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HomeMy WebLinkAboutBldci-17-003375-04 The Commonwealth of Massachusetts n A City\Town of l ' YARMOUTH t .t t a - 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 LOFT BLDCI-17-003375-04 Trade Name:THE LOFT Identify property address including street number, name,city or town and county Certificate Expiration Located at 183 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 02nd Floor 194 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 //3Q - Inspection Signature of Municipal Signature of Municipal Date of Fire Chief0(2 ,/,/,,,, r Building Commissioner Al." Issuance . 70 Or �' Fee: $150.00 BLDCertoflnspection.rpt TOWN OF YARMOUTH - BUILDING DEPARTMENT ? � 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION November 5, 2021 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( )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: le Alt j� � i9 i a i _ y y to K. Name of Premises: 1 (0�� 44)41 luckp /_ Tel: 71 S 5,j,2/7? • Purpose for which permit is used: )((S fl4; i -r- 6/V License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to ��J[2I1 b o-11 f 'cVp•ix& �JAddress: I�3 n m S)Yt� ' W! I- Ly'i/ Uviili �11- e 2 /> Owner of Record of Building etve fi se �'73 Address 61> i)'1 m ;5 U) 'l4't c, 0 V1/49- _ C'4)2) Present Holder of Certificate tt/ i-i y MU4 RECEIVED ig ature o , on to whom Title - Certificate is issued or his agent f 1(-a/ . NOV 15 2021 Date Email Address: Si S BUI D 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# 12/31/21-12/31/22 DATE A i CERTIFICATE OF LIABILITY INSURANCE 11/15/2021 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 00509-001 NpME•CT Branch 509-1 Baldwin Krystyn Sherman Partners LLC dba RogersGray Inc, RogersGray Inc FiloNa Ex8: (800)553-1801 (AAX No.: (508)398-0296 434 Route 134 ADDRESS: mail@rogersgray.com South Dennis,MA 02660 INSURER'S)AFFORDING COVERAGE NAIC# INSURER A: Associated Employers Insurance Company 11104 INSURED INSURER B: Rourkes Top Of The Cove LLC INSURER C: 183 Route 28 West Yarmouth, MA 02673 INSURERD: 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 LTR TYPE OF INSURANCE fat SWV� POLICY NUMBER (MM D//YYYY) (MM/DD/YYYIXT Y) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ �OLICY FrC)- ECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yypR�DEE�Dg �M ERNEgTpENNTIION $ yy�g �J TH $ gANNyD ffaRLRO�Y�ErRrSR'/LpUg1R671LNIETRY/p( X TORY LIAMITS OER OFFICER/MEMBER EXCLUDED?ECUrIVE Y I N E.L.EACH ACCIDENT $ 100,000.00 A Y N/A WCC-500-5024258-2021A 4/7/2021 4/7/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 D SCRIricio.N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) PROOF OF COVERAGE Kathryn Gianno is not covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Rourkes Top Of The Cove LLC 183 Route 28 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE West Yarmouth,MA 02673 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `.. --- 11/11/2021 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 INSUIER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) 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; SALEM FIVE INSURANCE SERVICES LLC PHONE FAX 445 Main Street E-MANs.Ext); (A1C,No): IL ADDRESS: Woburn, MA 01801 INSURER(S)AFFORDING COVERAGE NAICS INSURER A; Trisura Specialty Insurance Company 16188 INSURED INSURER B: Rourke's Top Of The Cove INsuReR C i _ 183 Main Street INSURERD: _ West Yarmouth, MA 02673 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE_OW 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' 'ADDL SUBR, POLICY EFF POLICY EXP i LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDONYYY)JMM/DONYYY) LIMITS - GENERAL LIABILITY EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO ccurD �/ PREMISES(Eaa o occurrence) $... --___ _ _ CLAIMS-MADE X OCCUR MED EXP(Any one person) _L._ A OSCPP-1000222-00 4/7/2021 4/7/2022 PERSONAL&ADV INJURY ___ ,._.. __ _ GENERAL AGGREGATE 1__. ___ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG t XPOLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Par accident) $--__.,._._.� $ UMBRELLA LIAB OCCUR EACL'OCCURRENCE _ $ __ _ _ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ --1 DED J RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER _____- . ANY PROPRIETOR/PARTNER/EXECUTIVE I F.L.EACh.ACCIDENT $ OFFICERIMEMBEREXCLUDED? I N/A - -__ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,coscribe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability OSCPP-1000222-00 4/7/2021 4/7/2022 Liquor Liability $1,000,000 Per Occurence P7 nnn nnn A..,.....,...M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Proof Of General Liability&Liquor Liability Certificate for Rourke's Top CIf The Cove LLC location 183 Main Street West Yarmouth MA 02673 General Liability&Liquor Liability Limits$1,000,000/$2,000,000. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI 'D REPRESENTAT _ ACORD 25(2010/05) ©1988-2010 ACO D CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: The Loft ADDRESS: 183 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 e . Date Comments Approved for License Issuance / es No Fire Department Rep. Date Comments Approved for License Issuance 'I lJaw es No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for //(3u/ Liense Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003