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HomeMy WebLinkAboutBLDCI-18-002140-05 The Commonwealth of Massachusetts E. =,= — r. City\Town of 111�ma, 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: CAPE DELI FOODS, INC. BLDCI-18-002140-05 Trade Name: PICCADILLY CAFE&DELI Identify property address including street number, name, city or town and county Certificate Expiration Located at 1105 ROUTE 28 12/31/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other. - — —Class ifl`cati o`ns(s) A-2 01st Floor 80 A-2 Nightclub/Restaurant/Bar/Banquet Hall 80 Persons-table& chairs/15 stools. Allowable Total:80 persons 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 Fire Chief —r rY Date of dw 4�y,t, Building Commissioner ��.2Z Inspection Signature of Municipal Signature of Municipal ' ate of Fire Chief Building Commissioner Issuance /Z 7,2,z... - el_ it----)/, Fee:$100.00 BLD_Certofl nspection.rpt BUILDING DE PA TME N. , 1146 Route 28, South arnnouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398..083 i LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Piccadilly Deli ADDRESS: 1105 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 Ca No Fire Department Rep. Date Comments Approved for 7`10?-?-- License Issuance LI. /)o2"6 ��� (e 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 a ..r(t` , , • - o TOWN OF YARMOUTH BUILDING DEPARTMENT O . -H N MATTA 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: ( I b 5- KOvt6 3.Q6 / jD. (ICt.rvvO c I h opt - (0 Name of Premises: Ft C (I CtSt fa-eI Tel: c "30v-t-oco 7 Purpose for which permit is used: R E C F I V� D License(s) or Permit(s) required for the premises by other governmental agencies: ° NOV 212022 License or Permit Agency BUILDING DEPANTMENT BY Certificate to be issued to re � 1 p(h �,�� Tel: SOF -3C1( 0 17 Address: 0�j O✓¢►- 7-,g r� LIG 0 jth /� ()?_ 6 Li Owner of Record of Building C5 r IS, l /145 G Address 1/ 6 5 M.)u i L Z So r V )f. 02. (v 6`1-- Present Holder of Certificate s (� a 41� k Lk eA C-'G. _ Sec r'e�a Signature of person to whom Title j Certificate is issued or his agent / /- Date Email Address: Cp, , AS� 01 . CO )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# /(IC/--/p- /y()_1(2t4L voS 1/01/2023 - 12/31/2023 __�� PICCA-1 OP ID:J!-, C RLY DATE(MWDDIYYYY) J ` !i /� CERTIFICATE OF LIABILITY INSURANCE 11/16/2022 v 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 i 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. i If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on 1 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .. i PRODUCER 508-775-6060 NAME CT Bryden&Sullivan Insurance __ Bryden&Sullivan Ins Agency PHONE 508-775-6060 I FAX 508-790-1414 . II8 Falmouth Road (A/c,No,Ext): (NC,No): Hyannis,MA 02601 E-MAILRSS: -- iBryden&Sullivan Insurance INSURER(S)AFFORDING COVERAGE NAIC# _ i INSURER A:Arbella Protection .._ i Ep Guard Insurance Group it ape Deli Foods,Inc a/o INSURER B: __ ,1105 Main Street INSURER C: ______ CSouth Yarmouth,MA 02664 INSURER D t INSURER E: _—_ I 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 zr 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. s.r,iSR S,j TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS ' R INSD JNVD _ IMM/DD/YYYY) IMM/DDIYYYYI , j A ,X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,h5.i CLAIMS-MADE I X OCCURDAMAGE TO RENTED 100,0+6; 8500062959 10/01/2022 10/01/2023 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 1 O,OOI ." , X Liquor Liability 8500062950 PERSONAL&ADV INJURY $ 1,000,Ou• GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0C`' X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,06.' , OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ .. 1 ANY AUTO i. OWNED — SCHEDULED BODILY INJURY(Per person) $ — _ AUTOS ONLY AUTOS- BODILY INJURY(Per accident) $ __ HIRED NON-OWNED PROPERTY DAMAGE l AUTOS ONLY _ AUTOS ONLY (Per accident) $ J - $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,011: EXCESS LIAB CLAIMS-MADE 462008718603 10/01/2022 10/01/2023 AGGREGATE $ 1,000,OC'. DED X RETENTION$ 10000 $ 1 AND EMPLOYERS COMPENSATION X I STATUTE R i I ER r ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N CAWC358795 08/01/2022 08/01/2023 E.L.EACH ACCIDENT $ 500;00':.. OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,0 If yes,describe under 500,Of1': DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) , ' i • CERTIFICATE HOLDER CANCELLATION 77.I TOWN-02 • �, 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. 1146 ROUTE 28 • S.YARMOUTH, MA 02664 AUTHORIZED REPRESENTATIVE Bryden&Sullivan Insurance <,, f ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserves�.,, The ACORD name and logo are registered marks of ACORD