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HomeMy WebLinkAboutbldci-17-002475-05 (2) The Commonwealth of Massachusetts } n • err. City\Town of YARMOUTH 11 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: IRISH VILLAGE RESTAURANT& RESORT, LLC BLDCI-17-002475-05 Trade Name: IRISH VILLAGE RESTAURANT&RESORT, LLC Identify property address including street number, name, city or town and county Certificate Expiration Located at 822 ROUTE 28 12/31/2022 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) --- A-2 01st Floor 643 A-2 Nightclub/Restaurant/Bar/Banquet Hall 91 persons-Pub& Function Rms Allowable Function Rm-Bay 164 persons-table/chairs Occupant Load 352 persons-chairs Function Rm-Bass River 36 Tables/chairs 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 rk Grylls Date of nR ��1 Fire Chief Building Commissioner Inspection < O',J Signature of Municipal , .<i ` Signature of Municipal j Date of Fire Chief L,(i/ - Building Commissioner / ,/ Issuance it( •W* -�' Fee: $150.00 BIJILDING DEPARTMENT 1146 Route 28, South Yarmouth, CIA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Irish Village Restaurant & Resort ADDRESS: 822 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 Re . Date Comments Approved for License Issuance '.X//// /A2- --0)/t No Fire Department Rep. Date Comments Approved for Li eIssuance I /23b' Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for 1/7Z,/7( License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 TOWN OF YARMOUTIAR E C El V E D • a BUILDING DEPARTMENT rnTr� n r 9221 1146 Route 28, South Yarmouth, MA 02664 508-39S-2231 . QZ60 BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2021 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: Z, j1/4 E, Zg Name of Premises://ZAMAV 1 LL f1 cr. E- e,C4s1s-flq.(Z1 kr Tel: S t % -3 U 0O Purpose for which permit is used: 1J 1�-HT Gi_lA�1 f AiSTefka.R't-SV, AP. , 1-)Qacrt 6t(^i, License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency L ( Certificate to be issued to %SN g►,4416 ; Q,a paizoisc'l e q el: SO%s-3°(`{ i3 00 Address: % 2-L e x% 2.g‘ .S Nik-12,MA:1."t4 NIA 6 2(o(,4 Owner of Record of Building M R( N ,' b 8A 't=� L� ,Z R,114 Address �L2. 12OJ•T E �� S AYAti eve K- lc:t (14-(o(4)4 Present Holder of Certificate�2ASH V1t�1-A€E; (4-5TANkiZt;Pt 4 (AS o rt Sign ture of person to whom Title Certificate is issued or his agent 1% I S''Z)1-1 Date Email Address: h,raa @) U r-vet , 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 CANNO ISSUE Y CERTIFICATE OF INSPECTION. Certificate of Inspection# QC LC 4-/'% SR PAs aL5`- 12/31/21-12/31/2022 _—'"""'" MACLLLC-01 MCOBUZZI A�oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) 3/23/2021 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 - FAx 434 Rte 134 (ac Na,E:q (800)553-1801 (A/c,Nel:(877)816-2156 South Dennis,MA 02660 E-MAIAooRiss:mail@rogersgray.com INSURER(S1AFFORDING COVERAGE ; __- NAIL# INSURER A Selective Insurance Company of the Southeast r 39926 INSURED INSURERB:AmTrust Insurance Company of Kansas 15954 Maclyn LLC INSURER C:Underwriters at Lloyd's London '15792 822 Route 28 INSURER D -South Yarmouth,MA02664 - 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. TYPE OF INSURANCE INSD A X ' COMMERCIAL GENERAL LIABILITY WVD LTR POLICY NUMBER LIMITS ' POLICY EFF POLICY EXP 1,000,000 INSR ADDL SUER (MMIDD/YYYY1 (MM/DD/YYYYI EACH OCCURRENCE �$ CLAIMS-MADE X OCCUR , DAMAGE TO RENTED 3/13/2021 3/13/2022 PREMISES.fEaoccurrence) $ 500,000 MED EXP An one person) $ 5,000 PERSONAL&ADV INJURY ,$ 1,000,000 CEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $. . X POLICY PRO- _ LOC 2,000,000 - .JECT PRODUCTS-COMP/OP AGG $ _ OTHER: $ _... —.._ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident). _$ ' ANY AUTO ' ' 3/13/2021 3/13/2022 BODILY INJURY(Per person] $ ' OWNED SCHEDULED - --AUTOS ONLY AUTOS ! ,BODILY INJURY(Per accident)_$ X HIRED X NON-OWNED PROPERTY DAMAGE . . .AUTOS ONLY , AUTOS ONLY (Per accident) 4$ $ A : X UMBRELLA LIAB i X OCCUR EACH OCCURRENCE $ EXCESS LIA B . _. 1,000,000 i CLAIMS-MADE_ AIMS-MADE. 3/13/2021 3/13/2022 AGGREGATE $ - 1,000,000 DED RETENTION$ ! $ B WORKERS COMPENSATION E.L.EACH ACCIDENT OTH AND EMPLOYERS'LIABILITY . , STATUTE ._-.._ER ______.- Y/N 3/13/2021 3/13/2022 E_.L.DISEASE_ _-EA EMPLOYEE $ 1,000,000 KWC1238746 ANY PROPRIETOR/PARTNER/EXECUTIVE "- - I E - -- --- MandatoryEn NE j EXCLUDED. N/A 1,000,000 E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below !$es,describe under , 1,oO0,000 C Commercial Property • S-1912-706664-01 3/13/2021 ; 4/13/2021 'Building ! 9,309,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE m2 Lease Funds LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 175 N.Patrick BLVD Suite 140 ACCORDANCE WITH THE POLICY PROVISIONS. Brookfield,WI 53045 AUTHORIZED REPRESENTATIVE 7 'r -_-)'--,,.,,,„..4 i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD