Loading...
HomeMy WebLinkAboutBLDCI-22-004737 The Commonwealth of Massachusetts City\Town of '"1= YARMOUTH s r v a �n 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:-Sandbar Holding LLC bI JU1-22-UU4rai Trade Name: Shark Bites Cafe Identify property address including street number, name, city or town and county Certificate Expiration Located at 518 ROUTE 28 08/24/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classificate(s) A-3 01st Floor 140 A-3 Amusement/Church/Gym/Library/Museum 40 SEATS INSIDE 100 SEATS OUTSIDE Allowable TOTAL-140 SEATS 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 �tJ Building Commissioner /' Inspection " v^%Z2 Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance F e: $150.00 BLD_Certoflnspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 50 -398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Shark Bites ADDRESS: 512 Route 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Re . Date Comments Approved for License Issuance C2fes No .•/#°177 Fire Department Rep. Date Comments Approved for APT- f4qCS Lice e Issuance � Z Z Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance :G ( �j�2'Z ,Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 l• �o TOWN OF YARMOUTH (0:.74-":;$) BUILDING DEPARTMENT 1 146 Route 28, South Yarmouth, MA 02664 508 39$ 2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION February 2, 2022 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: 5 13 vt W . ( U u+'`d Name of Premises: S la-t 12 k 11'6 C I _ PC Tel: 7 e Purpose for which permit is used: Lk (4 h. 5� License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency IRECF vED ((''�� p� ? FEB 24 2022 Certificate to be issued to S. I4 A YZ L( � ) t C A-�C Tel 1 2 J gDILDING D�PAR22 ] Address: S I Go h ST W 5 g 2 o v f- "IJ NT Owner of Record of Building S o,h 0 V� A - � . k CS C X o S P 4 01 "rr o Address S I e\ a I S T VU 1(a 2 ih6 u T , i" G 7 3 Present Holder of Certificate . (), ,J &A✓ , VVl 6 T p S I-} I►2 K V i ft S cc ignat ue of person to whom Title Certificate is issued or his agent 3 ( Date Email Address: $Il Q a K�iies_c e cod cod (911 ni Qt i . C a m 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 SSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# G I -OOP 37 , 04/01/2022-11/30/2022 Acc CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYWY) kir..~� 12/01/21 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). CONIACI PRODUCER NAME: Brian Allain OAX Choice Insurance Agency (AHicNr o,Ext): 978-343-4853 (A/C,No): 978-345-1007 376 Summer Street ADDRESS: ballain@choice-insurance.com Fitchburg,MA 01420 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: AmGuard Insurance Company INSURED INSURER B: Sandbar Management Inc INSURER C: Cape Ccd.inflatable Park INSURER D: P.O.Box 481 — West Yarmouth,MA 02673 INSURER E: 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 - ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM1DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(a occurrence) $ MED EXP(Any one person) $ ■ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- ■ POLICY I EGT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODL Y INJURY(Per person) $ ■AUTOS SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ■ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) II $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER X OTH v/N - AND EMPLOYERS'LIABILITY STATUTE ER 1,000,000 A ANY OFFICER/MEMBER ER EXCLUDED?ECUTIVE(� N/A SAWC283178 10/01/21 12/01/22 E.L.EACH ACCIDENT $ (Mandatory in NH) J E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If es,describe joder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 i. i I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Operations oc Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Sandbar Management,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 481 'Nest Yarmouth,MA 02673 AUTHORIZED REPRESENTATIVE 1 �©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD