Loading...
HomeMy WebLinkAboutBLDCI-22-006206-01 restaurant The Commonwealth of Massachusetts n 1 r 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. Identify Name of Establishment Issued to Certificate No. Business Name:RJ Resorts Blue Water Resort Beverage LLC BLDCI-22-006206-01 Trade Name: Blue Water Restaurant Identify property address including street number,name,city or town and county Certificate Expiration Located at 291 SOUTH SHORE DR 11/30/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group p Other A-2 01st Floor 226 A-2 Nightclub/Restaurant/Bar/Banquet Hall 153 Main dining room 26 dining room 1 Allowable 26 dining room 2 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 -lahitEMBNEINF Name of Municipal GFire Chief (.... .Markryll pa of fe��ON 5�Ca..." Building Commissioner Ispection 3.. s� i--023 Signature of Municipal Signature of Municipal Fire Chief to of Building CommissionerIssuance 372.77ty ".. Fee:$150.00 BLD_Certofl n spection.rpt BUILDING DEPA RTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Blue Water Motel Restaurant ADDRESS: 291 South Shore Drive 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 License Issuance 1 ►n/J �o�'o� 3 Y�Yes ❑ No Board of Health Rep. Date Comments Approved for License Issuance 17 Yes ❑ No Plumbing/Gas Inspector Date Comments Approved for License Issuance ❑ Yes Cl No Electrical Inspector Date Comments Approved for License Issuance L i Yes ❑ No Taxes Paid ❑ Yes ❑ No Rev.Sept.2003 (o ;." BUILDING DEPARTMENT Si/ ,36 "^T` Yarmouth, MA 02664 508-398-22a. . 6 rd 1146 Route 28, South ECEIVED r#oo 54 7 APPLICATION FOR CERTIFICATE OF INSPECTION FEB 2 41013 February 16, 2023 PAYABLE UPON R�. , _-_ MENT (X) Fee Reel t t t ( )No Fee Requirel Lid CD In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for% Certificate of Inspection for the below-named premises located at the following address: Street and Number: LC 1 c V ' c -A"'' Name of Premises: 13 I\LQ- k.1&,k.A/ Tel: tb 3 4 J Purpose for which permit is used: St4,ymp-1)... License(s)or Permit(s)required for the premises by other g ernmental agencies: License or Permit Agency Y J L L 1t tai Certificate to be issued to L Tel: ."� t�'Vg(` Address: a 1 S U n N('/Q� Owner of Record of B ng A"Anve< c� Address I fIdi1MC1-- YL5 lA/A- 1/h�Wd't— Present Holder of Certificate at)Wf igngure of person to whom Title Certificate is issued or his agent 3L 0� t Date � Email Address: h ;YG hC'l:t(. fA\`A( �J�I '�.att , Lan J 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# 1jC,7jC'Z -2 --0O4'1 4 - a 4/1/2023-11/30/2023 DATE(MM/DD/YYYY) A`CPRD CERTIFICATE OF LIABILITY INSURANCE 02/21/2023 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 Marsh USA,Inc. PHOE: PHONE FAX 1166 Avenue of the Americas (NC.No.Extl: (A/C,No): New York,NY 10036 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN133703919-GL-22-23 INSURER A:Everest Premier Insurance Company 16045 INSURED Hospitality RJR MA Employee LLC INSURER B:NIA N/A 444 Madison Avenue I Floor 14 INSURER C:N/A N/A New York,NY 10022 INSURER D:N/A N/A INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-011556130-04 REVISION NUMBER: 2 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSD_WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ CLAIMS-MADE OCCUR PREMISESO(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 COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION CC5WC00075-231 01/01/2023 01/01/2024 x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION RJ Resorts Blue Water Resort Owner LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 291 South Shore Drive THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Yarmouth,MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WicZ,Z4% 2L.�rg 'Z ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD