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HomeMy WebLinkAboutbldci-16-003260-05 The Commonwealth of Massachusetts 5,` .: City\Town of >i;� l_ a a . YARMOUTH �, Y 'L - 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: INAHO JAPANESE RESTAURANT BLDCI-16-003260-05 Trade Name: INAHO JAPANESE RESTAURANT Identify property address including street number, name,city or town and county Certificate Expiration Located at 157 ROUTE 6A 12/31/2022 I I YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 64 A-2 Nightclub/Restaurant/Bar/Banquet Hall 12 Persons-Counter 22 Persons-Booths 30 Persons-West Allowable Room-Tables&Chairs Occupant Load 01st Floor 16 A-2 Nightclub/Restaurant/Bar/Banquet Hall 16 Persons-East Room-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 Mark Grylls Date of Fire Chief Building Commissioner r Inspection /02 R( Signature of Municipal _/L ' , i0natureofMuniciPai �, ilding CommissionerL"---, Issuance Fee: $100.00 BLD Certoflnsoection.rot BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Inaho Japanese ADDRESS: 157 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 Rep. Date Comments Approved for License Issuance No Fire Department Rep. Date Comments Approved for Li e Issuance � � � ^ 1 Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date /Z/yo/Z,. Comments Approved for License,Issuance (Yes) No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 49° TOWN OF YARMOUTH Ni_ C BUILDING DEPARTMENT o; ,a r\»° ."�• : 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2021 PAYABLE UPON RECEIPT (X) Fee Required 100.00 ( ) 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: / 7. 10 4/ V4rirevA Port4, A/// .4. 76--- Name of Premises: n/Jp Ji4P/' JAG Se A2 S JA-p:6 %Tel: .502;fib) — Purpose for which permit is used: k ----57f4/1,e,9/(fT 7—"qqy ?,3 License(s) or Permit(s) required for the premises by other governmental agencies: C'911 . License or Permit Agency Certificate to be issued to . et O -J a " Tel: ,j 2)g-36 j --5 ,-,g-- Address: /61-- AD • /4 a�v►��v1-& 4'1 �.�/.� 3� Owner of Record of uildinng Address i 5-3- J --e Ct, ALi0.r �v 6'+- VYl 121- G,(o 7 S" Present Holder of Certificate .jiJ- Signature of person to whom Title Certificate is issued or his agent 1/ -vle `= ` Date Email Address: q c -b{ € or,cyTh . 1(ULA- 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# 12/31/21-12/31/2022 ' !ACORI�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY`() 11/22/2021 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 Elizabeth Bortone NAME: F.M.Walley Insurance (Arc,No,Ext): (781)779-6631 .r No): (781)326-8387 475 High Street E-MAIL beth@candsins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Dedham MA 02026 INSURERA: Hospitality Mutual Insurance Company 13163 INSURED INSURER B: Aida&Yugi Watanabe, DBA:Inaho Japanese Restaurant INSURER C: 157 Main Street Rte 6A INSURER D: INSURER E: Yarmouthport MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 2021-2022 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VI/VD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CPP2000326 04/20/2021 04/20/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS 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 PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Person $1,000,000 Liquor Liability A CPP2000326 04/20/2021 04/20/2022 Per Occurrence $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/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. 1146 Main Street AUTHORIZED REPRESENTATIVE Route 28 South Yarmouth MA 02664 (6 M. I u' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD