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HomeMy WebLinkAboutBLDCI-16-005165-05 The Co nwealth of Massachusetts -i _: =V City\Town of 1 t._e(_- YARMOUTH ._,,emu 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:RJ Resorts Red Jacket Beach Resort Owner LLC BLDCI-16-005168-05 Trade Name:RED JACKET BEACH RESORT Identify property address including street number,name,city or town and county Csriiflcata Expiration Located at 28 SOUTH SHORE DR 04/01/2022 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 75 R-1 Hotel/Motel/Boarding House/Transient 75 Units Allowable 02nd Floor 75 R-1 Hotel/Motel/Boarding House/Transient 75 Units Occupant Load i Other 10 R-1 Hotel/Motet/Boarding House/Transient 4 Duplex-8 Units I 2 Single Cottages 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. lame of Municipal Name of Municipal Mark Grylls Date of 3 Building Commissioner Inspection ` A3 gnature of Municipal Signature of Municipal Date of Building Commissioner Issuance roir 3 Fee:$550.00 B L D_Certoftnspection.rpt he ommonwealth of Massachusetts } WikeilMlw City\Town of . YARMOUTH P���` i 4. 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: PALMER DAVENPORT&DAVID MUGAR BLDCI-16-005165-05 Trade Name: RED JACKET MOTOR INN RESTAURANT Identify property address including street number, name,city or town and county Certificate Expiration Located at 28 SOUTH SHORE DR 11/30/2021 SOUTH YARMOUTH, MA 02664 - Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 120 A-2 Nightclub/Restaurant/Bar/Banquet Hall 18 Persons-bar 102-Persons-dining room Allowable 02nd Floor 225 A-3 Amusement/Church/Gym/Library/Museum 2nd floor meeting rooms Occupant Load -see attached addendum 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 Grylls Date of Fire Chief Building Commissioner Inspection 3 -3-a 1 Signature of Municipal Signature of Municipal 7 Date of //f/// . Fire Chief - Building Commissioner Issuance Ar Fee:$150.00 BLD_Certofl nspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, CIA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG — 2021 NAME: Red Jacket Motel Restaurant ADDRESS: 28 South Shore Drive 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 License No Fire Department Rep. Date Comments Approved for ti'i'‘) n u C 2 _ Li Yes a IssuanceNo /! I''�"" 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 ':a 'YgR TOWN OF YARMOUTH • I BUILDING DEPARTMENT '- w.,.��.• ..' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION February 5, 2021 PAYABLE UPON RECEIPT (13 Fee Required $ 150.00 (0) 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: 28 South Shore Drive Name of Premises: Red Jacket Beach Tel: 508-398-6941 Purpose for which permit is used: Liquor License Inspection License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Common Victualler Food Service Certificate to be issued to Red Jacket Beach LP Tel: 508-398-6941 Address: 28 South Shore Drive, South Yarmouth, MA 02664 Owner of Record of Building Red Jacket Beach LP Address 20 North Main Street, South Yarmouth, MA 02664 Present Holder of Certificate Red Jacket Beach LP r/i) G Assistant Controller Signature of son to whom Title 8n P Certificate is issued or his agent February 5, 2021 Date Email Address: mpurrierAdavenportcos.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# WC8196035 4/1/2021 - 11/30/21 L 6G / - I & v 0bc7 6 os-- _— " DAVEREA-01 OKAY ACORL7 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/3/2021 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: ValleyForge Captive Advisors PHONE 484 965-9627 FAX 630 Freedom Business Center Drive (A/C,No,Ext):(610)458-3659 (a/c,No):( ) EMAIL Suite 203 ADDRESS: King Of Prussia,PA 19406 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B: Red Jacket Beach LP INSURER C: 20 North Main Street INSURER D: South Yarmouth,MA 02664 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. SRADDL SUER POLICY EFF POLICY EXP LIMITS IN LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER IMM/DDIYYYYI IMM/DD/YYYY1 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR GL08196255 3/1/2021 3/1/2022 DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) S MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BAP8196256 3/1/2021 3/1/2022 BODILY INJURY(Per person) $ — OWNED — SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS p PROPERTY UAMAGE _ AUTOS ONLY — AUUTOSS ONLY (Per accident) $ $ _ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A AND EMPLOYERS'LIABILITY X STATUTE EER PER H WC8196035 3/1/2021 3/1/2022 E.L.FJ+CHACCIDENT g 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N NIA 1,000,000 Mandatory In NH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 0 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD