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HomeMy WebLinkAboutBLDCI-16-003683-04 I The Commonwealth of Massachusetts 1 n it City\Town of 1 ' 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: RED FACE JACK'S INC. BLDCI-16-003692-04 Trade Name: RED FACE JACKS Identify property address including street number, name,city or town and county Certificate Expiration Located at 585 ROUTE 28 12/31/2021 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) - A-2 01st Floor 299 A-2 Nightclub/Restaurant/Bar/Banquet Hall 95 Persons-Bar/Lounge 154 Persons-Main Dining Room Allowable TOTAL SEATS-248 Occupant Load seats TOTAL OCCUPANCY- 299 Persons 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 If•f 7.ZoZo Signature of Municipal Signature of Municipal Date of Fire Chief -,-;,gjBuilding Commissioner j Issuance ?-Loa, Fee: $150.00 BLD_Certofl nspection.rpt i TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Red Face Jack's ADDRESS: 585 Rte 28 Yarmouth This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for _ License Issuance � // 0 No Fire Department Rep. Date Comments Approved for License Issuance 1 Ye No ‘,(1..,..„(V.v......, 11 - 17-A0 Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 MY R TOWN OF YARMOUTH o •. ,y - y BUILDING DEPARTMENT a,M ...r�•�s�� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2020 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: �O�f CA Name of Premises: ' 1 '` \`6l�,�,J��1�t--S Tel: ` 5 ^1 ) I - Purpose for which permit is used: -ra4C.R. License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to r\ _u Vet, S Tel: Address: .5' S 5 � n �� y Owner of Record of Building yyte_ Address Present Ho r of rtificate Jeke..kS D1c7 Si re of son to whom Title Certificate is issued or his agent iC 1(510 �," Date Email Address: \ O YW1UVtY► i'YM,S�. 1��CS4 r4 &31-0.C.-0 • c-6(11\ 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# t --0 o2 _/, _,,Q 12/31/2020—12/31/2021 R d'L CERTIFICATE OF LIABILITY INSURANCE DCTE(M10/07/2020 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 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 ANDY RLGULA NAME: STANDISH INSURANCE GROUP INC. PHONE 774.283.4425 I FAX 774.283.4243 - IAIC.No,Ex*_--- -- I(NC.No): 303 COURT STREET UNIT 1 B E-MAIL ANDYR STANDISHINSURANCE.COM ADDRESS: PLYMOUTH,MA. 02360 I INSURER(S)AFFORDING COVERAGE NAIC k _ INSURER A:GUARD INSURANCE GROUP BERKSRIR2IHA`f�iAWA(t�C1AR6 INSURED INSURER 8: ' RED FACE JACK'S INC --GUARD INSURER C: D/B/A RED FACE JACKS INSURER D 585 ROUTE 28 INSURER E WEST YARMOUTH MA 02673 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 7IADDLISUBR� I POLICY EFF ' POLICY EXP LIMITS LTR I INSD I INVD POLICY NUMBER I(MMIDD/YYYY) IMM/DEVYYYYLI X COMMERCIAL GENERAL LIABILITY REBP079489 8/12/2020I 8/12/2021 -EACH OCCURRENCE i$ 1,000,000 A - —} DAMAGE TO — X ,PREMISES EaENTED occurrence) I$ 50,000 -f CLAIMS-MADE '��`__-. OCCUR I, I, , Tl MED EXP(Any one person) $ 5000 I PERSONAL&ADV INJURY I,$ 1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 1$ 2,000,000_ POLICY ECT i i LOC , PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO • BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ __f AUTOS ONLY _ AUTOS PROPERTY DAMAGE i I HIRED ,NON-OWNED $ __1 AUTOS ONLY r_ AUTOS ONLY (Per accident) - . -- Is I UMBRELLA UAB i OCCUR EACH OCCURRENCE $ _.- EXCESS LIAB I - ICLAIMS-MADE H. '',AGGREGATE $ WORKERS COMPENSATION I i DED I ,RETENTION S I '$ REWC159388 i STATUTE ,PER l 1.I ER I AND EMPLOYERS'LIABIUTY Y/N 6/19/2020' 6/19/2021! I 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L-EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A JJ . (Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE s 100 QQ9 It yes,describe under I DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT i$ 5D0 000 ,, LIQUOR LIABILITY j REBP079489 ' 8/12/2020 1 8/12/2021 $1,000,000 PER OCCUR $2,000.000 AGGREGATE i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) OUTSIDE DINING IS ALLOWED UNDER THE GL&LL CERTIFICATE HOLDER CANCELLATION I TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 RTE 28 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTATIVE I © 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD