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Home My WebLink AboutBLDCI-23-002160 The Commonwealth of Massachusetts r City\Town of �, ,= M YAROUTH .0 Y= 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:Sons of Erin Cape Cod BLDCI-23-002160 Trade Name: Sons of Erin Identify property address including street number, name,city or town and county Certificate Expiration I Located at 633 ROUTE 28 12/31/2023 WEST YARMOUTH, 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 Name of Municipal Mark Grylls Date of Fire Chief r� Building Commissioner ,_,��1lpspection J/" ^'�� Signature of Municipal Signature of Municipal Fire Chief / Date of Building Commissioner ,e Issuance Z 6 15 L Fee: $150.00 BLD_Certofl nspection.rpt BUIL ING DEPA TN1E N 1146 Route 28, South Yarmouth, MA 02664 50 -3 -2231 ext. 1260 )8 3 -0 3( LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Sons of Erin ADDRESS: 633 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 Re Date Comments Approved for License Issuance /I�7g_ //3c7 No Fire Department Rep. Date Comments Approved for ryesetsv...15uancel / (:60?-0-- // 23 _22- 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 . , ;YAR TOWN OF YARMOUTH ci o 1 -y BUILDING DEPARTMENT 4. <- ...-''c d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FO FICATE OF INSPECTION R E C I V E D September 16, 2022 CVj Sac PAYABLE UPON RECEIPT OCT 20 2022 ( X ) Fee Required $150.00 ( ) No Fee Required BUILDING DEPARTMENT In accordance with the provision of iusetts.Stat , 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: (.Q��J , ZCrl (�f L ti vivo* Name of Premises: SGn1 S Of etitA dtia.- f Tel: - i" 'O - 1 9 Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to ./ L ( 4i: --7q1) -63q Address: 6 tie ry (1 ' M1'i 6 73 Owner of Record of Building a,,, ca.4 q K.(✓) Cafeh.. Gjr,/ int. Address C{� `"c.' zc . .4(t LM'9 CI 4 7 J Pr Holder of Certificate s C -11.ii4) CAcj l ignatu per n to whom(-----2T/ C' i itle ertificate is issu or his agent ///.4QA ) / iiXai DateEmail Address: ( ya l `7. co— 7 7 C3 C f_3 C 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# g CiiC/23- OO /(,7J 1/01/2023 — 12/31/2023 VDAC CHUBB' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-4705P92-8-22) RENEWAL OF (6S62UB-4705P92-8-21) INSURER: ACE AMERICAN INSURANCE COMPANY A STOCK COMPANY NCCI CO CODE: 12165 1. INSURED: PRODUCER: SONS OF ERIN CAPE COD INC CHARLES RIVER INSURANCE PO BOX 403 29 MAIN STREET STE 102 SOUTH YARMOUTH MA 02664 LEOMINSTER MA 01453 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-02-22 to 08-02-23 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B volissom D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 07-14-22 WC ST ASSIGN: MA OFFICE: RMD CHUBB 24M PRODUCER: CHARLES RIVER INSURANCE 292KH 002427 VDAC CHUBB' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-4705P92-8-22) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 8641 NAICS: 813 990 STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 562 PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 250 TERRORISM 20 TOTAL ESTIMATED PREMIUM 832 TAXES AND SURCHARGES 23 DEPOSIT AMOUNT DUE 855 A/R (WCIP) # Minimum Premium: $ 210 ST ASSIGN: MA DATE OF ISSUE: 07-14-22 WC OFFICE: RMD CHUBB 24M PRODUCER: CHARLES RIVER INSURANCE 292KH CHUB B` WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-4705P92-8-22) INSURER: ACE AMERICAN INSURANCE COMPANY 12165-MA INSURED'S NAME: SONS OF ERIN CAPE COD INC RATE BUREAU ID: 000101187 PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 260111468 ENTITY CD 001 SONS OF ERIN CAPE COD INC 633 ROUTE 28 WEST YARMOUTH, MA 02673 SIC CODE: 8641 NAICS: 813990 CLUB NOC & CLERICAL 9061 67228 .88 592 O� O� nMIMMEi 0 .950 MERIT RATING MODIFICATION (9885) $ 30 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 562 EXPENSE CONSTANT(0900) 250 'J�� 0.0300 TERRORISM (9740) 20 4.18% MA WC SPECIAL FUND AND TRUST FUND 23 TOTAL ESTIMATED PREMIUM 855 DEPOSIT AMOUNT DUE 855 DATE OF ISSUE: 07-14-22 we ST ASSIGN: MA SCHEDULE NO: 1 OF LAST 002428