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Home My WebLink AboutBldci-17-00103-04 The Commonwealth of Massachusetts City\Town of T 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:SEA DOG BREW PUB BLDCI-17-000103-04 Trade Name: SEA DOG BREW PUB Identify property address including street number, name,city or town and county Certificate Expiration Located at 12/31/2021 23V WHITES PATH UNIT 1 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 148 A-2 Nightclub/Restaurant/Bar/Banquet Hall 130 SEATS 18 BAR STOOLS TOTAL PERSONS: 148 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 III Name of Municipal Mark Grylls Date of //✓/��aO Signature of Municipal g Fire Chief Building Commissioner �_. j Ihspection Signature of Municipal jf 1 j Date of Fire Chief uilding Commissioner / Issuance f�� ,Atee / / Fee: $150.00 r,I 1-1 Cs . (1 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2021 NAME: Sea Dog Brew Pub ADDRESS: 23 Whites Path, Yarmouth This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Dante/ Comments Approved for //r /tom70 License Issuance 7/4K;1„./Z/4 No Fire Department Rep. Date Comments Approved for Li e Issuance es No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 i÷-,, ,t.,c)R• TOWN OF YARMOUTH MATTAyrE,$ BUILDING DEPARTMENT `U`�\-�••�•/.� 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. S �)'\,1` k--\. V OM ) V Name of Premises:` ( c� ?A Tel: J b— 1 D Purpose for which permit is used: `, J rk 6v k License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency C011313 c0i6O--zs- is12 L� ucc C D. Gam- n - a103'c7? i3v l'evi Certificate to be issued to& ` 11e l� 1))9 Tel: 'S --Da?_19 0 Address: a? t pt- r `rp`-1- UK`i--. v . , et /L1 '6 ,�q Owner of Record of Building S '�p 1`56' I L'� J Address -as �L/(`f t S d 4.) S ,✓/� ) YEA �7�( / Present Holder of Certificate Se _kJ � Ni—r-2. ) CIC,1.1,-• Signature of person to whom Title 2 0 Certificate is issued or his agent Date �:, s (o ( �c�� IEmail Address: � / 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 CANN T ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# I-1 7—v O 0 /b3 ---ge-ff--d y 12/31/2020—12/31/2021 (Policy Provisions: WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: Hartford Accident and Indemnity Company t ONE HARTFORD PLAZA HARTFORD CT 06155 THE H ' HARTFORD NCCI Company Number: 10448 Company Code: 5 Suffix LARS RENEWAL POLICY NUMBER: 76 WEG AJOTML Previous Policy Number: New 1. Named Insured and Mailing Address: SEA DOG BREW PUB CAPE COD LLC (No., Street, Town, State, Zip Code) 23 WHITES PATH SOUTH YARMOUTH MA 02664 FEIN Number: 81-1283347 State Identification Number(s): The Named Insured is: LLC Business of Named Insured: Full-Service Restaurants Other workplaces not shown above: 23 WHITES PATH SOUTH YARMOUTH MA 02664 2. Policy Period: From 10/15/20 To 10/15/21 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: PAYCHEX INSURANCE AGENCY INC 150 SAWGRASS DRIVE ROCHESTER NY 14620 Producer's Code: 76210755 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877) 287-1312 Total Estimated Annual Premium: $3,293 Deposit Premium: Policy Minimum Premium: $211 MA Audit Period: ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized representative. Countersigned by 6-1�3-' 10/15/20 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 10/15/20 Policy Expiration Date: 10/15/21 INFORMATION PAGE (Continued) Policy Number: 76 WEG AJOTML 3.A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: 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 $100,000 each accident Bodily injury by Disease $500,000 policy limit Bodily injury by Disease $100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium $2,737 Expense Constant $338 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $105 Estimated Annual Premium (before Surcharges) $3,180 Total Estimated Surcharges $113 *See the attached Schedule(s) of Operations for Locatior and State Level Premium Information Total Estimated Annual Premium: $3,293 Deposit Premium: Policy Minimum Premium: $211 MA Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 722110 Labor Contractors Policy Number: SIC: 5812 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 10/15/20 Policy Expiration Date: 10/15/21 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - NAMED INSURED Policy Number: 76 WEG AJOTML Endorsement Number: Effective Date: 10/15/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Sea Dog Brew Pub Cape Cod LLC 23 WHITES PATH SOUTH YARMOUTH MA 02664 Item 1 of the Information Page is completed to include as named insured: Named Insured : Sea Dog Brew Pub Cape Cod LLC State ID : Not Applicable FEIN : 81-1283347 DBA Name Sea Dog Brew Pub Form WC 99 03 65 Printed in U.S.A. Process Date: 10/15/20 Policy Expiration Date: 10/15/21 • TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner October 1, 2020 Sea Dog Brew Pub 23 Whites Path Unit V South Yarmouth, Ma 02664 Re: Annual liquor license inspection Fee $150.00 Pursuant to the provisions of the Massachusetts State Building Code 780 CMR, Section 106.5 and Table 106,you are required to apply for a Certificate of Inspection for the building located at 23 Whites Path Unit V, South Yarmouth, Ma 02664. DBA Sea Dog Brew Pub. 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 and have your inspection completed before December 1, 2020, to insure that your liquor license will be renewed by the Board of Selectman on December 15, 2020. If your liquor license is not renewed at the December 15, 2020 Board of Selectman meeting, then the next available date may not be until after your current license expires on December 31, 2020. 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. etru Mark lls Building Commissioner t S