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Home My WebLink AboutBLDCI-23-003305 The C um'nonwealth of Massachusetts J City\Town of y YARMOUTH • _ fir -IIM 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 Business Name: Keltic Kitchen Issued to BLDCI-23-003305 Certificate Expiration Trade Name:Keltic Kitchen Identify property address including street number,name,city or town and county Located at 415 ROUTE 28 01/01/2024 WEST YARMOUTH, MA 02673 Certificate No. Other Use Group Floor Occupancy Use Group Classifications(s) 01 at Floor 75 A-2 Nightclub/Restaurant/Bar/Banquet Hall 75 Persons A-2 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. PhilipSimonian III Name of Municipal Mark Grylls Date of / �,/ Name of Municipal Inspection ( ` / — Fire Chief Building Commissioner Signature of Municipal Signature of Municipal Date of - Issuance //a/2f Building Commissioner �� Fire Chief Fee: $100.00 BLD Certoflnspection.rpt II The C i, I onwealth of Massachusetts 1 n � ' ti J City\Town of mui i YARMOUTH 4.! A ,, 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 Business Name: Keltic Kitchen Certificate No. Issued to BLDCI-23-003305 Certificate Expiration Trade Name:Keltic Kitchen Identify property address including street number,name,city or town and county Located at 415 ROUTE 28 01/01/2024 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) 01 st Floor 75 9 A-2 Ni htclub/Restaurant/Bar/Banquet Hall 75 Persons A-2 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. PhilipSimonian III Name of Municipal Mark Grylls Date of Name of Municipal Fire Chief Building Commissioner Inspection /`y"a3 Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance /40 /2/ Fee:$100.00 B LD_Ce rtofl nsp ecti o n.rpt TOWN OF YARMOUTH .,fay BUILDING DEPARTMENT 1 146 Route 28, South Yarmouth, MA 02664 508-398-2 I v E D APPLICATION FOR CERTIFICATE OF INSPECTION g DEC 131022 December 1,2022 PAYABLE UPON RE �jp'IIo N ING DEPARTMENT (X) Fee BY --`--1M0.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 4 ( gef 0'46 Name of Premises: �L'�1 L K {� I Tc 1 Tel: SO - n l rqt h Purpose for which permit is used: R SIPO -1 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to D ,k 0 DMPSel Tel: 9)6-9.3 I- Address: 4I6- 1zt 2$ WEST viziticort f\V ao6-3 3 Owner of Record of Building 0•5‘Ul BPS I Address 1 WIL.FL. P. S ` oot curtY- M \ c bE4( Present Holder of Certificate OAk.) 7 COMPsE1/4-1 tArJe2 Signature of person to whom Title Certificate is issued his nt -/3'a a Date Email Address: K is 1CI TO -e_cO VL1 C R,E ' /i-C. ' 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# (30J3-0033 /! 01/01/2023-01/01/2024 WNW' _ - ''''""11111111XF-r: * , ;• . : , . _ _ _ _ )1610--- NOTICE , _*=��.yyy,�_ NOTICE TO _` ,�� TO EMPLOYEES ,<1� �= ��:,, EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017 n17-727-4900 - httn://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22& 30,this will give you notice that I(we)have provided for payment to our injured employees under the above-mentioned chapter by insuring with: NorGUARD Insurance Company NAME OF INSURANCE COMPANY P.O. Box AH, 39 Public Square; Wilkes-Barre, PA 18703-0020 ADDRESS OF INSURANCE COMPANY 0AWC488137 01/01/2023 01/01/2024 .1CY NUMBER 225 Kenneth Drive EFFECTIVE DATES PAYCHEX INSURANCE AGENCY Rochester, NY 14623 877-266-6850 NAME OF INSURANCE AGENT ADDRESS PHONE 4 David Valentine 415 Main Street West Yarmouth, MA 02673 EMPLOYER ADDRESS 12/02/2022 EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRES= TO BE POSTED BY EMPLOYE'