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HomeMy WebLinkAboutBldci-22-002235 • The Com o ,wealth of Massachusetts _; : .t City\Town of YARMOUTH Nir 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: Kounadis Enterproses, Inc BLDCI-22-002235 Trade Name:Yarmouth House Restaurant Identify property address including street number, name,city or town and county Certificate Expiration Located at 335 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 264 A-2 Nightclub/Restaurant/Bar/Banquet Hall 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 Fire Chief Building Commissioner �' J spection if • • Signature of Municipal _ Signature of Municipal f r /Date of L Q Fire Chief /5 L3L- Building Commissioner /) /1 `V Issuance Fee: $150.00 • ai n (`nhnn 4:... ..1 BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: The Yarmouth House ADDRESS: 335 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 Rep Date Comments Approved for License Issuance Fire Department Rep. Date Comments Approved for License Issuance II No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date /(-1 U Comments Approved for Licen eIssuance No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 Ac;\ TOWN OF YARMOUTH o'� '� .' BUILDING DEPARTMENT Cq-n MAT-AL C LSIJ_� �����✓✓N .. 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260~----4, APPLICATION FOR CERTIFICATE OF INSPECTION October 1, 2021 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: ` 3 c cCt Name of Premises: YCkf m6,4 ‘ ��k'' Tel: - 77 1 - ci 511 Purpose for which permit is used: V . License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency RECEIVED Kou, t s Erg fto(, s OCT 18 2021 Certificate to be issued to tea-\Gtr mc,A.th I- u6' Tel: Address: 335- rnet.A \ AA- BUILDI Owner of Record of Building �[�'1GkSe- �c�-� �'C�r,�-�-t Address S3 c . S ,t Present Holder of Certificate kautinocoltea Ehtr p-L ,�'' ID /5),Qc: l Signature person to whom itle Certificate is issued or his agent Date Email Address: j( �� �, t,f�"�L yrj• C 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,1�'/ -Caao2a- 12/31/21-12/31/2022 C Q�A DATE(MMO/2O 2DT1 CERTIFICATE OF LIABILITY INSURANCE 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 MINIM KtLoULK NAME: STANDISH INSURANCE GROUP INC. PHONE 774.283.4425 FAX 774.283.4243--. (NC.No.Ext): i(NC,No): 303 COURT STREET UNIT 1 B ADDR�s: ANDYR@STANDISHINSURANCE.COM PLYMOUTH,MA. 02360 INSURER(S)AFFORDING COVERAGE _ _ NAIC U INSURER A:GUARD INSURANCE GROUP INSURED INSURER B:BERKSHIRE HA`fHAWAY GUARD RED FACE JACK'S INC INSURER C:GUARD D/B/A SCALLY'S IRISH ALE HOUSE INSURER D: 585 ROUTE 28 INSURER E: WEST YARMOUTH MA 02673 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. ILT R' TYPE OF INSURANCE 'INSD 1SUBR POLICY NUMBER (MM/DD/YYYY)1(MM/ODIYYYY)POLICY EXP ; LIMITS LTR' 'INSD i YVYD X ,COMMERCIAL GENERAL LIABILITY ! `EACH OCCURRENCE j$ 1,000,000 A ; 1 t REBP079489 $/12/2021 I 8/12/2022 DAMAGE TO RENTED L. CLAIMS MADE OCCUR ( 1 ----------- ---I 'PREMISES(Ea occurrence) $ 50,000 - --- ---- -LMED EXP(Any one person) $ 5000 Ik { >ONAL&ADV INJURY $ 1,000,000 1 GEN'LAGGREGATE LIMIT APPLIES PER: I ERAL AGGREGATE S 2,000,000 i( POLICY I j JE C r LOC q � � J )DUCTS-COMP/OP AGG $ 2,000,000 I .1 V ( $ OTHER: C{{t i- ( ., AUTOMOBILE LIABILITY i "�_ -L�/i S MBINED SINGLE LIMIT $ 3 / i accident) `fja OILY INJURY(Per person) $ I OWNED I SCHEDULED 1 I )DILY INJURY(Per aCc denl) $ AUTOS ONLY AUTOS j II HIRED NON-OWNED { 0 30PERTY DAMAGE $ ,AUTOS ONLY AUTOS ONLY ,,,,inNiA,0,,, [.....