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HomeMy WebLinkAboutBCOI-23-1765 The Commonwealth of Massachusetts Town of .-..._._ fir. \ st YARMOUTH ;� ' E 0, 1 �,�tio s �"o RATES�,,,..., 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: Loyal Order of the Moose Trade Name: Loyal Order of the Moose BCOI-23 1765 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 769 A& B ROUTE 28 SOUTH YARMOUTH, MA 02664 December 31, 2026 Use Group Classification(s) Floor Occupancy Use Group Other 01 st Floor 118 A-2 Restaurants,Night Clubs,or Allowable Occupant Load 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 Chief Enrique Arrascue Name of Municipal Building Commissioner Mark Grylls Date of Inspection /0/� 1eO ,E, Signature of Municipal Fire / vJ�� Signature of Municipal Building (J / Chief Li. '"'(a'': Commissioner Date of Issuance /° g(E �A TOWN OF YARMOUTH ,�� Office of the Building Commissioner 1146 Route 28, South Yarmouth, MA 02664 r 4 - y 1 508-398-2231 ext. 1260 Fax 508-398-0836 - MATTACHEE5E- �` /�c-RpORAT0 APPLICATION FOR CERTIFICATE OF INSPECTION August 15, 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: 7 (01 11 2, 51. 1/11 IN/17(m*Name of Premises: LC y/,`(, D /2 G r OF /409 5 Gel: 5-0 0- 73 7 /f9s_ Purpose for which permit is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit A, ency L I-yv2P i•-te.a►i �C _�P , c C G vet i/-eC k y,1 -/ ct rA 4- F-u 917t t. e-C ,4� I- /-/ell' ter-// Certificate to be issued to L()Y/tt O/ , ) ,0/4"/1[c Te1: S?f'r 737-/��J T Address: 164 n zz S. y ,,- t _l Owner of Record of Buildin 4, Address '7/' Z.U [f d7i1 ,- -I Present of Certificate 7/9/2/ agif z_,Ortiz a2D 1 or m a,C_.,_, 7 )- f40.0 Signa e of ers om e T' l Certificate is ' sued or his agent 7 - 3-2- - Date Email Address: _ C.) / , - vG C(, Oc/i RECE \ILDI SEP 112025 Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 0266 3 U I7L E F0`1- atill 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-23-1765 12/1/2025-12/31/2026 Aco DR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/04/2025 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(es) must 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 NAME:CONTACT Lockton Affinity, LWPHONE FAX _ _ Lockton Affinity, LLC I . 866-836-3373 .)401y913-652-7599- E-MAIL P. O. Box 879610 ADDRESS: Kansas City, MO 64187-9610 INSURER(S)AFFORDINGCOVERAGE NAIL# INSURER A:Fraternal Insurance Company, Inc. INSURED INSURER B: Yarmouth Moose Lodge #2270 INSURER C: 769 Main Street, Route 28 INSURER D: South Yarmouth, MA 02664 INSURER e. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFf THAT THE POLICIES OF INSLRANCE 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. (M NSURAiNcE HID WVD INSR' ADDLLSUBR' I POLICY EFF POLCYEXP LTR TYPE OF i 1. 3 POLICY NUMBER M9IDD YYYY) TMMfDD1YYYY) A x COMMERCIAL GENERAL LIABILITY FIC25GL0010 05/01/2025 05/01/2026 EACHOCCURRENCE S1,000,000 CLAIMS-MADE (x OCCt1R DAM/I S(a comm pRE�� (Ea ocurrNTED enoe) $1,000,000 General Liability/ MID DIP(My one person) $0 Liquor SIR PE250NAL&ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Applies per Policy ALAGGREGATE $2,000,000 Terms fi Conditions X POLICY Pia I LOC PRODUCTS-COMPAPPGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OV JET) SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S _ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABTY Y/N I STATUTEI 1 ER U ANY PROPRIETORIPARTNER1EXECUTNE N/A EL EACH ACCIDENT $ OFRCERIMEMBEREXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE$ If donate under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Liquor Liability 'FIC25GL0010 05/01/2025 05/01/2026 Occurrence $1,000,000 Aggregate $2,000,000 II � DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 3066414 Proof of Coverage SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRESENTATIVE r-� ©1988-2014 ACORD CORPORATION. All rights reserved. Ar-rion 9A l911 AIM1 Th.A!`ll Drl nmmn mnd L+.+n vn.nniclnex.l rr.e.Lc..f A/`llDll