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Home My WebLink AboutBCOI-23-1818 2024 The Commonwealth of Massachusetts _.... Town of ::z° ' '' 11/4611") YARMOUTH g i p',. ` , ` .O - H: \~,POR�TE .0°, I 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:Azzaro Yarmouth, LLC Trade Name:The Lobster Boat BCOI-23-1818 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 679&681 ROUTE 28 November 30, 2024 WEST YARMOUTH, MA 02673 Use Group Classification(s) Floor Occupancy_ Use Group Other 01 st Floor 334 A-2 Restaurants, Night Clubs,or 314 PERSONS Allowable Occupant Load similar uses 20 BAR STOOLS 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. Mark 'Name of Municipal Building Ii o I Z Li Name of Municipal Chief Enrique Arrascue D e of Inspection "7 Signature of Municipal Fire SignatureCommissioner of Municipal Building a to of Issuance 7 �� /L�j Chief Commissioner l/ J °i'YaR = TOWN OF YARMOUTH CI .)9' BUILDING DEPARTMENT I`�5A.,.....,,„Y,,,; 1146 Route 28, South Yarmouth, MA 02664 508-398-1 1 x r F � ,8 20 b December 8, 2023 APPLICATION FOR CERTIFICATE OF INSPECTION DEC q _ CN PAPA: I 6P { NT (X) Fee 'equirea 150.11 ( ) 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: !il Street and Number: (p n/ ' O t)74 ,7 Name of Premises: Ind� _ 420(6 Tel: 560 77 -04 S6 1 1,CV1) 1\ Vr Purpose for which permit is used: ziAAif j C� %(a11✓Wat) l� License(s)or Permit(s)required for the premises by other governmental agencies: ' License or Permit Agency ` air L/C, X..0 0 ^49% 62/9 �> �7 /0;� �_Wiyjk t C- Tel: 5Dg /�Dyr�6 , Certificate to be issu�to iZ7�� Cn (� Address:__S j ( 2 �/� 14 eMD 07'N , �I,-4 CO 2(a `�/�,� Owner of Record of Building ' Address 4 g/ 26.4 7 g Gvr_s I '/yle4. /i4A- 73 •,i Present Holder of Certificate A/2-4'4 Si re of person to whom cz2P_ Title �! C rtificate is issued or his agent Date Email Address: 60 ' 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'SYR COMPENSATION TIFICATE TIOF INSPECTION.NCE FORM WITH THIS APPLICATION OR WE CA��I�OT�j/ISSUE Certificate of Inspection# (- 4/1/2024 TO 11/30/2024 5-ea vK7at_-/ Li CI ;-/C- -- Workers Compensation and Employers Liability Insurance Policy insurer 10 No(s):34355 MA Retail Merchants WC Group Inc. Carrier Policy a: Policy Period PO Box 859222-9222 014005030290123 01/01/2023 to 01/01,2024 Braintree, MA 02185-0000 Information Page Renew Policy FEfN 7C0666393 Policy#:014005030290122 itern 1: Named insured arid Address Agency Azzaro Yarmouth,LLC Dowling&O'Neil Insurance Agency The Lobster Boat Restaurant " PO Box 1990 681 Main Street Hyannis, MA 02601 Route 28 I West Yarmouth,MA 02673 Other Workpiaces Not Shown Above: See Schedule of Operations Additional Named Insured: See Additional Named Insureds if Applicable !Type of Business: Corporation Federal MO: 200666393 !Frisk ID; 000000000 NCCI I Bureau it:34355 Unemployrnent ID#: File#:014005030290123 Item 2.Policy Period Tice policy period is from 12:01 AM on 0110112023 to 12:01AM on 01/01/2024 based on the insured's mailn address time zone. Item 3.Coverage: A. Wori'ers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed: MA B Employers Liability insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits or our liability under Part Two are Bodily injury by Accident S 500,000.00 each accident Bodily Injury by Disease $500,000,00 policy limit Bodily Injury by Disease $500,000.00 each employee C. Other States Insurance: D. This policy includes these endorsements and schedules: WC0000000(01i15),WC000414A(01119),WC0004220(01/21),NOE(01/01),WC200102(01/14),VVC200301(04184). WC200302A(09106),W0200303D(06110),W02003068(06/13),WC200405(06/01),WC200601A(07/1K) Item 4: Premium The Pnlmitim for the policy will be determined by our Manual of Rules,Classifications, Rates and Rating Plans. All information required belov., is subject iia verification and change by audit. Classifications Code# Premium Basis Rate Per$100 of Estimated Annual Premium Total Estimated Remuneration Annual Remuneration See Schedule of Operations on Following Pages) Minimum Premium Prorated Premium Estimated Annual Premium Expense Constant Deposit $259.00 $2.394.00 2.394,00 $0.00 $0.00 issuing Ciftesa 35 Braritree Hitt Office Park Ste 20e Date Pentad: countersigned by: Braintree MA 02185-0000 01-18-2023 "(Li Form WC 00 00 01 C Copyright 2011 National Coca-roil on Comp mAgeme‘i .All ptipmRer Neje 1 a,•