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HomeMy WebLinkAboutBLDCI-17-005596-05 The Commonwealth of Massachusetts City\Town of YARMOUTH • 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: EL MARIACHI MEXICAN RESTAURANT BLDCI-17-005596-05 Trade Name: EL MIRIACHI MEXICAN RESTAURANT Identify property address including street number, name, city or town and county Certificate Expiration Located at 416 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 117 A-2 Nightclub/Restaurant/Bar/Banquet Hall 102 lower 10 bar TOTAL PERSONS Allowable ALLOWED: 117 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 BuildingCommissioner 1Q2�p� Inspection Signature of Municipal Signature of Municipal Date of Fire Chief ilding Commissioner Issuance /. y_ 2 Fee: $150.00 BLD Certoflnsnection.nrnt °� aR TOWN OF YARMOUTH f CI anut A, ;1� BUILDING DEPARTMENT 1 L MATTACM St ',1 `�;4e�,.:t�•�- 1.1.46 Route 28, South Yarmouth, MA 02664 508-398 aly E ®: ° 1 V192021 G � APPLICATION FOR CERTIFICATE OF INSPECTION 77 BUILDING DEPARTMENT October 1, 2021 PAYABL _ (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: qg mQ/i7 ��, we c2 P Name of Premises: I IY2p1Vn Inn ''f b/kS ape ( d Tel: Purpose for which permit is used: Hole e License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency 4l/1UQ1 Li pot- License Certificate to be issued to£',ij A Yarnar i #IQ✓r�0elnn /M Tel: 50 P-�b a- 90_/0 Address: 99 /rlo;n Si-. Air a� o' s Owner of Record of Building fed /4rk'/S * tjnr/a:ny '0P_ trek pr ond' Address /105 T-G 11 p e Seekbr)k � �7/ - Present Holder of Certificate 1/0 ,-isr-2 bin i Svi les Cope Cod - Pies,den4 Signature of person to who Title Certificate is issued or his agent /i//P/O7 P - - Date Email Address: 6//P o€)horripior1®nr i eve c d Xorn 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# ,QL.)CJ"(a.j)& f 12/31/21-12/31/2022 -...14 DARLDEV-01 LBROWN ,4Coszo' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIWYY) --" 10/5/2021 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 art endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Loretta Brown NAME: FBinsure,LLC 128 Dean Street (A/C,NNo,Eat):(508)824-8666 FAX No):(508)880-0142 Taunton,MA 02780 E-MAILDSS:LBrown@fbinsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Ins Co 41360 INSURED INSURER B:New Hampshire Employers Ins Co 13083 FED Hotel Properties LLC INSURER C:Ohio Casualty Ins Company 24074 99 Main St INSURER D: West Yarmouth,MA 02673 INSURER E: INSURER#: 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X '. OCCUR ',8500068374 3/31/2021 1 3/31/2022 DAMAGE TO RENTED 250,000 PREMISES(Ea occurrence) _.$ MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Liquor Liab $ 1,000,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO 1020096475 3/31/2021 3/31/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ I $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE 4620092990 3/31/2021 3/31/2022 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ECC6004000999 3/31/2021 3/31/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE. $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Liability EC057913907 3/31/2021 3/31/2022 Per Occurrence 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Umbrella Liability and Excess Liability policies/limits extend over the General Liability,Liquor Liability,Automobile Liability,and Workers Compensation policies. Regarding:Hampton Inn&Suites,99 Main St(Route 28),West Yarmouth MA 02673. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 - ---. AUTHORIZED REPRESENTATIVE l X a ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Hampton Inn-Assembly ADDRESS: 99 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 Commis 'one ep. Date Comments Approved for License Issuance / 2 ` ( diimi;pNo Fire Department Rep. Date Comments Approved for License Issuance Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date/7 (c/2, Comments Approved for License Issuance ' No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003