The URL can be used to link to this page

Home My WebLink AboutBCOI-23-1784 2024 a) ) O N \co....A Ki- 1N� U to tC ii2 E. a) N N L C V I (d U a O E °tS aci N `� m a) N c p co o -C ..\ v2 -c .3 t a y0—_- a) o O 707 0.a-a c a •— .� o ,Q O 0 ` co U N L fl. tZ j c O 2 N C �' aca V U ' O "" . w O U U c rn a c c N m ) o 0 ca Z a) c coa a) 3 c c a) -ors �' p C 3 m y O t1 1,1 ki N O O` d .- Q c N++ U ,�, t9Ce@ o cca �C> V -1 N t� u°)) N -a mBUd O Sliliks N 0 n cooik 4- W o - c g � ` a cIli _ = o aNi ) a0) � O s cn 3 7 t � o a� say 1 � � rn ct G ' d C Z Z v CMo u.l I CD .- ay m o„ 1� U) 0 L '., 'U C) m c e o C m -a • p oa o a) c t) .a O N F- N c c p E c '' 0 O 3 O 0 p CO - N 0 N N'a (d ) 'O N �� "O N n 2 W 3 a) to a) o a) a) E m co t 'O L) t rn . I- Z m > tom ZUtn o C N u_ a) o. T a: c v a a) 3 ^ 3 y L CD m 0) N - o N U c NI.� rr p >, N 7 Ito A -c O L a) Q N �+ a) 7 L ... O 4-- E 1, CO) c J a0) Ili a) as r vqr. - N _ a) O 2 N = O c U a .0 d R Q V A V O o c a 3 N t) a. d :� (a 'v 3 O - J 7 o 0 a O N O ... o <.) w < I— c E c ._ d 0 m a) ra ... as m Z U c T WN OF r;" A M U TH":18 �k j ENT�MRTTRC,Y £SEy� �. M. _LC1� 1146 Route 28, South an nouth. �IA 02664 508 398-223.1 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION September 1 2023 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Co 5 Name of Premises: ,r � �� Tel: R E C �:° �r 0 ' -�-..�_„� Purpose for which permit is used: s.}-.r,,, .1-/ S‘ 6 • OCT 2 3 2023 License(s) or Permit(s)required for the premises by other governmental encies: BUILDING DEPART-M NT License or Permit BY. Agency """'�—=== 1.\16 c,r Lfk.U."1\1>, . ----rag___01__*xnevii-v, o ��ti Certificate toII e isste o n I Tel: 0 �ivty `� Address: so. -E.qb Faor"_ txli Ad,$dar CT 0-(rai C1 Owner of Record of Building C �, a j 1 c o Address iy,.�, (Zit ,.�+J�(� 4,,, mill O A, '1 Present Holder of Certificate — Signature of rson to whom Certificate is issued or his agent Title 1.0f0IWZ3 Date Email Address: L kaki i , C Z - - y lbM Ct Instructions: Make check payable to: Town of Yarmouth Return this application to: 1146 Route 28, South Yarmouth, MA 02664 Building Inspectors 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 CAT/II.F YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 12/31/2023-12/31/2024 /� ACORU CHEZHOS-01 AMCCORMACK `---- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/20/2023 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 Haberman Insurance NAME_ 95 Ashley Ave PHONE West Springfield,MA 01089 -(AJC No Ext):(413)781-7000 �a,No 41 Ei i ):( 3)733-9545 nooRESs_info@habermaninsurance.com - -- - INSURER(S)AFFORDING COVERAGE -- - -— NAIL#- -.INSURER A.Sentinel Insurance Companyr 11000 INSURED INSURER B:. Chez Hospitality LLC - — PO Box 498 _ URER c East Windsor,CT 06088 INSURER D:INSURER E: -- COVERAGES INSURER F CERTIFICATE NUMBER: REVISION NUBER: 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, INSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP ---- — -- INSD WVD POLICY NUMBER IMM/DD COMMERCIAL n'YYYI (MM/OD/YYYY1 LIMITS GENERAL LIABILITY CLAIMS-MADE OCCUR _EACH OCCURRENCE $ -- DAMAGE TO RENTED PREMISES jEa occurrencej__$ _MED EXP(Anone eerson_j_ $ _GEN'L AGGREGATE LIMIT APPLIES PER: _PERSONAL&ADV INJURY $ POLICY PRO- - JECT LOC GENERAL AGGREGATE $ OTHER: PRODUCTS_COMP/OP AGG $ AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO , a acciderA OWNED SCHEDULED AUTOS ONLY AUTOS _BODILY INJURY_(PerQersonl $ HIRED NON-OWNED _BODILY INJURY Per accident -._-_AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident $ -. UMBRELLA LIAR --- OCCUR --$ --- --- EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE A WORKERS COMPENSATION $ - -- AND EMPLOYERS'LIABILITY X PER' _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OBWECALI FGD STATUTE _ER"(MandatoryOFFICER/M in H)ER EXCLUDED? Y N/A 3/29/2023 3/29/2024 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) If yes,describe under r DESCRIPTION OF OPERATIONS below _.E.L.DISEASE-EA EMPLOYEE $ 500,000 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Marc Sparks is excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Grille at Bayberry Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 635 West Yarmouth Road ACCORDANCE WITH THE POLICY PROVISIONS. West Yarmouth,MA 02673 AUTHORIZED REPRESENTATIVE /.G, �,,c.,,,r;.q_i ACORD 25(2016/03) The ACORD name and logo are registered marrks988-2015 ACORD CORPORATION. All rights reserved. of ACORD �R 0 CHEZHOS-01 AMCCORMACK '4 CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 10/20/2023 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 polio ( ies)must 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 a do sement(s)have ADDITIONAL INSURED provisions or be endorsed. PRODUCER Haberman insurance CONTACT 95 Ashley Ave NAME:-- West Springfield,MA 01089 ADPHONE WC No Ext):(413)781 7000 E-MAIL Info _.-. FAX No)_(413)733 9545 DRESS @habermaninsurance.Com INSURERS AFFORDING COVERAGE INSURER A:Sentinel Insurance COm_pan�f 110001C# INSURED _INSURER B: -._--_ Chez Hospitality LLC O BOX 498 INSURER C_ ast Windsor,CT 06088 INSURER D: ---------- INSURER E: ------------.------_-. C OVERAGES CERTIFICATE NUMBER: INSURER F THIS IS TO CERTIFY THAT THENOTWITHSTANDING POLICIESANYREQUIREMENT,OF INSURANCE LISTED BELO HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH INDICATED. TERM OR CONDITIONW OF ANY CONTRACT OR OTHER DOREGS ENT WITH REION SPECT TO WHICH THI 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. E POLICY PERIOD INSR - - -- ---- ADDL SUE L R TYPE OF INSURANCE R. ----------- COMMERCIAL GENERAL LIABILITY N D POLICY NUMBER POLICY EFF POLICY EXP --------_ _.----_ M r.lAA11 M .D1»11 LIMITS $ CLAIMS-MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED -------- PREMISES_(Ea occurrence - ------------.- MED EXP(Anemone_personL $ ----. GEN'L AGGREGATE LIMIT APPLIES PER: -------- PERSONAL 8 ADV INJURY $ POLICY PRO -_-----__-._--. - JECT LOC GENERAL AGGREGATE $ OTHER: '_PRODUCTS-COMP/OP AGG__ $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ OWNED - SCHEDULED _LEaacciden� $. AUTOS ONLY -- AUTOS BODILY INJURY Per erson _ HIRED - -. S � 1 '$ ----:AUTOS ONLY NON-OWNED NLY BODILYINJURY Peracadent ---_ AUTOS ONLY S 4_$ ---- PROPERTY DAMAGE ---- _Per accident UMBRELLA LIAB -.-._-._-_---- ---- ---._ OCCUR EXCESS LIAB $ -- -- CLAIMS-MADE EACH OCCURRENCE DED RETENTION$ OCCURRENCE ----$-- A AGGREGATE -_ $ WORKERS COMPENSATION -- ND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE .YEN ABWECALiFGD PER _ $ OFFICER/MEMBER EXCLUDED? �/ N/A 3/29/2023 3/29/2024 `X STATUTE_ ERH (Mandatory in NH) __ --- If yes,describe under E.L.EACH ACCIDENT $ 500,000 DESCRIPTION OF OPERATIONS below E.L_DISEASE_EA EMPLOYEE'$-- 500,000 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Marc Sparks is excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 Route 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ` ,, The ACORD name and logo are registered m r s CORD CORPORATION. All rights reserved. of ACORD