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HomeMy WebLinkAboutBLDCI-22-004598 The Commonwealth of Massachusetts 3 _ !r City\Town of =11f= YARMOUTH .r». }}}}fie 44 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: Heavenly Restuarant rsLULl-12-UU4b9t3 Trade Name: Heavenly Restaurant Identify property address including street number, name, city or town and county Certificate Expiration Located at 194 ROUTE 28 08/16/2022 WEST YARMOUTH, MA 02673 I I Use Group Floor Occupancy Use Group Other Classificate(s) - A_2 ()1st Floor 89 A-2 Nightclub/Restaurant/Bar/Banquet Hall 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 withthe contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Grylls Date of Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner / Issuance 02/17/2022 Fee: $100.00 BLD_Certofinspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Heavenly Restaurant ADDRESS: 194 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 Re . Date Comments Approved for License Issuance o Fire Department Rep. Date Comments Approved for C AlYT. u C icense Issuance - -Z2 Yes ❑ No Board of Health Rep. Date Comments Approved for License Issuance ❑ Yes ❑ No Plumbing/Gas Inspect r Date Comments Approved for License Issuance ZZ ❑ 'es ❑ No Electrical Inspector Date Comments Approved for License Issuance ❑ Yes ❑ No Taxes Paid ❑ Yes ❑ No Rev.Sept.2003 The Commonwealth of Massachusetts n frr. City\Town of ' 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: Heavenly Restuarant BLDCI-22-004598 Trade Name: Heavenly Restaurant Identify property address including street number,name,city or town and county Certificate Expiration Located at 194 ROUTE 28 02/17/2023 WEST YARMOUTH, MA 02673 I Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 89 A-2 Nightclub/Restaurant/Bar/Banquet Hall 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 Q�.V Signature of Municipal Signature of Municipal / Date of Fire Chief Building Commissioner / LQ Issuance 3 2 Z Fee: $100.00 BLD Certoflnspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Heavenly Restaurant ADDRESS: 194 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 Re . Date Comments Approved for License Issuance 3— /—.2J � ❑ No 7// Fire Department Rep. Date Comments Approved for rklY . J CJ 3 /—ZZ icense Issuance Yes J No Board of Health Rep. Date Comments Approved for License Issuance Yes - No Plumbing/G�as Inspect r Date Comments Approved for i. 1(/ //Z' License Issuance 1 es C No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid ❑ Yes ❑ No Rev.Sept.2003 o0 Y'9R . . ~! TOWN OF YARMOUTH •o v,. ., BUILDING DEPARTMENT R E C E I V E Ci MATT CM [S[J 1 `- �`°*��•«-.0 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 xt 12617 2022 BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF INSPECTION By: February 1, 2022 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: 194- /n / jfr-eel" Name of Premises: Yet.We/7 G /iie:1 //2?2iTe1: 1' 62 f3--T --,e3 3=a-- 7 Purpose for which permit is used: O / ccc/7//2C License(s) or Permit(s)required for a premises by other governmental agencies: License or Permit Agency Certificate to be issued to /e21LL/1l Xed,hza rad Tel:SV13- 933. Address: /IV-/}2d .S.if ar-- Owner of Record of Building_ :__ t le s"._e 1ai'79 ,p) ,(f' ` Address �7 ?'2 R ''' l" '`l ��/ - Present Ho dI er+of Certificate � 1 / P 4i cn itek i ,i4‘ D--?,),ne,7-((yetAare, Signatur WAWerson to whom Title Certificat- is issued or his agent ©2//f/A, Date Email Address: ea 1 l red. ) ,�7a-/l,-�Y2 J 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# 03/01/2022-03/01/2023 A�� DATE(MMIDDIYYYY)� �.. CERTIFICATE OF LIABILITY INSURANCE 02/14/22 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: Robert M.Zagami Insurance A/C,No.Extl: 781-337 d033 FAX No): 781-337-4103 Agency E-MAIL bzagami@rmzinsurance.com 555 Bridge Street Weymouth,MA 02191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Travelers INSURED INSURER B: One Hope,Inc.,dba INSURER C: Heavenly Restaurant INSURER D: 194 Main Street W.Yarmouth,MA 02673 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. INSR DDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ - - DAMAGEIO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 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 MUTE STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? n N/A UB2J200118 02/24/22 02/24/23 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 Arrnonnurc\NITU TUC DAr rry°DM/IQrn1.1C