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HomeMy WebLinkAboutBLDC-22-004737-01 , The Commonwealth of Massachusetts r, City\Town of YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to BLDCI-22-004737-01 Business Name:Sandbar Holding LLC Trade Name:Shark Bites Cafe Identify property address including street number,name,city or town and county Certificate Expiration Located at 518 ROUTE 28 11/30/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 140 A-3 Amusement/Church/Gym/Library/Museum 40 SEATS INSIDE 100 SEATS OUTSIDE TOTAL-140 SEATS 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 Name of Municipal Mark Grylls Date of �oA SC<,,,,..ie C Building Commissioner Inspection 3-7—a 3 Signature of Municipal Signature of Municipal , Date of -.----6 .A.---2/.---- Building Commissionerail, Issuance ?/B. /�1 Fee: $150.00 BLD_Certofl nspection.rpt BUILDINGART_ f ENT 1146 Route 28. South \ armouth, MA 02664 +08-398-2231 eat. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Shark Bites ADDRESS: 512 Route 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 License Issuance I1 No Fire Department Rep. Date Comments Approved for License Issuance /77, 3 "� ❑ No Board of Health Rep. Date Comments Approved for License Issuance fU Yes ❑ No Plumbing/Gas Inspector Date Comments Approved for License Issuance ❑ Yes 11 No Electrical Inspector Date Comments Approved for License Issuance [1 Yes 1] No Taxes Paid ❑ Yes I No Rev.Sept.2003 °i'aR�� TOWN OF YARMOUTH -1 1c BUILDING DEPARTMENT M L= CS[`� 1 146 Route 28, Yarmouth,��«�a,,:t��CC :. South MA 02664 508-398-2231 ext. 126{) APPLICATION FOR CERTIFICATE OF INSPECTION February 1, 20230-15PAYABLE 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: ,I V 2- 4' .f k 2 8 Name of Premises: St-vI64- M0-✓.41.ti.e...>' 4/l6/.r f 1/44' ' Tel: '7 g' 31 i- 'Y v L D E Purpose for which permit is used: (1044 License(s) or Permit(s) required for the premises by other governmental agencies: R E c E ' V License or Permit Agency r~ I FEB 212023 1 t BUIL By: - Certificate to be issued to c,,4JIhWW M04/?v..ie../ Tj.Ai( Tel: q- ki- 37 S- S`'4)Z' Address: 678 AaJr 26 Owner of Record of Building J ..nI J T Ho k4-vr, "7'0'c Address S'a. 2.' Z 8 Present Holder of Certificate ci.vl‘4r M. y7,-+4.,ii. %vc t1/5/4 S1.4 F/Q A. fri"64-i "rj Signs re of person to whom Title Certificate is issued or his agent Vp4 / 3 Date Email Address: sly, "arr.4,"4(Pl M4'1• cv•+^ 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# 04/01/2023-11/3 0/2023 DATE(MMJDD/YYYY) AC:GT?,E) CERTIFICATE OF LIABILITY INSURANCE 11/14/22 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 CONTACTNAME: Brian Allain PHONE 978-343-4853 FAX nfo): 978-345-1007 Choice Insurance Agency LAfC,No,Exrf: 376 Summer Street E-MAIL ADDRESS: baliain@choice-insurance.com Fitchburg,MA 01420 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: AmGuard Ins Co 1 42390— INSURED INSURER B: Sandbar Management Inc/Sandbar Holdings LLC INSURER C: Cape Cod Inflatable Park/Shark Bites Cafe INSURER D: 100 Wood Ave S,Suite 209 Iselin,NJ 08830 INSURER E: INSURER 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 CON,JITION 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 NAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'AODLBUBRI POLICY EFF POLICY CXV t LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDO/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINEDISINGLE LIMIT $ 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) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ __DED I_ RETENTION$ _ $ WORKERS COMPENSATION PER .� STATUTE X OE RH AND EMPLOYERS'L.tABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? NIA SAWC374351 10/01/22 10/01/23 1,000,000 (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Opeations of Insured. 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. Sandbar Management,Inc. P.O.Box 409 Iselin,NJ 08830 AUTHORIZED REPRESENTATIVE y Qrv".+'y. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD