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HomeMy WebLinkAboutBLDCI-16-004965-07 The Commonwealth of Massachusetts rr, City\Town of . =u '=v 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:AZZARO YARMOUTH, LLC BLDCI-16-004965-07 Trade Name:THE LOBSTER BOAT Identify property address including street number,name,city or town and county Certificate Expiration Located at 679&681 ROUTE 28 11/30/2023 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 334 A-2 Nightclub/Restaurant/Bar/Banquet Hall 314 PERSONS 20 BAR STOOLS 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 -1114mmoIW Name of Municipal Mark Grylls Date of Fire Chief 6>1 SAw�Lr Building Commissioner spection �2.3 Signature of Municipal Signature of Municipal 7 Date of Fire Chief ,---- .1(----(,„. uilding Commissioner Issuance / Z? ee: $15500.00 BLD_Certofl nspection.rpt BUILDING DEPA TMENT 1146 Route 28, South ' 'armouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: The Lobster Boat ADDRESS: 681 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 R Date Comments Approved for License Issuance //1(/ .cam ❑ No Fire Department Rep. Date Comments Approved for License Issuance l� G�a-e 3 -p Y-.23 Cl No Board of Health Rep. Date Comments Approved for License Issuance ❑ Yes Li No Plumbing/Gas Inspector Date 3/7 /23 Comments Approved for License Issuance Ll Yes CI No Electrical Inspector Date Comments Approved for License Issuance l I Yes I I No Taxes Paid ❑ Yes ❑ No Rev.Sept.2003 s? incerw iry 1,1•frpt.metsul uoizosuoewerp uo itsu.lcs vuo4t.4 ct lutp,(60 4•P3) 0 1,0 00 00 OM# ezomt t-10 c000-cgtz V .Aq peu6iieu piu eie43 ''DZ"IS VEe aogtO 4444,443 4K)9,30 evie, { 00 0 S 000 S 001,6C'Z S 00"P6C'Z S 0069Z S uscdao sueptuoo asuadxg turuumoi lernuuy putsa turuu.seld pawioid Lunuushi usnuquipi {Ogled Bulmotio4 uo suopetecio jo ofolooLloS ooS uogetauntuald yestuu've t.ortetauottsa):1 Peletolls3!viol wniwalci telluuN Peieut4s9 to 001.S Pad a4Ri Elses tunituald 4 oP00 sucmeollisseID woe Aq ab-ueqo pue uoleotivaA 0 perqns Sf molaq pannbat umpeuuoiut trif -sueld 6u4eN pue sal%-t uogingieseto lenuen Jrto Aq paumualap aq filM Aottod aui to)tunpaid atti turiguatd tip ulau (90/LO)vt0900ZOM (1.0/90)SOIPOOZOM (C1,t90)99000OZOM'(0i/B0)(1£0000ZOM (90/60)YZ0000ZOM (1-910)lOCOOMM lil0)Z0140ZOM 11.040)30N"( 0).-)Z7t70000M (61.11-0)Vt4t70000M'(31.11.0)30000000M .sainpayos pue spratuattopue asaui sepopu!Aptiod sqj -(3 :aquetnsui S4121S 1940 ,0 aaAp;dula Lpes 00•000vos s aseasta Aq nfu Moog mull&Nod 90`000*009$ eseas!ci Aq ktnrul/Wog 1U415133?Wee 00'000O0S S luePPON Aq Aln(ul APPo8 .aue omi lied/spun At!Iicleli Joo JO st!tult 4,41. NT LuG11 u!Oats!!ems pee u!)pom oi sellaoha Af-itoci aka to omi ved :eoustneu!Atpliet.1 ateAoldut3 g P1fi saesek0 to mei uo4esuackucr3 sJewoAA sett ot seitOde A.,Hod eta jo auo ped eoutiunsul uoliesueclwco sia)ooM 'V :aBetonoo•E uta;i 9140Z Oti41 sseippe Buipetu speunsui aqi uo prig t7Z0Z110/1.0uoIAPV10:Zi.02£Z9Z/1.0/10 u0 vtt):Z watt Si MAW Ao!lod ota Pouad 4,110d*Z CZ1.06Z0C0S0041,0:# :#Qt2uawA0tdwaufl cstre 4nee4o9/103N 000000000 'al msai I C6C99900Z lemPed uolmtodioo :$tau%n93OOdAj` eIq. ,ddyp spa4nsui paweN jeuoll!PPV sag petueN 1eu011112PY suorie.lado io npatps aas :aAogy umous)oN sapefdvom no £1.9Z0 VV4*titnoolieA tsoM RZ oloo):1 1.090 VP/'siuueAH iaas uleVI 149 0661,xo$210d itmrte)saki wog Jazscioi ask!, Aouaely a,uetosullIeN.0 V huilmoe oTi•umouz.aA o.ntrzy faue8y sso.ropy pue Nunsui peumN :I.wolf ZZi06Z0£0900171.0:#Aollod IOLkd LZJ3 E6E99gOOZ MBA kIIOdteNukua?:i afied u04eutiojui 0000-seao vw•Ganu!eis P0ZII.0iL0 01 cza&t.cao i.06z0cos00tn0 • LZZ6-ZZL698 xoe Od PolJad itOd 10904:1 JaPie0 dnoso om sluotiolais feeNtri SSCK:(s)oN at JeJnsul Aouod eouemsul %men sAaAoldui3 pue uonesuadwoo sJal.iom TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-223 J.260 E R CEIVED APPLICATION FOR CERTIFICATE OF INSPECTION FEB 07 2023 February 1, 2023 PAYABLE UPON REC tLDING D (X) Fee ed$i 0..Uu ENT ( ) 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: (og l ,Q3k O 6e${, an-y 0(?t , l 1"i 024 3 Name of Premises: -�. flt,t/tq(A'Tel: 5t -3:3:S" D LtgCa.. Purpose for which permit is used: p i 1 i t 0.0, -ct.CQ, o _J nS - 11.M Foe. isA Q, License(s) or Permit(s) required for the premises by other governmental agencies: L c u( - r License or Permit Agency Certificate to be issued to I--'t7 7 a,eiamnbAL� Tel: --34 - O� Address: (oS 213 ' J •mil IF-I�t- O2��3 Owner of Record of Building (�'o \J i, ' Address Crg\ (2 ZS c-£ P_..A�ubks% 'µ o2(p Present Holder of Certificate ItZ2C3Lrp a.i U..,C EN ill A Lohsae' E tX� Signa e of person to who Tit e Certificate is issued or his agent (O Date Email Address: Qz„z Gip C'o P corn CQ.Si'. /tom 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# 04/01/2023-11/30/2023 . „ r . r? frtz4C • 't, t r , ; • • 1 • • •-• • • - • - cT r- r , . • . : 71 • rsr, • . r, • . 4sf, • Workers Compensation and Employers Liability Insurance Policy Insurer ID No(s): 34355 MA Retail Merchants WC Group Inc. _ Carrier Policy#: Policy Period PO Box 859222-9222 014005030290122 01/01/2022 to 01/01/2023 Braintree, MA 02185-0000 Information Page Renewal Policy FEIN: 200666393 Carrier Prior Policy#: 014005030290121 Item 1: Named Insured and Address Agency Azzaro Yarmouth, LLC Dowling &O'Neil Insurance Agency The Lobster Boat Restaurant PO Box 1990 681 Main Street Hyannis, MA 02601 Route 28 West Yarmouth, MA 02673 Other Workplaces Not Shown Above: See Schedule of Operations Additional Named Insured: See Additional Named Insureds if Applicable Type of Business: Corporation Federal ID#: 200666393 Risk ID: 000000000 NCCI/Bureau#: 34355 Unemployment ID#: File#: 014005030290122 Item 2. Policy Period The policy period is from 12:01 AM on 01/01/2022 to 12:01AM on 01/01/2023 based on the insured's mailing address time zone. Item 3.Coverage: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed: MA 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 $500,000.00 each accident Bodily Injury by Disease $500,000.00 policy limit Bodily Injury by Disease $500,000.00 each employee C. Other States Insurance: D. This policy includes these endorsements and schedules: WC0000000(01/15), WC000414A(01/19),WC000422C(01/21), NOE(01/01), WC200102(01/14),WC200301(04/84), WC200302A(09/08), WC200303D(08/10), WC200306B(06/13), WC200405(06/01), WC200601A(07/08) Item 4: Premium The Premium for the policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code# Premium Basis Rate Per$100 of Estimated Annual Premium Total Estimated Remuneration Annual Remuneration See Schedule of Operations on Following Page(s) Minimum Premium Prorated Premium Estimated Annual Premium Expense Constant Deposit $261.00 $2,549.00 $2,549.00 $0.00 $0.00 Issuing Office: 35 Braintree Hill Office Park Ste 206 Date Printed: Countersigned by: Braintree MA 02185-0000 01-12-2022 (!� Form#WC 00 00 01 C (Ed. ) ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. Pane 1 of 1 Workers Compensation and Employers Liability Insurance Policy Insurer ID No(s): 34355 MA Retail Merchants WC Group Inc. Carrier Policy#: Policy Period PO Box 859222-9222 014005030290122 01/01/2022 to 01/01/2023 Braintree, MA 02185-0000 Information Page Renewal Policy FEIN: 200666393 Carrier Prior Policy#: 014005030290121 Item 1: Named Insured and Address Agency Azzaro Yarmouth, LLC Dowling &O'Neil Insurance Agency The Lobster Boat Restaurant PO Box 1990 681 Main Street Hyannis, MA 02601 Route 28 West Yarmouth, MA 02673 Schedule of Covered Workplaces Other Workplace Azzaro Yarmouth, LLC Effective Date: 01/01/2022 The Lobster Boat Restaurant NAICS Code: 722511 679-681 Main Street Division#: 0 Route 28 Workplace#: 0000000001 West Yarmouth, MA 02673 State Risk ID#: 000154319 Mailing: 681 Main Street Route 28 West Yarmouth, MA 02673 Form#WC000001 C (Ed. ) ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. Page 1 of 1