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Home My WebLink AboutBLDCI-16-003257-05 1 The C( nittionwealth of Massachusetts } ` .—. << ° City\Town of ., f �' NI ; YARMOUTH 41 4 ��`III Ir— 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: CAPTAIN PARKER'S PUB, INC. BLDCI-16-003257-05 Trade Name: CAPTAIN PARKER'S PUB Identify property address including street number, name, city or town and county Certificate Expiration Located at 668 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 • Use Group Floor Occupancy Use Group Other Classifications(s) A-2 ()1st Floor 89 A-2 Nightclub/Restaurant/Bar/Banquet Hall interior Other 40 A-2 Nightclub/Restaurant/Bar/Banquet Hall outside 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 Ill Name of Municipal Mark Grylls Date of //`��' Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief y Building Commissioner Issuance /// iA__ f Fee:;150.00 BLD_Certoflnspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, 11A 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Capt Parkers Restaurant ADDRESS: 668 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 io er ep. Date Comments Approved for License Issuance /7- �j ! No Fire Department Rep. Date Comments Approved for Lic se Issuance Yes No Alb Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for //4(Z/ License,Issuance <YesJ No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 { 0 �R TOWN OF YARMOUTH � o- BUILDING DEPARTMENT `` "�' ;," 3`JA 1146 Route 28, South Yarmouth, MA 02664 508-398-2 OCT_ APPLICATION FOR CERTIFICATE OF INSPECTION 06 2021 —BUBILDING DEPARTMENT October 1, 2021 PAYABLE U t l EC IP - (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: 6 6 * /Qt fir' ��(,, StXeel- f- 34 1,4-r7&dAe-72/.11407‘‘ Name of Premises: C�'o� �� KKPK s ! v6 Tel: �v Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to G-eKr41c\ / "4""'" Tel: S-7)"6 y. 1716 U Address: tat /`lrl f Lo 4,fe teiz. Svv 1 A yJ4✓'e'44111i MO 0 c 9 6 6 zit Owner of Record of tuilding Address Present Holder of Certificate 'Sldcn7 t4Rwq y!� Signature of person to whom itle Certificate is issued or his agent l G-d I Date Email Address: "Avy "I tei r Ali P Co"'c,,,s-7�✓e t 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# L3 /-Ito-cools-9-(s 12/31/21-12/31/2022 Oct. 6. 2021 1 : 28PM No. 9291 F. 1 Fax;(508)396-0836 • 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM°DIYYIY) o/06/2021 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(SI,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlfloate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condltIons 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 endorsements) PRODUCER CONTACT RAMC, Sharon COVInO McShea Insurance Agency, Inc PHONE No Pet1 (608)420-9011 'A,c,Na), (5oS)420-9010 1645 Falmouth Road, Rt 28 BLDG D E-MAILss sharon@mcshealnsurance.com Centerville, MA 02632 INSURER(S)AFFORDING COVERAGE NAICd INSURER A: The Hartford Insurance Company 11004_. INSURED INeURiRE: NATIONAL GRANGE MUTUAL 14788 Captain Parkers Pub, Inc. INSURER LI: The Hartford.Insurance Company 22357 688 Route 28 INSURER U; West Yarmouth, MA 02673 INSURER fi; Y INSURER F': _ COVERAGES CERTIFICATE NUMBER: 00000413-218476 REVISION NUMBER: 7 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSJED 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 SEEN REDUCED BY PAID CLAIMS. IN$R TYPE OF INSURANCE ADM.SUER POLICY EFr POLICY EXP LTF�, INSD MD POLICY NUMBER (MMlpprYYYY) IMM,00IYYYTL LIMITS A X COMMERCIALOLNERALLIAHILITY 08SBANX5037 0410612021 :04106/2022 EACH OCCURRENCE $ 2,000,000 JCLAIMS-MADE OCCUR PREM1SF.S ifdw'iChCd) v 1,000,000 MED EXP(Any One person) $ 5000 PERSONAL B ADV INJURY I $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PEft GENERAL AGGREGATE $ 4,000,000 X POLICY fEGT LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER $ B AUTOMOBILE LIABILITY M1 T2388U 08/07/202i 08/07/2022 Ea a70MrIlflenllSRJGLE LIMIT $ ANY AUTO I BODILY INJURY(Per pB!SOn) $ OY.NED I SCHEDULED --• AUTOS ONLY X AUTO$ BODILY INJURY(Par BCCJtlert) i HIRED NON-OWNED I PROPERTY DAMAGE i AUTOS ONLY X AUTOS ONLY I(PRr ecodart) ! x A UMBRELLA LIAR X OCCUR '08SBANX5037 04105/2021 04/05/2022 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 _ , DED RETENTION$ $ C WORKERS COMPENSATION 08WECCM3443 f 04/01/2021 04/01/2022 STER.TUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIEIOR,FARTNERlEXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Myyandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 r DES RIPTIONy- rOPERATIONS baIow ,.,---„_—,--. E.L.DISEASE-POLlCY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (AGORA Ill,AMOItIoneI ReMlrke Sohedule,may be■Naohed If more■paoa Is requlrad) LIQUOR LIABILITY INCLUDED ONE MILLION PER OCCURRENCE,TWO MILLION AGGREGATE.LIABILITY COVERAGE INCLUDES THE PREMISE ADDRESS,668 ROUTE 28,WEST YARMOUTH,MA,THE PERIMETER AND PARKING LOT. 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, Building Department, Board of Health, Liquor South Yarmouth, MA 02664 AUTHORIZE)REPRESENTATIVE �T / 4", i J� I (SSC) 0 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by SSC on October 06,2021 at 01:2SPM