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HomeMy WebLinkAboutBldci-16-005427-05 The Common ieiilth of Massachusetts i ii —'' Ciiy\Town of Y Tu ■ y �'� �� Y 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: SKIPPER RESTAURANT BLDCI-16-005427-05 Trade Name: SKIPPER RESTAURANT Identify property address including street number, name, city or town and county Certificate Expiration 152 SOUTH SHORE DR 11/30/2021 SOUTH YARMOUTH, MA 02664 IUse Group Floor Occupancy P Y Use Group Other Classifications(s) A-2 01st Floor 80 A-2 Nightclub/Restaurant/Bar/Banquet Hall Up to 80 Persons Allowable 02nd Floor 24 A-2 Nightclub/Restaurant/Bar/Banquet Hall 24 Upstairs Bar Occupant Load Other 60 A-2 Nightclub/Restaurant/Bar/Banquet Hall Outside Deck 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 Fire Chief rY Date of ��� Building Commissioner nspection Signature of Municipal Signature of Municipal _ Date of Fire Chief 42401±kip Building Commissioner Issuance / _ 4 Fee: $150.00 BLD_Certofinspection.rpt INC;BUIL T . 1 146 Route 28, South Yarmouth, M A 02664 50 -398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Skippers Restaurant ADDRESS: 152 South Shore Drive 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 p. Date Comments Approved for a/ License Issuance 7,./..77: / 01, es No Fire Department Rep. Date Comments Approved for License Issuance Ye No !\*.- — 3 ..fi_e ( 19- 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 o.,.--- Rom, . .�o TOWN OF YARMOUTH ' BUILDING DEPARTMENT , 28, Yarmouth, a 1146 Route South MA 02664 508-398-2231 ext. 1260 APPLICATION FOR C SPECTION r - ate ® Febuary 5, 2021 FEB 4 _ M PAYABLE UPON RECEIPT 2 2021 (X)Fee Required 150.00 `' _ ( ) No Fee Required BUILIUI(VG vEP~- By: ARTMENT In accordance with the provisions of the Massachusetts toe - de, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Sou 5' L Q'/I/� Name of Premises: fo J A a�✓ /�� Sfr4&Te Sc 2 7 Z Z Pu ose for whichpermit is used: �(( rP 1 ll License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to fk.A') cD Jn � Tel: -)7�f Address: 17 (o✓� !6� ©2 /-iapeitpfo Owner of Record of Building v 4 CAI-) 6-4. Address t GJ 60,444 ✓ 9/j s- 0(11\ 14 - Present Holder of Certificate Signature of perso o whom Title J Certificate is issued or his agent � /Z2 2/ Date Email Address: 511-1, C-f�1��6Gn2 j/6:X„, Go,o/ 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# BLOC j— ]lc-005' Q-7-US 4/1/2021 -11/30/21 TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner February 5, 2021 Skipper Restaurant 152 South Shore Drive South Yarmouth, Ma 02664 Re: Seasonal liquor license inspection 4/1/21-11/30/21 Fee $150.00 Pursuant to the provisions of the Massachusetts State Building Code 780 CMR, Section 110.7 and Table 110, you are required to apply for a Certificate of Inspection for the building located at 152 South Shore Drive, South Yarmouth, Ma 02664 DBA Skipper Restaurant. Please complete the enclosed application and return it with the appropriate fee payment to the Town of Yarmouth Building Department, 1146 Route 28,South Yarmouth,MA 02664. Checks should be made payable to the Town of Yarmouth. Please note that you must return your application by February 26,2021 and have your inspection completed before March 8,2021,to insure that your liquor license will be renewed by the Board of Selectman on March 23, 2021. Unless otherwise requested, inspections will be performed unannounced. Typically the following elements/ systems are inspected: fire protection equipment, means of egress, including emergency lights, exit signs, egress doors & hardware, clear path of travel, adequate lighting and occupancy total. Also, the building shall be maintained and adequate housekeeping provided to insure public safety. Rooms such as basements and attics are included. Violation details will be provided in the form of a Violation Notice and may delay the issuance of your certificate and/or license,if applicable. BE ADVISED after receiving your application a minimum of 2 week's notice is required for an inspection. One re-inspection will be included in the initial fee to confirm the abatement of any violations. Additional re-inspections will cost$80 each,which is payable in advance of the re-inspection. tru , Mark ' . e 'l' Mb Building Com issioner 111 Workers Compensation and Employers Liability Insurance Policy Insurer ID No (s): 34355 MA Retail Merchants WC Group Inc. _ Carrier Policy#: Policy Period PO Box 859222-9222 014005032678121 01/01/2021 to 01/01/2022 Braintree, MA 02185-0000 Information Page Renewal Polk FEIN: 043438184 Carrier Prior Policy#: 01400503267812 Item 1: Named Insured and Address Agency Beachview, Inc. Deland Gibson Insurance Associates Inc. The Skipper Restaurant 36 Washington St 152 South Shore Drive Wellesley Hills, MA 02481 South Yarmouth, MA 02664 Other Workplaces Not Shown Above: No Other Workplaces for this Policy Additional Named Insured: See Additional Named Insureds if Applicable Type of Business: Corporation Federal ID#: 043438184 Risk ID: 000000000 NCCI/Bureau#: 34355 Unemployment ID#: File#: 014005032678121 Item 2. Policy Period The policy period is from 12:01 AM on 01/01/2021 to 12:01AM on 01/01/2022 based on the insured's mailing address time zone. Item 3.Coverage: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed: 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 $500,000.00 each accident Bodily Injury by Disease $500,000.00 policy limit Bodily Injury by Disease $500,000.00 each employee C. Other States Insurance: D. This policy includes these endorsements and schedules: WC000000C(01/15),WC000414A(01/19),WC000422B(01/15), NOE(01/01),WC200102(01/14),WC200301(04/84), WC200302A(09/08),WC200303D(08/10),WC200306B(06/13),WC200405(06/01),WC200601A(07/08) Item 4: Premium The Premium for the policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code# Premium Basis Rate Per$100 of Estimated Annual Premium Total Estimated Remuneration Annual Remuneration See Schedule of Operations on Following Page(s) Minimum Premium Prorated Premium Estimated Annual Premium Expense Constant Deposit $261.00 $6,912.00 $6,912.00 $0.00 $0.00 Issuing Office: 35 Braintree Hill Office Park Ste 206 Date Printed: Countersigned by: raintree MA 02185-0000 01-21-2021 Form#WC 00 00 01 C w• _ (Ed.) ©Copyright 2013 National Council on Compensation Insurance.Inc.All Riohts Reserved. .......... ..,.....____... . . $7.ii .:c!v3. 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All municipal taxes and fees must be paid to date. c. Allow time to correct any problems and get a re-inspection completed by MARCH 8. 3.Application must be filed with the Building Department by FEBRUARY 26. Don't wait until the last minute! 4. Complete Inspection (or re-inspection) so that your Certificate of Inspection can be submitted to the Licensing office prior to March 19. *. THIS TIMELINE MUST BE FOLLOWED FOR AIA., SEASONAL LICENSES REGARDLESS OF YOUR ACTUAL OPENING DATES. A VALID,CURRENT CERTIFICATE OF INSPECTION MUST BF IN PLACE IN ORDER TO BE APPROVED BY THE SELECTMEN FOR RENEWAL ON MARCH 23,2021. LICENSING OFFICE: 1. Alcohol License Renewal Applications emailed to licensees AS SOON AS RECEIVED FROM THE ABCC. APPLICATIONS MUST BE SIGNED IN MARCH DO NOT SIGN IN FEBRUARY 2. SUBMIT WITH RENEWAL APPLICATION: a. Certificate of Inspection from Fire & Building will be delivered to the Licensing Office once it has been signed. b. Current Workers Comp and Liquor Liability Insurance Certificates. c. Payment of License fee. d. List of Assistant Managers for 2021. e. All taxes and fees must be current. 3. MARCH 17,2021: File ALCOHOL(ABCC) renewal applications. 4. MARCH 19,2021: List of Liquor Licenses for renewal to Selectmen. YOUR LICENSE CANNOT BE INCLUDED ON THIS LIST UNLESS THE FIRE SAFETY CERTIFICATE IS SIGNED, ALL TAXES AND FEES ARE PAID AND ALL OTHER REQUIREMENTS ARE MET. MARCH 23,2021: SELECTMEN VOTE TO RENEW LICENSES ON LIST.