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BLDCI-23-002382 The Commonwealth of Massachusetts City\Town of —u- '— 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: Longfellow's Pub BLDCI-23-002382 Trade Name: Longfellow's Pub Identify property address including street number,name,city or town and county Certificate Expiration Located at 182 OLD TOWNHOUSE RD 12/31/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 66 A-2 Nightclub/Restaurant/Bar/Banquet Hall 20-Bar Stools 6-Standing 40-Main Dining Room 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 l- Name of Municipal Mark Grylls Date of /�� Fire Chief - j Building Commissioner _ _ Inspection Aig Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance #/ Z0L Fee:$100.00 BLD_Certofl nspection.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: Longfellow's Pub ADDRESS: 182 Old Townhouse Road 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 License Issuance No Fire Department Rep. Date Comments Approved for L-1, �'� Issuance Z Yes 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 • TOWN OF YARMOUTH i !. J) BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 APPLICATION FOR CERTIFICATE OF INSPECTION OCT 28 2022 September 16, 2022 PAYABLE UPQN RECEIPT ,r Fee Re uired ( ) 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: 82. OLD Toon �co� l o 14o( I A- Name of Premises: Lonoi e�\Old ?uV Tel: tA n37- 1 Ocfr Purpose for which permit is used: R.)kpt\101- License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency k • U tL 1,I r e.W Ce -e C.�J-�- i afar �C 1 GVO-- �v i d�Net S R I,ee h, 6 . -E0/ -109 1a p T 1 i- Certificate to be issued to VAN-1k)e.sird(YI "I -f.Q Tel: 5 d e-73-7-kg r Address: (Q 1+1Cv-tA• I�( 'IL (Z.b IU flt.Q �/'1'14 MO OZG(0q Owner of Record of Building e"-- 0 Pj Q�-T 41 Address , ' ,b(LPh - F 'ot W'P*' GSlf1r►w��. Present Holder of Certificate '�C( .. ic ) 6/u,cC,r r k)44-\,\MA5tt a Signature of person to whonV Title Certificate is issued or his agent t --3 d' 2 2-- Date Email Address: VON., (M,c9►ook. 1`QLl Oct t S a Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return thisapplication 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# (�C/-oq 3 3 ` ()_,442 1/01/2023 - 12/31/2023 1 A�ORO. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDo/YYYY) 11/01/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFIC/VE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certif. URED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAI E s ,- II oEheieWtsEi 'Bons of the policy,certain policies may require an endorsement. A statement on this certificate does not of tothe-eertifical r in lieu of such endorsement(s). PRODUCER CONTACT Christian Barber,CIC NAME: The Oceanside Insurance Gro NOV 0 4 2022 PHONE ( )]]5.0500 FAX(AI No, (50B)790-7955 (A/C,No,Ext): E-MAIL ADDRESS: 52 West Main Street BUILDING DEPARTMENT INSURER(S)AFFORDING COVERAGE NAIC Hyannis By: -- w MCI _INSURER A: Hartford Underwriters Insurance Company _ 30104 INSURED INSURER B. Hartford Insurance Company of the Midwest 37478 RCR Management Inc.DBA Longlellows Pub INSURER C: 182 Old Town House Rd INSURER D: INSURER E: West Yarmouth MA 02673-1531 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2251308995 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 1,000,000 CLAIMS-MADE XI OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) $ 5,000 A OBSBAAS50EJ 05/11/2022 05/11 2023 PERSONALAADV INJURY S 1'°°°'°°° GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIM!?APPLIES PER PRCti X POLICY JECT �LOC PRODUCTS-COMP/OP AGG $ 2' ' W EPLI s 25,000 OTHER COMBINED SINGLE LIMB $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS PROPERTY TY DAMAGE HIRED NON-OWNED p P R S AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ _ DED RETENTION$ PER �/I OTH- WORKERS COMPENSATION STATUTE ON ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEE08WECAS50C7L.EACH ACCIDENT 5 1,000,000 Bo OFFICER/MEMBER EXCLUDED' N NIA 05/11/2022 05/11/2023 1,00 (Mandatory in NH) 0,000 E.L.DISFARF-EA EMPLOYEE S If yes,describe under E.L.DISEASE-POLICY LIMIT S 1'�0'� DESCRIPTION OF OPERATIONS below - Aggregate Aggregate $2,000,000 Liquor A �� O8SBAAS50EJ 05/11/2022 05/11/2023 Each Occurrence $1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsement of the policy.Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions.This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This is to certify that the policies of insurance listed have been issued to the insured named above. CERTIFICATE HOLDER CANCELLATION 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 Rte 28 AUTHORIZED REPRESENTATIVE S Yarmouth MA 02664 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ti ) , _• Sl, litA I . 1, 't es . .. ft.i R i -._ , , .,., , . .• .._.._..... •^ '"i° .....'.." `.._w'�_. _ . . .way J.,t . tt. • t , .. . . ^.tpt tea,, i 1 7 ±�S7t i t r i i ... ......a _ _.w I x_{,_ _ a i • ai '4Ma f1dAi F _� { i i { 5 { I , 4' • o i cam.., .,.,.�. ......w,.»...•...�.,...v .<.. -.,-. ...., _ .. �.,.., .