Loading...
HomeMy WebLinkAboutBCOI-24-31 2026 annual ,�"g — TOWN OF YARMOUTH `"-- Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 Cu' 508-398-2231 ext. 1260 Fax 508 398 0836 a CNEESZ ... " /4,0 bya/ \. QRPORAT0 t ' : .. APPLICATION FOR CERTIFICATE OF INSPECTION RECEIVED August 15, 2025 1 PAYABLE UPON RECEIPT AUG 2 9 2025 (X) Fee Required$100.00 ( ) No Fee Required BU In accordance with th ivisio s o`f the Massac usetts 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: //q- 7)()qi n 5b'e-t Name of Premises: tieN Wil ta 2.4,//7:?47 Tel: ,cog_-7?c 333.E 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 Tel: Address: Owner of Record of B ilding Gj C/J dL - Address /7 1/r 1) crnofi,i77t1 O2 '/3 Present Holder o '- ficate ?fir/ d .4 Pg --5'= -rl T Signature of on to whom Title Certificate is issued or his agent d 8‘226/.25— ate 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# BCOI-24-31 12/01/2025-12/31/2026 AC�a DATE(MM/DDr YY) CERTIFICATE OF LIABILITY INSURANCE 07/07/26 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 NAME: g -781-337-4033 Robert M.Za ami Insurance Mat No Exel. lac,No): 781-337-4103 Agency EMAIL 666 Bridge Street ADDRESS: bzagami@rmsinsurance.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 TYPEOFINSURANCE ADDLAUbR POLICY NUMBER POLICYE PODGYEXP LIMITS LTRINSD WYDIMMIDERYYY),IMM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 600,000 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 PROT ❑LOC PRODUCTS-COMP/OP AGG $ JEC OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 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 DAB _OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION XI STATUTE I I0T AND EMPLOYERS LIABILITY Y/N A ANY OFFICER/MEMBERR EXCLUDED', N/A UB2J200118 02/24/26 02/24/26 E.L EACH ACCIDENT $ 600,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 600,000 0 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000 1,000,000 Liquor Liability added to above policy eft 04I24I2026 BMA0028670 04/24/26 02/27/26 claims made form DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured:Andreas Evangelidis and Artemis Evangelidis,194 Main Street,W.Yarmouth MA 02673 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 ' ©1988.2016 ACORD C RPO ION. II rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD