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HomeMy WebLinkAboutBldci-16-003285-05 • The Commonw a h of Massachusetts } it Ci own 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:AB PIZZA II INC. BLDCI-16-003285-05 Trade Name: ROYAL II RESTAURANT&GRILLE Identify property address including street number, name,city or town and county Certificate Expiration Located at 715 ROUTE 6A 12/31/2022 YARMOUTH, MA 02675 I Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 72 A-2 Nightclub/Restaurant/Bar/Banquet Hall 56 Persons-Dining 16 Persons-Bar Allowable Other 18 A-2 Nightclub/Restaurant/Bar/Banquet Hall 18 Persons-Outdoor Occupant Load Deck > (Seasonal) 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 ,,// Fire Chief Building Commissioner Inspection //f `Ci 1 Signature of Municipal Signature of Municipal ci;?, Date of Fire Chief Building Commissioner Issuance /1.2z4zf Fee:S100.00 BLDCertoflnspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Royal II Rest & Grille ADDRESS: 715 RTE 6A 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. Date Comments Approved for License Issuance LX. No Fire Department Rep. Date Comments Approved for License Issuance Ve‘e\i - it; I • No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for ////0/ LicIssuance Z-- Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 s°a„=- ak TOWN OF YARMOUTH 3�- BUILDING DEPARTMENT :r\rf,-,, `s`;- 1 1146 Route 28, South Yarmouth MA 02664 508-39 - ? ext. 1260 -.A RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION OCT 14 2021 October 1, 2021 PAYABLE i n r rnnENT (X) Fee R•attired-M .0 _ ( )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: A.B. PIZZA II, INC. Street and Number: d/bla ROYAL II RESTAURANT&GRILLE 715 MAIN STREET (Route 6A) f- 3 62'3 28 Name of Premises: Yarmouth Port, MA 02675 Tel. �� Purpose for which permit is used: V-e.~t 0•--i L �+`,SP+/l C C' 04 Vi.10A-C. License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to (( V--(2-5ACt-leiC2-22-S2C) Address: 1- J V2 i er,0 PGAyacvyt.d024Afc..026-7-S Owner of Record of Building .942 - iI p Address 2 5 v-1..c-lam 1 .. ...el, /' Set"Ise /'� ®2 �� Present Holder of C rtificate ip97 (fir AP,i�e� 14 A Pc 24>/1 L7 Ae\-i Ce - Sig1!i re of son to whom Title Ce ficate is issued or his agent ,A)o�G�a'�_ J l Date Email Address: %`�r/'21614 Q•L��>"1 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# (366C7-/(o—a),2a-S-ac" 12/31/21-12/31/2022 ,4 ©® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlrYYY) 11/02/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UP°,.jai THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVEF AJE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE,...,SUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(Ies)must have ADDITIO'I L INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may r+rttuire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tina Reeves NAME. Dowling&O'Neil Insurance Agency PHONE (800)640•162` FAX A� 1I�Ex„ (A/C,No): 973 lyannough Road ADDRESS: treevesi dons.c.r INSURER(;;'AFFORDING COVERAGE NAIC I Hyannis MA 02601 ArnGuard Ins C INSURESR A: 42390 INSURED INSURER B; Safety Indemnity-1'Isurance Company 33618 A.B.Pizza II.Inc.DBA INSURER G: NorGuard Ins C 31470 Royal Restaurant&Grille INSURER 0: 715 Route 8A )NSURE R E YanTtouthport MA 02675 INSURER SURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA+•1(O ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU'1,-NT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE'IG SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE MSC/ WYD POLICY NUMBER '(M�.Y `Mf ii r—r LI/YYYY) (MMlDD'�""YY) UMRS X COMMERCIAL GENERAL ABILrrY EACH OCCURRENCE $ 1,000,000 LI CLAIMS-MADE nX OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) S MED EXP(Any one person) S 5,000 A . ABBP004778 12 20/2019 12/20': ,'0 PERBONAL a ADv INJURY S Included GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY JECT 7 LOG PRODUCTS-COMPIOPAGG S 2,000.000 OTHER: ? i f AUTOMOBILE LIABILITY -._ COMBINED SINGLE LIMIT S 1.000,000 ANY AUTO (Es oxidant) BODILY INJURY(Per person I S B OWNED XSCHEWLED 5901241 AUTOS ONLY AUTOS , 02/15/2020 02/15:>'-:21 BODILY INJURY iPer accident) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) S UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS 11AB CLAWS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION • AND EMPLOYERS LIABILITY YIN XN STATUTE ER PER H ANY PROPRIETOR/PARTNER/EXECUTIVE E.LEACHACGIDENT $. 500,000 C OFFICERIMEMBEREXCLUDED/ Y NIA ABWC181980 ! 03/18/2020 03/18: ' (Mandatory In NH) 500,000 It yea,describe under _ - fJ:L DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L..DISEASE-POLICY LIMIT S 500,000 Liquor Liability Common Cause Limit $1.000,000 A ABBP004778 12/20/2019 12/20i,.'O Aggregate Limit $2.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional RemarksNSchedute,may be attached If more space is re..:a=-rad) Workers Comp Information" Proprietors/PartnercJExecutive Officers/Members Excluded' A.Bolonas,officers Insurance coverage is limited to the terms,conditions,exclusions,other limitations,and endorser tents.Nothing cantair=_r,n the Certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provis, ns CERTIFICATE HOLDER CANCELLATION SHOI dLO ANY OF THE ABO s>ts DESCRIBED POLICIES BE CANCELLED BEFORE THE?XPIRATION DATE TH,kEOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE F' OCY PROVISIONS. 1146 Route 28 AUTHORZED REPRESENTATIVE �_ South Yarmouth MA 02664 r---... ©1988 ',15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACO,i E NOTICE NOTICE ,700 TO 4, UMW Mai TO min aloW Tall* E PI4()YEES E IPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL CCIDENTS Congress Street.. Suite 100, Boston, Massachtl)etts 02114-2017 617-727-4900 - http://www.statem ' us/dia As required by Massachusetts General Law, Chapter 152 Sections 21, & 30, this will give you notice that I (we) have provided for payment to our injured ertmloyees under e above-mentioned chapter by insuring with: NorGUARD Insurance Company NAME OF INSURANCE COMPANY P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18 3-0020 ADDRESS OF INSURANCE COMPAN A8WC223028 03/18/2021 03/18/2022 POLICY NUMBER 973 Iyanrough Road P.O. Box 199( EFFECTIVE DATES DOWLING & O'NEIL INSURANCE A Hyannis, MA 02601 508-775-1620 NAME OF INSURANCE AGENT ADDRESS PHONE # A.B. Pizza II Inc 715 Rte 6a Yam, thport, MA 02675 EMPLOYER ADDRESS 02/11/2021 EMPLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMEN' The above named insurer is required in cases of personal injuries arising iut of and in the course of employment to furnish adequate and reasonable hospital And medical se ices in accordance with the provisions of the Workers' Compensation Act. A copy ot*the First Rep, of Injury must be given to the injured employee. The employee may select his or her own physician le reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if tI treatment is necessary and reasonably connected to the work related injury. In cases requiring hos attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLO` ER