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HomeMy WebLinkAboutbldci-17-002517-05 i The Co 4 onwealth of Massachusetts it 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: HEARTH N' KETTLE PROPERTIES, LP BLDCI-17-002517-05 • Trade Name: HEARTH N'KETTLE RESTAURANT identify property address including street number, name, city or town and county Certificate Expiration Located at • • 1196&1198 ROUTE 28 12/31/2022 • SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other • Classifications(s) A-2 01st Floor 209 A 2 Nightclub/RestaurantBar/Banquet Hall 209 PERSONS • 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 k Grylls Date of //�/�� Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal /J' Date of Fire Chief . - Building Commissioner Issuance //. 2 . Z] Fee: $150.00 • B L DCe rtofi n s pectio n.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Hearth N' Kettle ADDRESS: 1196 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 Commissioner Rep. Date Comments Approved for License Issuance Fire Department Rep. Date Comments Approved for License Issuance ft"4#1 ►1 I ,Ja, Ye No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date ii/i/2 / Comments Approved for 07 License,Issuance (let) No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 • lit!•-•`', • i Rr TOWN OF YARMOUTH i� $ BUILDING DEPARTMENT "„T,, „. s./, 1146. Route����� �� a 28, South Yarmouth, MA 02664508-398-223 vRECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION OCT 12 2021 October 1, 2021 PAYABLE UP i= lI a)!Tz7'." PARTMENT (X) Fee Requir r-- ( )No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspectionfor the bel w-named/ remises located at the following address: / Street and Number: 1, CG �I m S (tl Ci Name of Premises: e r el'n ! h ke/td '& leJ r4i, r4 /i/yTel: id 4'02 S - Purpose for which permit is used: Rd';:f ti ir‘h License(s) or Permit(s) required for the premises by oth r governmental agencies: License or Permit Agency Certificate to be issuedA t,o 1frar 'It4E'�'IX-� Tel: 3 4 ( 7-i rZ Address: !/?0 G,/t1 1r S y 6 f' i ovii Owner of Rec rd opf 9ui ing 4 1 ?r t Address 1 CO 141 a{A1 C IRV 19 0 (' Present Holder f Certificate 1 cr. ' Pir-{( 1-cii S gn ture of person to whom Title Certificate is issued or his agent id/CM )105 Date Email Address: )--!/t' C C4. n (4 ii) 1f/.J/ /6 r CG/11 ' l 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# ,/344C/ /7—( S/7 -- 12/31/21-12/31/2022 CATAHOS-01 APELL ,d►CORn CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/6/2021 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). PRODUCER CONTACT NAME: RogersGray,Inc. PHONE 434 Rte 134 (a/c,No,EXt):(800)553-1801 ____ ; (A/C,No):(877) 816-2156 South Dennis,MA 02660 E-MAILSS: � 9 9 Y•ers ra mail ro com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Protection Insurance Company, Inc. 41360 INSURED INSURER B:Burlington Insurance Company 23620 Hearth N Kettle of Yarmouth,Inc. INSURER C:MEMIC Indemnity Company 11030 1196-1198 Main St 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. INSR TYPE OF INSURANCE IADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP j LIMITS LTR INSD WVD (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE L X J OCCUR 18500041114 11/16/2020 11/16/2021 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE IL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000,000 POLICY JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER LIQUOR LIABILIT $ 1,000,000 - - --- - - - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY I �Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident)1 $ AUTOS ONLY NON-OWNEDUUT N PROPERTY accidentDAMAGE -- $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE HFF0014893 11/16/2020 11/16/2021 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION X PER 1OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER 3102808148 Ill/2021 1/1/2022 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ SOO,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD (A OR 101, 1,Additional Remarks Schedule,may be attached if more space is required) Certificate holder as additional Insured as respects General Liability when required by written contract or agreement. Location-1196-1198 Main Street Rouite 28,South Yarmouth,MA 02664; Current liquor liability also covers the outdoor seating area. 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD