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BLDCI-23-002385
The Commonwealth of Massachusetts City\Town of 'maw.. 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 Issued to Certificate No. Business Name:Gerardi's Cafe Trade Name:Gerardi's Cafe BLDCI-23-002385 , Identify property address including street number,name,city or town and county Certificate Expiration Located at 902 ROUTE 28 SOUTH YARMOUTH, MA 02664 12/31/2023 Use Group Floor l Occupancy Use Group Classifications(s) Other A-2 01st Floor 57 A-2 Nightclub/Restaurant/Bar/Banquet Hall 57-Person Allowable Tables/Chairs/Booths 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 Fire Chief Name of Municipal Mark Grylls Date of gyp„ S,;Z 7 4,__ Building Commissioner /� Inspection OCR" Signature of Municipal Signature of Municipal Fire Chief e (26/4'. Date of Building Commissioner Issuance /0 /VZZ 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: Gerardi's Café ADDRESS: 902 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 Lie- e Issuance J. 232Z CIO 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 to TOWN OF YARMOUTH o� $ BUILDING DEPARTMENT iMATTACsirM [ [/�� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION September 16, 2022 PAYABLE UPON RECEIPT (X) Fee Required $100.00 ( ) 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: Z R-4-. Z A S� �37_y l 1 -2_ Name of Premises: Qi ra ra ( s Tel: 50g sqq 31 I ( Purpose for which permit is used: s1-uu On -I— License(s) or Permit(s) required for the premises by other governmental agencies: •,v : License or Permit Agency 0 OCT 25 2022 Certificate to be issued to ( Tel: 5usg, 7 769 t (o t/!Z Address: gq L biteK 1� 2((r 0-0va/ Owner of Record of Buildi rg/ 'I Address J 1 Present Holder of Certificate 1,1 I LAI BMtek ' til- re o'person z whom Title C- ifica • is issued or ' a:- Date Email Address: L Ko c► 6 l`_. kria L (,(//' 1 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# gL. -073- ,383" 1/01/2023 - 12/31/2023 4 I s - .. • ,• 5 GERACAF-01 PAN AC ORD CERTIFICATE OF LIABILITY INSURANCE DATE 10/18/8/2022Y) 0/1022 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: Pa Box 27 Insurance (A/HC,No,Ext):(508)255-7880 jaC,No):(508)240-2908 PO Box 2743 8 Main St E-MAIL ADDRESS: info@kaplansky.com Orleans,MA 02663 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FirStCOmp INSURED INSURER B: Gerardi's Cafe Inc dba Gerardi's Café &Diego&Sasha INSURER C Gerardi 902 Rte 28 INSURER D: 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 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI IMM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea ocaarence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEO- $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LABIUTY EaMaaaden SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSR ONLY AUTOS yyN p BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS ONLY PROPERTY DAMAGE (Per t) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ & A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LABILITY Y/N STATUTE ER WCO222682-01 6/19/2022 6/18/2023 ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 500,000 OFFICER/M in NH)EXCLUDED? N N/A 500,000 (MandatoryE.L DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Yarmouth Town Hall-Building Dept. 1146 Massachusetts 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD