HomeMy WebLinkAboutWest Beach Club New CV 05 15 23Common Victualler License
This application is for restaurant establishments with seating. Please contact staff if you have questions
regarding the online application at 508-862-4774 or at erin.logan@town.barnstable.ma.us
Transaction Details
Number: F175E221T1
Date: 5/1/2023 8:04 AM
Method: American Express x-1019
Type of Application - New License
= Application Fee ($100) + Actual
cost of License ($100)
$200.00
Required Legal Ad Fee - Required
Legal Ad Fee $82.22
Do you have Entertainment? - No $0.00
Subtotal:$282.22
Processing Fees:$8.74
Order Total: $290.96
Name of Corporation
Riverway Lobster House, Inc.
Doing Business As:
West Beach Club
Name of Applicant
Jason Siscoe
Applicant Email
jason.clambake@gmail.com
Applicant Cell Phone
(508) 789-3226
Address of Business
9 Dale Ave., Hyannis Port, Massachusetts 02647
Mailing Address (if different)
27 Trudy Lane, Cotuit, Massachusetts 02635
Name of Manager
Jason Siscoe
Manager's Email
jason.clambake@gmail.com
Manager's Cell Phone
(508) 789-3226
Type of Application
New License = Application Fee ($100) +
Actual cost of License ($100) - $200.00
Required Legal Ad - Additional
Fee
$82.22
*Abutter notification will be required - Fees
associated will depend on number of direct abutters.
The Licensing Division will guide applicant through
the process once application is submitted.
Do you have Entertainment?
No
Name of former business at location:
West Beach Club
# of Seats Inside
48
# of Seats Outside
0
Detailed Floor Plan
WBC Floor Plan.pdf
Copy of Lease Agreement or Purchase & Sales Agreement
WBC Snack Shack Agreement modified.docx
Copy of Articles of Organization or Business Certificate
Riverway Articles of Organization.pdf
Certificate of General Liability
Insurance (Acord 25)
2022-2023 Riverway Business
Insurance Policy.pdf
Liability Insurance Visual
Example
Workers' Compensation Insurance
Affadavit
WC Affidavit.pdf
Workers' Comp
Visual Example
To access a blank Workers'
Comp form:
Step One: Click here;
Step Two: Fill out blank fields;
Step Three: Save to desktop; and,
Step Four: Upload to this
application.
NOTICE: Any misstatement in this application or violation of the applicable town ordinances, bylaws or
regulations shall be considered sufficient cause for refusal, suspension, or revocation of any and all
licenses.
I warrant the truth of the forgoing statement under the penalty of perjury.
Signature
Form of Payment
Credit Card (Online Only)