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HomeMy WebLinkAboutBLDCI-17-006523-04 i The Commonwealth of Massachusetts 4 ._ t City\Town of �eam Ai,/ s YARMOUTH .,k ,_,f New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: GRAND CAFE BLDCI-17-006523-04 Trade Name: GRAND CAFE Identify property address including street number, name,city or town and county Certificate Expiration Located at 80 ROUTE 28 12/31/2021 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 92 A-2 Nightclub/Restaurant/Bar/Banquet Hall 92 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 Name of Municipal Mark G, Date of /_ P` ti Stm0.?l h,,) if Building Commissioner ,' Inspection /�j� Signature of Municipal 0 Signature of Municipal �� Date of , ,. _ Building Commissioner � Issuance r /.�f/c' Vinef-kt' Fee: $100.00 B LD_Certofl nspection.rpt BUILDING DEPARTMENT 1 146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Grand Café ADDRESS: 80 Route 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 /�� —2° �2 No Fire Department Rep. Date Comments Approved for Lic se Issuance fl es No ^ 17 -Iej Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 ° .YM TOWN OF YARMOUTH o y"� y BUILDING DEPARTMENT MATTA M CSE �,4°•• •% 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2020 PAYABLE UPON RECEIPT ( X ) Fee Requ' ed.100.00 ( ) No Fee e • 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 premisesw / located at the following address: Street and Number: SO Ro ,i-e, VV(94 e.S f )/ rioc41 0,2_6 7-3 Name of Premises: ,r�n d �ti�� Re s A(J fjyl rTel: D d—O 6-3 1 Purpose for which permit is used: I ( u o ( t ` 11, RECEIVED License(s) or Permit(s)required for the prmises by other governmental agencies: License or Permit Agency f k3V < 2020 • k 0 VCAVC BEiyuciefLitz Certificate to be issued`to- �Gcoc'cI((\-� \ Address: f Q ikOutt e`Lg • �/1��J 64/61(.9t/k �2-3 Owner of Kecord of Building (t7 L°U( � V C-I i�('('t� J c) Address Present Holder of Certificate 6 rovj C x e i 1-00 0 C/ c2 - Signatur pe on to om Title Certificate is issued or is agent kt6-(/)t> Date Email Address: ) � 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# , 6 /-/7-C'A $ 13 /2"-vl- bc( 12/31/2020-12/31/2021 9 �- 4 � PAGUA-1 OP ID:JA AC='ORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/19/2020 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 508-775-6060 CONTACT Bryden&Sullivan Insurance Bryden&Sullivan Ins Agency PHONE FAx 88 Falmouth Road (A/C,No,Ext):508-775-6060 I (A/C,No)_508-790-1414 Hyannis,MA 02601 E-MAIL Bryden&Sullivan Insurance ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Hartford INSURER B:SCOTTSDALE INSURANCE COMPANY 41297J QNSURrana D Cafe Restaurant Inc. 80 Rte 28 INSURER C: West Yarmouth,MA 02673 INSURER D: INSURER E I 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. NOTVNTHSTANDING 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IINSD 4WD (MM/DD/YYYY1 (MM/DDNYYYI B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPS7107325 04/26/2020 04/25/2021 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 x Liquor PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I PE Qj I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: COMBINED I $ AUTOMOBILE LIABILITY (Ea accdentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY _ NON-OWNED ONLYY PROPERTY DAMAGE (Per ccident) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED I RETENTION$ $ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 08WECAA2S20 06/04/2020 06/04/2021 600,000 ANY EACH ACCIDENT OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N/A E.L. $ (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 600,000 If yes,describe under 600,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B LIQUOR CPS7107326 04/26/2020 04/26/2021 Per Occ 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Year round restaurant with liquor CERTIFICATE HOLDER CANCELLATION TOWN-25 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 ST SOUTH YARMOUTH, MA 02664 AUTHORIZED REPRESENTATIVE Bryden &Sullivan Insurance ACORD 26(2016/03) ©1988-2015 ACORD CORPORATION. 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