Loading...
HomeMy WebLinkAboutBCOI-24-20 2025 The Commonwealth of Massachusetts �.. Y Town of o. YARMOUTH ,Ol,0 �1= y. . RPORAiE0�r4/ 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: Skipper RestaurantC7:44:\ Trade Name: Skipper Restaurant BCOI 24-20 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 152 SOUTH SHORE DR SOUTH YARMOUTH, MA 02664 November 30, 2025 Floor Occupancy Use Group Other 01 st Floor 80 A-2 Restaurants,Night Clubs,or Up to 80 Persons Use Group Classification(s) similar uses 01 st Floor 24 A-2 Restaurants,Night Clubs,or 24 Upstairs Bar Allowable Occupant Load similar uses Other 60 A-2 Restaurants,Night Clubs,or Outside Deck 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 Inspection Arrascue Enrique Chiefi Name of MunicipalG Mark G s if Commissioner f���i, Signature of Municipal Fire Signature of Municipal Building Da!of Issuance Chief ���`�6ommissioner 3/j0/Z-r- 05r/ iOfc Y TOWN OF YARMOUTH lir � Office of the Building Commissioner �t 1146 Route 28, South Yarmouth, MA 02664 -- ;�i 508-398-2231 ext. 1260 Fax 508-398-0836 MATTAEHEE5E / F A \c1RPORATVO. APPLICATION FOR CERTIFICATE OF INSPECTION January 31, 2025 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: /3a2 S -) )-f,4 ,SfI c-e ,o/Lt tr_ Name of Premises: Ski ) f0 C,}_ri rA4-i" Tel: S e.)8 s?Li 7%z Purpose for which permit is used: .�.0-,q,JrI9\J 77 L-{-�S3(0-O Li 2 7 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to Ski o�p cf n�j,r.. Tel:c p1 3 q LI.741 8,4 Address: j.S 7 ,S(1,11.\ 1S1.4.0rG r Sv 1/44/41/009--, i1//A n'zle Owner of Record of Building A La"! .7e= 4/;c Address ►1G[9✓'l//=,✓ Or _Cc:, t -� 'yb4 ..i,vo-'JA "') - Present Holder of Certificate 4 L-r1 Ai ,)&..1_,yqn/a j/ j,47 Signature of person tb whom Title Certificate is issued or his agent z6 2j4j � Date Email Address: s 'filer C'r e. CU�. L 44>e_. Cap'/ RECEIVED HBO52O27 BUILDING DEPARTMENT Rv 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# 04/01/2025-11/30/2025 e,,v/_- (I b • r-- y Workers Compensation and Employers Liability Insurance Policy Insurer ID No(s):34355 MA Retail Merchants WC Group Inc. Carrier Policy#: Policy Period PO Box 859222-9222 014005032678125 01/01/2025 to 01/01/2026 Braintree, MA 02185-0000 Information Page Renewal Policy FEIN: 043438184 Carrier Prior Policy#: 014005032678124 Item 1: Named Insured and Address Agency Beachview,Inc. Deland Gibson Insurance Associates Inc. The Skipper Restaurant 36 Washington St 152 South Shore Drive Wellesley Hills, MA 02481 South Yarmouth, MA 02664 Other Workplaces Not Shown Above: No Other Workplaces for this Policy Additional Named Insured: See Additional Named Insureds if Applicable Type of Business: Corporation Federal ID#: 043438184 Risk ID: 000000000 NCCI/Bureau#: 34355 Unemployment ID#: File#:014005032678125 Item 2. Policy Period The policy period is from 12:01 AM on 01/01/2025 to 12:01AM on 01/01/2026 based on the insured's mailing address time zone. Item 3. Coverage: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $500,000.00 each accident Bodily Injury by Disease $500,000.00 policy limit Bodily Injury by Disease $500,000.00 each employee C. Other States Insurance: D. This policy includes these endorsements and schedules: WC000000C(01/15),WC000414A(01/19),WC000422C(01/21), NOE(01/01), WC200102(01/14),WC200301(04/84), WC200302A(09/08),WC200303D(08/10),WC200306B(06/13),WC200405(06/01),WC200601A(07/08) Item 4: Premium The Premium for the policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code# Premium Basis Rate Per$100 of Estimated Annual Premium Total Estimated Remuneration Annual Remuneration See Sc'iedule of Operations on Following Page(s) Minimum Premium Prorated Premium Estimated Annual Premium Expense Constant $251.00 $6,881.00 $6,881.00 $0.00 Issuing Office: 35 Braintree Hill Office Park Ste 206 Date Printed: Countersigned by: Braintree MA 02185-0000 12-18-2024 Form#WC 00 00 01 C (Ed.05/17) ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. Page 1 of 1