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HomeMy WebLinkAboutBCOI-24-17 2025 The Commonwealth of Mass :h setts " Town of - ' Y9.YARMOUTH ._, Al 4P - -I1k7111CSt�4t1 �''yCRRPORATE��„i , :111 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: RJ Blue Water Resort Beverage LLC Trade Name: Blue Water Resort Restaurant BCOI-24 17 — Identify property address including street number, name, city or town, and county Certificate Expiration Located at 291 SOUTH SHORE DR SOUTH YARMOUTH, MA 02664 November 30,2025 — Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 226 A-2 Restaurants,Night Clubs,or 153 Main Dining Room similar uses 26-Dining Room 1 Allowable Occupant Load 26-dining Room 2 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 Enrique Arrascue Commissioner Mark Gryl ---- Date of Inspection i s. Signature of Municipal Fire ,-� �� Signature of Municipal Building ' ( Date of Issuance r0 1 2 7 / 2- _ ;"0 xA TOWN OF YARMOUTH Office of the Building Commissioner 4 _ 1146 Route 28, South Yarmouth, MA 02664 0 `_ � 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHEESE CORPORATE°\b:_, 1'y 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::``�j� Street and Number: A6 I vil-` < ��t :S' orin- • u itlkq Y\) w QILWt y 1NameofPremises: ? )L 0 Tel:( 36 b Jzwi) 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 31�e- AIR 42i(f1t Tel: Slc4 Address: Owner of Record of Building C -t Address - � �t�5 /�t, S avth M er 61.14.0`-1 Pre en Hol r of Certificate b.US .( > ,. _ Sign re of person to whom Certificate is issued or his agent &It) 1a Date Email Address: 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# 04/01/202 5-11/3 0/202 5 AMR() CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/15/2024 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 CONTACT _ ..._....._ _... _. MARSH USA,LLC. NAME:PHONE FAX 1166 Avenue of the Americas INC.No.Ext): (A/C,Not: New York,NY 10036 E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# CN133703919-all-GAU-24-25 INSURER A: WA N/A INSURED INSURER B: WA N/A EOS Hospitality RJR MA Employee LLC 444 Madison Avenue I Floor 14 INSURER C: State National Insurance Company.Inc. 12831 New York,NY 10022 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-012077315-01 REVISION NUMBER: 1 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 LTR TYPE OF INSURANCE BBISD SUBR POLICY NUMBER POLICY EFF POUCY EXP LIMITS (MO/DD/YEFF ( YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTHER: $ COMBINED SINGLE LIMIT AUTOMOBLE LIABIL(IY (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 LJAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION VTLWC03100600 09/28/2024 09/28/2025 PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Blue Water Resort-291 S Shore Dr,South Yarmouth,MA 02664 CERTIFICATE HOLDER CANCELLATION EOS Hospitality RJR MA Employee LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 444 Madison Avenue Floor 14 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN New York,NY 10022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ?7La•z.ce _'_G'! ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD