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HomeMy WebLinkAboutBLDCI-23-002796 The Commonwealth _ of Massachusetts l T. ili City\Town of • � ' 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. Issued to Identify Name of Establishment Certificate No. Business Name:Chez Hospitality Group LLC Trade Name:The Grill at Bayberry Hills BLDCI-23-002796 Identify property address including street number,name,city or town and county Located at Certificate Expiration 635 WEST YARMOUTH RD WEST YARMOUTH, MA 02673 12/31/2023 Use Group Floor Classifications(s) occupancy Use Group Other A-2 01st Floor 41 A-2 Nightclub/Restaurant/Bar/Banquet Hall 41 Person/Tables& Allowable Chairs 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 ' -Rbilipsimpargow Fire Chief Name of Municipal Mark Grylls Sc {�. Building Commissioner Date of Signature of Municipal / Inspection Fire Chief Signature of Municipal i\._ Building Commissioner Date of Issuance /56 Z 22- e:$100.00 B L D_Certofl ns pecti on.rpt TING EPA T.. ENT 1146 Route 28, South Yarmouth, M.A 026O4 508-398-2231 ext. 120 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: The Grill at Bayberry Hill ADDRESS: 635 West Yarmouth 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 Re Date Comments Approved for License Issuance /,2 _ 7-2 2- No • Fire Department Rep. Date Comments Approved for Li•-so seIssuance la/4/ 4.2 dip 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 RAW' $) BULLDII G DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION November 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: fjj E C EI v E D Street and Number: 635 West Yarmouth Road Nov 18 2022 Name of Premises: The Grill at Bayberry Hills Tel: 508-744-5012 BU 1 NT By' Purpose for which permit is used: sale of liquor/restaurant License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Liquor License Town of Yarmouth Certificate to be issued to Chez Hospitality Group,LLC.dba The Grill at Bayberry Hills Tel: 860-506-1450 Address: PO Box 498 East Windsor CT 06088 Dwner of Record of Building Town of Yarmouth Address 1146 Route 28,South Yarmouth MA 02664 Present Holder of Certificate Chez Hospitality Group,LLC III 1 V Principal Signature of per to whom Title Certificate is issued or his agent 11-15-22 Date Email Address: lhaley@chezhospitality.com 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# /3t1�1 - ,3�Q b,;279, 12/31/2022 to 12/1/2023 0 • t .,1 _ . . a. :. +ram — ' } t .y.'. S 4 ' i `S ..1 s� CHEZHOS-01 i DALDRICH COKLJ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/4/2022 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 . CONTACT NAME: Haberman Insurance PHONE FAX 95 Ashley Ave (NC,No,Ext):(413)781-7000 (A/c,No):(413)733-9545 West Springfield, MA 01089 i IEiIDoREss:info@habermaninsurance.com INSURER(S)AFFORDMG COVERAGE NAtC• INSURER A:Sentinel Insurance Company 11000 INSURED INSURER B: Chez Hospitality LLC MSURERC: PO Box 498 NSURERD: East Windsor,CT 06088 MSURERE: MSURER 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER ,NUMBER POLICY EFF POLICY EXP UNITS LTR INSET VIVO INMIDRIYYYYI MhWO/YYYY), COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) S PERSONAL S ADV INJURY _ $ GEM_AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S POLICY 0. LOC PRODUCTS-COMP/OP AGG S OTHER: _ S AUTOMOBILE UABLITY COMBINED SINGLE LIMIT (Ea accident) E I ANY AUTO BOOLY INJURY Ter person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODLY INJURY(Per accdent) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LAI B CLAIMS-MADE AGGREGATE S DEO I ;RETENTIONS $ A WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE X ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN 08WECALI FGD 3/29/2022 3129/2023 El.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? Y N I A (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT S i I ; DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Marc Sparks is excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE � ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD