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HomeMy WebLinkAboutBLDCI-16-005425-06 The Commonwealth of Massachusetts 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 Business Name: OLYMPIA FISH HOUSE BLDCI-16-005425-06 Trade Name: OLYMPIA FISH HOUSE Identify property address including street number, name,city or town and county Certificate Expiration Located at 1341 ROUTE 28 11/30/2022 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 95 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 III Name of Municipal Mark G Date of Fire Chief Building Commissioner �/' Inspection Signature of Municipal Signature of Municipal or, -� Date of Fire Chief — Building Commissioner Issuance 3//0 2 Fee:$100.00 BLDCertofl nspection.rpt A�D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 02/15/2022 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 Johanna Moloney NAME: Guard Insurance Agency,Inc PHONE FAX (A/C.No,Eat): (A/C,No): 279 Mt Auburn Street E-MAIL Johanna@quinngroupins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Watertown MA 02472 INSURER A: Twin City Fire Insurance Company 29459 INSURED INSURER B: Olympia Fish House Restaurant,Inc. INSURER C: 1341 Main St,Rte 28 INSURER D: INSURER E: S Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2221500373 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 ADDL-SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEa LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILYINJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION v PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER Y/N 100,000 A ANYCER/MEETOR/PARTNER/EXECUTIVE Y N/A 08WECAL3CMX 04/19/2021 04/19/2022 E.L.EACH ACCIDENT $ (Mandatory In N ) EXCLUDED? 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 50 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 0' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddltIonal Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 ' `) ; ©1988-2015 ACORD CORPORATION. All rights reserved. A¢ORD 25(2016/03) The ACORD name and logo are registered marks of ACORD M,.�,Yr:rz.rzat:.. °�°� YaR TOWN OF YARMOUTH o , , .. .;-4 BUILDING DEPARTMENT ',."\""T'"`" wt,szY 1146 Route 28, South Yarmouth, MA 02664 508-34 E p APPLICATION FOR CERTIFICATE OF INSPECTION; 1\._ FEB 1'7 2022 I. February 2, 2022 PAYABLE UPON I tarI-PING )EPHRTMENT (X) Fee Req . ' ( ) 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: I 0 12\ -.S Name of Premises: OIvfic c-,5 \ \\0✓S Z Tel: 5O'— OI 41-02 Ca\ l, Purpose for which permit is used: 5efvi►1 YjD\� coro0A G.j G I(olna` to 1•x 0r'If�� (1 L License(s) or Permit(s) required for the premiees by other governmental agencies: License or Permit Agency L1 vo.2._ 0 G. Cs Certificate to be issued to DalvvArko& \Lon- a5 Tel: J� D 3d/`'/'•fit/2 Address: 9 MchAk�c ��o fe,:► w,i,} l'Y1i . 02.66a Owner of Record of Building m0, \\pj j cJ1ct�`1�?V(/ ` Address ay '„._ t r J-Q., WocGo r; rhA GU 09 Present Holder of Certificate NV-Q., k.rio S cLor ct C ))) ,i _- e Signature of person to whom Title Certificate is issued or his agent(P 4o,j ) P.6 /± )0,22 Date Email Address: ea ,-k p rU►G{5 7 ' & q t I , Com 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# ja.Visik igS---06 04/01/2022-11/30/2022 BUILDING G DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1 260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Olympia Fish House ADDRESS: 1341 Route 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 Re Date Comments Approved for License Issuance Maw No G' Fire Department Rep. Date Comments Approved for & „r L,(-- Lic Issuance - JI -ZZ Yes No )4 ��-- Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for j/(/1 L License Issuance Yes► No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003