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HomeMy WebLinkAboutBLDCI-17-005620-06 The Commonwealth of Massachusetts • City\Town of I • YARMOUTH • am 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: IL Montebello Inc BLDCI-17-005620-06 Trade Name: IL Montebello Restaurant Identify property address including street number, name,city or town and county Certificate Expiration Located at KINGS CIRCUIT 12/31/2022 YARMQI ITH MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 172 A-2 Nightclub/Restaurant/Bar/Banquet Hall 124-Restaurant/Bar waiting Allowable Outside Patio seating- 48 Occupant Load Bar&Lounge-34 chairs/ 10 Bar stools 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 late of Fire Chief Building Commissioner Issuance Fee: $150.00 B L DCertofl nspectio n.rpt TOWN OF YARMOUTH 101-- a BUILDING DEPARTMENT " 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 APPLICATION FOR CERTIFICATE OF INSPECTION 7la0E-I 29L0 November 4, 2021 PAYABLE UPON (X) Fee Required 150.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: 1 Street and Number: 9 ( kt L c� - tip v'. �'i!Gl,� �' �JEt rp.tou 7.4 pD�7 (46,{ 02 C'7 f- Name of Premises: )) "gait +D cf.A 'L Tel: -60$ 362 --s 0 Purpose for which permit is used: U '"S -y t it License(s) or Permit(s)required for the premises by other governmental agencies: RECEIVED License or Permit Agency NOV 0 4 2021 ButEr NT Certificate to be issued to /4,0s 4-.4' ��'1 Tel: .�U�3 -26Z^�Dd Address: 8( 'tom S� f.0 Y CC'Se-eycc ' ✓"01j(1.1 r° "9 O '7 Owner of Record of Building Address Present Holder of Certificate V t CC' FY6 t jefiD Signature of person to whom Title Certificate is issued or his agent I -0L/ 7,p 2-0 Date Email Address: 1.1"" 4e4e- '�` f tae L rK 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# ,86� /7.- .(a0--6_4, 12/31/21-12/31/22 ACQRR pP' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHISI 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 Met. At, NAME: JIM HINDMAN Schlegel&Schlegel Ins Broker PHONE 508-771-8381 34 Main Street Esc•N� Ext), FAX No): 508-771-0663 ADDRESS: schlegelinsurance@gmail.com West Yarmouth,MA 02673 9 @gmail.com INSURER(S)AFFORDING COVERAGE NAIC C INSURER A: GUARD INSURED _ INSURER B: GUARD IL MONTEBELLO IN KINGS WAY INC INSURER C: MA RETAIL MERCHANTS WC 81 KINGS WAY YARMOUTHPORT,MA 02675 INSURER D: 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. MT( ADDLSUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP {MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE [XI OCCUR DA M AGE TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 1LBP072582 12/29/20 12/29/21 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION r PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER C ANY NFICER/MEMBER EXCLUDED?ECUTIVE N/A (Mandatory inBENH 014005034204120 01/01/21 01/01/22 E.L.EACH ACCIDENT $ 500,000 It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 liquor liability Each occurranence 1,000,000 B ILBP072582 12/29/20 12/29/21 Aggragert 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/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. LICENSING DEPARTMENT AUTHORIZED REP ATIVg_ar��;J'��-• i 1 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD BUILDING N DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: II Montebello @kingsway ADDRESS: 81 RTE 6A 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 ep. Date Comments Approved for / License Issuance No Fire Department Rep. Date Comments Approved for L nse Issuance �� ���• E7 CAL t I -2-9 ' Z t Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance /�����2/ Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003