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Home My WebLink AboutBLDCI-22-006206 Restaurant The Commonwealth of Massachusetts City\Town of "4)_ 1.g��_ 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 Certificate No. Issued to Business Name:RJ Resorts Blue Water Resort Beverage LLC BLDCI-22-006206 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 11/30/2022 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 226 A-2 Nightclub/Restaurant/Bar/Banquet Hall 153 Main dining room 26 dining room 1 26 dining room 2 Allowable 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 tire 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 Philip Simonian Ill Name of Municipal Mark Gryl Date of Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief wilding Commissioner Issuance C/X4 Z.,r-- l Fee $150.00 • �t , k� TOWN OF YARMOUTH RECEIVED t° `+ 1?, BUILDING DEPARTMENT APR 252022 1146 Route 28,South Yarmouth,MA 02664 5 ' -0$-398-2717041446A1'ARTMENT By April 5,2022 APPLICATION FOR CERTIFICATE OF INSPECTION 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 291 South Shore Drive Name of Premises: Blue Water Restaurant Tel: 214-773-8671 Purpose for which permit is used: Operation of resort providing food and beverage services. License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Seasonal Section 121nnholder All Agency Alcoholic Beverages License Town of Yarmouth Licensing Department; ---- Massachusetts Alcoholic Beverages Control Commission Certificate to be issued to RJ Resorts Blue Water Resort Beverage LLC Tell 214-773-8671 Address: 65 East 55th Street,33rd Floor,New York,NY 10022 Owner of Record of Building RI Resorts Blue Water Resort Owner LLC Address 65 East 55th Street 33rd Floor,New lark,NY 10022 - Present Holder of Certificate Signature o ersonLLC Manager to whom Jonathan Wang --- Certificate i 'slued or his agent Title 4/7/2022 Date Email Address: gboyer@eosinvestors.com Instructions: Make check payable to: Town of Yarmouth 1 146 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# 4/1//2022-I1/30/2023 8/`' c/ , io 147 The Commonwealth of Massachusetts _— Department oflndustrialAccidents =ail t Office oflnvesligations 1 Congress Street,Suite 100 7°c Boston,MA 02114-2017 •�• • www.niass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses Applicant Information Please Print Legibly Business/Organization Name: RI Resorts Blue Water Resort Beverage LLC_ -_ Address: 65 East 55th Street,.33rd Floor City/State/Zip: New York,NY 10022 Phone#: r Are you an employer? Check the appropriate bo Business Type(required): — r: 1.® I am a employer with 18 - employees(full and/ 5. ❑Retail • - or part-time).* 6. ®Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any Capacity. 8. Non-profit [No workers'comp.insurance required] p 3.DI We-are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c.152,§1(4),and we have 10.13 Mannf,ctulring no employees. [No workers'comp.insurance required]*` Il.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, • with no employees. [No workers'comp.insurance req.] 12.0 Other Any applicant that checks box MI must also Ell out the section below showing their workers'cwnpeasatiaapolicy information. 'If the corporate offices have exempted themselves.bat the corporation has other employees,a workers'compensation policy is regtwrd.and such an :gamradoa sbould check box#I. "AB employees will be covered under.the Worker's Compensation Insurance Policy issued to EOS Hospitality, am all employer that is providing workers'compensation insurance for my employees. Below is the policy information. isurance Company Name: AON Rids Services South inc. ]sorer'S Address: 35SO Lenox Road NE Ulm 1700 sty/State/Zip: ACl45ta-rA. :J6ai94 olio #or Self-ins.Lie.# wca it-: y . it-� Expiration Date: Ri,123 ,teach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ne up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to$250.00 a day against.the violator. Be advised that a copy of this statement may be forwarded to the Office of lvestigations of the DIA for insurance coverage verification. do-hereby ce f}y ci-the pains and penalties of perjury that the information provided above is true and correct. iy:ature: _ . Date: 3111 ja1 bone#: 1,13l9--- S vol Official use only. Do not write in this area,to be completed by city or town official. City or Town: _-- Permit(License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wsvw.mass.gouidia -_ UILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Blue Water Restaurant ADDRESS: 291 South Shore Drive This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for License Issuance 57--ZdA-2_ ems ` No Fire Department Rep. Date Comments Approved for P , (-1 U C$ �r Lic e Issuance es No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept. 2003