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HomeMy WebLinkAboutBLDCI-16-003446-05 The Commonwealth of Massachusetts 1 =_ t City\Town of „Tzar., YARMOUTH 1 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: SONS OF ERIN CAPE COD, INC. BLDCI-16-003446-05 Trade Name: SONS OF ERIN Identify property address including street number, name,city or town and county Certificate Expiration Located at 633 ROUTE 28 12/31/2022 1 WEST VARMOI ITH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 160 A-2 Nightclub/Restaurant/Bar/Banquet Hall 160 PERSONS TOTAL 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 Ill Name of Municipal Mark Grylls Date of //��_�! Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal (244. Date of Fire Chief �,b,3, /4/,..t /�; uilding Commissioner Issuance Ii •r0• U Fee: $150.00 BLD CPrtnflnsnuctinn rnt •° ''� TOWN OF YARMOUTH otitV BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 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: Get, —1-7 ,23F-0 gag' Street and Number: 6 ,3,3 ,e0 „)---c- ._ -2_ Name of Premises: S 6,t 3 O F £/n) (/3/0 _ Cu/1 Tel: S o i ,79 o -O)v f 7 Purpose for which permit is used: 4 /7004 , PD, tAir J/61,rYm e ' R E C I V E D License(s)or Permit(s)required for the premises by other governmental agencies: r--.- License or Permit Agency NOV 0 9 2021 -ENT BUt BY I Certificate to be issued to ycrt,/ 6 c Cp , eac Cr% Tel: S-13 s--710 -J; y Address: Owner of Record of Building S c' o 24.v C'iv,es._ G o/7 Address C 33 /2,a till 2 t- GJ A F 7.1,F2,. o rw, ap¢ o 2,62 3 Present Holder of Certificate ikeisk elm Pi A►JQ R. Signature of person to whom Title� Certificate is issued or his agent // _ 9 — 2/ Date Email Address:,' S. / L/./�'/Z f"E- xr 4 fi rt ) 4c10 ke 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# Age-LW—A,—Oi.)3(M(p— /6f --06-- 12/31/21-12/31/2022 ACORO0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/09/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS I'..') RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTAR 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 Charles River Insurance Brokerage Inc. PHONE Thomas J Vocatura FAX 29 Main Street IA/C.No Fgt)__ (9783 343_6946 I(A/C,No):(978) 345-2514 E-MAIL Leominster MA 01453 ADDRESS: meaton@charlesriverinsurance.com INSURER(S)AFFORDING COVERAGE NAIC_# INSURER A:United States Liability Ins Co. _ 25895 INSURED INSURER B: Sons of Erin Cape Cod Inc. -- -- — INSURER C: P.O. Box 403 INSURERD: South Yarmouth MA 026647 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER:Cert ID 8994 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR NPP15197755A 09/07/2021 09/07/2022 PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&AOVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY(7 PRO JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Aga accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _._. AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE_ $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION —I PPR EATUTE ERH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability NPP15197755A 09/07/2021 09/07/2022 Per Person $ 1,000,000 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth AUTHORIZED REPRESENTATIVE Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 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: Sons of Erin ADDRESS: 633 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 Re Date Comments Approved for // License Issuance 1 � �� � No Fire Department Rep. Date Comments Approved for C/�P T• $�V C�- l l_ License Issuance No Z9-Z ) 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