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HomeMy WebLinkAboutBLDCI-17-005596-06 The Commonwealth of Massachusetts t R City\Town of YARMOUTH R 1 # tA, NM 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: EL MARIACHI MEXICAN RESTAURANT BLDCI-17-005596-06 Trade Name: EL MIRIACHI MEXICAN RESTAURANT Identify property address including street number, name,city or town and county Certificate Expiration Located at 416 ROUTE 28 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 117 A-2 Nightclub/Restaurant/Bar/Banquet Hall 102 lower 10 bar TOTAL PERSONS Allowable ALLOWED:117 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 ItteME5ffetemlaw1W. Name of Municipal Mark Grylls Date of Q Fire Chief Se N S0.w {,. Building Commissioner �. .. Inspection _ Signature of Municipal Signature of Municipal Date of Fire Chief // Building Commissioner �. „� 1j� 7 Issuance ,41/P/ 7"'a vG l(••••-- Fee: $150.00 BLD_Certoflnspection.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: El Mariachi Family Restaurant ADDRESS: . 416 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 Rep. Date Comments Approved for Lice suance ,zre.„4„,Z! 411111M No Fire Department Rep. Date Comments Approved for Lic se Issuance LI1 /2.(��2 Yes 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, BUILDING DEPARTMENT 51 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION December 2, 2022 PAYABLE UPON RECEIPT (X) Fee Required 150.00 ( )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 theit below-named premises located at the following address: Street and Number: L I+c0 Roof o10 W y (,fir P10 Ut'14 , PA, 01 6 Name of Premises: CI'MCIVIVIAti IA/Al(CM Fern I Iy 'L�3-1-C Q14Tel: 5 0 k+_ Z} 4(}(C, Purpose for which permit is used: VSS 6,0An1- - c 2 13-3 C� License(s) or Permit(s) required for the premises by other governmental agencies: T License or Permit Agency Certificate to be issued to LA QUA'(1►iNCDIWALM4t1a( iMR Qr.Q.Tel: SQ2 g29 31 Address: I'M/ (do#C c 1arfoU}1n .MA , p7.bft RECEIVED Owner of Record of Building nay!d t3va h^1),�q -.- Address AV eft kits S4-, Svc)burl t Y" 0134(4 - DEC 0 2 2022 Present Holder of Certificate P. v/�,r r,(� BUIL NT Po �" 1Un` -er By Sign re of person to whom Title Certificate is issued or his agent I Z 1 Date Email Address: .e1^'11110 b ltri(D 5 Q 'vii( (Or p 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 of Inspection# 12/31/2022 to 12/1/2023 Acc eo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/02/2022 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 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 endorsemerrt(s). PRODUCER CONTACT Debbie Kleponis NAME: Brown&Brown of Massachusetts, LLC PHO N.Eat): (781)455-6664 FA(A/CX No): 980 Washington Street E-MAIL Deborah.Kleponis@bbrown.com ADDRESS: Suite 325 INSURER(S)AFFORDING COVERAGE NAIC# Dedham MA 02026 INSURER A: Twin City Fire Insurance Company 29459 INSURED INSURER B: Wesco Insurance Company 25011 LaPlaya dba El Mariachi INSURER C: 1506 N Washington Street INSURER D: INSURER E: Spokane WA 99201 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2212283373 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. INSRLTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ADDL SUBR /YPOLICY EFF POLICY EXP LIMITS (MMIDDYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000DAMAGE ,000 RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 1,000,000 X Liquor Liability MED EXP(Any one person) $ 5,000 A 08SBMAD4757 06/18/2022 06/18/2023 PERSONAL&ADV INJURY $ 1'000'000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 500'000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WWC3603102 OSI15I2022 08/15/2023 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under 500000 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) 416 Route 28,West Yarmouth,Mass. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of West Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE West Yarmouth MA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD