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HomeMy WebLinkAboutBCOI-23-1791 The Commonwealth of Massachusetts Town of of YAK ,,,-• -0 .40i j YARMOUTH �_e.lif-.:: �� � oy 4. 4 x CCRPO RATED`, 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: Inaho Japanese Restaurant • Trade Name: Inaho Japanese Restaurant BCOI 23 1791 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 157 ROUTE 6A YARMOUTH PORT, MA 02675 December 31, 2026 Floor Occupancy_ Use Group Other 01 st Floor 64 A-2 Restaurants, Night Clubs,or 12 Persons-Counter Use Group Classification(s) similar uses 22 Persons-Booth 30 Persons-West Room tables& Allowable Occupant Load Chairs 01st Floor 16 A-2 Restaurants, Night Clubs,or 16-Person-East Room Tables& similar uses Chairs 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. ue Arrascue Name of Municipal Building Name of Municipal Chief Enrique Commissioner Mark Gr a f Inspection /// /i - .Signature of Municipal Fire L/i "( Signature of Municipal Building ) .-. Chief � =1 Commissioner - ' -4, ate of Issuance r r '/Z-j'' 1 !ter"-YA TOWN OF YARMOUTH �� LL - . Office of the Building Commissioner . - - '( 0', 1146 Route 28, South Yarmouth, MA 02664 '-se♦r� M-r 508-398-2231 ext. 1260 Fax 508-398-0836 MA GHE TLAESE �"/,/� Ely - .�q;'' �RPORME ' APPLI ATE OF INSPECTION August 15, 2025 PAYABLE UPON RECEIPT OCT 07 2025 1 (X) Fee Required$100.00 �'r41 a 9 1 ( ) No Fee Required BUILDING DEP H In accordance with the provisions o -t e-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: ' 1 a „ S Street and Number: �' --e (e _ + 101vt 1� U 6 c �� F Name of Premises: n a Tel: ,5 O g -34 c; -55cp �D la�0.hes� �e S1 - o Purpose for which permit is used: el e A U 12 -to-r- _Y 4 , l3 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issu o -�h a-� a &elect Tel: -3 3- a 5 ffe Address: � e l at DI,Ptiti e r t(-- o� Owner of Record f Build < ii Address �5 � c Y'VY�I� . e c rn 6c)--Co Holder of Certificate Otz) -K ature of per on to whom Title Certificate is issued or his agent /� //p 5 1 (�te 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-23-1791 12/1/2025-12/31/2026 Acc D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4Illiskir, 10/01/2025 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 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 Automatic Data Processing Insurance Agency,Inc. Automatic Data Processing Insurance Agency, Inc. PHONE Ext): 1-800-524-7024 FAX ,No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC s _ Roseland NJ 07068 INSURER A: Employers Preferred Insurance Company 10346 INSURED Inaho Japanese House INSURER B: INSURER C: 157 Route 6a INSURER D: INSURER E: Yarmouth Port MA 026751713 INSURER F: COVERAGES CERTIFICATE NUMBER: 4579143 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 ADDLISUBR' POLICY EFF POLICY EXPMI LIMITS LTR INSD I WVD POLICY NUMBER (MDDIYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ , DAMAGE CLAIMS-MADE OCCUR PREMISESO(EaENTED occur 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) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION vOTH- AND EMPLOYERS'LIABILITY ^�STATUTE ERH Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N N/A N EIG248569608 05/02/2025 05/02/2026 - — - I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ I I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town Of Yarmouth,Attn:building ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Main St AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 —7 .-,)'+-)k... ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD