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Home My WebLink AboutBLDCI-22-004473 The Commonwealth of Massachusetts A47, City\Town of YARMOUTH nor —rim YJ •.*`TJ 1�fi, New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Pancake Man tiLUL.I-LL-UU44/d Trade Name: Pancake Man Identify property address including street number, name, city or town and county Certificate Expiration Located at 952 ROUTE 28 02/10/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classification(s) R-2 01st Floor 185 A-2 Nightclub/Restaurant/Bar/Banquet Hall 185 Person 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 withthe contents of the certificate is strictly prohibited. Name of Municipal Philip Simonian Ill Name of Municipal Mark Grylls Date of �� Building Commissioner % —i O �nspection " ' - - Signature of Municipal Signature of Municipal Z' Date of Building Commissioner ' Issuance OiliZ Fee: $150.00 B LD_Certofl nspection.rpt TOWN OF YARMOUTH BUILDING DEPARTMENT ® 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 FEB 10 2022 APPLICATION FOR CERTIFICATE OF INSPECTION BUILDING DEPARTMENT 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: 2F6 S Ll 1`) Yt °'r 1 . Name of Premises: the 'Pa-4 4( >✓ p\ tN1 . Tel: 5Z ) 5— q 6-3 2 Purpose for which permit is used: r"ectadi li License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit I Agency ,10.6+3449) a a b Ci L i c. ex cJ' vl Certificate to be issued to 5L 1 . Tel: �) eZ ? t Address: ? E30, (fig Y1 c`S P -P • (9,2601 Owner of Record of Building Address f Q 7 ctX‘i-z7v1 Au-0_, aA, 5 or" 6 Q,(o 47 Present Holder of Certificate • ems P, G ,n G- P, PaKtan Signature of person to whom Title Certificate is issued or his agent 4 yG • ' Date VIA'n Email Address: - PX c U,. G U rY1 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 CA T ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# --c 1 --COY / S 4/1/22-11/30/2022 DATE(YMIDO/YYVY) ACCORD CERTIFICATE OF LIABILITY INSURANCE o2(WAIDO22 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 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 endorsernent(s). coNTAcr PRODUCER NAME;_._-,_Martha Findlay__ I OLDE CAPE COD INSURANCE AGENCY INC pHorIMC_Itl,Ext .(508)771-3300_ __ 1 FAX NM: EMAIL marthaf occia.com INSURE_(_S)AFFORDING COVERAGE NAIC$ 300 WINTER ST -_--___.___`.___. HYANNIS MA 02601 INSURERA: AIM MUTUAL INS CO 3375E - INSURED INSURER B: PANCAKE MAN LTD INSURER C: _ - INSURER D: --- P O BOX 148 INSURER E: ---- -. --- HYANNISPORT MA 02647 I INSURER F: i COVERAGES CERTIFICATE NUMBER: 742309 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 REDUCEDT-POLICYBFY PAIPOL CLAIMS. EIXP s WertTYPE OF INSURANCE 1USD i WVD POLICY NUMBER I IMIA/DDIYYYYI}(Ml WlYY(Y1 i LTR 1 EACH OCCURRENCE I$ COMMERCIAL GENERAL LIABILITY 1 ,PTO� j -t $ CLAIMS-MADE OCCUR in MED EXP(An one person) S ^. ,,.,,. — { N/A 'PERSONAL R ADV INJURY $ ._.-__ t GENERAL AGGREGATE S GEN.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP! AGO f _�1 __+POLICY 1_ JECT I_-L� V. S ~- OTHER: COMBINED$ANGLE LIM17 $ AUTOMOBILE UA IUTY CO Ell) BODILY INJURY(Per person) S ANY AUTO BODILY INJURY(Per m odent) S E- ALL -.� N/A_ AUTOS OWNED �i SCHEDULED _ i- ------ --- AUTOS PROPERTY DAMAGE S r NON-OWNED irj a_PgC0111.1 . I HIRED AUTOS I AUTOS $ EACH OCCURRENCE S I UMBRELLALIAB I OCCUR i- ExCESS T LIAR i CLAIMS-MADEj N/A I AGGREGATE f S i DED ,RETENTION S �/I PER 1 OTH- WORKERSCO T X 1 STATUTE 1 (E)Ft - AND EMPLOYERS'LIABIUTY Y/N i E.L.EACH ACCIDENT S 500.000 AFFICER/METORIPARTNERIE%ECUTNE I A Osa iindately In EXCLUDED? WA WA : WA VWC10060160112021A 1f2021 D61D1/2022 MS E.L.DISEASE-EAEMPLOYEE,$ 500,000 N yt 8 describe 1 E.L.DISEASE-POLICY LIMIT ,S 500,000 DESCRIPTION OF OPERATIONS pass ) 4 N/A DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govfwd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth 1146 Main Street AUTHORIZED REPRESENTATIVE BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: The Pancake Man ADDRESS: 952 RTE 28 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 No ///7 .-7-47/7 Fire Department Rep. Date Comments Approved for License Issuance � LI '/ 2- 1? 22 No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for ? / 7/7 License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003