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HomeMy WebLinkAboutBCOI-23-1767- The Commonwealth of Massachusetts Town of ,of YAK._ YARMOUTH 4 "� 0 H- `'1-eRRPORATsoo:/: 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:Yarmouth House Trade Name:Yarmouth House Restaurant BCOI-23-1767 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 335 ROUTE 28 December 31,2025 WEST YARMOUTH, MA 02673 Use Group Classification(s) Floor Occupancy Use Group Other 01 st Floor 264 A-2 Restaurants,Night Clubs,or Allowable Occupant Load 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 Building Name of Municipal Chief Enrique Arrascue Mark II ate of Inspection / f Commissioner /C1 -i r�v�� Signature of Municipal Fire ---> Signature of Municipal Buildin Date of Issuance Chief 1 Commissioner !7/4/Z y OV YAK\ TOWN OF YARMOUTH - Office of the BuildingCommissioner r l p" f 4, `, 1146 Route 28, South Yarmouth, MA 02664 p - v i 508-398-2231 ext. 1260 Fax 508-398-0836 „, MATTAEHEESE , 49RPORATE� , "` APPLICATION FOR CERTIFICATE OF INSPECTION September 23, 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: 3c -um Si(L.(_¢_i , Name of Premises: Val mrAAANr\ t.11.k � UA.rQti1/L,Tel: tj-.),Y- 1-) 1 - S.191 Purpose for which permit is used: (x License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to KDry 1tx % t�24-prt.seS Tel: Address: 3 '�0'u r1 ` Owner of Record of Building —vet L ZAmhe t I S Address 33,E Mati,f1 Present Holder of Certificate ''_Y j a- r pr%s-e-S eTresteia4,t Signature of person to whom Tit el is issued or his agent I a 1+-/ _F..RC._E__WED Date r Email Address: ; OCT 09 2024 i BUILDING DEPARTMENT By ----- 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. ' �C- Certificate of Inspection# wvi j7r0? 12/31/2024-12/31/2025 ACX)R;D CERTIFICATE OF LIABILITY INSURANCE DATE(MMlOD/YYYY) 10/09/24 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: WORLD INSURANCE ASSOCIATES LLC (A/C. Ext): 508-771-8381 (NC,No): 508-771-0663 34 Main Street E-MAIL West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A: AIM MUTUAL _ INSURED INSURER B: CAP SPECIALTY KOUNADIS ENTERPRISES D/B/A THE YARMOUTH HOUSE INSURER C 335 MAIN ST WEST YARMOUTH,MA 02673 INSURER D 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 ADDLBUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 B CSI800192502 04/10/24 04/10/25 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE4 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY OFFICER/MEMBER EXCLUDED?XECUTIVE Y I N N/A WCC5005022314 06/08/24 06/08/25 E.L.EACH ACCIDENT 500,000 $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 PER OCCURENCE 1,000 000 LIQUOR LIABILITY g BR20220502 04/01/24 04/01/25 GENERAL AGGREGE 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) OUTSIDE DINING IS ALLOWED PER GL POLICY 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 RTE 28 SOUTH YARMOUTH MA 02664 AUTHORIZED REPRESENTATIVE itv ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD