Loading...
HomeMy WebLinkAboutBldci-22-002219 • Commonwealth of Massachusetts • 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: Crazy Rooster BLDCI-22-002219 Trade Name: Crazy Rooster Identify property address including street number, name, city or town and county Certificate Expiration Located at 1329 ROUTE 28 12/31/2022 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 96 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 //����1 Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal ► Date of Fire Chief � � tiG� /' Building Commissioner CA Issuance /f•ft • Fee: $150.00 BLD Certoflnspection.rpt BUILDING DEPARTMENT TMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Crazy Rooster Restaurant ADDRESS: 1329 RTE 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 Date Comments Approved for License Issuance ��.—�f[�Q� es No Fire Department Rep. Date Comments Approved for _ _g' License Issuance L es No 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 °� YAR TOWN OF YARMOUTH ,o�r ;.. ;4 11 BUILDING DEPARTMENT -^`MATTAC f1 LSt$1, > . OT, . 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2021 PAYABLE UPON REIPT (X) Fee Required 00 / 1 ( )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: / 32 l S• yo CI IZ M O U I tl Name of Premises: c.R. Z:1 R 00 S4 e,r Tel: -O - gL/o - s-r 1 Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Lrct, t SCervSc GE� VED OCT 18 2021 Certificate to be issued to Tel: B u l L'• - ,yi , Address: Owner of Record of Building `7 ff 6 j)c,i2 o 1-1 S Address Present Holder of Certificate i/f6 Alith i/'4 /1/ /e-, Signature of person to whom Title Certificate is issued or his agent I Date Email Address: VQ' 1,B� its 0 (- IA-A l I-- , 60k. 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. I 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# eat/_ac2-OO 970?//F 12/31/21-12/31/2022 va,n a--fie..- 1 9 "-At_it....... CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DD!YYY) 10/12/2021 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 it lieu of such endorsement(s). PRODUCER 508-771-3300 ' NAME CT Martha..1 Findlay Olde Cape Cod Insurance 1 PHONE 508-771-3300 FAz 508-775-3821 Martha Findlay ,(A/C,No,Ext): sic. 300 Winter Street i E-MAfL oc- —I �� Hyannis, MA 02601 ADDRESS:f118rth$f@OGC18.COm Martha J Findlay INSURERS)AFFORDING COVERAGE NAIC• , --- INSURER A:Scottsdale Insurance Company -- INSURED BISURERB:_ --- Teddy's Three Son's LLC&TATA INC Teddy's Three Sons LLC INSURER C: 25 Pine Grove Ave Hyannis, MA 02601 INSURER0: 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I sus NSRR TYPE OF INSURANCE M�SDD WWII POLICY NUMBER POLICY EFF POLICY EXP _-- - —IYWDDIYYYYI LIMITS -- - A X COMMERCIAL GENERAL LIABILITY I 1,000,000 EACH OCCURRENCE_ -,b— _ 1 CLAIMS-MADE X I OCCUR 100,000 1 CPS7379894 07/01/202i 07/01/2022 pR sus{EosNairDel ) S MED EXP(Any oneperson) $..._ 10,000 PERSONAL.&ADVINJURY $-_--_-- 1,000,000 GERI AGGREGATE UNIT APPLES PER: GENERAL AGGREGATE II 2,000,000 POLICY r l I I LOC PRODUCTS-COMP/OP AGC S 2,000,000 - OTHER OTHER: S --- AUTOMOBILE UABILITYCOMBINED (Ea accidert)SIN(aLE UNIT S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per aO den()_t__ HIRED NON-OWNED PROPERTY GE AUTOS ONLY ___1 AUTOS ONLY (Petacatlerrt UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE- $ DEO RETENTION$ S WORKERS COMPENSATION I IP�ER� ( OTH- AND EMPLOYERS'UABILITY YIN _ I,oT�T!)Jlit__J_ER_- ANYPROPRIETORIPARTNERIEXECU'IVE I _ -- OFFICER/MEMBER EXCLUDED? 1. j N/A E�_FACH ACCIDENT ��--- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1 If yes,describe under — -AHDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LBAIT S Commercial Applica CPS7379894 f 07/01/2021 07/01/2022 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t,Additional Remarks Schedule,may be attached if more space Is required) Food and Liquor CERTIFICATE H LDER CANCELLATION TOWN-15 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of Yarmouth 1146 Main Street Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE moo. `.s (26-1.t ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A`CORO® DIY CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DYYY) 10/12/2021 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 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: Erica Barrett OLDE CAPE COD INSURANCE AGENCY INC PHONE )_(508)771-3300 FAX ADDRESS: ericabOoccia.Corn 300 WINTER ST INSURER(S)AFFORDING COVERAGE NNE HYANNIS MA 02601 INSURER A: AN MUTUAL INS CO 33758 INSURED INSURER B: TATA INC NSURERc: — —INSURER D: —26 PINE GROVE AVENUE INSURER E: HYANNIS MA 02601 WSURERF: COVERAGES CERTIFICATE NUMBER: 704944 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. B TYPE OF INSURANCE mot_SUBR POLICY EFF POLICY EXP--- - ----- -- INSD wvni POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY), LIMITS COMMERCIAL GENERALUABILRY EACH OCCURRENCE -1 CLAIMS-MADE - OCCUR DAMAGE IO-I(ENTED _ --- PREMISES(Ea occurrencNL $ MED EXP(Any one person) S —--- — N/A PERSONAL Si ADV INJURY $ GEKL AGGREGATE uurr APPLIES PER: — POLICY[� LOC GENERAL AGGREGATE i-- PRODUCTS-COMPIOP AG(; S OTHER: S AUTOMOBILE LABILITY COMBINED SINGLE LET S jga occident) ANY AUTO _ GODLY INJURY(Per person) S AUTOS OWNEDALL AUTOSCHES N/A BODILY INJURY(Per accident)NON-O $ — HIRED AUTOS UTOS ED (Per.PROPERTY DAMAGE AUTOS $ UMBRELLA LIAB OCCUR EACH OCCU- EXCESS LIAR CLAIMS-MADE N/A AGGREGATE --- S DED T RETENTIONS S WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY YIN •"--'I'STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTNE EL EACH ACCIDENT S 100,000 A IOFFICER/MEMBEREXCLUDED7 NIA NIA N/A VWC10060253242021A 04/27/2021 04/272022 (Mandatory In NH) EL DISEASE-EA EMPLOYEE S 100,000 I describe under _ DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 -- N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1e1,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdfworkers-compensation/investigations/. 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 Yarmouth MA 02664 Daniel M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD