Loading...
HomeMy WebLinkAboutBCOI-23-1704 2025 The Commonwealth of Massachusetts -. Town of 1` 5•�. YARMOUTH ►� 41 _O y: New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: Wendy's Restaurant Trade Name:Wendy's Restaurant BCOI-23-1704 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 465 STATION AVE May 24, 2025 SOUTH YARMOUTH, MA 02664 Use Group Classification(s) Floor Occupancy_ Use Group Other 01 st Floor 96 A-2 Restaurants, Night Clubs,or Allowable Occupant Load similar uses 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 line safety features. This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Chief Name of Municipal Building l/�',, P Mar G I Date of Inspection / p� Commissioner Signature of Municipal Fire Signature of Municipal Building Date of Issuance Chief Commissioner /� v a) 0 a) o Tr _e v aa)) n ~ N M w N ao �l(1 N 10 (r) c V U 1t N — N O. —1�n` 0 re m N a) ` `V y C V tc (.\ m c 5 `•~ 8 5 ,..) (0 o.a-o c = a) Z. 0 a) o .0 C CD ._,2L O Na7Q V c..) c co :5- O � •� 2 2 G Z to c y a> a) c C N +� 0 co a a = y 2o � H p 0 e V, 2 °n a'C t y C C d tt Q•y 2 N t N V C d = Es E CO= to j 0 0 en p N C O E C co enh y 6 W Q Co as O as • A4 C" O � o ccc W v 01— a QwO F acw -D aN Ce m 0 li C� co a) y Q co" 3E— Q Zz � e ,r ti Ya . c ; ,. N z vs cI ,Z,v m = 5 d c 0 -0z D -- `� cE Z m d p m C C v V L +� Co 0. E c - = 1- cn v 0 O a) �6 Ts .- m h rn .. O n. •E '0 c +. �u C Q0cc co Om v1yO 3•I r "JD m E EZ al t v . E E c E4 _ 21 UO c a) co U V U o = C � C 0. am m o CO c _ V ca CO m = 'C a) 40 ID a) U) 8p� N U C .�.c 0 O % N F- L a) �a) LL C y N 40 - .�. c CO c J N •>, ai O a3 i+ aO ✓ C W N + N O s' a0 C co w d w ++ 'O W 7 0 C N L. L d ate+ R V — c) d y 0 o � c a) in Q. d a= a3 a cv —I 2 0 8 w o 41* v Na3 do im a) N c~0 w co =0 o• Q ~ ca) E C a) c Z cn 0 12 1 ',BUILDING. DEPARTMENT � � „ " :R,,' 1.I46.Itoute 28 SOUth Yarrrxouth,MA!.02 4 r.0S398�2231 eXt 1260 . : .' -7" -:.' --,:' ';•-.1 :- :i-::: :I.:::1,'APPLICATION FOR CERTIFICATE OF INSPECTION:. :-.. . :.:. . . ,. ..: . ,.,_ .. . .. -,,,,,,1 April.i,2423 PAYABLE UPON RECEIPT (X) Fee Required$l00 00. . ( ) No Fee Required In.accordance witli the o isions'of the Massachusetts State Build in Code,Section 110.7 I herebyapply for a: . 1� $ .pPY Certificate:of Inspection for the below-named premises located at:the: following address: 32 Old Townhouse Road` �treet`anclNumbFer: -. :_.: . . Wendy's 508 394-2985 .Name of Premises ::. �:_. _. r Tel : Purpose forwhich permit is used:; Restaurant Licenses)or Permits}.required for the premises by other governmental agencies . License or Permit: Agency t= MAY 1 2 2023: Certificate to be issued to Fashion Food•LLC.d/b/a Wendy's Tel 508 207 6322 0 . ; €w Address; 66.Pondside Circk Cepterville,N1A D2632 Owner ofRecord:of Building Montrose Yarmouth Station LLB Address 159 Cambnd&e St Allston,NIA 02:1:34 Present Holder of Certificate Fashion:Food C"CC d1b/a Wendys Partner Signs (person_ oin Title Certificate is issued or his agent 5/4/2023 _ , i : . . ' : ;Date' EmailAddress ;oshl@fashionfoodllc corn i Instructions: Make check::payable to Town:of Yarmouth 1146 Route 28,South Yarmouth,.VIA.02664 Return this application to - Building Inspeector's Office.' Please note:' Application,:form with accompanying fee must,be submitted for each building or structure or part thereof to be certified .Appli atcion must be received:before:the certificate will be issued::'.The building official.shall be notified withi 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# .. C O/- .3= /7 b : 05/2512023-05/2512024 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 014005030559123 01/01/2023 to 01/01/2024 Braintree,MA 02185-0000 Information Page Renewal Policy FEIN: 861176398 Carrier Prior Policy#: 014005030559122 Item 1: Named Insured and Address Agency Fashion Food LLC HUB NE Association Programs Wendy's 300 Ballardvale Street 66 Pondside Circle Wilmington,MA 01887 Centerville, MA 02632 Other Workplaces Not Shown Above: See Schedule of Operations Additional Named Insured: See Additional Named Insureds if Applicable Type of Business: Corporation Federal ID#: 861176398 Risk ID: 000000000 NCCI I Bureau#: 34355 Unemployment ID#: File#: 014005030559123 Item 2.Policy Period The policy period is from 12:01 AM on 01/01/2023 to 12:01AM on 01/01/2024 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 $ 100,000.00 each accident Bodily Injury by Disease $500,000.00 policy limit Bodily Injury by Disease $ 100,000.00 each employee C. Other States Insurance: D. This policy includes these endorsements and schedules: WC000000C(01/15),WC000406(/),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 $209.00 $23,266.00 $23,266.00 $0.00 $0.00 Issuing Office: 35 Braintree Hill Office Park Ste 206 Date Printed: Countersigned by: Braintree MA 02185-0000 01-18-2023 Form#WC 00 00 01 C (Ed.) ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. Page 1 of 1 Workers Compensation and Employers Liability Insurance Policy Insurer ID No(s): 34355 Carrier Policy#: Policy Period MA Box 8 9222-9222 WC Group Inc. 014005030559123 01/01/2023 to 01/01/2024 PO Box 859222-9222 Braintree,MA 02185-0000 Renewal Policy Information Page FEIN: 861176398 Carrier Prior Policy#: 014005030559122 Agency Item 1: Named Insured and Address HUB NE Association Programs W n yn Food LLC 300 Ballardvale Street 66 Pondside Circle Wilmington,MA 01887 Centerville,MA 02632 Schedule of Covered Workplaces Other Workplace Effectiive Date: 01/01/2023 Fashion fiuod LLC-._____ __._...___...___..._._._ NAICS Code: 0 69 Long 0000000005 -- - --- Division#: 69 Long Pond Drive ....__.. '_...---Workplace#: 000072530 Pl molalh_MA 0238fl" State RisR TD#: FaEffective Date: 01/01/2023 Wendy's Food LLC NAICS Code: 722511 endy's 32 Old Townhouse Road Division#: 0Workplace#: 0000000007 South Yarmouth, MA 02664 State Risk ID#: 000072530 Form#WC 00 00 01 C (Ed.) Page 2 of 2 ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. R 'i , TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 01, 2024 PAYABLE UPON RECEIPT (X) Fee Required S 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: Street and Number: 32 Old Townhouse Road S Name of Premises: Wendy's Tel: 508-394-2985 Purpose for which permit is used: Restaurant License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency --- RECEIVK D LFashion Food LLC 617 549 5131 MAY 2 8 2024 Certificate to be issued to Tel Address: 66 Pondside Circle Centerville MA 02632 BUILDING DEPARTMENT Owner of Record of Building Montrose Yarmout Station LC By: Address 159 Cambridge Street Allston MA 02134 Present Holder of Certificate Fashion Food LLC aka, ��,4A4 CFO Signature of person to whom Title Certificate is issued or his agent 5/24/2024 Date Email Address joshl@fashionfoodllc.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# 05/25/2024-05/25/2025 P\Vi I • °1:Y4so TOWN OF YARMOUTH BUILDING DEPARTMENT Ate:.':;;,,;.'" / 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext.1260 May 1,2024 Wendy's 32 Old Townhouse Road South Yarmouth,MA 02664 Re: Inspection Date—05/25/2024—05/25/2025 Fee$100.00 Pursuant to the provisions of the Massachusetts State Building Code 780 CMR,Section 110.7 and Table 110,you are required to apply for a Certificate of Inspection for the building located at 32 Old Townhouse Road,South Yarmouth,MA 02664 D/B/A Wendy's. Please complete the enclosed application and return it with the appropriate fee payment to the Town of Yarmouth Building Department,1146 Route 28,South Yarmouth,MA 02664.Checks should be made payable to the Town of Yarmouth. IMPORTANT:One(1)re-inspection to confirm the abatement of any violations listed during the initial inspection will be included in the initial fee if the abatement is completed during the time period(typically 10 days)listed on the Inspection Report. Additional re-inspections will cost S80.each,which is payable in advance of the re-inspections. Unless otherwise requested, inspections will be performed unannounced. Typically, the following elements/systems are inspected:fire protection equipment,means of egress,including emergency lights,exit signs,egress doors&hardware,clear path of travel,adequate lighting and occupancy total. Also,the building shall be maintained,and adequate housekeeping provided to ensure public safety. Rooms such as basements and attics are included. Violation details will be provided in the form of a Violation Notice and may delay the issuance of your certificate and/or license,if applicable. Note:After receivine your application,a minimum of 3 weeks'notice is required for an inspection. Finally,applications and fees must be received within ten(10)days of receipt of this letter. failure to comply may jeopardize your license where applicable,and/or the occupancy of the building per 780 CMR section 110.7 periodic inspections. "yettruly you Mark A.Grylls Building Commissioner 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 014005030559124 01/01/2024 to 01/01/2025 Braintree, MA 02185-0000 Information Page Renewal Policy FEIN: 861176398 Carrier Prior Policy #: 014005030559123 Item 1 : _ Named Insured and Address _ Agency _ Fashion Food LLC HUB NE Association Programs Wendy's 300 Ballardvale Street 66 Pondside Circle Wilmington, MA 01887 Centerville! MA 02632 Schedule of Covered Workplaces Other Workplace Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 0 45 Commerce Way Division #: 0000000004 Plymouth, MA 02360 Workplace #: 72530 State Risk ID #: Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 0 69 Long Pond Drive Division #: 0000000005 Plymouth, MA 02360 Workplace #: 000072530 State Risk ID #: • Fashion Food LLC Effective Date: 01/01/2024 f Wendy's NAICS Code: 722511 ` 32 Old Townhouse Road Division #: 0 ' South Yarmouth, MA 02664 Workplace #: 0000000007 State Risk ID #: 000072530 Form # WC 00 00 01 C (Ed. 05/17) Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 2 of 2 I Workers Compensation and Employers Liability Insurance Policy Insurer ID No(s):34355 r -- MA Retail Merchants WC Group Inc. I Carrier Policy#: Policy Period PO Box 859222-9222 014005030559124 01/01/2024 to 01/01/2025 Braintree,MA 02185-0000 Information Page Renewal Policy FEIN:861176398 Carrier Prior Policy#:014005030559123 Item 1: Named Insured and Address Agency Fashion Food LLC HUB NE Association Programs Wendy's 300 Ballardvale Street 66 Pondside Circle Wilmington,MA 01887 Centerville,MA 02632 Schedule of Covered Workplaces • Other Workplace Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 722513 554 Route 28 Division#: 0 Hyannis,MA 02601 Workplace#: 0000000001 State Risk ID#: 000072530 Mailing: 66 Pondside Circle Centerville,MA 02632 Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 722511 44 Falmouth Road Division#: 0 Mashpee,MA 02449 Workplace#: 0000000010 State Risk ID#: 000072530_ Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 722511 15 Canal Road Division#: 0 Orleans,MA 02653 Workplace#: 0000000008 State Risk ID#: 000072530 • Fashion Food LLC Effective Date: 01/01/2024 Wendy's NAICS Code: 722511 15 Canal Road Division#: 0 Orleans,MA 02653 Workplace#: 0000000009 State Risk ID#: 000072530 Form#WC000001C (Ed.05/17) ®Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved, Page 1 of