The URL can be used to link to this page

Home My WebLink About2025-26o9-Y-{1,'{#.115;;,,1" \t//ilt-Zq'20 Lr('L,NSE r-'EE sr50 B HfiN-ZV- ZA ch,AIo'10{To\\'N ()T'YAI{}IOTII'H B0ARD ()F IIEAI,TH 2025/2026 HANDI,IN(i AND SI'ORA(;[, ()I.' II)XI(' OR HAZARDOTiS }IATERIAI,S LICENSE APPLICATION COMPLETE TIIIS APPT,ICATION AND RETURN IT WITH THT, I BY JUNE 30.2025 $.-iStillilDE COMPLETE AI,I-UE TI N NAME OF ggg111pgg Cape Sands lnn gusrNnss tEL. + 5o BUSTNESS ADDRESS rN yARM9UTH 1491151 Ma 28, West Yarmouth, MA 02670 MAILING ADDRESS '1491151 Ma 28, West Yarmouth, MA 02670 AU0 1.e 2025 775EHUTB DEPT. ED EMAIL ADDRESg kashemno@gmail.com REO r it RF n MANAC;ER/C9N j ACt' pE RS9N Lenny Fab rano TELEpHONtI d 508-360-0241 Rr. oL t Rt_t)OwNER ry4yg Monzur Khan HOMF. ADDRESS 1/2 3rd Avenue, Taunton, MA 02780 1p 1 a 508-967-5381 CORPORATION NAME (IF APPLICABLE)Two Families lnc CORpORATTON ADDRESS 149/151 Ma 28, West Yarmouth, MA 02670 rs1 x 508-775-3825 MAILING ADDRF.SS 149-151 Ma 28, West Yarmouth, MA 02670 TA,X ID (FEIN OR SSN)REO1TtRED 77-0606723 LICENSES RUN ANNUALLY FROM JULY I 'TO JUNE 30. 11'IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY JUNE 30. FAILURE TO DO SO WILL RESULT IN CLOSURE OF YOUR ESI'ABLISHMENT UNTIL'IHE REQUIRED APPLICATIONS(S) AND FEE(S) ARE RECEIVED. A HEARING BEFORE THE BOARD OF HtsALTH MAY BE REQUIRED PRIOR TO REOPENING. Town of Yarmouth taxes and liens must be paid prior to renewal or issuance ofyour permits. Please check appropriately ifpaid: yes x no_ nla- Under Chapter 152, Sec. 25C, subsection 6. the Town of Yarmouth is required to hold issuance or renewal ofany license or permit to operate a business ifa person or company does not have a Certification of Workers Compensation insurance. As part ofthe rcncwal or issuance ofyour pcrmits, you must complete the enclosed Workers Compensation Affidavit. If' not applicable. plcasc cxplain: REGISTRATION f ORM SIGNI--D ANt) ('oMPI-}.,IF,I) CHECK AND WORKEI{S ('()MP AIIFIDAVIT I.,N('LoSEI) Y ALL SAI"ETY DATA SHEETS ON !-ll-ll YN ANY NEW CHEMICALS MUST BE PRI,-APPROYED BY THf, HEALTH DEPARTMEN'I" RENEWAL APPLICATION X x N APPLICANT'S SIGNATURE Nhw APPLICAI lON t>stv. 0811512024 ,-\ .ACORI)- 021061202s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES BfLOW. THIS CERTTFICATE OF INSURANCE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE tSSU|NG TNSURER(S), AUTHORTZED REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate holder is an ADOITIONAL INSUREO, the policy{ies) must have AODITIONAL INSUREO provisions or b€ endorsed lf SUBROGATION lS WAIVED, subject to the terms and conditions ot the policy, certain policies may require an endorsement. A statement on this ce.tificate does nol confer rights to the certificate holder in lieu of such endorsemenl(s). PRODUCER Taylor lnsurance Aqency dba Easton lnsurance Agency 448 Tumpike Street South Easlon r\,!A 02375 Oavid Polutchko l5o8t 230-2244 (508) 23&5014 ADORESS.DavidP@jlaylonnsurance.com IIISURER(5) AFFORDITTG COVENAGE tNsuRER a . Palms Specially lnsurance Co Two Familios lnc, DBA| Cap€ Sands lnn '149 Main Sireot M4.28 Wost Yarmouth r\tA 02763 rNsuRER B . Associaled Employers lns. Co IITSURER O CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER: M](T,' 25.26COVERAGES REVISION NUMBER THIS IS TO CERTIFYIHATTHE POLICIES OF INSURANCE LiSTEO BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEOABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENI TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIIH RESPECI IO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN tS SUBJECT TOALL THE TERMS, EXCLUSIONSANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE AEEN REDUCED BY PAID CLAIMS INSD COMI/IERCIAL GENERAL LlAAILIIY clarMs-MADE ffi o""r" GEN'LAGGREGATE LIMITAPPLIES PER OIHER, JECT PSt000175/2500 01t27t2025 41i27 t2026 EACH OCCURFENCE t 1,000,000 DAMAGE IO RENTEO PREMISES (Ea @.udene)r 50.000 MEO ExP lAny orc p€Mn)s Exduded PERSONAL &AOV INJURY s 1.000.000 GENERA!AGGREGATE $ 2.000.000 PRODUCIS COMP/OPAGC $ 2.0o0,000 Asault 8 Batlery r 25.000 AUTOMOBILE LIABILITY SCHEOULED AUTOS NON.OWNED AUTOS ONI-Y COMBINED SINGLE LIMIT S BOOILY INJURY tPerpecon) BOoTLY TNJURY lPer accidenl)5 I UIIBRELTAIIA6 EXCESS LIAB OCCUR EACH OCCURRENCE s AGGREGAIE s DED RETENIION $s B vyoRxERsco PElisaIoN AI'ID Ef, PIOYERS' LIABLrTY ANY PROPRIETORIPARTNER/EXECIJIIVE OFFICER/MEMBER EXCLUOEO? OESCRIPTIoN OF OP€RATIONS telo! N wcc5005026341202sA 41,2712026 xl STATUTE x OTH. E L EAC}1 ACCiDENT $'t.000.000 EL DISEASE - EAEMPLOYEE ! 1,000.000 E L DISEASE. POTICY LIMIT ,1,000.000 OEScRlPilOtl OF OPEFATIOiIS / LocAlloNs /vEHlclES (ACoRO lol.AddiDnal Remar*. Schedlle, m.y bG.ttached i, nore lpre i3 requir.d) CERTIFICATE HOLOER CANCELLATION The Town of Yarmouth 1146 Roule 28 Soulh Yarmouth [4A 02664 I SHOULO ANY OF THE AAOVE OESCRIBED POLICIES BE CANCELLEO AEFORErHE EXPIRATION DATE TH€REOE XOTICE WILL BE DELIVERED II.I ACCORDANCE WlIH THE POLICY PROVISIONS. AIJTHORIZED REPRESENTAIIVE O 1988-2015 ACORD CORPORAT|ON. Alt rights.eserved. The ACORD name and logo are registered marks ofACORDacoRD 25 {2016/03) AUIOS ONLY HIREO AUTOS ONLY 01t27t2025