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Home My WebLink AboutBLDCI-22-006208 Restaurant • The Commonwealth of Massachusetts ►y err. City\Town of %_'�Il= 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 Issued to BLDCI-22-OOs208 Business Name:Red Jacket Restaurant Trade Name:Red Jacket Restaurant Identify property address including street number,name,city or town and county Certificate Expiration Located at - 28 SOUTH SHORE DR 11/30/2022 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classiflcatlons(s) A-2 01st Floor 120 A-2 Nightclub/Restaurant/Bar/Banquet Hall 18-persons-bar 102-persons-dining room Allowable 02nd Floor 225 A-2 Nightclub/Restaurant/Bar/Banquet Hall 2nd floor meeting Occupant Load rooms l 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 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 Gryll Date of Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief — �✓� Building Commissioner Issuance S 44 L r Fee:$150.00 RI_D Certoflnsoection.mt RECEIVED °�.,,'R TOWN OF YARMOUT -_•__.�. ' G o ,.� BUILDING DEPARTME ' AP 0: nil ' x 1146 Route 28.South Yarmouth, MA 02664 508-39'. 2 11-att'1(2 4 RTMENT APPLICATION FOR CERTIFICATE OF INSPECTION April 5, 2022 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: 28 South Shore Drive Name of Premises: Red Jacket 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 Agency Seasonal Section 12 Innholder All Town of Yarmouth Licensing Department; Alcoholic Beverages License Massachusetts Alcoholic Beverages Control Commission Certificate to be issued to RJ Resorts Beach Resort Beverage LLC Tel: 214-773-8671 Address:65 East 55th Street,33rd Floor,New York,NY 10022 Owner of Record of Building RJ Resorts Beach Resort Owner LLC Address 65 East 55th Street,33rd Floor,New York,NY 10022 Present Holder of Certificate LLC Manager Signature f person to whom Jonathan Wang Title Certifica is issued or his agent 4/7/2022_ Date Email Address: gboyer@cosinvestors.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# 4/1//2022-11/30/2023 6(& • The Commonwealth of Massachusetts ERROR: undefined Department oflndusirlalAccidents OFFENDING COMMAND: t Office of Investigations 1 Congress Street,Suite 100 STACK:=_ Boston,MA 02114-2017 •w' www.mass.gov/dia Workers'Compensation Insurance Affidavit: General Businesses A,UnlicantInforination - Please Print Leeibty Business/Organization Name: RI Resorts_Beach Resort Beverage j l.0 • Address: 65 East 55th Street,•33rd Floor • City/State/Zip: New York NY 10022 Phone#: Areyen an employer?Check the appropriate box:. , Business Type(required): 1.® I am a employer with 35 employees(full and/ 5- ❑Retail • or part-time).* 6. ®Restaurant/Bar/Eating Batabli.,hrru ra 2.❑ I am a sole proprietor or partnership and have no 7, []Office and/or Sales(rncl.real estate,auto,etc.) employees working for me on my capacity: [No workers' 6. ❑Non-profit comp.insurance required] 3.0 We•are a corporation and its officers have exercised 9. ❑'Entertainment their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing • no employees. [No workers'comp.insurance required]*• • 11.0 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, • with no employees. [No workers'comp.insurance req.] 12.[]Other _ Any appIicantthst checks boa:#1 esust also fill oat the section below slaving their workers' — — — conspensetionpormy informatics. 'tithe corporate officers have osctopted thmastlres,but the ovrwilier has other employ,a wisdoms'compensation Policy is required and such en litnizationahoald cheek box#1. "All employees will be covered under,the Worser'e Compensation Insurance Policyluued to EOS Hospitality am an employer that is providing workers'compensatlon Insurance for my employees. Below is the policy Information. Istaxnce Company Name: AON Risk Sambas South lee. loner's Address: 3550 Lenox Road NE,Suite 1700 y�� aty/State1Zip: Attui,V.A 1132L.7S) olicy#or Self-ins.Liu# wc:0105642-0; Bxpiratlon Date: 6/1/2022 ,ttach a copy of theworkers'compensation policy declaration page(showing the policy number and expiration date). allure to secure coverage as required under Section 25A of MGL c.152:An 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 ag#inst,tlle violator. Be advised that a copy of this statement may be forwarded to the Office of rvestigations of the DIA for insuretx:e coverage verification. do-hereby f n the paints and penalties of perjury that the Information provided above is true and correct — i state: Date: 3/tr1). -- !me t at,— 3 01 Official use only. Do not write In flits area,to be completed by city or town official. ;1 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#: wwwmacs.gov/dia BUILDING DEPARTMENT TMEN 1146 Rotate 28, South 'Yarmouth, MA 02664 508-398-2231 ext. 1260 F ax 508-398-083 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Red Jacket Restaurant ADDRESS: 27 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 5-- e5 � � No v Fire Department Rep. Date Comments Approved for C A T L‘- 5 A q- zz Li nse 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