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HomeMy WebLinkAboutBLDCI-23-002551 The Commonwealth of Massachusetts A . ...nr,- . r_ City\Town of —r l= YARMOUTH wa!1• t /. a #i-... ♦ L 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:908 Bistro BLDCI-23-002551 Trade Name:908 Bistro Identify property address including street number,name,city or town and county Certificate Expiration Located at 908&928 ROUTE 28 12/31/2023 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classificatiorrs(w) A-2 01 st Floor 39 A-2 Nightclub/Restaurant/Bar/Banquet Hall 39 Persons Allowable Other 12 A-2 Nightclub/Restaurant/Bar/Banquet Hall 12 Persons-outside deck 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 o S1�r Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief A Building Commissioner Issuance Fee: $100.00 B LD_Certofl nspection.rpt BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: 908 Bistro ADDRESS: 908 Route 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner ep. Date Comments Approved for License Issuance /f �� Yes No 4. � f/ Fire Department Rep. Date Comments Approved for Lic-IseIssuance 2,/ . GG /2`(o .2-Z No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Insp ector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 °� Y TOWN OF YARMOUTH oy'� -y BUILDING DEPARTMENT NATTA N •3GJ$ 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION NOV 07 2022 September 16, 2022 PAYABLE P ` ECEIET _ X Fee Re. B LI Th 3 PARTMENT ( ) No Fee 'equire. 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: 906 ) Name of Premises: 1v &SAVO Tel: ` j 3C"C.a c O O Purpose for which permit is used: License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency dtyt \A-Npfi Certificate to be issued to S1yi Tel: S1.1 . 10 Address: 1' (\`a=T1 ;n��V,�},ae ,( 51AM Owner of Record of Building r?�fQl1� Address \\3 re\-e y\t Yr. S5v,-11.1 Ir,r► 1iA 61144 4 Present Holder of Certificate 0 '�S-tw \ Mitkiat ignature of person to whomTitle Certificate is issued or his agent 1\ 0-1 )/Y Date Email Address:qb3istYDe maut,t •cow 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# 3 /— Q3- OD "-/,q.PP - 1/01/2023 — 12/31/2023 r_ � r .>�,....4) 908BI-1 OP ID: NN A`COR[7" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/18/2022 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 617-648-5103 CONTACT NAMF: Nancy O'Connor Intercontinental PHONE 617-648-5103 I FAX 617-426-1015 Insurance Brokers, LLC (NC,No,Ext): (NC,No): 70 Federal Street,Suite 300A E-MAILss:noconnor@intercobrokers.com Boston, MA 02110-2202 INSURER(S)AFFORDING COVERAGE NAIC# Michael D Rose INSURER A:Ohio Security Insurance Co. IN U ED INSURER B: 908 Bistro, Inc. 1 Fillmore Rd. INSURER C: West Yarmouth,MA 02673 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE !NM WVD POLICY NUMBER (MM/DDIYYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 CLAIMS-MADE X OCCUR 64772223BLS 05/09/2022 05/09/2023 oor MLSES(Ea oc e�c $ MED EXP(Any one person) $ 15,000 X Liq Liab$1 Mil/$2M PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BAS6472223 05/16/2022 05/16/2023 BODILY INJURY(Per person) $ AAONED UTOS ONLY SCHEDULED S BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 64772223US01 05/09/2022 05/09/2023 AGGREGATE $ 1,000,000 DED RETENTION$ $ A WORKERS AND COM PENSATION LIABILITY X STATUTF OTH- ER YIN XW564772223 05/17/2022 05/17/2023 E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE 500,000 OFFICER/MEMBER EXCLUDED? N/A(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/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 ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth, MA 1146 Route 28 AUTHORIZED REPRESENTATIVE So.Yarmouth, MA 02664 _ j��2 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD