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Home My WebLink AboutBCOI-23-1786 2024 17 / a) _ � k / CV \ 2 2 / Q. g \ 2 @ f 2 / / \ cc f o ¢ E / / CD 0 - ƒ / --, IN -c) # ) / co k as c7 - fR ƒ §0 / 2 ' \ 2 3 / ao ) k 2 7 % / / 2 2 ¥ / \ \ \ a , \ § $ # Cl) c a. co 4 0 ® ° e # § ate# kk ' 2 �} oc C.) /z CI .- CD /7 / ® � E ° f q co / � 2 c, Z / / 2 = / �k \ k - a 5 ■ ~ 2 f o k_ W / @2 / � / 2 % o 0 ° 0 0 0_ 0 k ( / / k / R\ it• < r � � � ; ®co / & \ dam = f(1 . v § t § Ea ® k ° k c » E c w k Z CO 2 = g t 7 E co E c $ § f & d Sc \ Z. d ƒ oo .0 - a) _ ® . o = = o \ . c o 2L2 = _ # 9 � � CU M E cc § % $ co \\ 2 \ 2 S. EECE o Q. ' kE k/ // 0 0 / $ � • o a / �fk 7 7 = / .o c � m ® 2 k \ / / } _a/ 5 9 / k7 E ® / ( $ ". a / oi >, / .D ( = k % � 77 ƒa) \ co c ® / ¢ k� ƒ / R # $ § / $ 2 _ -a 2 go { } _ 7 0 2 S $ \ m u) u G ooc a g /41)111 2 9 ° f § f § $ = f \ 0 0 o 2 / / / @ Q G ( a ] . 3 0 2 :ƒ Z ao °a 1 1� t ` _ BUILDING DEPARTN't ENT 1MATFACr1 3E 1146 Route 28, South N. annouth, VIA 02664 508-3 8-223I ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 16. 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: 1 3\ , D Name of Premises: DC PO r ce S fie Tel: 50S- (Qq y- c L 5T Purpose for whichpermit is -\"A O rp used: ��25 � 1-r\' License(s) or Permit(s)required for the premises by other governmental agencies: f License or Permit Agency tOt Certificate to be issued to DC, POY-Ce_'ljjc Prizes t rc Tel: j(13-109t4--5CK,S Address: —j 3 'iZ� 2,T Owner of Record of Building 3c c - 1 ovn nn Address t g �'� RECEIVED Present Holder of Certificate -bCnarce), c OCT 30 2023 illrtv E learlvr Kele Ile( mom, v • B ILDINGDEPARTMENT Signature of person to whom �, ,� • �Y. -- Title Certificate is issued or his agent Date Email Address: DC Po Cc€ iS lei 22Q�i e,,® &1/41 )f--) U. 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# ft0/--0733/]c9,6 12/31/2023 to 12/31/2024 ACEORE,® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD ) 08/14/2023 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 POUCIES 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 WANED,subject to the terms and conditions of the policy,certain policies may require aan endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER /IACT Robert Abraham Amity Insurance a Division of Brown&Brown of MA, PRoNE (617)471-1220 I No: (617)479-5147 Brown&Brown of MA,LLC bran cw►II ADDRESS: 500 Victory Road If&WRERISIAFFORDING COVERAGE NAIL p North Quincy MA 02171 NSURERA: Mount Vernon Fire Insurance Co. 26522 INSURED INSURER B: DC Porcelks Pizzeria&More LLC NSURER C: 731 Route 28 N1SURER D INSURER E S.Yamwuth MA 02664 INSURER F COVERAGES CERTIFICATE NUMBER- C1235564919 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. NOTWiTHSTANDINGANY 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 St/IJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD YMVD POIICYAABER pINDO YYy ►N y ( LNITS X COMMERCIAL GENERAL LABILITYEACH OCCURRENCE s 1,000,000 DAMAGE TO RENTED CLAIMS-MADE ®OCCUR PREMISES ocaromoN S 100,000 MED ExP(Any are person) S 5.000 A CP2668846 06/012023 06/01/2024 PERSONAL aADVINJURY § 1,000,000 GEN'LAGGREGATE LIMVTAPPLES PER X POLICY n JE n GENERAL AGGREGATE § 2.000,000 T LOX: 2000000 PRODUCTS- A� , , AGG s OTHER: S AUTOMOBILE LIABIUTY CO SINGLE LIMIT $ lEa accident) ANY AUTO BODILY INJURY(Per person) S OWNED _-SCHEDULED AUTOS ONLY AUTOS BODILY I RY/Per acdeem) S HIRED _^ AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CIAIMS-MADE AGGREGATE § DED I RETENTION S WORKERS COMPENSATION STATUTE I ii(ER S AND EMPLOYERS'LIABILITY YINI ANY PROPRIETOMPANTNEREXECuTIVE - OFFICERrMEMBER OCCLUDED? n NIA EL EACHACCIENT S (Mandatory In NH) It yes,describe under EL DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS peim EL DISEASE-POLICY LMBT S Liquor Liability Each Occurrence $1,000,000 A CP2666846 06101/2023 061012024 Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS J LOCATIONS r VEHICLES IAroRD'at A may be lei N mac rice M leeebele- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE VIM THE POLICY PROVISIONS. AUTHOR/ZED NATIVE ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 5 ACORD CORPORATION. All rights reserved. °A�`"""°°""Y" AC R® CERTIFICATE OF LIABILITY INSURANCE 08/14/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELYAMEND,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 t.:tKIIFICATE 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 cantht)orns 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 NTACT Robert Abraham Amity Insurance a Division of Brown&Brown of MA, rPHONE F,d4 (617)471-1220 FAX (617)479-5147 Brown&Brown of MA,LLC Erna Not ADOtaFSS: CDr1t 500 Victory Road NSfR(5)AFFORONG COVERAGE NAIC# North Quincy MA 02171 INSURERA: AI.M_Mutual Insurance Company 33758 INSURED INSURER B: DC Porcellis Pizzeria&Mae LW Ns C: 731 Route 28 INSURER D: INSURER E: S.Yarmouth MA 02564 INSURER F COVERAGES CERTIFICATE NUMBER: C1-2381465987 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 CONDITION OFANY 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMiTS SHOVYN MAY HAVE BEEN REDUCED BY PAS CLAIMS. INSR ADOLSUBR LTR TYPE OF N YYY) 01$1lLLayyYY) LBBTS INSURANCE IDO y POLICY NUMBER COMMERCIAL GENERAL LIABRSTY EACH OCCURRENCE S CLAIMS-MADE ri OCCUR PREINSE.S(Ea awrence) $ MED EXP tArn me person) $ PERSONAL 8,ADV INJURY $ GENT_AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ POLICY n87 n LOC PRODUCTS-COMPIOPAGG $ OTHER: S AUTOMOBILE LIABILITY (COMBINED Eri acr l SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY `- AUTOS YINIMY(Per accitlenq $ HIRED AUTOS ONLY AY (Per PRODA6fAGE $ accideNJ S UMBRELLA UAB OCCUR EXCESS LIAB EACH OOCt $ CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYLRS'UABRJTY YIN STATUTE I I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Q NIA WC 400 7041052 2023A 05104/2023 05/0412024 EL EACH ACCIDENT S (Mandatory in NH) - EL DISEASE-EA EMPLOYEE $ 100,0 I y00 t yes,,describe ibe order DESCRIPTION OF OPERATIONS bedor EL DISErLSE_PCIUCY UNIT $ ' DESCRIPTION OF OPERATIONS!LOCATIONS I VEIMGLES(ACoRQ pt,Addled poydo Schedule,way be aRached IF woe space le ea) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRIESEPORTWE 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD