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Home My WebLink AboutBCOI-23-1790 application/document YA':- • TOWN OF YARMOUTH '°fOffice of the Building Commissioner 1 E 1146 Route 28, South Yarmouth, MA 02664 �► �,�►. 508-398-2231 ext. 1260 Fax 508-398-0836 (\\,\,, ` ''� APPLICATION FOR CERTIFICATE OF INSPECTION August 24, 2026 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 below-named premises located at the following address: Street and Number: el OOti '2.x54.4,--e, 2.3 Name of Premises: ►c..L' boss ' es au►raw, Tel: 5a 259. -o-61D Purpose for which permit is used: 5`5l..)sq.....,- License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to SP%c..e. loss % .s }v.,A( ---Tel: 6 0% �;g obi V Address: 9o8(Zooke. 9--I3 50%x/rh `rArM ) J)c mA OZ 61-f- Owner of Record of Building 1 g cc 1" i ve r L L L Address I'13 `t'ktigx.Nsa.,,,\_ s c . 5vv rL YAr flvl 0 Ake. Present Holder of Certificate 1 '�g�0 g b (-0 q.IYl cam,,d2. Di....) n e T Signature of person to whom Title Certificate is issued or his agent 9- I J4- ?02 6 \ Date Email Address: Sei`e6css(-esVc.,,A :aAh+ q, Imv.k • ,,-n 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 12/31/2026-12/31/2027 v✓d re(+ I A! C'NI JrDATE IMMIDDIYYYY) �.-- CERTIFICATE OF LIABILITY INSURANCE 1 03/23/2026 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 II_not cooler rights to the certificate holder In lieu of such sndorsement(s). PRODUCER CONTACT NAME: FLAGSHIP INSURANCE AGENCY INC 08089081 PHONE (508)994.9688 FAX (508)991-5461 No.651 ORCHARD STREET (NC. enl. "- (�NPI. EMAIL ADDRESS- NEW BEDFORD MA 02744 - INSURERIS)AFFORDING COVERAGE NAX INSURER A: Property and Casualty Insurance Company of Hartford 34690 INSURED INSURER a: Hartford insurance Company of the Midwest 37478 SPICE BOSS RESTAURANT AND GRILL INC INSURER C: 28 4 908 MA INSURER D: SOUTH YARMOUTH MA 02664 INSURER E: INSURER P: 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 ADM SUBS POLICY NUMBER POLICY EFF POLICY ESP UNITS LTR INSR MVO IMAUDDNYYYI IMYIDOIY YYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS MADE[]OCCUR DAMAGE TO RENTED PREMISES tEa aatie rl0al S1000000 General Liability y MED EXIT(Any one parson) S5,000 A 08 SBM BZ2T1D 03/03/2026 03/03/2027 PERSONAL A ADV INJURY $1,000,000 GENL AGGREEGGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY c ❑LOG PRODUCTS COMP/OP AGG $2,000,OGO `OTHER.LL AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IFS P.'aEWILL ANY AUTO BODILY INJURY(Par person) ALL OWNED SCHEDULED BODILY INJURY(Per Rociden) AUTOS _AUTOS HIRED NONOWNED PROPERTY DAMAGE AUTOS AUTOS Par acrnden0 UMBRELLA UA! OCCUR EACH OCCURRENCE FlirsEE LIAR CLAIMS AGGREGATE MADE DED RETENTION§ WOBIIERS OAW[NSATION -•___-_�.......__-.AND EMPLOYERS.UAB X ISTATUIE I IERm LRY ANY YIN EL.EACH ACCIDENT 51,000,000 8 PROPRit loP.PAR I NC R,EXECUTIVE r wA 08 WEC CBOEKP 03/20/2026 03/202027 OFFICE Ft ME MBE R EXCLUDED, LE L DISEASE'EA EMPLOYEE $1,000,000 (Wndoey In NH) II yr.duv.nln undo, E L DISEASE•POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A Liquor Liability 08 SBM BZ2TID 03/03/2028 03/03/2027 Each Common Cause S1,000,005 J I ga DESCRIPTION OF OPERATIONS/LOCATIONS/VEINCLEE IACORD 10t,AddIWa,M Semmes Schedule,my he Attached R mere epees le needed) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 28 N 908 MA BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED SOUTH YARMOUTH MA 02664 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _!'Aga....)cif Cyr.oe 01988-2015 ACORD CORPORATION.All rights rsssrved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Annual NFPA 17A & NFPA 96 Kitchen Suppression 2021 ed 1 MERRITT FIRE PROTECTION&VENTILATION IFC Status 10 Kendrick Road Suite 17 Main Office Wareham, MA 02571 Inspector: Geoffrey Cardoza Job Number: 47476644 Inspection Date: 08/21/2026 Inspection Location Customer Spice Boss Restaurant Bar and Grill 908 Bistro 908 Massachusetts 28 908 Route 28 Yarmouth, MA 02664 South Yarmouth, MA 2664 Inspection performed in accordance with NFPA 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations 2021 edition and NFPA 17A Standard for Wet Chemical Extinguishing Systems 2021 edition. Hood System Inspections Hood System Description Location System Model System Mfr left of hood r-102 Ansul Hazard Area System Size - -------------______—___ 3 gal Duct Size Hood Size 16" round 10' Manufacture Date Number of Flow Points 1359694800 11 Number of Cylinders Cylinder Agent 1 Wet Chemical i Expellant Gas Type Cartridge Model Nitrogen Lt-30-R 1 Kitchenhood Kitchenhood i i Heat detector other than fusible links, free of damage,clean & functions _ properly? Proper number and placement of detectors/links? Replaced fusible links with proper temperature rating? Number of links replaced? (also indicate temperature ratings) Mechanical detection operates properly? Remote manual pull tested and operated properly? ! i Remote manual pull ai proper height, in path of egress, unobstructed and clearly identifying the hazard protected? F________ — Audio/visual device(s) installed and operating properly? Alarm monitoring entity, if used, received alarm? ! Piping & conduit securely bracketed? Correct type and # of nozzle(s) properly positioned? Nozzles inspected and found to be clear of visible obstructions? Nozzle caps or seals in place and replaced as required? _ w___._..______ ____. Agent distribution piping blown through with dry air or nitrogen to verify no Number of Caps/Seals replaced. obstruction? _____ .___•--__.�._....._-.--._.. ___..--._�- _ �.._._.J__._._,.—._._ _._".__-_.._.._.._...-.... .._,--_•._.._.-.. .. ....... ...... .........._.__.___...__-_-.__-__--_-__.-__.- Fuel Shutoff Type Gas shutoff valve works properly, if applicable? Automatic shutoff devices shut down sources of fuel/power to cooking Gas Valve Size equipment system? ir•- - --- ________ All gas/electric appliances shut down upon system activation? Exhaust fans continue to run upon system activation? Return air fans shut down upon system activation? Manual reset working properly? t Portable extinguisher of proper type mounted with sign/placard? Required service performed on extinguisher? Interlocks in place and operating properly? Proper separation between fryers&flame? Proper clearance from cooking surface to filters? Grease buildup inspection;cleaning required? Observable hood and duct penetrations sealed with a weld or a UL listed Measurement of grease buildup. device? Cylinders securely mounted? Cylinders&cartridges without damage or corrosion? Piping unobstructed? Test adapters/links,pins,etc,removed from system? Temperature sensing detection link line has proper tensioning? Control head reset? Cartridges reinstalled? Fuel sources and power restored? Pilot lights supplied by gas valve,if present,reset? Microswitch/relays reset-electrical appliances on? Filters and baffles in place? System operational and seals in place? Tandem system reset and operational? Inspection tag affixed to system? Alarm monitoring company notified of completion of inspection? Instructions for manual operation posted in the kitchen area? System meets UL300 standard? Overall condition of the system at end of test. Cooking Appliances(left to right) Location Appliance Type Power Type Size Nozzle Type Cylinders Area Size Gauge Operable Pressure Reading Correct Agent Agent Volume Cylydrindeo Dr ate H Las[ Cayrtdridg roDeate Last Volume H Deficiency Summary Liability Statement The owner and/or designated representative acknowledges the responsibility of the operating condition of the component parts at the time of this inspection.It is agreed that the inspection service provided by the contractor as prescribed herein is limited to performing a visual inspection and/or routine testing,and any investigation or unscheduled testing, modification, maintenance,repair,etc.,of the component parts is not included as part of the inspection work performed. It is further understood that all information contained herein is provided to the best of the knowledge of the party providing such information. Customer Name Technician Name Spice boss Geoffrey Cardoza Customer Signature Technician Signature Technician License 6288gc Email Cardozageoff@gmail.com Phone* 5088630872 Annual NFPA 10 Fire Extinguisher 2022 ed. Ak. MERRITT FIRE • PROTECTION&VENTILATION IFC Status Main Office 10 Kendrick Road Suite 17 Wareham, MA 02571 Inspector: Geoffrey Cardoza Job Number: 47476644 Inspection Date: 08/21/2026 Inspection Location Customer Spice Boss Restaurant Bar and Grill 908 Bistro 908 Massachusetts 28 908 Route 28 Yarmouth, MA 02664 South Yarmouth, MA 2664 Inspection performed in accordance with NFPA 10 Standard for Portable Fire Extinguishers 2022 ed. Hand Portable Fire Extinguishers Building Name Building Address Spice Boss Restaurant Bar and Grill Extinguishers with 12 Year Hydrostatic Test Area Location Type Size Mfr Model Mfr Date Serial No. 6yr Maint. Hydro Date Service Date Results 1 Dinning ABC 10 lb 08/01/2025 Pass 2 Basement ABC 10 lb 01/01/2023 Pass Extinguishers with 5 Year Hydrostatic Test Area Location Type Size Mfr Model Mfr Date Serial No. Hydro Date Service Conductivity Results Test 1 kitchen door K Class 6 li-e- Pass Deficiency Summary Liability Statement The owner and/or designated representative acknowledges the responsibility of the operating condition of the component parts at the time of this inspection.It is agreed that the inspection service provided by the contractor as prescribed herein is limited to performing a visual inspection and/or routine testing,and any investigation or unscheduled testing, modification, maintenance, repair, etc., of the component parts is not included as part of the inspection work performed. It is further understood that all information contained herein is provided to the best of the knowledge of the party providing such information. Customer Name Technician Name Spice boss Geoffrey Cardoza Customer Signature Technician Signature Technician License 6288gc Email Cardozageoff@gmail.com Phone# 5085300440