The URL can be used to link to this page

Home My WebLink AboutBLDCI-23-001974 The Commonwealth of Massachusetts City\Town of _'�'„ra = 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:99 Restaurant BLDCI-23-001974 Trade Name:99 Restaurant Identify property address including street number,name,city or town and county Certificate Expiration Located at 14 BERRY AVE 12/31/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) , A-2 01st Floor 142 A-2 Nightclub/Restaurant/Bar/Banquet Hall 142 person-tables"@ chairs Allowable 01st Floor 28 A-2 Nightclub/Restaurant/Bar/Banquet Hall 28 Bar Stool _ Total Occupancy limited Occupant Load to per Board of Health 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 Building Commissioner Inspection Signature of Municipal ' nature of Municipal Date of Fire Chief Building Commissioner G Issuance /I'" / . Z 1, Fee:$150.00 BLD_Certoflnspection.rpt t BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: 99 Restaurant ADDRESS: 940 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 Co ioner Rep. Date Comments Approved for Li k se Issuance VIP No Fire Department Rep. Date Comments Approved for License Issuance ` . /7 22 tap 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 RECEIvE TOWN OF YARMOUTH Flo LOCT 13 2022 - , ` -cz BUILDING DEPARTMENT F\^a" - 9 UU1 DING 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 e.t.ta,hoo DEPART APPLICATION FOR CERTIFICATE OF INSPECTION �//^ \C September 16,2022 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 the below-named premises located at the following address: Street and Number: Name of Premises: Tel: 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 Tel: Address: Owner of Record of Building Address Present Holder of Certificate Sales,Use A Property Tax Accountant Signature of person to whom Title Certificate is issued or his agent Date Email Address: 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# 1/01/2023— 12/31/2023 ► '.( L I-a 3 -Do lc 7 y SAFETY NATIONAL CASUALTY CORP Workers' Compensation and Employers' Liability 1832 SCHUETZ ROAD Insurance Policy Information Page ST. LOUIS, MO 63146 (888) 995-5300 Policy Period Policy Number From To LDC4055543 08/01/2022 08/01/2023 12:01 A.M.Standard Time at the address of the Insured as stated herein Prior Policy Number LDC4055543 Transaction Renewal Issue 1. Named Insured and Address *see below Agent RESTAURANT GROWTH SERVICES, LLC Stephens Insurance, LLC 61088 3038 SIDCO DRIVE 111 Center Street NASHVILLE, TN 37204 Suite 100 Little Rock,AR 72201 Telephone: Customer# Carrier# FEIN# Risk ID# Entity of Insured 16349 371689186 917057680 LLC * If applicable, Item 1 is continued on attached Named Insured and/or Additional Locations Page: 2. The Policy Period is from 08/01/2022 to 08/01/2023 12:01 a.m. Standard Time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: AL AR CT FL GA IL IN KY LA ME MA MS MO NH NY NC RI SC TN VT VA WV 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 $ 1,000,000 each accident Bodily Injury by Disease S 1,000,000 policy limit Bodily Injury by Disease S 1,000,0Q0 each employee C. Other States Insurance: Part Three of the policy applies to states, if any, listed here: All states except ND, OH, PR, VI, WA, WY and states designated in Item 3.A. D. This policy includes these endorsements and schedules: See attached Schedule of Forms and Endorsements. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE Minimum Premium Total Estimated Annual Premium S _ Expense Constant $ Assessments and Taxes S Premium Discount (Taxes not applicable in Puerto Rico) Deposit Premium This is a Three Year Fixed Rate Policy Premium Adjustment Period: x Annual _ Semiannual _ Quarterly _ Monthly Countersigned this Day of Issued Date: 08/25/2022 Authorized Representative Issuing Office: Safety National Casualty Corporation WC 99 00 00 (07 17)