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HomeMy WebLinkAboutBLDCI-23-001774 The Commonwealth of Massachusetts 1 �h c City\Town of • YARMOUTH y 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:Captain Parkers Pub BLDCI-23-001774 Trade Name:Captain Parkers Pub Identify property address including street number, name,city or town and county Certificate Expiration Located at 668 ROUTE 28 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 80 A-2 Nightclub/Restaurant/Bar/Banquet Hall Interior Allowable Other 40 A-2 Nightclub/Restaurant/Bar/Banquet Hall Outside 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 Name of Municipal Mark Grylls Date of Fire Chief 1/��r--�� O �c�w1 er BuildingCommissioner /ram Inspection V—' Signature of Municipal Signature of Municipal Date of Fire Chief f A-....... Building Commissioner i Issuance Sitiz,a Fee: $150.00 BLD_Certofl nspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Capt Parker's Pub ADDRESS: 668 RTE 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Re Date Comments Approved for ? License Issuance No Fire Department Rep. Date Comments Approved for License Issuance 1 1 /C/ 4901 es No tz.4d1 g. Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date ///f/2 z- Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 TOWN OF YARMOUTH (11.0.'$ BUILDING DEPARTMENT 1146 Route 28 South Yarmouth MA 2 5 -i 0 G64 .(18 .98-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION September 16,2022 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: G r'f 0. Y Name of Premises: CA rikKei( 15 gV .5h c Tel: 5-61 3` D 7o° Purpose for which permit is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency eqtkor Certificate to be issued to C9,81 /S (a of) Tel: S-`p"?7/- 07 Address: (,L Sr' If F • a fir- w e s t YAgrt010,-14 MIA 6,94-Et D a b 73 Owner of Record of Building G'ticA t<< M rr rtnr+y Address 1 a r lrlw y(Lott/ex 'tee . S ov'}� •1 VAk iodT4 HA 0?LLS/ Present Holder of Certificate G'ccQ[d A9 hhl�*f (Kes,eem-r" Signature of person to om Title Certificate is issued or his agent 9 d a-? a Date Email Address: (� L�{/L K y h 1 h i Ivry & CC C/y S .yj err— 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# e /'9?3-ob/7 ' T 1/01/2023—12/31/2023 AC�® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE ATE(MW DNYV 022 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: Joseph Dupuis McShea Insurance Agency, Inc talc°O."Nu.Extl: (508)420-9011 FAX (NC, (508)420-9010 1645 Falmouth Road, Rt 28 BLDG D ADMDRESS: joe@mcsheainsurance.com Centerville, MA 02632 INSURER(S)AFFORDING COVERAGE NAIL# INSURERA: The Hartford Insurance Company 11000 INSURED INSURERB: NATIONAL GRANGE MUTUAL 14788 Captain Parkers Pub, Inc. INSURERC: The Hartford Insurance Company -22357 668 Route 28 INSURER D: West Yarmouth, MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000413-0 REVISION NUMBER: 1 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 NOD WVD (MMIDDIYYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY 08SBANX5037 04/05/2022 04/05/2023 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 4,000,000 X POLICY jE I I LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER' it $ B AUTOMOBILE LIABILITY M1T2388U 08/07/2021 08/07/2022 COMBINEDj INGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accident) A X UMBRELLALIAB X OCCUR 08SBANX5037 04/05/2022 04/05/2023 EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS $ C WORKERS COMPENSATION 08WECCM3443 04/01/2022 04/01/2023 X STATUTE ERH 1,000,000 AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N 1 A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Liquor Liability 08SBANX5037 04/05/2022 04/05/2023 per occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Intrax Work Travel ACCORDANCE WITH THE POLICY PROVISIONS. 600 California Street, 10th Floor San Francisco, CA 94108 AUTHORIZED REPRESENTATIVE (JFD) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are re ered marks of ACORD Printed by JFD on 04/11/2022 at 11:07AM