /� ❑ Emergency egress lighting Location ?'1 ffe. ❑Maintenance of exits Location ❑ Guards/handrails Location &rag ❑ Signs Location ❑Parking Location ❑Other Location Mechanical ❑Combustion Air Location Storage in Boiler Room Location Vents Location • ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents • Location tither 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 t our;next anti al inspection. o Make corrections wi iv-w� days and contact this office for a follow-up inspection. • Local Off ci Or '" / Received By Tide Revised 2/8/13 4- AR TOWN OF YARMOUTH y BUILDING DEPARTMENT MATTA H E•U 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: g Street and Number: kt<&i \ Name of Premises: flir te-CO, / ge4460(44Tel: 3y,s-s)-:?-1-27 �Y eI Purpose for which permit is used: , ,/1-4't t4111— WkS License(s) or Permit(s)required for the premises by other governmental agencies: RECEIVED License or Permit Agen BUILDING DEPARTMENT Certificate to ssued to 110(11, ,'�� Tel:` Address: I WL n1 c'tc' . �✓- mail,'hl ►'N/f �n y Owner of Record of Building (. Address ) K3 h1Fin S . w, y4 r41au 7 3 Present Holde ,of Certificate S �p � , �, rii VIPPIWA Ilk *AA AW ",nature 'II rson to whom Tit e, C.. ificate is sued or his agent Dat Email Address: 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 ERR OF INSPECTION. Certificate of Inspection# BGd c��- /7 12/30/2019-12/30/2020 xb WORKERS COMPENSATION AND EMPLOYERS LIABILITY • INSURANCE POLICY Liberty Mutual. INSURANCE AR INFORMATION PAGE 175 Berkeley Street Boston,MA 02116 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-621418-019 Issuing Office 016C NEW BUSINESS NEW Issue Date 04-10-19 Account Number 1-621418 Sub Account 0000 1. Insured and Mailing Address ROURKES TOP OF THE COVE LLC RISK ID 001058718 183 MAIN ST WEST YARMOUTH,MA 02673 Status 46 - LIMITED LIABILITY CO Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE 2. Policy Period: The policy period is from 04-07-2019 to 04-07-2020 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage 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 $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: 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. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 215 (MA) Total Estimated Annual Premium $ 2,378 Premium will be billed ANNUAL Producer 0004-005707 ROGERS & GRAY INSURANCE AGENCY INC 434 RTE 134 STE F1 SOUTH DENNIS MA 02660 • WC 00 00 01 A ©1987 National Council on Compensation Insurance,Inc. WC 00 00 01 B (CA) Ed. 07/01/2011 All Rights Reserved Page 1 of 1 Insured Copy 1111 tension of Information Page WC 00 00 01 A Item 4. State of: MASSACHUSETTS Classification of Operations Premium Basis Rate :ries in this item,except as specifically provided elsewhere in this Code Estimated Total An- Per$100 Of Estimated Annual policy;do not modify any of the other provisions of this policy No. nual Remuneration Remuneration Premium D1-01 ROURKES TOP OF THE COVE LLC FEIN # 81-0989493 SIC CODE 5812 NAIC CODE 711110 183 MAIN ST WEST YARMOUTH MA 02673 RESTAURANT NOC 9079 $ 185,545 1.03 $ 1,911.00 )TAL CLASS PREMIUM $ 1,911.00 ,ANDARD TOTAL $ 1,911.00 CPENSE CONSTANT 0900 $ 338.00 3RRORISM RISK INS ACT )02 .03 9740 $ 56.00 t.CHWC (SURCHARGE) 1.0383 0936 $ 73.00 CNAL TOTAL $ 2,378.00 )LICY TOTAL ESTIMATED COST $ 2,378.00 ;parlance Modification: RISK ID: 001058718 ,icy No. WC5-31S-621418-019 Page No. 1 GPO 2923 WC 00 00 01 A Insured Copy • • Extension of Information Page WC 00 00 01 A Endorsement Schedule WC5-31S-621418-019 FORM NUMBER FORM NAME WORKERS COMPENSATION FORMS AND ENDORSEMENTS WC 00 04 14 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 00 04 22 B TERRORISM RISK PGM REAUTH ACT DISCL ENDT WC 20 03 01 MA LIMITS OF LIABILITY ENDT WC 20 03 02 A MA ASSESSMENT CHARGE WC 20 03 03 D MA NOTICE TO POLICYHOLDER ENDT WC 20 03 06 B MA LIMITED OTHER STATES INSURANCE WC 20 03 07 MA A/R POOL ELIGIBILITY ENDT WC 20 04 05 MA PREMIUM DUE DATE ENDT WC 20 06 01 A MA CANCELLATION ENDT WC 20 06 04 MA POLICY DEFINITION ENDT • • WC000001A Insured Copy