HomeMy WebLinkAboutBCOI-23-1751- The Commonwealth of Massachusetts
Town of g:;x to`.
") YARMOUTH � _.`
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: Golden Jalapenos Tex Mex Cusine, INC
Trade Name: Golden Jalapenos Tex Mex BCOI-23-1751
Identify property address including street number, name, city or town, and county Certificate Expiration
Located at 134 ROUTE 6A
YARMOUTH PORT, MA 02675 December 31, 2025
Use Group Classification(s) Floor Occupancy Use Group Other
01 st Floor 80 A-2 Restaurants,Night Clubs,or 80 PERSONS
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 Chief Enrique Arrascue Name of Municipal Building Mark G Date of Inspection / //Gj/d oR y
Commissioner
Signature of Municipal Fire I' Signature of Municipal Buildin
Chief ci_ Commissioner , Date of Issuance /2* r
f Y.4 TOWN OF YARMOUTH
,�
rdro,, Office of the Building Commissioner
_ 1146 Route 28, South Yarmouth, MA 02664
ot)t�N _ -- --,-,,r 508-398-2231 ext. 1260 Fax 508-398-0836
/ MATTACHEESE 4
,RPORATEO Nb•�.r�.
�```'`1" 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: j 3LI Fo o1 ( l4 Y�U"lnou� Pori-Ha OZ G q-5
Name of Premises: Go /den 3c�1a67ert o fie-3/ ilex( Tel: 5-0 g-4 j - `35 6 v
Purpose for which permit is used: L t T u r l i,re4 S e CA/ 693/— (y s0-Q 901 y
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency 34. E C 7,, `:4V 7 D
OCT 16 2024 I
Certificate to be issued to (2ol d44'\ S ct't o_.pe n U 3 Tel: C
/
i Bt �/ ' t ,C:NT
Address: l3 4 �-1"� (4 ��-{ fine 1.ir 4- 1 ,3� IL' - -
Owner of Record of Building �,. ry'�t---
Address
Present Holder of Certificate Golden SQict.. iv-,U S
..g.
0W
Signa re of person to whom Title
Certificate is issued or his agent (0-- /4- - ?CI
Date
Email Address: 6 O I den l/a re ri a f'e'&f le' ,0.1jo 0' o ,r7-7
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 ISS,V4 YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection# I J 1 D- 1-6
12/31/2024-12/31/2025
NOTICE ? t * A .1. NOTICE
TO I , ' j TO
EMPLOYEES �r EMPLOYEES
ay _
The Commonwealth of Massachusetts
DEP8 RTMENT OF INDUSTRI8 L 8 CCIDENTS
Lafayette City Center, 2 8 venue de Lafayette, Boston, Massachusetts 02111
800-323-3249
: s required by Massachusetts General Law, Chapter 152, Sections 21, 22. & 30, this will give you
notice that I (we) have provided payment to our injured employees under the above mentioned
chapter by insuring with:
7ssociated Employers Insurance Company
N8 ME OF INSUR8 NCE COMP8 NY
P.O. Box 4070 Burlington, M7 01803-0970
8 DDRESS OF INSUR8 NCE COMP8 NY
WCC-500-5028097-20237 12/15/2023 - 12/15/2024
POLICY NUMBER EFFECTIVE D8 TES
973 lyannough Road
The Hilb Group of New England LLC Hyannis, M7 02601 (508)775-1620
N8 ME OF INSUR8 NCE 8 GENT 8 DDRESS PHONE
Golden Jalapeno Tex Mex Cuisine Inc 134 Route 67 Yarmouth Port, M7 02675
EMPLOYER 8 DDRESS
11/15/2023
D8 TE
MEDICS L TRE8 TMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers Compensation 8 ct. 8 copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NE7 REST 7ND BEST MEDIC7L F7CILITY
HOSPIT8 L 8 DDRESS
TO BE POSTED BY EMPLOYER