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HomeMy WebLinkAboutBldci-16-003278-05 Yrhe / jig; Commonwealth of Massachusetts it , 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: FOUR SEASONS TRATTORIA, INC. BLDCI-16-003278-05 Trade Name: FOUR SEASONS TRATTORIA Identify property address including street number, name,city or town and county Certificate Expiration Located at 1077 ROUTE 28 12/31/2022 SCH ITH YARMOUTu MA 02E64 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 54 A-2 Nightclub/Restaurant/Bar/Banquet Hall Inside Allowable Other 16 A-2 Nightclub/Restaurant/Bar/Banquet Hall Outside Occupant Load OCCUPANCY LOAD SET BY HEALTH DEPARTMENT TOTAL PERSONS-70 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 Signature of Municipal Signature of Municipal ,' - D , ate of Fire Chief Building Commissioner 7 Issuance it-e!- ni •ei _ (,.._.2 Fee: $100.00 RI fl ('Prtnflncnprtinn mt BUILDING DEPARTMENT EN 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME Seasons Trattoria ADDRESS: 1077 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 Re . Date Comments Approved for License Issuance Fire Department Rep. Date Comments Approved for V°1/1 . )1 -16- 1 License Issuance No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance 427 l�l/�b lie License Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 6 Y \ TOWN OF YARMOUTH 101 ;4W .5'3 BUILDING DEPARTMENT \" ,,,r-" 5`;_ , 1146 Route 28, Yarmouth,S`�, .. SouthMA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION 7 7y_26s..-`,12(o October 1, 2021 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: (0 ( 1 'O Lk ke •S. '-/arh'i c t 'ti'( /a't/l 02.4-6-c f Name of Premises: Wxt i SC>�Vt S 'tY�0Y1 +'? Tel: 5og, = 6 0*—' 44 co Purpose for which permit is used: ASA(-4 '0i vrt License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency FNOV----0- 4 2011 L______ 4 BUILDI G E T By - Certificate to be issued to , U r 5 4( t' f Hof la' .1 Tel:4C 508 WO eC©O Address: I 0 77 �Ot e• �.SoLt i h ya s kith IK" 02 ee Owner of Record of Building CA 5'r4CJ, WoLel Address a q5- w ° i (b ft(14 Present Holder of Certificate hi IsvW Signature o'per on to whom Title Certificate is issued or his agent 04/70,0-°Z I Date Email Address: Prkt q'vt Gt t'2 L -36fi Paz' e..owL 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# L, _ -7e gei)�6 12/31/21-12/31/2022 ACORe CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/03/21 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: JIM HINDMAN Schlegel&Schlegel Ins Broker Lac.No.ExI): 508-771-8381 34 Main Street E-MAIL FAX No): 508-771-0663 West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A; ENDURANCE INSURED INSURER B: MT VERNON FIRE INSURANCE Four Seasons Trattoria Inc INSURER C: MA RETAIL MERCHANTS WC 1077 ROUTE 28 INSURER D: SOUTH YARMOUTH,MA 02664 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) UMITS X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A DSCGL0110 01/14/21 01/14/22 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 _ 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 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 014005033240120 01/01/21 01/01/22 E.L.EACH ACCIDENT E 500,000 C OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 liquor liability Each occurranence 1,000,000 B CL 26408001C 04/19/21 04/19/22 Aggragert 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks S:hedule,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 TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. LICENSING DEPARTMENT 1146 ROUTE 28 SOUTH YARMOUTH MA 02664 AUTHORIZED REP ATIV -_ ( ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD