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HomeMy WebLinkAboutBCOI-23-1790 2026 1 of,YA `4 TOWN OF YARMOUTH ' Office of the BuildingCommissioner f,1; 1146 Route 28, South Yarmouth, MA 02664 y 508-398-2231 ext. 1260 Fax 508-398-0836 \NPORATE ,bb APPLICATION FOR CERTIFICATE OF INSPECTION August 15, 2025 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ( ) 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 beel� '`p�ow-named premises located\� at the following address: Street and Number: (10 0 Atli)V l t2 Y 11., '.C1,.4,, \-\.. \ Tel: tn4 ?9 7 l Name of Premises: °,�% Q IS � 0 `Purpose for which permit is used: I-.\ v o r 1\CR.-Ng License(s) or Permit(s)required for the idremises by other governmental agencies: License or Permit Agency Certificate to be issued to \ti SO LV S a,.. Tel: ;p 1, y\3 0 S C g Address: 1 KWr.a•.a r a , l.� • 1 r v�� ( O't(').3 Owner of Record of Building -"[o•n., b'l\c-\(-:.-w-\\Q Address Ci4 MBA- Stk.3 v)cr r^' \ Y'i Present Holder of Certificate Ves Sc-\ —5A-,^3 -- Signature of person to whom Ti e Certificate is issued or his agent Ocli 14 D D, Date Email Address: �0 i �S\-rto Q fMc,� y,.. E E I E --.1 SEP 2 6 2025 I .10 3L 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-23-1790 12/1/2025-12/31/2026 AC(7f21, DATE(MM/DD/YYYY) t.......-. CERTIFICATE OF LIABILITY INSURANCE 09/25/2025 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: FLAGSHIP INSURANCE AGENCY INC 08089081 PHONE (508)994-9688 FAX (508)991-5461 651 ORCHARD STREET (A/C,No,Ext): (A/C,No): E-MAIL ADDRESS: NEW BEDFORD MA 02744 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Insurance Company of the Midwest 37478 INSURED INSURER B: 908 BISTRO INC INSURER C: 1 FILLMORE RD WEST YARMOUTH MA 02673-2415 INSURER D: 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 EFF POLICY EXP POLICY NUMBER 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- LOC PRODUCTS-COMP/OP AGG JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED —AUTOS _AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS —AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE —^ EXCESS LIAR CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $500,000 A PROPRIETOR/PARTNER/EXECUTIVE N/A 08 WEC BE8M7T 05/09/2025 05/09/2026 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 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 For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1 FILLMORE RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED WEST YARMOUTH MA 02673-2415 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.Affrights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD h. L Co- u w '`----) t,, F I LSEP 2 6 2025 .1 i I LL1iUILDING `-- The Commonwealth of Massachusetts Town of og Y9) �� YARMOUTH 1� 0' O yi ,`'°PORATto•... 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: 908 Bistro BCOI-23-1790 Trade Name: 908 Bistro Identify property address including street number, name, city or town, and county Certificate Expiration Located at 908&928 ROUTE 28 December 31, 2026 SOUTH YARMOUTH, MA 02664 Floor Occupancy_ Use Group Other Use Group Classification(s) 01 st Floor 39 A-2 Restaurants,Night Clubs,or 39 Persons similar uses Allowable Occupant Load Other 12 A-2 Restaurants, Night Clubs,or 12 Person-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 Name of Municipal Chief Enrique Arrascue Mark Gryls <' . ate of Inspection Commissioner , , J t � I Signature of Municipal Fire Z1 -e Signature of Municipal Building /L Chief �-/ _' -��` Commissioner Date of Issuance 2 r-