Loading...
HomeMy WebLinkAboutBCOI-24-20 2024 The Commonwealth of Massachusetts Town of 19.1 YARMOUTH 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:Skipper Restaurant BCOI-24-20 Trade Name:Skipper Restaurant Identify property address including street number,name,city or town,and county Certificate Expiration Located at 152 SOUTH SHORE DR SOUTH YARMOUTH,MA 02664 November 30,2024 Floor Occupancy_ Use Group Other 01st Floor 80 A-2 Restaurants,Night Clubs,or Up to 80 Persons Use Group Classification(s) similar uses 01st Floor 24 A-2 Restaurants,Night Clubs,or 24 Upstairs Bar Allowable Occupant Load similar uses Other 60 A-2 Restaurants,Night Clubs,or Outside Deck 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 Enrique Arrascue Name of Municipal Building 3/S/�Da 4 Commissioner Mark Gy� Date of Inspection Signature of Municipal Fire 'Signature of Municipal Building �sj/� Date of Issuance Chief Commissioner � , /� �Z y t-----)Y`�R TOWN OF YARMOUTH tI". BUILDING DEPARTMENT14 ,�ono,..,cc,,;:„ d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 /5/ ,,,,,A. J ` I ;t-- '. to APPLICATION FOR CERTIFICATE OF INSPECTION January 5, 2024 PAYABLE UPON RECEIPT (X) Fee Required $150.00 ( ) 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: / 52_ _� ,,,C .e___. Name of Premises: _. k\ Weir /' --/--- Tel: ‘023 741L6'C Purpose for which permit is used: ,S' -1/' License(s) or Permit(s) required for the premises by other governmental agencies: R E c E , vED License or Permit Agency FEB 28 ?024 BULL I C 5,,r7„ - By: ' diENT ' -).\ Certificate to be issued to . ,ow Wc, :1r73J4 * Tel: ..( 9 74 Address: / f2 —CO d ...rj c /e- ���' ��� 44-071-• 419-- (.2Z 6,- Owner of Record of Building 4ti4. ,vY Address /S,, ,Cot.; � .. I +(2t " y4 44/..-s Present Holder of Certificate ,;`' z:--- ,,,, __ . , _...-- , _.„- , ___ ----,.-__ _ ,-). ti,1 iALSA.---- ignature of person to whom Title Certificate is issued or his agent _4 Z t- /'2-_tr -- _ Date I "'' . 2 ' ; ' -,�� L. MEmail Address: 4 � � , ', - �'= , 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 # 04/01/2024-11/30/2024 / ® DATE(MMlDDlYx�Y) AC RO CERTIFICATE OF LIABILITY INSURANCE 2/16/2024 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 NAME: _— RogersGray,A Baldwin Risk Partner PHONE ' FAX 410 University Ave �_uM�o.FatL-.800-553-1801 i (A/C,No):877-816-2156E- - Westwood MA 02090 ADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# _ License#:PC-514062 INSURER A:Arbella Protection Insurance C 41360 INSURED BEACVIE-02 INSURER B: Beach View Inc dba The Skipper Restaurant 152 South Shore Drive INSURER C: South Yarmouth MA 02664 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:718085914 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 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: 'ADDL SUBRI I POLICY EFF POLICY EXP I LIMBS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER I(MM/DD/YYYY) (MM/DDIYYYY)! A X COMMERCIAL GENERAL LIABILITY ' 3600071450 111/12/2023 11/12/2024 EACH OCCURRENCE I$1,000,000 � ' DAMAGE TO RENTED CLAIMS-MADE ! X OCCUR . PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) t$5,000 PERSONAL&ADV INJURY I$1,000,000 i GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY!JE X LOCH , PRODUCTS-COMP,OP AGG $2,000,000 - OTHER: I$ i AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT $ (Ea accident) i ANY AUTO i BODILY INJURY(Per person) I$ —i OWNED SCHEDULED : BODILY INJURY(Per accident) $ I AUTOS ONLY ___I AUTOS ----- — i HIRED ( ;NON-OWNED -PROPERTY DAMAGE $ 'AUTOS ONLY -AUTOS ONLY (Per accident) UMBRELLAUAB 'OCCUR EACH OCCURRENCE $ EXCESS UAB JI CLAIMS-MADE AGGREGATE $ I DED ; I RETENTION 5 $ WORKERS COMPENSATION I I PER .OTH- AND EMPLOYERS'LIABILITY Y/N ' STATUTE ER -, ANYPROPRIETORIPARTNER.EXECUTIVE -EL.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? I I N 1A E.L.DISEASE-EA EMPLOYEE'$ I(Mandatory in NH) If yes.describe under . i DESCRIPTION OF OPERATIONS below E.L. •DISEASE-POLICY LIMIT $ A LquorLiabiity 3600071450 11/1212023 11/12/2024 Each Occurrence 1,000,000 A Liquor Liabiity 3600071450 11/1212023 11/12/2024 .Annual Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth 1146 Route 28 . AU D REPRESENTATIVE South Yarmouth MA 02664 , 7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 2"""141 THESKIP-01 DATTRIDGE AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D24YY) 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 NAME: Deland,Gibson Insurance Associates,Inc. PHONE FAX 36 Washington Street (A/C.No,E:t):(781) 237-1515 lac,No):(781)237-1805 Suite 40 AIL ADDRESS:info@delandgibson.com Wellesley Hills,MA 02481 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Mass Retail Merchants Workers Comp Group INSURED INSURER B The Skipper Restaurant Beachview,Inc. INSURER C: 152 South Shore Drive INSURER D: South Yarmouth,MA 02664 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 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 NUMBER POLICY EFF POLICY EXP LIMITS LTRINSO WVD IMM/DD/YYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES fEa occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ POLICY JE T 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) $ UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER 014005032678124 1/1/2024 1/1/2025 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N/A 500 000 Mandatory In NH) E.L.DISEASE-EA EMPLOYE$ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POUCY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZao-xis-4,44,— ACORDD REPRESENTATIVE 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD came and logo are registered marks of ACORD