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HomeMy WebLinkAboutBLDCI-16-003683-04 The Commonwealth of Massachusetts , 1 it City\Town of YARMOUTH . #,, J 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 BLDCI 16 003683-04 Business Name: KOUNADIS ENTERPRISES, INC. Trade Name:YARMOUTH HOUSE RESTAURANT Identify property address including street number, name,city or town and county Certificate Expiration Located at 12/31/2021 335 ROUTE 28 WEST YARMOUTH, MA 02673 I I Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 264 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 Grylls Date of Fire Chief Building Commissioner Inspection /1'/7- Z0 ZO Signature of Municipal Signature of Municipal Date of Fire Chiefd#, . _ Building Commissioner p Issuance ,,,j!,,,,n,�'S� -- --- Fee:$150.00 BLD Certoflnspection.rpt 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: The Yarmouth House ADDRESS: 335 Route 28, West 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 R2e5,,, Date Comments Approved for �/ / �^ License Issuance G �/���`C J ( I=' No Fire Department Rep. Date Comments Approved for License Issuance (1,1, Yes No Y 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 TOWN OF YARMOUTH o� _.._ BUILDING DEPARTMENT MATTA M [Sf �, �.o•,•o..�G; 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: 3:3 c rrv; .l, Name of Premises: \-)Gt r mbi O\4 aa'el: 5fir' in/-S Purpose for which permit is used: Ke.A A_rctrl€ License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to leis , piiS. S Tel: Address: 33( (Yait-►1 ,j- . Owner of Record of Building t Address Y Present er of Certificate V. al.a. ek°- e-/pY 15 'Press cAekk- ignature of person to whom Title Certificate is issued or his agent 10 I o'1I. f a'O ' _ I _ — Date Email Address: \[oxY'0u 1 �.r€fis . L&, q • Can/1 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# ,gar//7--(:)Q -3-- a-d 12/31/2020—12/31/2021 / -��v ( DATE(MMlDD/YYYY CERTIFICATE OF LIABILITY INSURANCE 10/07/2020 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: It 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 7/4.283.4425 FAx 774.283.4243 LNG p.Ext)- — I lac,No) 303 COURT STREET UNIT 1 B NEODREss: ANDYR@STANDISHINSURANCE.COM PLYMOUTH,MA. 02360 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:AIM MUTUAL INSURED INSURER B: AP SPECIALITY KOUNADIS ENTERPRISES INSURER C: THE YARMOUTH HOUSE IN INSURER D: 335 MAIN ST 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. —lADDL`•SUBR --- -�-- POLICY EFF POLICY EXP !--- - - LTR TYPE OF INSURANCE i INSD I WVD POLICY NUMBER IMM/DD/YYYY1 I(MMIDD/YYYY)' UMITS TX COMMERCIAL GENERAL LIABILITY 1 ,CSI800192502 4/01/2020 4/01/2021 EACH OCCURRENCE I$ 1,000,000 B (}� DAm7CTE-fiO RETJTE-O i CLAIMS-MADE L J OCCUR 'Pr REMISES(Ea occurrence) i$ 100,000 L !MED EXP(Any one person) ($ 5,000 !PERSONAL&ADV INJURY $ 1,000,000 G_EN'L AGGREGATE LIMIT APPLIES PER: ._GENERAL AGGREGATE }$ 2,000,000 ' 1 POLICY JECT L- LOC I PRODUCTS-COMP/OP AGG I$ __2 000,0 0 I OTHER. + AUTOMOBILE LIABILITY E MaccIciden DSINGLE LIMIT) !• $ANY AUTO _ j BODILY INJURY(Per person) $ _ I i - !----- OWNED 1 SCHEDULED I i V-BODILY INJURY(Per accident)I$ AUTOS ONLY II— ;'- - -- AUTOS I ROPERTY DAMAGE HIRED NON-OWNED ' I$ I AUTOS ONLY i _ AUTOS ONLY I !(Per accident) I I r$ UMBRELLA LIAR OCCUR { I EACH OCCURRENCE $ .---I i EXCESS LIAB _I CLAIMS-MADE I 'AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N WCC5005022314 ;PER I ERH ' 6/08/2020 8/08/2021 ` -- - ANY PROPRIETOR/PARTNER/EXECUTIVE ! ! E.L.EACH ACCIDENT I S 500.000 A :OFFICER/MEMBER EXCLUDED' N/A - -"-- '--(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 500.000 If yes,describe under DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT 1S 500 000 B ! LIQUOR LIABILITY CSI800192502 4/01/2020 4/01/2021 PER OCCURRENCE$1,000,000 i GENERAL AGGREGATE$2,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS!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 ROUTE 28 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664 AU1HORIZED REPRESENTATIVE ©19 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD