Loading...
HomeMy WebLinkAboutBLDCI-23-002553 The Commonwealth of Massachusetts _� ,= City\Town of =sate= v=, 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 CertificateIssued to No. Business Name:Saga Sushi BLDCI-23-002553 Trade Name:Saga Sushi Identify property address including street number,name,city or town and county Certificate Expiration Located at 517 ROUTE 28 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occu anc Classifications s p y Use Group Other A-2 01st Floor 36 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 - Fire Chief Name of Municipal Mark Grylls Date of �`p,t � Building Commissioner Insiction /���"�� +en • Signature of Municipal Signature of Municipal ' Fire Chief ate of /( 66 Building Commissioner Issuance /Z/j�Z, Fee:$100.00 BLD_Certoflnspection.rpt BUIL 1 146 Route 28, South N ar°mouth, MA 02664 508-398-2231 ext. 1260 Fax 08-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Saga Fusion ADDRESS: 721 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 4 ;5Licen ssuance /7 ' � No Fire Departme t Rep. Date Comments Approved for Zi Vl Th Lics• e Issuance (Gea‘"2— 7,2 z. "2 2 &EP 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 74 ° _4,0 TOWN OF YARMOUTH BUILDING DEPARTMENT nATTA •3 4" %:''......,n*ve-:d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 e ,. _ E APPLICATION FOR CERTIFICATE OF INSPECTION NOV 0 4 �01,. September 16, 2022 PAYABLE UP S 13t P DEPARTMENT ( ) Fee Require. i i.i i ( X ) 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: 611 R,1*--,A- �e t YAIWIADIrtk l '1\ 0)-664 Name of Premises: LK SU Tel: E7- 777- 4e" 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 teft SUSh( Tel: 50g_S-3.-1-77U3 Address: 611 R I - A I/l)e Rt vinfloot h AA-pi o1U64 Owner of Record of Building Address Present Holder of Certificate Il '\jiN �� OU)11eY lignature of person to whom Title Certificate is issued or his agent /V -51 - 1rt Z Z Date Email Address: 511CPR(S-10111 lWiA-Gin 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# 130 C/-�73_ OC&S-S3 1/01/2023 - 12/31/2023 r. n t 1 \_ ,,, i t _ K , ►t _ '{ -4 111-1�#r 1,1 _.: 1 . -< i w • • , '.-1 t ,_ I- r.-f.-.-- __- =ate. _�. - _�-�•C- _-�_.- a __ _ ._ _� < •r @_. n ' . y {E+'= a=sp',IrARiF9fr�¢."'.ti�- • ,Y )"+4,y-tit<d iF :#:f;€9ft:itf`4"i`f'1 , ',: r a ��— SASUS-3 OP ID: JL Ai4Co�RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/01/2022 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 617-338-8168 ACT Richard Soo Hoo Ins Agency Richard Soo Hoo Insurance PHONE 617-338-8168 I FAx 617-338-1148 123 Beach Street (A/ Boston,MA 02111-2511 ADDcq�No,Ext): (A/C,Na): RESS• INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:The Hartford 29424 INSURES/ INSURER B: Saga ushi Saga Yarmouth Inc INSURER C: 521 Route 28 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 LTR TYPE OF INSURANCE INSD WVR POLICY NUMBER IMM/DD/YYYY1 IMM/DD/YYYY1 LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS MADE X OCCUR 08SBAAJ3NSY 11/10/2022 11/10/2023 PRAMAGE TO EMISES Ea occu ence) $ 1,000,000 x Business Owners MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC 4,000,000 PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY (Ea acclideDISINGLE LIMIT) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident)__ $ HIREDNON-OWNED PROPERTY DAMAGE AUTS ONLY AUTOS ONLY (Per accident) $ A UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 08SBAAJ3NSY 11/10/2022 11/10/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 A WORKERS COMPENSATION X PER OTH- $ AND EMPLOYERS'LIABILITY STATUTE ER Y/N 08WECAJ3NWK 11/10/2022 11/1012023 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Liquor Liability 08SBAAJ3NSY 11/10/2022 11/10/2023 Corn Cause 1,000,000 Aggregate 2,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Restaurant Location: 521 Route 28,West Yarmouth, MA 02673 CERTIFICATE HOLDER CANCELLATION YARMOUI 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 1146 Route 28 South Yarmouth, MA 02664-4492 AUTHORIZED REPRESENTATIVE ...CIFe.c.A..--1;reesfries I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD