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Home My WebLink AboutBCOI-23-1748 2025 The Commonwealth of Massachusetts Town of og 7.4' - i� YARMOUTH o _ -,t4,1. -!--coo ORAT0 ` c 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: Ryan Family Amusement Trade Name: Ryan Family Amusement BCOI-23-1748 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 1067 ROUTE 28 SOUTH YARMOUTH, MA 02664 December 31, 2025 Floor Occupancy Use Group Other Use Group Classification(s) 01 st Floor 480 A-2 Restaurants,Night Clubs,or similar uses Allowable Occupant Load 02nd Floor 150 A-2 Restaurants,Night Clubs,or 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 Mark G of Inspection /f✓ // J�a,A , j Commissioner 7 Signature of Municipal Fire,_,----� Signature of Municipal Buildin Chief Commissioner �' Date of Issuance /G9 /7 f '1 Yek N TOWN OF YARMOUTH �.,. Office of the Building Commissioner y 1146 Route 28, South Yarmouth, MA 02664 .� _- --� =--_- 4':- 508-398-2231 ext. 1260 Fax 508-398-0836 / MATTACHEESE' G ` NcOR EO\b9F'ORAT APPLICATION FOR CERTIFICATE OF INSPECTION September 23, 2024 PAYABLE UPON RECEIPT (X) Fee Required $150.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at,,the// following address: Street and Number: /% ? 2 SDU(Vl Vkf1414)`-ik4 (tit-‘ Name of Premises: Acjq 0 Tar^a`y ' 44Q460,r Tel: AS 3Lb /,it) Ceii Purpose for which permit is used: 1QQro-r kiGev1 5 C License(s)or Permit(s)required for the premises by other governmental agencies: Ipcenw or Permit ('� 0 Agency . e j euN'-(/2r- L i C-e✓ s-e Certificate to be issued to 74A ',.' f, 74.,d.3zua ti r Tel: ,fib$--34 -/fW Address: / Owner of Record of Building qa H A,./4 liehnui4eklis,4--r- Address Present Holder of Certificate &fir G.•rf6e(( Signature of person to whom T'tle) Certificate is issued or his agent / /1 L y Email Address: 13ow 1,:ti ill C✓ 8 1--—CO I ate RECEIVED SEP 18 2024 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. Certificate of Inspection# 12/31/2024-12/31/2025 Worker's Compensation and Employer's Liability Polk v!Berksh i re Hathaway/ AmGUARD Insurance Company - A Stock Cc i; ' y Policy Number RYWC34318 t' G U ARD Insurance Renewal of RYWC27778 �•A Companies NCCI 4-248-73 iQe,(,0 "7 4-17510 I Policy Information Page [1]Named Insured and Mailing Address Agency _ �.-i--------- Ryan Family Amusements Inc PAYCHEX INSURANCE AGENCY DBA/TA Ten Pin Eatery 225 Kenneth Drive 116 Waterhouse Rd Rochester, NY 14623 Bourne, MA 02532 Agency Code: NYPAYC10 Federal Employer's ID XX-XXX1210 Insured is Corporation Risk ID Number 917565287 Additional Names of Insured (N3) Ten Pin Eatery (N2) 769 Iyannough, Inc. Locations on Policy - See Extension of Information Page - Schedule of Locations • [2] Policy Period From December 31, 2022 to December 31, 2023, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts, New Hampshire, Rhode Island B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 29,079 Total Surcharges/Assessments $ $1,078.00 Total Estimated Cost 0 4157.00 INTERNAL USE XX $3Page- 1 - Information Page MGA : RYWC343183 WC 000001A Date : 12/01/2022 MANOTE Issuing Office: P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com Worker's Compensation and Employer's Liability Polk 7 �� AmGUARD Insurance Company - A Stock CI �V1 Berkshire Hathaway Policy Number RYWC34318 r `' GUARD InsuCompaance nies Renewal of RYWC27778 NCCI No. [21873 p Policy Information Page Extension of Information Page Schedule of Locations (L2) 200 Main Street , Buzzards Bay, MA 02532 (12/31/2022 - 12/31/2023) (L4) 1067 Rte 28 , South Yarmouth, MA 02664 (12/31/2022 - 12/31/2023) (L5) 115 New State Hwy , Raynham, MA 02767 (12/31/2022 - 12/31/2023) (L6) 1170 Main Street , Millis, MA 02054 (12/31/2022 - 12/31/2023) (L9) 19 Circuit Ave , Oak Bluffs, MA 02557 (12/31/2022 - 12/31/2023) (L10) 268 Thames St , Newport, RI 02840 (12/31/2022 - 12/31/2023) (L11) 769 Iyannough Rd , Hyannis, MA 02601-5027 (12/31/2022 - 12/31/2023) (L12) Cape Cod Inflatable Park, 512 Route 28 , Yarmouth, MA 02664 (12/31/2022 - 12/31/2023) (L13) Cape Codder Resort, 1225 Iyannough Road , Hyannis, MA 02601 (12/31/2022 - 12/31/2023) (L14) 136 Water St , Plymouth, MA 02360-8727 (12/31/2022 - 12/31/2023) (L15) 769 Iyannough Rd Cape Cod Mall, Hyannis, MA 02601-5027 (12/31/2022 - 12/31/2023) (L16) 2 Common Ct Unit 310 , North Conway, NH 03860-5424 (12/31/2022 - 12/31/2023) Extension of Information Page Schedule of Forms WC000001A - INFORMATION PAGE WC000000C - STANDARD POLICY WC000403 - EXPERIENCE RATING MODIFICATION FACTOR WC000404 - PENDING RATE CHANGE ENDORSEMENT WC000406 - PREMIUM DISCOUNT ENDORSEMENT WC000406A - PREMIUM DISCOUNT ENDORSEMENT WC000414 - NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC000414A - NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC000419A - PART FIVE - PREMIUM AMENDATORY ENDT WC000421F - CATASTROPHE (OTHER THAN CERT ACTS OF TER WC000422C - TERR RISK INS PROG REAUTHORIZATION ACT WC000424 - AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT WC000425 - EXP. RATING MODIF. FACTOR REVISION END'T WC200301 - MA LIMITS OF LIABILITY ENDORSEMENT WC200302A - MA ASSESSMENT CHARGE WC200401 - MA PENDING PREMIUM CHANGE ENDORSEMENT WC200405 - MA PREMIUM DUE DATE ENDORSEMENT WC200601A - MA CANCELLATION RSEMENT WC280404 - NH PENDING RATE CHANGE ENDORSEMENT WC280601 - NH SOLE REPRESENTATIVE ENDORSEMENT WC280604 - NH AMENDATORY ENDORSEMENT WC380401B - RHODE ISLAND SHORT RATE CANCELLATION END WC380601 - RI DIRECT LIABILITY STATUTE ENDORSEMENT WC990000 - AUTHORIZATION AND ATTESTATION END'T Remember, we make a variety of loss control services available to you at no additional charge, including educational resources accessible from our Policyholder Service Center at https://policyholder.guard.com. INTERNAL USE XX Page - 2 - Page MGA : RYWC343183 Information OOOOOge Date : 12/01/2022 1A MANOTE Issuing Office: P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com