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HomeMy WebLinkAboutBCOI-24-31 2026 The Commonwealth of Massachusetts Town of of Y`�'? * x YARMOUTH 402. ,4•0 °00 RATED. 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: Heavenly Restaurant Trade Name: Heavenly Restaurant BCOI 24 31 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 194 ROUTE 28 March 6,2026 WEST YARMOUTH, MA 02673 Use Group Classification(s) Floor Occupancy_ Use Group Other 01 st Floor 89 R-1 Hotels,motels, boarding houses, Allowable Occupant Load etc. 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 Mark Gr Date of Inspection 1. I I AD':''- Commissioner Signature of Municipal Fire Signature of Municipal Building(�� ,, Chief Commissioner `'--� ^. Date of Issuance 11 /i/fr \\ p - �'YA '� TOWN OF YARMOUTH ,� -. 6 Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 ,;� , 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESE 9q �/NC°: E% "ORAT APPLICATION FOR CERTIFICATE OF INSPECTION February 03, 2025 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ( ) 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 q l ryo-i.A0c 7 &G T Name of Premises: 1-kow enly .Q.Plei--L(�rd Tel: $be -. 2r 33.,32 Purpose for which permit is used: 01 and ,eYic/ 'e L 1- License(s) or Permit(s)required for the premises by other governmental ncies: License or Permit Agency Certificate t9 e issued to i1:1 '/ �//_ , 0 j Tel: s 3,3.2_ Address: / T,i//) r oU d/Y?. ,0,2Owner of Record of building �,1111A.41W4 a % " i Address P1,/) / l Irt .=1'' Al� /2.24-2--,3 I Present Ho ertificate pe ,y_e f �, L` '/'��L/I ok/l1 ry74 er, Signature person to whom Ti _e U Certificate is issued or his agent 2z/2_ Email Address: /1W/ re-41- // i A -OU�j 0t /netl/.0 R E C E i .� t v FEB 24 2025 BUILDING DEPARTMENT 8Y - - - 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# 03/06/2025-03/06/2026 /-CCD 1----04-3/ AC()RL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ��_ 01/09/25 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 CON IACI NAME: PA Robert M.Zagami Insurance IACNo,Extl: 781-337 4033 (A/C,No): 781-337-4103 Agency E-MAIL 555 Bridge Street ADDRESS: bzagami@rmzinsurance.com Weymouth,MA 02191 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Travelers INSURED INSURER B: Safety Insurance — One Hope,Inc.,dba INSURER C: _ Heavenly Restaurant INSURER D: 194 Main Street W.Yarmouth,MA 02673 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 ADDL5 TYPE OF INSURANCE UBR POLICY EFF POLICY EXP — LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 B y y BMA0028670 02/27/25 02/27/26 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ PRO- JECT _ OTHER: $ _ 1 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 'se STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? n N/A UB2J200118 02/24/25 02/24/26 (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Licensing 1146 Route 28 AUTHORIZED REPRES TATIVE South Yarmouth,MA 02664 n t,,,., ' ©1988-2015 ACORD C RPORATION. II rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD