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Home My WebLink AboutBCOI-23-1799 The Commonwealth of Massachusetts Town of ;og Y' 4i YARMOUTH ,i _T ►e,C •`--a°00RATEON" 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: El Mariachi Mexican Family Restaurant Trade Name: El Mariachi Mexican Restaurant BCOI-23-1799 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 416 ROUTE 28 WEST YARMOUTH, MA 02673 December 31,2025 I Use Group Classification(s) Floor Occupancy Use Group Other I 01 st Floor 117 A-2 Restaurants,Night Clubs,or 107 Lower similar uses 10 Bar Allowable Occupant Load 117-Total Person 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 i 41) Commissioner Signature of Municipal Fire Chief Signature of Municipal Building �"�(�C Date of Issuance f I �T /- Commissioner r -�- NA \. TOWN OF YARMOUTH 14, Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 ,L y7 J 508-398-2231 ext. 1260 Fax 508-398-0836 \ MAITACHE,ESE _ // N VN RpORATEC) 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: MAT&et an lNumbe (At a% Its? 1 Wan OV - Mk, 01-0-3 Name of Premises: EL nArlcychi• AtekeK9r, Fora. Tel: 50' —1'2 1 )40 Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to EL Okrq('H I Mek,VOhn -. Vos , Tel: }l i, NOV S 2024 — Address: BUILDING DEPARTMENT Owner of Record of Building bctvlal gra►vNiotkA BY -Address 42, AUUc r AN . Sudbury MA. O fl% Present Holder of Certificate � - IV j O( Signature of person to whom Title Certificate is issued or his agent 11'S-2(1 Date Email Address:«. eIN'1T IMNavIrD(IT ltht71 II,eQii`'1 —. _ .- - � Cp Z 343 50& 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 a'O/ d.--/7 q y 30 Z abed NV 6£ 0£ T iiZOZ/£/8 �,N Workers' Compensation and Employers Liability E►, nTha FIT Insurance Policy EMPLOYERS PREFERRED INS. CO. Policy Number From olicy Period TO A Stock Company EIG 5593111 00 08/15/2024 08/15/2025 12:01A.M.Standard Time at the address of the Insured as stated herein Transaction AMENDED DECLARATIONS Effective: 08/15/2024 NCCI Carrier# 31283 WCIRB CARRIER# PRIOR POLICY NUM PM NEW 1. Named Insured and Address Agent LAPLAYA, INC. ADP - PITTSBURGH - SBS 0033005 416 ROUTE 28 EL PASO SALES WEST YARMOUTH MA 02673 1 ADP BLVD M/S 625 ROSELAND, NJ 07068 Telephone: 8005247024 Customer# Carrier# FEIN # Risk ID # Entity of Insured 31283 562510954 CORPORATION Additional Locations: 2. The Policy Period is from 08/15/2024 to 08/15/2025 12:01 a.m. Standard Time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part TWO are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY and states listed in item 3.A. D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 201 Expense Constant $ 338 Premium Discount $ Assessments and Taxes $ Total Estimated AnnualPremium $ 2,053 0 This is a Three Year Fixed Rate Policy Premium Adjustment Period: ® Annual; ❑ Semiannual; ❑ Quarterly; ❑ Monthly t--�Countersigned this Day of g Issued Date: 07/12/2024 Authorized Representative Issuing Office EMPLOYERS PREFERRED INS. CO. 06 'L0 - 3a1-110—PT0A P.O. BOX 539003 HENDERSON, NV 89053-9003 Issued Date 07/12/2024 INSURED COPY } S WC990630 (5/98 Ed.)