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HomeMy WebLinkAboutBCOI-24-15 2025 The Commonwealth of Massachul et . Town of g Y9"T. i;kRf itilieoit YARMOUTH .: \-,Mc�RPO RA�EO. / 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 Resorts Riviera Beach Resorts Beverage LLC BCOl-24-15 Trade Name: Riviera Beach Restaurant Identify property address including street number, name, city or town, and county Certificate Expiration Located at 327 SOUTH SHORE DR November 30, 2025 SOUTH YARMOUTH, MA 02664 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 40 A-2 Restaurants, Night Clubs,or 40 Persons similar uses Allowable Occupant Load 02nd Floor 48 A-2 Restaurants,Night Clubs,or 48 Persons 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 Name of Municipal Chief Enrique Arrascue Mark G Its Date of Inspection i13I� ,�_ Commissioner Signature of Municipal Fire 3 Signature of Municipal Buildi g Date of Issuance 2 Z j" Chief � �� Commissioner I TOWN OF YARMOUTH p ®.„ Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 3.1 508-398-2231 ext. 1260 Fax 508-398-0836 MATTAEHEESE 4‘O4'PORAVS0�b:f 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: 3 Sin) ht.Ave, Name of Premises: Ziv)el((,L �L( kl'Q ) Tel: 3 .� - 3" 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 k N Q 1 Tel: ` 1.4 Address: -ja:1 u'LAVE 4. 4-irY114 V^ M 0?4(t_Owner of Record of Building p,oks Address 5 - 5(MA_ tyre. D(L�1/Q�_ Pr s t Holder of Certificate Iz pls 4414002.4 ,�y 0 Lew - Si ature o person to whom Title Certificate is issued or his agent a.) f J 2 n Date Email Address: 1 hCP( vJoi® o i d� j�r� J 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 E YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# C,I) 01y—(.S 04/01/2025-11/30/2025 c_L ACO I1 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. PHONAME' 1166 Avenue of the Americas WCC.NNo.Ext):E FAX No): New York,NY 10036 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC/ CN133703919-all-GAU-24-25 INSURER A: N/A N/A INSURED INSURER B: N/A 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-012977317-01 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITSLTR INSD WVD POLICY NUMBER IMMIDDIYYYY),JMMIDDMIYY7 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO $ CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ 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 LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION VTLWC03100600 09/28/2024 09/28/2025 X eg_13ATUTE EOTH- R AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) El.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Red Jacket Beach Resort-1 S Shore Dr.South Yarmouth,MA 02664 CERTIFICATE HOLDER CANCELLATION E4 4 MadisonnlA RJR MA Employee LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE New a Avenue Floor 14 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN New York NY 10022 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD