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HomeMy WebLinkAboutBldci-17-000103-05 The Commonwealth of Massachusetts } • 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: SEA DOG BREW PUB BLDCI-17-000103-05 Trade Name: SEA DOG BREW PUB Identify property address including street number, name, city or town and county Certificate Expiration Located at 23V WHITES PATH UNIT 1 12/31/2022 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 Allowable TOTAL PERSONS: 148 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 Inspection la Signature of Municipal Signature of Municipal z / Date of Fire Chief #J, v/- uilding Commissioner / Issuance Fee: $150.00 DI r% r...+..A a:.... _..a BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Sea Dog Brew Pub ADDRESS: 123 Whites Path 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 /*/ Fire Department Rep. Date Comments Approved for CAS i 1 oCF-✓ f License Issuance Z Yes No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for _ /f/2 zf License Issuance Cie) No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 sti- TOWN OF YARMOUTH a:, t),- BUILDING DEPARTMENT \."6.. .,..,t.,-„r,' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FO PECTION ECEIVED October 1, 2021 r_.___e--,_....r—__.-. PAYABLE UPON RECEIPT ?1 (X) Fee Required 150.00 L NOVC'3� ( )No Fee Required BUILDING DEPARTMENT In accordance with the provisions of the Massach B ection 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at t)he following address: r- ,y_i_l_ Street and Number: Oz.-1-_-- l`� r v Name of Premises:�� ? D ftj t G1 J Tel: ? —69 1( J(3 0 Purpose for which permit is used: 4 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency C'4ec+ 14, t „‘--1- -- I‘-. ?-67 LiQi, nc- libez4te, Cin 1 0 ie,5 - I 0?;II S 12,1-D( - 7 - 5r-oi 0s--D`t` Certificate to be issued to SEC. l c `Z6-6i j : Tel: _eel - 6u2--0 Address: ? Ai .s 'p S. IJ i k--Q Owner of Record of Building C>C t j c� ( �(� Address & Lc, N 7-f ' 7 �l � Present Holder of Certificate `p.ct-C- L.u 0,c}r) - (- (R -e_,A) ....... .......)— (71. (0, -- Signature of person to whom Title Certificate is issued or his agent --7__ Date Email Address: -g m5 I ni)n © GMIgi , , (` 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 I SUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# L�—n-C9/03 12/31/21-12/31/2022 A -/Z DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/06/2021 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 SUBROGATIONIS 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: PAYCHEX INSURANCE AGENCY INC PHONE (800)472-0072 FAX (585)389-7894 76210755 150 SAWGRASS DRIVE (A/C,No,Ext): (A/C,No): ROCHESTER NY 14620 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Accident and Indemnity Company 22357 INSURED INSURER B: SEA DOG CAPE COD LLC DBA SEA DOG BREW PUB INSURER C: 23 WHITES PATH SOUTH YARMOUTH MA 02664-1221 INSURER D: 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DDIYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- LOC PRODUCTS-COMP/OP AGG JECT OTHER: • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED ^SCHEDULED _AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $100,000 A PROPRIETOR/PARTNER/EXECUTIVE — N/A 76 WEG AJOTML 10/15/2021 10/15/2022 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION Peter Lucido SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2 FEDERAL EAGLE RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED DUXBURY MA 02332 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �u®an off' C�za�z`�z r � ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD