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HomeMy WebLinkAboutBLDCI-23-002396 The Commonwealth of Massachusetts 1City\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: Loyal Order of Moose BLDCI-23-002396 Trade Name: Loyal Order of Moose Identify property address including street number, name,city or town and county Certificate Expiration Located at 12/31/2023 769 ROUTE 28 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 118 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 Phil.ilr8ienelii'n HJ - Name of Municipal Mark Grylls �' Date of � (7 Fire Chief Building Commissioner , Inspection Signature of Municipal Signature of Municipal Date of Fire Chief L Building Commissioner G Issuance / (/ Fee: $150.00 BLD Certoflnspection.rpt • BUILDING DEPARTMENT 146 Route 28, South 'arrouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Loyal Order of the Moose ADDRESS: 769 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 Rep. Date Comments Approved for License Issuance No Fire Department Rep. Date Comments Approved for Lic-,seIssuance / 2. -` •LZ 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 Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 C I �--..„ ft764 St LOB,: ACC)R>D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/02/2022 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 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 end o Y EIV E PRODUCER CONTACT NAME Lockton Affinity, LLC PHONE FAX Lockton Affinity, LLC iAt .F'866-836-3373 .**913-652-7599 P. O. Box 879610 r NOV 04 2022 IL ADDRESS Kansas City, MO 64187-9610 INSURERMAFFORDR4GCOVERAGE NMC# BUILDING DEPARTMENT A: Casualty co 42552 INSURED 408y_ �_ INSURERS: Yarmouth Moose Lodge #227D - INSURER C: _ 769 Main Street, Route 28 NSURERD: South Yarmouth, MA 02664 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 1HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE IIFFN REDUCED BY PAID CLAIMS. INSR' -_..- _.-. ADDL SUER POLICY EFF POLICY EXP--- LTR TYPE OF INSURANCE NSD V/VD POIJCYMIMBEt IMM DIYYYY) (MMIDDIYYYY) LBWS COMMERCIAL GENERAL UABILTTY EACH OCCURRENCE S DAMAGETO RENTED CLAIMs-MADE I J OCCUR PREMISES oaaarenoel $. LIM EXP(My one person) $ PERSONALBADVINJURY $ GEM.AGGREGATE WIT APPLIES PE2 GENERAL AGGREGATE $ POLICY ,EST " LOC PRODUCTS-CCAPIOP AGG $ $ OTHER: COMBINED SIN AUTOMOBILE UAB JTYa '�UNIT $ ) ANY AUTO BODILY INJURY(Per person) S ALL OWNED ,SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ — EXCccS(JAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION LFR-WK-10001421-03 06/13/2022 06/13/2023 x E ER AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETOR/PARTNER/ ECUTIVE EER ACCIDENT !A EL EACH ACCT S 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) _EL DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LpifT $500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 780345 Proof of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORr T /2a ©1988-2014 ACORD CORPORATION. All rights reserved. i I - 1 3.4.. k s~ Fsl;r C.i 4}i.•,r .iw 1" f�6^yr i $ h "a' -O L'?/6.�ZSfF� i '�' L t •': '^:Kii,"1 WA s d ASV€11.� $' dT rt. ` l {` f k i . 1 :.....�� __.... -_- _,.-.�._._.�_._-.. ._.._..... ._ _... .. .. ... -...._._. _ _ _ ._ _ 1 ttiriyfS.0 Fsit r i c` AtF1> f tt ilSw :i3'Td1 ii.„, d tr vtFKS3tr^U fiMse L1Li4 $FS� # 8 t _ a 1 1f. S ...: d.'�.- A i ...s.j. 4#dSeT hq .!?E E y' Y' r � c i - — _ _ _ { f � :•t.r 44, aka .4- r 1l?F;i4""r•.'.l.Er_; 1Sf+�r,' t _ s_. • e. -:w,. . . u..., ._i. _ .. C*_ .,.. r f.. -Ion:, _. 34,-,.„'-i.:. <. , COAE CEP .0 4 A.tsm.. . _z__.._�___.— _ i,z. ?,40471 X$17.1VOZW ' f' 07 E.'c: : i A - 9E my717 gcx. 'ss.:' Kong 58 ;:-, ,: . . . _ i xtititilFOncp y ons roce.col iif.57,<J._ t y .. �ii s ... rig i Xs+'ssft'�xCr rt+ h ,.3. ..<c. ., +, "vi_ irk> '* :4 j i b __ , i43�ah li -J SUSS j', ` ' ,. ' - _ .. e i i - {,73� a a, k 4C . i 9 ' {z4.4.+j cs,hr ,y", .tel4f?4 i '.t-,.a`i -.+ - i ,,::Mi vf:.l ,-�:k � .. � 'T,::t•<4y.?2r�3:i�++f,ij- ��f.� .^zxi�d.. ..'tom'';: .r7:._ ..`.�t,'C'.'E�'.i -_fr::frt!ff-;: `.7 p:f' Ulla:ek 1.1/ -• is itfli c -i-PAC"T C 3 ,r,ir 11 i; zs+r 4• a?e.is A. it-" b-;t t is : a +14 4-r 14 e.r v,# s S,1ti*.' r•'' ErCi r c .1.ti . tdE ' ES::wi.s. C= 1. :t. '•"1t ...iac'i,.�'?�'.E v C: l C.t rr f f�1 s.'r. ,a ie1 ."#';. .bsa 4 _troth i t s` SIEkfs' 1F`u F Vial C t.Y6,L,i9F • r>gx!:'ti. A. 't`l.4.Y€ Y E'kC1E 'a ' 1ft.ifili ,r'- - rnr j- 4 i.1-1. f'E) BA .1:4F bonctfF B4U,C.»rattieViE- try ?titt3 Vr ?s.I.t c -71--.'76ri?-;')3 Vile .`.L'i ,00 iik-MI flit -; r '•, „F. }4Y t siie , r The Commonwealth of Massachusetts 1City\Town of y 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 BLDCI-23-002396 Business Name: Loyal Order of Moose Trade Name: Loyal Order of Moose Identify property address including street number, name,city or town and county Certificate Expiration Located at 12/31/2023 769 ROUTE 28 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01 st Floor 118 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 Rhilif.cie—niat "' Name of Municipal Mark Grylls _,� Date of /_.�s� Fire Chief Building Commissioner �f / Inspection '—C� O� p ,✓ Saws.�r- Signature of Municipal Signature of Municipal / Or Date of Fire Chief Building Commissioner � �;� Issuance /2 b !/. Fee: $150.00 BLD Certoflnspection.rpt aR (*--.;,,,, . o TOWN OF YARMOUTH yy BUILDING DEPARTMENT ccacs,""T " ; v,$ 1146 Route 28, South Yarmouth, MA 02664 508-398-2711 ext. 1260 . da RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION p �3 P22 September 16, 2022 PAYABLE UP - F3 FTq TMENT (X ) Fee Reqati acn nn_ _ ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply foiva Certificate of Inspection for the below-named premises located at the following address: Street and Number: l 6 / trod re-- 2. Name of Premises: Lv COL Or at-0 (2f P 5 t Tel: SOr-131 I L5 Purpose for which permit is used: CL.u6 License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency L.4 urn L I emu-- 2e,l €11 oil Silty ke 8a td or I hitrit C a Moot trPc i 11 A ft' go p_p,xr g y 4./SOaeaxi Certificate to be issued to Loptc- 0 dUt �� Tel: ,bP 737 169 Address: 7(Qq it/ • 28 Owner of Record of Building Vef,h o4d i&gfh Address 16T CRRAI.46 1/1/ r�l�d#u5P'9Cc 4Nz 0 z63Z). Present Holder of Certificate L oy" _ Oda-6f &odu, Ad PI ihtitlitg*-' Signature of person hom Title Certificate is issue or his agent /O•_D-Z2 f Date Email Address: �i�/YGC tU(1,ro`t ORl1® Horiwt4d - con 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 # BLid 3—0 39,6 1/01/2023 — 12/31/2023 ��*•+�_ ...ems--- _ - �- . ._ ;._-—�:�-.� -..>..F,..�,,- F 1