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Home My WebLink AboutBldci-16-003546-03 The Commonwealth of Massachusetts 11-- ,zS . t City\Town of v YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to BLDCI-16-003546-03 Business Name: RYAN FAMILY AMUSEMENTS Trade Name: RYAN FAMILY AMUSEMENTS Identify property address including street number, name, city or town and county Certificate Expiration Located at 1067 ROUTE 28 12/31/2021 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 300 A-3 Amusement/Church/Gym/Library/Museum 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 1 / Name of Municipal Mark Grylls =7 Date of ��Q — / t//0' SiUnOMO Building Commissioner inspection / p C) Signature of Municipal / Signature of Municipal Date of uilding Commissioner J'4eV Issuance /lY .20727y/411441.-(=::-? Fee: $150.00 DI Il rnhnflncnor#inn rrf TOWN OF A MOUTH BUILDING DEPARTMENT '1 1146 Route 28, South Yarmouth, :VIA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Ryan Family Amusement Center ADDRESS: 1067 Rte 28, Yarmouth 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 No Fire Department Rep. Date Comments Approved for UTT• P Gp- (I,q_ Z0 License Issuance l 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 . aRo TOWN OF YARMOUTH • o� - '' - BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2020 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: /06 -7 /2c A e 45 S Yo_ryv-a-✓ r- Name of Premises: RI, 4 h f olkhl Ar/.‘-e' 7 Tel: a y OCT 1 q 2(1''!? Purpose for which permit is used: + ua License(s) or Permit(s) required for the jfemises by other governmental agencies: C[64.va5-33Z-7 License or Permit Agency Ll Udf Armed Certificate to be issued to h�ct„‘ F6-wti/ / /h VSee. 1 Tel: 3y, Yy Address: �d G 7 2c�v/c Zb' S. ti/ -i Owner of Record of Building ".147_ ems,,,,tr C Address //G ttivfer u ,Qd Jjaum-c.f 0/,4 o7-5-3 Z Present Holder of Certificate ki)<-4 Signature of person to whom Title Certificate is issued or his agent /a f jy/L v Date / J Email Address: R-Co... Yck V CorAcetSf . /Uc' 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 CAJNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# (.Ci--14,„ax -t16 /7-03 12/31/2020-12/31/2021 { A V i R Worker's Compensation and Employer's Liability Policy Berkshire Hathaway AmGUARD Insurance Company - A StockCo. G LI frt Y Policy Number RYWC017284 ARD Insurance Renewal of RYWC995289 Companies NCCI No. [21873] Policy Information Page [1]Named Insured and MailingAddress Agency Ryan Family Amusements Inc MACKINAW UNDERWRITERS INC. DBA/TA Ten Pin Eatery 10 NEW ENGLAND BUS CTR 116 Waterhouse Road SUITE 110 Bourne, MA 02532-3867 Andover, MA 01810 Agency Code: MATPAA10 Federal Employer's ID 04-3541210 Insured is Corporation Risk ID Number 917565287 Additional Names of Insured (N2) 769 Iyannough, Inc. (N3) Ten Pin Eatery Locations on Policy - See Extension of Information Page - Schedule of Locations [2] Policy Period From December 31, 2019 to December 31, 2020, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts, Rhode Island B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) ,359,0 Total Estimated Policy Premium $ 33,654 Total Surcharges/Assessments $ $1,133.00 Total Estimated Cost $ $34,787.00 NTERNALUSE , iXX Page - 1 - Information Page MGA RYWC017284 WC 000001A Date : 11/26/2019 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square,Wilkes-Barre, PA 18703-0020 • www.guard.com A Worker's Compensation and Employer's Liability Police j/Berkshire� Hathawa AmGUARD Insurance Company - A StockCo. Y Policy Number RYWC017284 � Insurance Renewal of RYWC995289 �� . G UARD Companies NCCI No. [21873] Policy Information Page Extension of Information Page Schedule of Locations (L2) 200 Main Street , Buzzards Bay, MA 02532 (12/31/2019 -12/31/2020) (L3) 441 Main Street , Hyannis, MA 02601 (12/31/2019 - 12/31/2020) (L4) 1067 Rte 28 , South Yarmouth, MA 02664 (12/31/2019 - 12/31/2020) (L5) 115 New State Hwy , Raynham, MA 02767 (12/31/2019 -12/31/2020) (L6) 1170 Main Street , Millis, MA 02054 (12/31/2019 - 12/31/2020) (L8) 23 Town Hall Sq. , Falmouth, MA 02540 (12/31/2019 -12/31/2020) (L9) 19 Circuit Ave , Oak Bluffs, MA 02557 (12/31/2019 - 12/31/2020) (L10) 268 Thames St , Newport, RI 02840 (12/31/2019 - 12/31/2020) (L11) 769 Iyannough Rd , Hyannis, MA 02601-5027 (12/31/2019 - 12/31/2020) (L12) Cape Cod Inflatable Park, 512 Route 28 , Yarmouth, MA 02664 (12/31/2019 - 12/31/2020) (L13) Cape Codder Resort, 1225 Iyannough Road , Hyannis, MA 02601 (12/31/2019 - 12/31/2020) (L14) 136 Water St , Plymouth, MA 02360-8727 (12/31/2019 - 12/31/2020) (L15) 769 Iyannough Rd Cape Cod Mall, Hyannis, MA 02601-5027 (12/31/2019 - 12/31/2020) INTERNAL USE XX Page - 2 - Information Page MGA : RYWC017284 WC 000001A Date : 11/26/2019 MANOTE Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com