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Home My WebLink AboutBLDCI-19-002913-03 The Commonwealth of Massachusetts h } �,,.` City\Town of i:‘, vil *a 4- 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:THE OPTIMIST CAFE BLDCI-19-002913-03 Trade Name: THE OPTIMIST CAFE Identify property address including street number, name,city or town and county Certificate Expiration Located at 134 ROUTE 6A 12/31/2022 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 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 / --.-- o2( Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Q---- Issuance .f Fee: $100.00 DI tl (`...4..CI ♦i.... ...I. BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG — 2022 NAME: Optimist Deli ADDRESS: 134 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 Commissions ep. Date Comments Approved for 77, Licensese Issuance /2. No Fire Department Rep. Date Comments Approved for Li eIssuance 11Y2p� Yes No r �-g'c3( Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for /Z(7/ 7/ Licen e Issuance <Ye3 No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 November 13, 2021 To Whom It May Concern: Please contact Jessie McMahon, General Manager- Optimist Café, to schedule all inspections. We are currently only open on an as needed basis. Her phone number is#508-364-1487. Thank you. Kristina Dittmer, Owner- Optimist Café Cell #860-670-5896 °� YqR TOWN OF YARMOUTH o� .141 BUILDING DEPARTMENT\M„T. s�/ 1146 Route 28, South Yarmouth, MA 02664 508-398-22 3 �..a.,t��T, um 1 V E D APPLICATION FOR CERTIFICATE OF INSPECTIONii Nov 1 8 2021 October 1, 2021 PAYABLE UP( _ith� I� AR_ (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: 1314 AQU - (pi4 Yetio l \ ( Name of Premises: 0 — C Tel: all I goo— 7D , !6 Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency NOV 18 2021 IL eyBU t NT Certificate to be issued to - C044am Tel: g1120-610_c Address: (34 R. --G A- V.:L(1,110v.11r\K(+ Chin`]3 Owner of Record of Building lattAL ItO 12ecj e L,LC.. Address rye _ Present Holder of Certificate OpIto 1/1)t C'a- üt7Lt& 0 tLrnli'' ig ature of person to whom Title Certificate is issued or his agent g - _--- --- 1il3-2re /""' '" Date Email Address: ' - r1ur� , t1�20 ia,rloo,C.pr, tr 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 (Policy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: Hartford Insurance Company of the Midwest ONE HARTFORD PLAZA HARTFORD CT 06155 THE , HARTFORD NCCI Company Number: 20605 Company Code: G Suffix LARS RENEWAL POLICY NUMBER: 08 WEC CL8815 8 Previous Policy Number: 08 WEC CL8815 1. Named Insured and Mailing Address: KRISTINA'S KITCHEN, INC. (No., Street, Town, State, Zip Code) 134 ROUTE 6A YARMOUTH PORT MA 02675 FEIN Number: 38-3892174 State Identification Number(s): The Named Insured is: Corporation Business of Named Insured: Full-Service Restaurants Other workplaces not shown above: 2. Policy Period: From 02/01/21 To 02/01/22 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: DOWLING & O'NEIL INS AGENCY/PHS PO BOX 1990 HYANNIS MA 02601 Producer's Code: 08088233 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (866)467-8730 Total Estimated Annual Premium: $830 Deposit Premium: Policy Minimum Premium: $261 MA (Includes Increased Limit Min. Prem.) Audit Period: ANNUAL Installment Term: Four Pay (30%Down+2@25%+1@20%) The policy is not binding unless countersigned by our authorized representative. Countersigned by d` 12/22/20 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 12/22/20 Policy Expiration Date: 02/01/22 INFORMATION PAGE (Continued) Policy Number: 08 WEC CL8815 3.A.Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $500,000 each accident Bodily injury by Disease $500,000 policy limit Bodily injury by Disease $500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO. WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D.This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $530 Expense Constant $250 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $31 Estimated Annual Premium (before Surcharges) $811 Total Estimated Surcharges $19 *See the attached Schedule(s)of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $830 Deposit Premium: Policy Minimum Premium: $261 MA(Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 722511 Labor Contractors Policy Number: SIC: 5812 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 12/22/20 Policy Expiration Date: 02/01/22