\e �� �' //�� 'er accident) is UMBRELLA LIAR II I OCCUR t �r v y EACH OCCURRENCE $ I EXCESS LIAB ' �( 1 I 1 CLAIMS MADE; l \ 1 ' (��� 4GGREGATE s DED ; 1 RETENTIONS i \��\\llJJ `L�t�J e $ WORKERS COMPENSATION PERf AND EMPLOYERS'LIABILITY ��` I STATUTE I OR I Y J N 'ANY PROPRIETOR/PARTNER/EXECUTIVE _ E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? N/A; I - (Mandatory In NH) j E.L.DISEASE-EA EMPLOYES$ 1Q0 QDQ if yes.describe under DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT 1 $ 500 000 LIQUOR LIABILITY { jREBP0794139 i 8/12/2021 i 8/12/2022 I $1,000,000 PER OCCUR j ;$2,000,000 AGGREGATE 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace is required) OUTSIDE DINING IS ALLOWED UNDER THE GL&LL CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 RTE 28 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTATIVE ,©1988-201 CORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of A RD t DATE(MM)DD/YYYY A�Ro CERTIFICATE OF LIABILITY INSURANCE 1o/2I'YYY 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: STANDISH INSURANCE GROUP INC. PHONE 774.283.4425 FAX FAX 7/4.283.4243 (A/C.No ExtJ_ (A/C,No): -- 303 COURT STREET UNIT 1 B E-MAIL ANDYR@STANDISHINSURANCE.COM ADDRESS: PLYMOUTH,MA. 02360 1 —_ 1NSURER(S)AFFORDING COVERAGE NAIC a INSURER A:AIM MUTUAL — — — — CAP SPECIALITY 1 INSURED INSURERB: KOUNADIS ENTERPRISES INSURERC: i _ THE YARMOUTH HOUSE INSURER O: _ - 335 MAIN ST INSURERE: WEST YARMOUTH MA 02673 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. 1ADDLiSUBRI POLICY EFF I POLICY EXP 1 ILA TYPE OF INSURANCE i INSD MD POLICY NUMBER :(MM/DD/YYYY)i(MM/DD/YYYY)' LIMITS X COMMERCIAL GENERAL LIABILITY 'CS1800192502 4/01/2021 ' 4/01/2022 EACH OCCURRENCE I S 1,000,000 B DAMAGE TO RENTED i �� , PREM SESJEa occurrence) S 100,000 J CLAIMS-MADE � , OCCUR , i I I�11 MED EXP(Any one person) $ 5,000 1 I PERSONAL 8 0 ADV INJURY S 1, 00000 I GEN'L AGGREGATE LIMIT APPLIES PER it GENERAL AGGREGATE $ 2,000,000 ri PI PRODUCTS-COMP/OP AGG $ 2.000.000 POLICY JECT ;_j LOC S I OTHER' I j COMBINED SINGLE LIMIT s AUTOMOBILE LIABILITY (Ea accident) _ ANY AUTO BODILY INJURY(Per person) S OWNED I SCHEDULED BODILY INJURY(Per accident) $ _ _;AUTOS ONLY 'AUTOS DAMAGE t HIRED I NON-OWNED PR PROPERTY PERTYt) i$ AUTOS ONLY !AUTOS ONLY I (P $ • !UMBRELLA LIAB OCCUR EACH OCCURRENCE $ —L EXCESS UAB I CLAIMS-MADE I I 1 AGGREGATE $ _ _ ' DED !RETENTION 5 i 4i 5 WORKERS COMPENSATION i WCC5005022314 1 1 STATUTE I I EERH• AND EMPLOYERS'LIABILITY Y/N 6/08/2021 I 6/08/2022 I ANY PROPRIETOR/PARTNER/EXECUTIVE I N/A i I I E.L.EACH ACCIDENT 1 S 500,000 A (MandOFFICatory in NH)ER EXCLUDED? I E.L.DISEASE-EA EMPLOYEE$ 500.000 (Mandatory in �If yes,describe under DESCRIPTION OF OPERATIONS below , I i E.L.DISEASE-POLICY LIMIT{$ 500 000 3 LIQUOR LIABILITY I I ICS1800192502 4/01/2021 14/01/2022 PER OCCURRENCE$1,000,000 GENERAL AGGREGATE$2,000,000 I I DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) OUTSIDE DINING IS ALLOWED UNDER THE GL&LL CERTIFICATE HOLDER CANCELLATION TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 ROUTE 28 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTATIVE f 019 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD