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HomeMy WebLinkAboutBCOI-23-1756 2026 The Commonwealth of Massachusetts u Town of zfY`4t . 'o YARMOUTH �c '_ y£ art MATINCStcf[ v ?4PORATED\ 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: Skippy's Pier 1 • Trade Name: Skippy's Pier 1 BCOI 23 1756 pPY' _ Identify property address including street number, name, city or town, and county Certificate Expiration Located at 17 NEPTUNE LN SOUTH YARMOUTH, MA 02664 December 31, 2026 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 252 A-2 Restaurants, Night Clubs,or 68-2 Small Dinning similar uses 142-Main Dinning Allowable Occupant Load 42-2 Small Dinning-Opposite Bar Total-1st Floor 252 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 Gryll Date of Inspection - j`' r' 1t Commissioner I 1 M'L.� S' Signature of Municipal Fire [/ / .t � Signature of Municipal Building `\---J= ate of Issuance /z Chief �'j /! " Commissioner /,+ 1�,�� ;Rt , YA TOWN OF YARMOUTH - ' Office of the Building Commissioner )' �t 1146 Route 28, South Yarmouth, MA 02664 L`_ - y. 508-398-2231 ext. 1260 Fax 508-398-0836 MATTACHECSC ' i ORP0RAIEO,b'! `-w.z,,---' APPLICATION FOR CERTIFICATE OF INSPECTION August 15, 202.5 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: tn ki epl- n r Lci V-'-e Name of Premises:5. 1()1)115Prc'( " U Tel: U 3q 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 5 k (p,I / r Tel: ! 5-5-6, Address: I '1 tifp�A r-C LQ nt 1 crr h.o\/l.t-h Y►,4 0)-Coco / Owner of Record of Building Scp l. Yn 11 I r Address i 9 N ry (. ,-y 5 -00a-1 i1') A— (2 F 9' Present Holder of Certificate tS a V-C. Signature of person to whom Title Certificate is issued or his agent f- 6)- r Date RECEIVED Email Address: SRI cJhu r CO do `, Corn SEP 08 2025 BUI 1 T By 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-23-1756 12/01/2025-12/31/2026 'WZ1_ an DATE(MM/DD/YYYY) 4: ` " CERTIFICATE OF LIABILITY INSURANCE 05/01/2025 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 be endorsed. If SUBROGATIONIS 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: THE OCEANSIDE INSURANCE GROUP 08084400 PHONE (508)771-1660 FAX (508)775-1135 (A/C,No,Ext): (A/C,No): PO BOX 38 E-MAIL ADDRESS: WEST DENNIS MA 02670 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Fire Insurance Company 19682 INSURED INSURER B: SKP1 M,LLC.,731 MAIN STREET LLC,277 S.SHORE INSURER C: DRIVE LLC DBA SKIPPY'S PIER 1 PO BOX 370 INSURER D: SOUTH YARMOUTH MA 02664-0370 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/Y YYY) 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��PRO- JECT LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED _ BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY YIN E.L.EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE NIA 08 WEC AD1A4A 05/30/2025 05/30/2026 OFFICER/MEMBE:R EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION SKPM1,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Skippy's Pier I Restaurant BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED Sandra M DiGiovanni IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 370 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD