HomeMy WebLinkAboutApplications, WC and Licenses _._,�,.._- ::. -�,..�, : ,
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,� � � � �� TOWN OF YARMOUTH BOARD OF HEA�,�'H- a� ;
APPLICATION FOR LICEN5E/PEF►1l�'�� �0�� � �1 5 Z008
....• � .,�� �
* Please complete form and attach all necessary do ent s�'6y Dec n �,t�'Ai��I��-i�.
Failure to do so will result in the return of yc�application pac�et.
NAME OF ESTABLISHMENT: TEL. # J`�4�'7qU rr�o2��
LOCATION ADDRESS: �
MAILING ADDRESS: f :��
OWNER NAME: TAX ID FEIN or SSN :
CORRORATION NAME (IF APPLICABLE):.
.,,�J�MANAGER'S NAME: TEL. # 6 ~ " �
,
��'U�MAILING ADDRESS: � ^ �37' 7a
C
POOL CERTIFICATIONS:
The pool supervisar must be certified as a Pool Operator,as required by State law. Please list the designated
Pool Operator(s} and attach a c�py of the certification to this form.
1._�Wtl'la, ��Tt3���! 2.
Pool operators must list a minimum of two employees cunently certified in basic water safety, standard First Aid and
Community Cardiopulmonary Resuscitation(CPR). Please list these empioyees below and attach copies of employee
certifications to this form. The Health Department will not use past years' records. You must provide new
copies and maintain a file at your place of business.
1. 2.
3. 4.
FOOD PROTECTI4N MANAGERS - CERTIFICATIONS:
All food service establishments are required to have at least one full-tune employee who is cei-tified as a Food
Protection Manager, as defined in the State Sanitary CodE for Food Service Establishments, 105 CMR 590.000.
Please attach capies of certification to this application. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your establishment. ,
1. 2. �
______P�RSOI�T IN CHARGE: -------- ----__^_----- _
Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation.
1. 2.
,
;
HEIMLICH CERTIFICATIONS:
All food service establishments with 25 seats or more must have at least one employee trained in the Heunlich
Maneuver on the premises at all times. Please list your employees trained in anti-chokmg procedures below and
attach co�aies of employee certifications to this form. The Health Department will not use past years' records. '
You must provide new copies and maintain a file at your place of business. '
1. 2.
3. 4.
RESTAURANT SEATING: TOTAL#
OFFICE USE ONLY
LODGIti G:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQLTIRED FEE PERMIT#
B&B S55 CABIN $55 MOTEL �55
_11ViV J�� _�;A1V�1' J�� LJ�Ni1Vi1Vi11VlTYUVL J2SUea. ��—(�� '
_LODGE $55 �TRAILER PARK �105 _WHIRLPOOL �80ea.
FOOD SERVICE:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
0-100 SEATS S85 _CONTINENTAL S35 NON-PROFIT �30
>100 SEATS �160 COMMON VIC. $60 WHOLESALE �80
RETAIL SERVICE: —RESID.KITCHEN �80
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
_<50 sq.ft. $50 _>25,000 sq.ft. $225 _VE��tDING-FOOD $25
_<25,000 sq.f�. S80 _FROZEN DESSERT �40 _TOBACCO �a»
v��z�cxa�cE: �lo AMOITNT DUE = S 80.00
**""*PLEASE TLTR�i OVER AND CO'VIPLETE UTfIER 5IDE OF FORVI*****
,. � _ �„ �
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ADMINISTRATION ,
Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal
of any license or permit to operate a business if a person or company does not have a Certificate of Worker's
Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR
CERT. OF INSURANCE ATTACHED
OR /
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED �/
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK �
APPROPRIATELY IF PAID: �
YES NO _
MOTELS AND OTHER LODGING ESTABLISHN�NTS
TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be
limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use.
Transient occupants must have and be able to demonstrate that they maintain a principal place ofresidence elsewhere. �
Transient occupancy sha11 generally refer to continuous occupancy of not more than thirty (30) days, and an f
aggregate of not more than ninety(90) days within any s�(6)month period. Use of a guest unit as a residence or
dwelling unit sha11 not be considered transient. Occupancy that is subject to the collection of Room Occupancy
Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, sha11 generally be considered Transient.
POOLS
POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be ins ected
by the Health Department prior to opening. Contact the Health De�artment to schedule the inspection five(S�days
pnor to opening. PLEASE NOTE:People are NOT allowed to srt m the pool area until the pool has been inspected �
and opened.
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count ";
by a State certified lab, prior to opening, and quarterly thereafter.
POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of
closing.
FOOD SERVICE
CATERING POLICY: � � � `
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Departmerrt by filing the required '
Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the
Health Department.
FROZEN DESSERTS:
Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health
Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the
above terms have been met.
OUTSIDE CAFES:
Outside cafes(i.e., outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth.
OUTDOOR COOHING: '
Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited.
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NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETCJRN
THE COMPLETED RENEWAL APPLICATION(S)AND REQLTIltED FEE(S)BY DECEMBER 15, 2008.
ALL RENOVATIONS TO ANY FOOD ESTABLIS�-Il1�1ENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIl'MENT,ETC.),MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN.
DATE: �Z��S�u;� SIGNATURE: �
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PRINT NAME&TITLE: �, ����1�h �o�rc,,�e.� .
io�ziios
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The Commonwealth of Marssachusetts ',
DepaKmeni of Industrial Accidents
M�Nr�s�
64+0 Washington Stree� 7`�`Floor
Bos�on,Mass. 02111 ;
Workers'Compensxtio�Iesaraace Atlidavih Bsildieg/Plambiag/Elecirical Coetractors
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work site location ffull address):
❑ I am a hom�wner perfarming all worlc myself. Project Type: ❑New Constnx�ian QRemodel
❑ I am a sole proprietor and have no ane working in any cap�city. Q Building Addition
❑ I am an employer providing warkers'.compensation for my employees wodcing�this job. �6 �^-,�0 I�`��e s '
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❑ I am a sole proprietor,geaeral co�tractor,or i�ameowRer(cirde owi)and have}ured the co�actors listed below who have :
the following workers'cornpensation Polices: �
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cen�nv ea�te•
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addresss i
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T'i�lY�XC�R CMQi�1f l�Eq�bl�HdQ$�M��[�('iL�.Cv���!���f CI�t��q�f a�t�M��i�/O!
�Ot y�a!!��e�t ff�IM,1!C�H p�tl�ti!f�K!STO!WORK ORDER!b t$Y!e[SiN.N�day�iC. 1�ud�at� �
«ry.cu���y���+a�a��e c�a�.ru�nu���w.. ,
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!ro 6ertby cerdjy irwder tbe palns and p�ofl�er�irrry f�r�t t14e iwformallow prodderi above is bzre owd c»mect I
Signatuc+e � ��,��,�D� W dV,�,n.a Date �L ) '�I b �
Frint name � [ , �i zor 1�r.-�'h �ra nc� P�# � �� �O - .Z,Z,� ! i
�ai a�e oaly da eet write i this area te 6e�ided b3'�Y«'�� '
city sr tewa• ��� ��n�
❑chedc if�a1e reap�me is reqdred O���
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B$ACSI�OOD CC►ND�INIL�M �i33QC7J�TI011 POOL RULES AND
REGULATION3
1. The pool season will be from June 1, 2Q0�$' thru
September 30, 200�. �
��
2. The pool hours of operation will be from m till
8: QOp.m.
3. The authorization for use of the pool is li�ited to
the pool and the immediate adjacent area only.
4. The authorized users will be Owners and their
immediate family and/or guests accompanied by the owner.
Tenants will be allowed pool privileges, and will
receive a key from the Board of Managers, when they provide
to the Board af Managers a valid CPR certificate, a valid
First Aid certificate, and a valid Town of Yarmouth Water
Safety certificate. Tenants eligibl� for cansideration of
pool priviZeges are only those tenants listed on the lease
provided to the Assaeiation. In addition only those tenants
listed on the lease may accompany an authorized tenant in
the pool area. Authorized tenants may not invite guests to
the pool area and may not invite tenants fro� other Units
to the pool area. owners that do not want this privilege
af�orded to their tenants must put this restriction in the
lease and notify the Board of Managers of this clause.
For all Units the Treasurer must verify that aIl
monies owed to the Associatian for said Unit are paid in
full and a current lease is on file with the Association.
Only t"wo keys will be issued per Unit.
If at any time during the season an owner, guests
andlor tenants should become delinquent in maintaining
their positive status with the Association all privileges,
for the ownex and/or the tenant will be revoked until such
time as the specific shortcomings are rectified.
5. The minimum age for any person unaccompanied by a
respansible adult is 18 years of age.
6. The poQl gate will be locked at all times, even when
the pool area is occupied by users. Each entrant as well as
each user departing will be responsible to assure that the
gate is locked behind them. Under no circumstances is a
user to open the gate for another party. It is each
individual' s responsibility to provide their own key and to
palice themselves.
7. Al1 users and guests are required to sign in and out
of the pool area. A log book will be provided for this
function.
8. If an authorized user should leave the pool area for
any reason (including to utilize lavatory facilities) all
parties in the pool area with that authorized user then
become unapproved users and must leave with their host.
9. Although it is strongly recommended that no individual
swim alone (alone being without another responsible adult
accompanying them) any person possessing the three required
certifications will not be held to this requirement. All
non-certified users wiil require a responsible adult
poalside at all times while utilizing the pool for
recreational purposes.
10. Any perceived violation of these Rules and Regulation
will be submitted to the Board of Managers by the persan
interpreting the offense. The Board of Managers will review
the submission with bath the submitter of the complaint and
, the party against whom the complaint has been lodged. If
the Board of Managers after conferring with both parties
deem that a violatian has occurred Article 11 will be
invoked. There will be no appeal process for this
proceeding.
11 . Any violation of these rules and regulations wiil
result in the following penalties:
FIRST O�F�N3B: 24 Hour Suspension from
Privileges.
S�COND OFB'ErT3E: $5 0. 0 0 Fi n e. *
THIRD OF'FEN3S: Revocation from pQol privileges
for the remainder of the season
as well as $100. 00 Fine. *
*Manetary fines aill be assesaed to the OMuer of
th� Unit in Violatioa.
i , �
Safety Report Beachwood Condominium Association Ma.y 23,� �S
Yarmouth Health Department:
In accordance with the tawn of Yarmouth we are providing the followin�rules.
The pool hours are from 9:Q0 AI1ri to 10 PM
Oniy owners and immediate family are allowed pool priveleges accompanied by owners
only. Only owners possess keys for pool.
Pvoltection is our pool opeiator and Don Stair is aur property manager who will also test
and register the chemieals four times a da.y in log book.
Self locking gate for pool entrance.
Attendance log kept in pool area.
� .
THE COMMONWEALTH OF 1ViASSACHUSETTS
TOWN OF YARMOUTH
BOARD UF HEALTIi
PERMIT NUMBER: #09-Q53 FEE: 580.00
N This is to Gertify that Beachwo�d C'andc�AseQciation
638 Route 28�West Yarmou�,MA
,
IS HEREBY GRANTED A PERMIT
To Operate a Public, Semi-Pubtic Swimming or Wading Paol
At Beachwood Condo Association - OUTDOOR POOL
638 Route 28
West Yarmout , MA
i This permit isgranted in confornuty with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31,2009 unless sooner suspended or revoked.
January 8,2009 BOARD OF HEALTH: .�Ee�t S��J �..N.� ��[XI►tl�t
�ar����N�it����R��4 .�n.���?J��G������tCe ���Itl�XfftlYtL
•Restriction:Safety report must be submitted annually�c7th application. J't�t'J�G�..J��ltlL(RfL� �:.�X,�Jt[Ft
Board of Health Hearing.0621'99-Do not need CPR � �f�1�QFfL�QltttL� �../�'.
First Aid and Water Safety certifications. �"""'�"��' .;�(�Qd
ce .
Director of Health '
r, C�'�1cfJulooD
F•Ya .t,",'� '
J -=k� TOWN OF YARMOUTH BOARD OF HF.�..T� h
j ��� � APPLICATION FOR LICENSE/P�;l�1VM�1'�*�.�AO�; ��
r?�'.!!��a a, a G� � (� � ;� �;'7 r' r�
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- * Please complete form and attach all necessary doeum�n�s�iy ecem e 31, 2007.
Failure to do so will result in the return of your application pack . r �: ;� � l f��i% '
;
NAME OF ESTABLISHMENT: ��G��,�,,,00d' Cor,cla �Ssr� TEL. �-�] '
LOCATION ADDRESS: �i 3 Inl , o
MAILING ADDRESS: OC.,� rvrv,S O Z bo L;z, l�o <,t,
OWN�R NAME: �ndo �Ssn- �nd��i clt,,m,l o�.�„A1 u.�o T ID fFEIN or SSNI' '
CORPORATION NAME (IF APPLICABLE):
MANAGER'S NAME: a�� ,�;� �: L; z �gr�,nc,r Tr�c�L.re r � TEL. # 08` �1 O- �,(�7 ;
MAILING ADDRESS: 5 �-. �� � O b � r +s �n S r�- Sop+ 7-
� � ��� f
POOL CERTIFICATIONS:
The pool supervisor must be certified as a Pool Operator,as required by State law. Please list tlie designated
Pool Operator(s) and attach a copy of the certification to tlus form. t
�. � �,�,s - p� 1 ��,�6►,, 2. _
Pool operators must list a minimuxn of two employees currently certified in basic water safety, standard First Aid and
Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee ',
eertifications to this form. T�te �ealth Dep�rtment will not use past years' reco�ds. �'o� must pravide new
copies and maintain a fite at your place of business.
1. 2.
3. 4.
FOOD PROTECTION Mt�NAGERS - CERTIFICATIONS:
All food service establishments are required to have at least one full-time employee who is certified as a Food ;
Protection Manager, as defined in the State Sanitary Code for Food Service Establislunents, 105 CMR 590.000.
Flease attaeh copies of eertification to this applieation. 'i'he Health Departme�nt wi11 not nse past ye�rs'rPcords.
You must provide new copies and maintain a file at your establishment.
1. 2.
PER�9N_IN_�I�.R�E: _ _
_ . __ . _
Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation.
l. 2.
HEIMLICH CERTIFICATIONS:
All faod service establishments with 25 seats or more must have at least one employee trained in the Heimlich
Maneuver on the premises at all times. Please list your employees trained in anti-chokuig procedures below and '
attach copies of�mployee certifications to this form. The I�ealth Department will not use past years' records.
You must provide new copies and maintain a file at your place of business. '
l. 2.
3. 4.
RESTAURANT SEATING: TOTAL #
OFFICE USE ONLY
LQDGING:
LICENSE REQUIRED FEE PER'�IIT# LICENSE REQUIRED FEE PER'41II'* LICEI�'SE REQL'IRED FEE PER'�IIT=
TB&B S50 _CABIN S50 MOTEL S50
INN �50 _CAi�IP S�0 ,,�SVCItiLVIING POOL S75ea. 6 —6 �'
LODGE SSQ TRAILERPARK S100 �WHIRLPOOL S75ea.
FOOD SERVICE:
LIC£NSE ItEQUIItED FEE PERMIT# LIC£NSE REQUIRED FEE P£R'4iIT* LICE:�iSE REQI:IRED FEE PER'�i1T=
0-100 SEATS S75 _CONTINENTAL S30 NON-PROFIT S3�
>100 SEATS S150 C0;�410N VIC. S50 V4'HOLESALE S75
RETAIL SERVICE: --.RESID.KITCHEN S7S
�� LICENSE REQUIRED FEE PERMI?� LICENSE REQUIRED FEE PERtiIIT= LICENSE REQL7RED FEE PER�rIIT�
_<50 sq.ft. �45 T>35,000 sq.ft. S200 _�'ENDING-FOOD S20
_<25,000 sq.ft. �a75 _FROZEN DESSERT S3� _TOBACCO S50
NA11�CHANGE: sio AMOUNT DUE _ $ -7�.ov
***«*PLEASE TL'IL\O�'ER A\D C0�IPLETE OTHER SIDE OF FOR�Z**"�`*
I
` • I
ADMINISTRATION
Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal
of any license or permit to operate a business if a person or company does not have a Certificate of Worker's
Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR
CERT. OF INSURANCE ATTACHED
OR \ ,
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED `�
Town of Yarmouth t�es and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK
APPROPRIATELY IF PAID:
YES� NO
MOTELS AND OTHER LODGING ESTABLISHMENTS
TRANSIENT OCCIJPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be
limited to the temporary and short term occupancy, ordinarily and customarily associated with motel and hotel us�:
Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere.
Transient occupancy sha11 generally refer to continuous occupancy of not more than thirty (30) days, and an
aggregate of not more than ninety(90) days within any six(6)manth period. Use of a guest unit as a residence or
dwelling unit sha11 not be considered transient. Occupancy that is subject to the collection of Room Occupancy ',
Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, sha11 generally be considered Transient.
* NOTE: Enciosed Motel Census must be completed and'returned with this application.
POOLS
POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be ins ed
by the Health Department prior to opening. Contact the Health Department to schedule the inspection five(�ys
pnor to apenu�g.
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a S�a�e c�rti€ied�b, prior-ta a�ni�, ax�d c�uarterly thereafter. -
POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of '
closing. �
I
�
FOOD SERVICE
i
CATERIlVG POLICY:
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health�)epartment by filing the required �
Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtasned at the .
Health Department.
FROZEN DESSERTS:
Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health
Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Peimit uirtil the
above terms have been met.
OUTSIDE CAFES:
4utside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth.
OUTDOOR COOKING: ;
_--_ E�dec3r eeel�ing;-pre�;or�is��l�y s€any�aa�pr�uc�by-a-r�ai�ar-€aad ser�iee ;
NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2007.
ALL RENOVATIONS TO ANY FOOD ESTABLIS�IlVIENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIPMENT,ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEMENT. RENOVAT'IONS MAY REQUIRE A SITE PLAN.
U�. �.
DATE: )Z.,�21v�,�'� SIGNATURE: " �-
PRINT NAME&TITLE: �z �'s,-�,.,-., )�xa c,,�w,,
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� The�'ominonwealth o Massachuselts
f
Departmeat of Industrial Accidents
> MNfra/fiw�MMi
600 Washington Stree� f"'Floor
Boston,Mass. 02111
Workers'Compegsation I�aaranee Aifi�vih Bailding/PlambiHglElectrical Contracbrs
, P�e�e 1'��Ii�i1'la�► ,
name' �G C,f 1 W o a � a�-�i ll��n m �,4,!',�{1-oL�lll
acldress: �� $ 1�d I,��-t.. �g' -rti,•.��
city `/'�� ►�i✓'rYWtw 7'I'1 state: �Y, zin• Rhone# Sag '1 L� - �� 1
work site location full address:
I am a hom�wner perforn�ing all work myseif. Project Type: ❑New Camstzuctiari�Remodel
I am a sole proprietor and have no one working in any capacity. ❑Building Addition
❑ I am an employer providing w�kers'compensation far my employees wo�cing an this job.
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❑ I am a sole proprietor,ge8eral costraetor,or homeowaer(circli o►rej and have lured tbe contract�s listed below who have
the following workers'compensation polices:
��1�_Y�fine:
address'
citv u�#:
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FaYrTe/o�eeme t�ve�a�e as reqai�ed aader 3eeliol iSA�f MGL 1S2 qt Ind b tte�p�a�f eriwl�al pefaNio sf a�ase�b S1,S�f.M a�dlK�
oae ynn'imptbonment�n wes as dvi pcatlUes h t6e ferm af a 3TOt WORK ORDER aed a Ane of s1A�Ys f day�t se. 1 aadezs�d t6at a
cepy ef fiis sta�my 6e feneaMed to tAe ORke�t lavafi�atloffi of Ike D!A tor cavetage verNlcatMa
I do hd�eby ce ' un�t\e p�atns ae�pexddes ofP��7iur}'tliet NYe i�for�xaelon prov�ded abov�e is d�re awd c»rrect
Signature �� Date � 2,b�7
Print name `�,Z, f � Phone# �a g 1 l �� 1' �z�o I
T
e�acw�on�y do not�vrke�t6ia area to be�mpkted by�y er town o�cch!
city or tewn: pet�/lioe�e# �Boidi�DeP,rtment
❑check if immediaFe re�eme is reqoired �SdaY�ea's 018ee
�HnIt6 Dq�at�eat
costact peraon phoae#; QOlher
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BEACHWOOD C4NDOMINIUM ASSOCIATION POOL RUL�:S AND
REGULATIONS
1. The pool season will be from June 1, 200�' thru
September 30, 200�.
,,OU
2. The pool hours of operation will be from �m till
8 : OOp.m.
3. The authorization for use of the pool is limited to
the pool and the immediate adjacent area only.
4. The authorized users will be Owners and their
immediate family and/or guests accompanied by the owner.
Tenants will be allowed pool privileges, and will
receive a key trom the Board of Managers, when they provide
to the Board of Managers a valid CPR certificate, a valid
First Aid certificate, and a valid Town of Yarmouth Water
Safety certificate. Tenants eligible for consideration of
pool privileges are only those tenants listed on the lease
provided to the Association. In addition only those tenants
listed on the lease may accompany an authorized tenant in
the pool area. Authorized tenants may not invite guests to
the pool area and may not invite tenants from other Units
to the pool area. Owners that do not want this privilege
afforded to their tenants must put this restr�ction in the
lease and notify the Board of Managers of this clause.
For all Units the Treasurer must verify that all
monies owed to the Association for said Unit are paid in '
full and a current lease is on file with the Association.
Only two keys will be issued per Unit.
If at any time during the season an owner, guests
and/or tenants should become delinquent in maintaining
their positive status with the Association all privileges,
for the owner and/or the tenant will be revoked until such
time as the specific shortcomings are rectified.
5. The minimum age for any person unaccompanied by a
responsible adult is 18 years of age.
6. The pool gate will be locked at all times, even when
the pool area is occupied by users. Each entrant as well as
each user departing will be responsible to assure that the
gate is loeked behind them. Under no circumstances is a
user to apen the gate for another party. It is each
individual' s responsibility to provide their own key and to
police �hemselves.
7. All users and guests are required to sign in and ou�
of the pool area. A log book will be provided for this
function.
8. If an authorized user should leave the pool area for
any reason (including to utilize lavatory facilities) al1
parties in the pool area with that authorized user then
become unapproved users and must leave with their host.
9. Although it is strongly recommended that no individual
swim alone (alone being without another responsible adult
accompanying them) any person possessing the three required
certifications will not be held to this requirement. All
non-certified users will require a responsible adult
poolside at all times while uti�izing the pool for
recreational purposes.
10. Any perceived violation of these Rules and Regulation
will be submitted to the Board of Managers by the person
interpreting the offense. The Board of Managers will review
the submission with both the submitter of the camplaint and
the party against whom the complaint has been lodged. If
the Board of Managers after conferring with both parties
deem that a violation has occurred Article 11 will be
invoked. There will be no appeal process for this
proceeding.
lI . Any violation of these rules and regulations will
result in the following penalties:
FIRST OFFSNSE: 24 Hour Suspension from
Privileges.
SECOND OFFENSE: $50. 00 Fine. *
THIRD OFFENSE: Revocation from pool privileges
for the remainder of the season
as well as $100. 00 Fine. *
*Monetary fines will be assess�d to the Ov�ner of
the Unit in Violation.
� f
R�ER UTILIZATION OF THE POOL UNDER THESE GUIDELINES AR1�
A PRIVLEDGE OF THE VARIANCE AWARDED BY THL YARMOUTH BO.ARD
OF HEAt�TH. IN T� PAST THE POOL HAS BEEN UNDERUTILIZED. WE
ARL RESPONSIBLE dWNERS AND WILL BE TREATED AS SUCH UNTIL WE
PROVE OURSELVES OTSERWISE.
�
Safety Report Beachwood Condominiurn Association May 23,2008
Yarmouth Health Deparhnent:
In accordance with the town of Yarmouth we are providing the following rules.
The pool hours are from 9:00 AM to 10 PM
Only owners and immediate family are allowed pool priveleges accompanied by owners
only. Only owners possess keys for pool.
Pooltection is our pool operator and Don Starr is our property manager who will also test
and register the chemicals four times a day in log book.
Self locking gate for pool entrance.
Attendance log kept in pool area.
� + •
THE COMMONWEALTH OF MASSACHUSETTS
i TOWN OF YARMOUTH
BOARD OF HEAI,TH
PERMIT NUMBER: #07-067 FEE: $75.00
� This is to Ce th
rnfy at Beachwood Condommmm Association
638 Route 28 West Yarmouth MA
IS HEREBY GRANTED A PERMIT
�
To Operate a Public, Semi-Public Swimming or Wading Pool
At Beachwood Condominium Association - OUTDOOR POOL
638 Route 28
West Yarmout �MA
This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31_2008 unless sooner suspended or revoked.
January 23,2008 BOARD OF HEALTH: ��fZ$�(�� ✓`�.J�/,� (�L(Xft
(.hcavr�ea .`�A. `,I�e�t'Pi�e�c��tcE (.Pccr,vYrfiaart
*Restricrion:Safety report must be submitted annuai(y with application. �/�Q�,t 3�./��{,�!(Z�
Board of Health Iiearing,06121/99-Do not need CPIt, � ����Cf�✓�.✓v.
First Aid and Water Safety certificarions. ��
BI'L1CC
Director of Healy� � �
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; �. :: 3�-wcpo
9 - �°f;aR o TOWN OF YARMOUTH BOARD OF HEAL,�r���
� �`. �;� APPLICATION FOR LICENSE�PERMIT"-2007 ��s � � ���� ;
* Please complete form and attach all necessary documents b� ece�nlr,e�31, 2006:.
� Failure to do so will result in the return of your application packet.
�
�
� NAME OF ESTABLIS���NT: ��G�y„F,f,a a ��dom;n i�t,r, ��;ot��s;}��v TEL. � 50 R�-(�O- Z Z(q 1
; LOCATION ADDRESS: W�
� MaII,nvG aDnxEss: G� . N- 01 i� z �R n� .� r S�
' OWNER NAME:_S�d,�v;�►1 - Ccv,cio Astn_ TA (FEIN or SSN)•
� CORPORATION NAME(IF APPLICABLE): �
MANAGER'S NAME: o l� TEL. # SO g� 737 •'7��1�'�
MAII,ING ADDRE5 = ^ r1� " S, r M
,
POOL CERTIFICATIONS:
� The pool supervisor must be certified as a Poal Operator,as required by State law. Please list the designated
Pool Operator(s)and attach a copy of the c�rtification to this form. _
� 1. 6U �' F"�'-� 2. _ _
�
� � Pool operatars must list a minimum of two employees currently certified in basic water safety,standard First Aid and
' � Community Cardiopulmonary Resuscitation(CPR). Please list these employees below and attach copies of employee
L, certifications to this form. The Heatth Department will not use past years' records. You must provide new
' � copies and maintain a file at your place of business.
,.S 1 � 2
i 3• 4.
FOOD PROTECTI4N MANAGERS - CERTIFICATIONS:
All food service establishments a.re required to have at least one full-time employee who is certified as a Food
Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000.
Plea.se attach copies of certification to this application. The Health Department wiil not use past years' records.
You must provide new copies and maintain a file at your establishmen�
1. 2.
PERSOAF IN CHARGE: _ __ _ _ —_ _ _. _ _ ___
Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation.
1. 2.
HEIlVILICH CERTIFICATIONS:
All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich
Maneuver on the premises at a11 times. Please list your employees trained in anti-choking procedures below and
attach copies of employee certifications to this form. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your place of business.
1. 2.
3. 4.
RESTALTRANT SEATING: TOTAL#
OFFICE USE ON
LODGING: ht�` nrt�.r� � �-
�,�' a�-� � a ��`
LICENSE REQUIItED FEE PERMIT# CENSE REQ FEE PBRMIT# LICENSE REQUfft�D FEE PERMIT#
_B&B S50 � CABIN $50 _MOTEL J„$SQ„�
_INN $50 _ $50 �SWIIvIIvIING L$75 d?-�67
_LODGE $50 _TRAII,ERPARK $lOQ WHIItLPOOL $75ea.
FOOD SERVICE:
LICENSE REQUII2ED FEE PERMIT# LICENSE REQUIltED FEE PERMtf# LICENSE REQUIItED FEE PERMI'T#
_0-100 SEATS $75 _CONTIlVENTAL $30 NON-PROFfT $25
_>100 SEATS $150 COMMON VIC. $50 WHOLESALE $75
RETAIL SERVICE: —.RESID.KITCI�EN $75
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERNIIT#
�<50 sq.ft. $45 _>25,000 sq.8. $200 VENDING-FOOD $20 '
_QS,OOOsq.ft. $75 _„FROZENDESSERT 535 TOBACGO $50
NAME CHANGE: �10 AMOITNT DUE _ $ ��$6—
,� i
'*'•'PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM"•""* �S
, t, �
4 9
ADMINISTRATION
Under Chapter 152, Section 25C, Subsection 6,the Town of Yartnouth is now required to hold issuance or renewal
of any license or permit to operate a business if a person or company does not have a Certificafie of Worker's
Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR
CERT. OF INSURANCE ATTACHED
4R
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED�
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK
APPROPRIATELY IF PAID: �
YES �i NO
MOTELS AND OTHER LODGING ESTABLISHMENTS
TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be
limited to the temporary and short term occupancy, ordinarily and customarily associated with motel and hotel use.
Transient occupants must have and be able to demonstrate that they maintain a principal place ofresidence elsewhere. t
Transient occupancy shall generally refer to continuous occupancy of nat more than thirty (30) days, and an t
aggregate of not more than ninety(90)days within any s�(6)month period. Use of a guest unit as a residence or
dwelling unit sha11 not be considered transient. Occupancy that is subject to the collection of Room Occupancy
Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, sha11 generally be considered Transient.
POOLS
POOL OPENING: A11 swimming,wadin�and whirlpools which have been closed for the season must be ins ected `
by the Health Department prior to opening. Contact the Health Department to schedule the inspection five(5�days !
pnar to opening.
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a State certified lab,prior to opening, and qua��rly thereafter. _
POOL CLOSING: Every outdoor in ground swimming pool Fnust be drained or covered within seven(7)days of
closing.
i
�
FOOD SERVICE
CATERING POLICY: t
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required
Temporary Food Service Application form 72 hours prior to the catered event. These forms can be abtained at the
Health Department.
FROZEN DESSERTS:
Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health
Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the
. above terms have been met.
OUTSIDE CAFES•
Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board ofHealth.
OUTDOOR COOKING: '
_ _ Outdoor cooking,preparation,or display of any food product by a retail or food service establishr�e�t is�ro6ibited.--
�
�
NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIB�LITY TO RETLTRN {
TI-�COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2006.
ALL RENOVATIONS TO ANY FOOD ESTABLIS�-IlVIENT, MOTEL OR POOL (i.e., PAINTING, NEW :
EQUIPMENT,ETC.),MUST BE REPORTED TO AND APPROVED BY TI-�BOARD OF HEALTH PRIOR
TO CONIlVIENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN. ,
DATE: � 2 b' �b SIGNATLTRE: ' � '
PRINT NAME&TITLE: l-�`Z �a ra,►�c, 7rcu,��gr
ion�ro�
} �
i r .
� � ' � _ ,
! � The Commonweatth o Massachuset[s
� f
Deparhxent of Indrtsd ial Accidents
N�'1N��i
60t1 Washingto�Shee� f"Floor
Bosto�,Mas� �2111
� Workers Com � hoa I=s�agee Affidavi�B�il ' bi'�iEleettical Codraetors
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aaa�s: (0 3 f� I2c��,�, A --
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�itv �•yct,r.,��.;�+h sate• M zin• r►hon�# 5D S��1�4 Z�i��
work site 1 '� fnll s:
I am a homeowne�perfonning all wark my�if. Project Type: ❑New Canstructi��R�nadel
I am a sole ' and have na one w � in an ' . ❑Buil ' Addition
❑ I am an employer p�oviding workeis'compensati�fa�r my e.mgloyees wo�cing aai this job.
_. -_-- _ ___
� . _ - _- __,_ - _- �
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� ni�e�-
❑ I am a sole proprietor,g�e�ral c�tractar,or komeowaer(drelt owe)and have hinad the coatr�ctors listed belovr wlw have
the following workers'compe�ation polices:
��
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Fai�rt M seca+e te+era�e at reqdred uda SeNMa ZSA�f MGL 1S2 eaa lad b tl�e hrp�dcrfirid pe�aNia d a�e�b=1,'SN�N aadh�
�Y� �Pr�t as we�as dv�peaaltla la tre 6rn of a STO!WORK ORDER ard t A�e e[S1A6.M a day apimt�e. 1 ndeMa�d dat a
npy�t tlde�a�t my 6e forwarded M Ne b�ce of lm�aquu of fhe DIA far avr�aae ver�talire.
I�o IFeneby cerif n�er dYe�s mui penaNi�ojperfwry thot tA�e b�forNee�loe prav�ded abov�e is a�rre a�rrd ceon�
A � �+
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Print name �+ Phone# �6�'1�6 ~ �.,��
e�iai ax on�y aa�ot wdte ia rhia ara ce ne os�piaed by dtY or ln.n s�d�al
dly or tewn: p�g ("�soid�e p�t
❑e4eek if�emmedhle reapsese b neqa'ved �g�
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' THE COMMQNWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
� PERMIT NUMBER: #07-067 FEE: $75.00
This is to Certify that __ Beachwood C'ondo inium a o iation
638 Route 28_ West Yarmouth, MA
IS HEREBY GRAN�ED A�'ERMIT
i'
To Operate a Public, Semi-Public Swimming or Wading Pool
! At Beachwood Condominium Association -OUTDOOR POOL
j 63 8 Route 28
j West Yarmouth,MA
This pennit is grant�in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31_2007 unless sooner suspended ar revoked.
Anril 2.2007 BOARD OF HEALTH: B �. ,�j�o�,/�f.,$., •
e/��fe������s��ils�Qli, R.N.�,/'?/�u�;e G�lu-�sr�si
"Restrickion:Safe�y npaR must be submitted affivally with applic�tion. K/}(�'9'�.L�i�� (�B/J/e
Boazd of Heattt►Hearins;06/21/99-Do not nced CPR, /+G�IC��a��/� y
First Aid and Water Safety ceatificatiaos. 1QftIL�hBP�L�LpI� KJI.
i
�
t
:� Dir�tor•olf Halth •,
i
,
• , • K C1t.:�'"l8?0 �1�:5�� G� G �� o °O:.
^R TOWN OF YARMOUTH BOARD O �H
�2 j --yc
APPLICATION FOR LICENSE�`'E -20�6 D E C 2 2 2005
o;- •;'� p ,. � �� �
* Please complete form and attach all necess�ry d�c�ments by Dec ��,�.EPT.
Failure to do so will result in the retutn of your application p . �
�E�'P��S�:'�' Qea c,�oo Co h(�e�n cp�u�r+�1 ��' �_'��so8- .8f-�3'�' '
, _.,� : �3�ES�: 8 ?8 So v�� Y � o �l m�
�5�:` 5 ��✓ n'I �2 7
;= -
"�t�1�1��{�������}:
� ����� Qo N srr�2R - .��.. 8- -
. w�,�n�l�h �e,���, D�/vf , So�t l� Y�t�����1� A'i�o O ZG G 4 ;
_�y ;
POOL CERTIFICATIONS: �
The pool supervisor must be certified as a Pool Operator,as required by State taw. Please list th�designated
_Pool Dperator�s�and attach-�r.opy of the-certif c�ion t�t�is farcn. __ _— _ �
_ ___ �
1. ��o /T�h�n Ol,x.� S�� on 2. '
�
Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid and
Community Cardiopulmonary Resuscitation(CPR}. Plea.se list these employees below and attach copies of employee ';
certifications to this form. The Health Department will not use past years' records. You must provide new �
copies and maintain a file at your place of business.
�
1. 2. �
3. 4.
FOOD PROTECTION MANAGERS - CERTIFICATIONS: ;
All food service establishments aze required to have at least one full-time employee who is certified as a Food �
Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. ;
Please attach copies of certification to this application. The Health Department will not use p�st years' records. �
You must provide new copies and maintain a file at your establishment.
E
1. 2•
PF,�SQL�I IN _ __ _ __;
�NARC`TE:--- _ -- - - - --- -- -- _ _
Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation. '
1. 2-
HEIlI��CH CERTIFICATIONS: '
All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich ;
Maneuver on the premises at all times. Please list your employees trained in anti-chokmg procedures belaw and �
at�a.e�i�opies of employee certifications to this form. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your place of business.
1. 2.
3. 4.
RESTAURANT SEATING: TOTAL#
4FFICE USE ONLY
LODGING:
LICENSE REQUIRED FEE PERMIT# LICENSE REQtIIItED FEE PERMIT# LICENSE REQUIRED FEE PF1tMiT#
�B $50 I CABIN $50 ��L�--�� ._MOTEL $50
INN $50 CAMP $50 I SWIlvIlvIING POOL�75ea. ,=��/
LODGE $50 _TRAII,ER PARK $50 WHTRLPOOL �75ea.
FOOD SERVICE:
LICENSE REQUIRED FEE PERMIT# LICENSE I2EQUIItED FEE PERMIT# LICENSE REQUIRED FEE PERNIIT#
0-100 SEATS $75 CONTINENTAL $30 NON-PROFIT $25
>100 SEATS $150 _COMMON VIC. $SO WHOLESALE $75
RETAIL SERVICE:
LICENSE REQUIRED FEE PERMTf# LICENSE REQiJIIZED FEE PERMI f# LICENSE REQUIl2ED FEE PERMIT#
_<50 sq.ft. $45 >25,000 sq.ft. $200 _VF.NDING-FOOD $20
li OZEN DESSERT $35 `TOBACCO �25
� _Q5,000 sq.ft. $75 —�
I NAME CHANGE: $10 AMOUNT DUE = S 12S•�
� PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM•""""
AR1k1lR
�
�
�
�
i
i
I ' �
ADn�IINISTRATION
Under Chapter 152, Sectian 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal
of any license or permit to operate a business if a person or company does not have a Certificate of Worker's
Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
' AFFIDAVIT MUST BE COMPLETED AND 5IGNED, OR
; Q�
1 CERT. OF INSURANCE ATTACHED
�
OR
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED
i
� Town of Yarmouth taxes and liens must be paid p or to renewal or issuance of your pernuts. ' f '�'"��1
���'����'�:
YES NO
NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETiJRN
TI-�COMPLETED APPLICATION(S)AND REQUIKED FEE(S)BY DECEMBER 31, 2005.
� SEASONAL ESTABLIS�IMENTS ARE TO CONTACT THE HEALTH DEPARTMENT FOR INSPECTION 7-
� 10 DAYS PRIOR TO OPENING FOR TI� SEASON.
,
� ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIl'MENT,ETC.),MUST BE REPORTED TO AND APPROVED BY TI�BOARD OF HEALTH PRIOR TO
COl�R�NCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN.
�
i, �
I
j ADDITIONAL REGULATIONS �
,
,
' POOLS
i
�
;
POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be inspected !
� by the Health Department prior to opemng. �
r ;
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a State certified lab, prior to opening, and quarterly thereafter. �
f
POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of �
closing.
FOOD SERVICE
CONSUMER ADVISORY:
Each food establishment wluch serves or sells ready-to-eat,raw or undercooked animal products are required to post
Consumer Advisories.
CATERING POLICY•
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required
Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtauied at the
Health Department. ,
FROZEN DESSERTS:
- - Frozen desserts mustb�tested on aYrramnly-basisfiy a State certifie+�ia�. �st results-must �h--
Department. Failure ta do so will result in the suspension or revocation of your Frozen Dessert Permit until the
a bove terms have been met.
OUTSIDE CAFES:
Outside cafes{i.e., outdoor seating with waiter/waitress service},must have prior approval from the Board ofHealth.
OUTDOOR COOKING: �
Outdoor cooking,preparation, or display of any food product by a retail or food service establishmerrt is prohibited.
�
� ���
DATE: Oec�,,,�.- l9 Zvo_� SIGNATURE:
-�
PRINTNAME&TITLE:��Q� F- �',�l�e�iar� Pres�dpnf
09l28/OS
r
BEACHWOOD CONDOMINIUM ASSOCIATION
Dan Callahan, President, 508-285-3037, S Gary Road, Norton, MA 02766
Ronald Gramazio, Vice President, 508-362-7126, P.O. Box 234, Cummaquid, MA 02637
Liz Forance, Treasurer, 508-790-2267, 557 Ocean Street, Hyannis, MA 02601
Meredith Keane, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02301
December 19, 2005
Town of Yarmouth �
Board of Health i
1146 Route 28
South Yarmouth MA 02664-4451
Attn: Mary Alice Florio '
Re: Workers Compensation
Dear Mary Alice;
I am responding to 2006 Application for License/Permit. In particular to the
Workers Compensation Affidavit or Certificate Insurance.
We at Beachwood Condominiums do not employ any workers requiring said
coverage. We are privately owned and do not function as a business.
Thank you for your considerations
Sincerely,
G'� '
Daniel F. Callahan, President
BEACHWOOD CONDOMINIUM ASSOCIATION
Dan Callahan, President, 508-285-3037, 5 Gary Road, Norton, MA D2766
Ronald Gramazio, Vice President, 508-362-7126, P.O. Box 234, Cummaquid, MA 02637
Liz Forance, Treasurer, 508-790-2267, 557 Ocean Street, Hyannis, MA 02601
Meredith Keane, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02301 "
December 19, 2005
i
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Mr. Bruce Murphy �
�
Director of Health j
Town of Yarmouth �
1146 Route 28 '
South Yarmouth, MA 02664-4451
Re: Pool Usage Variance
Dear Mr. Murphy;
The Board of Directors of the Beachwood Condominium Association would like
to submit a request for the re-issuance of a variance to utilize the swimming pool at our
complex for the 2006 suxnmer season. As previously recorded we are an owner run
complex, with only rentals being allowed usage of the pool if they posses the three
certificates (CPR, First Aid, and Water Safety). We do not operate in the same vain as a
MoteL '
This will be our fourth request for such a variance and to date we have maintained
what we perceive to be an acceptable operation. I certify that again in 2005 we
maintained our continuing safety record of no accidents and/or incidents detrimental to
the intended use of the previously issued variance.
In 2005 we were serviced by Dave Stevenson from Pooltechnics. We will again
be utilizing Dave in 2006. '
Respectfully Submitted,
��„ --�. �'���
Daniel F. Callahan, President
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THE CONIl��IONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BQARD UF HEALTH
PERMIT NUMBER: #Q6-006 FEE: $SO.QO
This is to certafy that Beachwood Condominiums
638 Route 28 West Yarmouth MA
HAS BEEN GRANTED A LICENSE TO
OPERATE CABINS
This License is issued in confornuty with the authority granted to the Board ofHealth,by.Chapter 140,Sections 32A,32B,
32C,32D and 32E as amended,and is subject to the provisions of the Laws of the Commonwealth of Massachusetts relating
thereto,and upon such terms and conditions,and to the rules and regulations in regard to said Cabins so licensed as adoptsd
by the Board of Health,and expires December 31,2006 unless sooner suspended ar revoked.
Feb 2.2006 BOARD OF HEALTH: ����� ��e e •�u�st
Rodent� �no�, C�
� /�c�c�/�c�Se�imo�
�t��j'�ee�ux, R./V.
0
Bruce G. Murphy, , S.,CHO
Director of Health
�
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_ _ _ .,r __ _F._ --- t_...�_
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O�.Y``�I�,,� ��,�, ,
�� .- . � TOWN OF Y � RMOUTH
�, �-_, `� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
�MAT7ACHEES �
°`��4o�A,to�6�'� �I'elephone (508) 398-2231, Ext. 241 — Fax (508} '760-3472
B O A R D O F H E A L T H
; To: Yarmouth Board of Health Permit Holders r-.--��---�!
'' i � 2 - . ��
From David D. Flaherty Jr.,RS. ;��r M1�, ;, #
Health Inspector ✓ " `��'�
' Town of Yarmouth H�qLT� ���,-�-
; Re: Federal Tax ID Number
�
D��: Mazch 22,2045
The Massachusetts Department of Revenue is now requiring that we furnish detailed information
to them regarding all permits and licenses that we issue. One of the details that they require we
send to them is every estabiishment's Federal Empioyer ldentification Number(FEIN}otherw�se
lrnown as your"Tax ID Number". This is purely for administrative purposes only.
Some businesses use the owner's Social Security Number (SSN} for this purpose, If this is the
case for your establishment, be assured that we will not allow this information to be public
record
;
Please fill out the fields below and return this letter to
�
Yarmouth Health Department
1 I46 Route 2$
South Yarmouth,MA 02664
Tha.nk you for your anticipated compliance. If you l�.ve any questions regarding this matter,
please do rc>t hesrtate to c�tl. T'he of�ce hau�s �-�A��r�day to Friday, �;30 a.an. tc 4:��J p.m �
telephone number is{508) 398-2231,ext.241.
Establishment: 13 (on c�o M�navms FEIN or SSN: _� -
Location Address: �a� �a�n s j f�;�
Signa.ture:_�����_���
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I�iOI,LVN LSII�IINiQ�
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BEACHWOOD CONDOMINIUM ASSOCIATION
Dan Callahan, President, 508-285-3037, 5 Gary Road, Norton, MA 02766
Bob Astle, Vice President, 508-587-1077, 638Rt 28, Unit 3, W. Yarmouth, MA 02673
Liz Forance, Secretary, 508-790-2267, 557 Ocean Street, Hyannis, MA 02601
Jonathan Sides, Treasurer, 203-269-9883, 12 Deer Run Road, Wallingf'ord, CT 06492
Meredith Keane, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02301
� December 27, 2004
Mr. Bruce Murphy
Director of Health
Town of Yarmouth
1146 Route 28
South Yarmouth, MA 02664-4451
Re: Pool Usage Variance
Dear Mr. Murphy;
The Board of Directors of the Beachwood Condominium Association would like
to submit a request for the re-issuance of a variance to utilize the swimming pool at our
complex for the 2005 summer season. As previously recorded we are an owner run
complex, with only rentals being allowed usage of the pool if they posses the three
��S� certificates (CPR, First Aid, and Water Safety). We do not operate in the same vain as a
�,� Motel.
w��
� This will be o_ur third request for such a variance�n�l to date w�have maintained
�k-��S- - _ ;
� what we perceive to be an acceptable operation. I certify that again in 2004 we
maintained our continuing safety record of no accidents and/or incidents detrimental to
the intended use of the previously issued variance.
In 2004 we were serviced by Dave Stevenson from Pooltechnics. We will again
be utilizing Dave in 2005.
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Respectfully Submitted, :
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Daniel F. Callahan, President �
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BEACHWOOD CONDOMINIUM ASSOCIATION
, Dan Callahan, President, 508-285-3037, S Gary Road, Norton, MA 02766
Bob Astle, Vice President, 508-587-1077, 638Rt 28, Unit 3, W. Yarmouth, MA 02673
Liz Forance, Secretary, 508-790-2267, 557 Ocean Street, Hyannis, MA 02601
Jonathan Sides, Treasurer, 203-269-9883, 12 Deer Run Road, Wallingf'ord, CT 06492
Meredith Keane, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02301
December 27, 2004 �
Town of Yarmouth
Board of Health
1146 Route 28
South Yarmouth, MA 02664-4451
Re: Workers Compensation
We at the Beachwood Condominiums are a privately owned condominium and do
not have any employees requiring the above-described coverage. Therefore no Affidavit
or policy is in effect.
Thank you for your assistance.
Sincerely,
- - -- Daniel F, Callahan, President
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� JUL 0 5 2005
BEACHWOOD CONDOMII�TILTM ASSOCIATION HEALTH DEPT.
Dan Callahan, President, �08-285-3037, S Gary Road, Norton, MA 02766
Bob Astle, Vice President, 508-587-1077, 638Rt 28, Unit 3, W. Yarmouth, MA 02673
Liz Forance, Secretary, 508-790-2267, 557 Ocean Street, Hyannis, MA 02601
Jonathan Sides, Treasure��, 203-269-9883, 12 Deer Run Road, Wallingford, CT 06492
Meredith Keane, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02301
July l, 2005
Town of Yarmouth
Board of Health
1146 Route 28
South Yarmouth, MA 02664-4451
Re: Pool Usage Policy
Mr. Murphy;
As requested I am forwarding this letter to outline our procedures for enforcing
the Rules and Regulations pertaining to the usage of the pool at our Beachwood
Condominium Complex.
Our main control is the regulation that only owners are eligible to utilize the pool.
Tenants are not to be poolside, unless accompanied by the owner of the Unit. It has never '
happened, nor do we anticipate that things should change, that an owner is on site
utilizing the pool with a tenant. '
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I know Unit#25 is a concern, but as tenants the pool is not available to these
occupants. In addition Mr. Rudnick has been issued a notice from the Board of Managers
to evict these people. �
The owner of Unit#3 is retired and lives adjacent to the pool. He is there on a i
regular basis and is the priinary authority for evaluating who is utilizing the pool as well '
as the behavior of the authorized owners. As owners we are respectful of the facility and `
there has never been an occasion to discipline anyone for behavioral problems. i
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The following is the list of the Units that are eligible to be at the pool.
Unit's l, 2, 3, 4, 6, 1 l, 12, 13, 14, 15, 16, & Unit#19.
These are all Owner Occupied, but rarely is there more then six or so Owners
down there at the same time.
Thanlc you for your assistance. �
Sincerely,
��
Daniel F. Callahan, President
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THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBER: #OS-003 FEE: $50_00
i
� This is to certify that Beachwood Condominiums
� 638 Route 28 West Yarmouth MA
1
? HAS BEEN GRANTED A LICENSE TO
4PERATE CABINS
This License is issued in conformity with the authority granted to the Board of Health,by Chapter 140,Sections 32A,32B,
32C,32D and 32E as amended,and is subject to the provisions of the Laws of the Commonwealth of Massachusetts relating
thereto,and upon such teims and conditions,and to the rules and regulations in regazd to said Cabins so licensed as adopted
by the Board of Health,and expires December 31,2005 unless sooner suspended or revoked.
_ January 26.Z005 BOARD OF HEALTH: Be�rr�r��. (�'r�o�s,/�f.�,
A�tsc�a A�lc�` e�ok`, ?lsce C�icar�rirass
��l�l�, R./V.�
�4�4'���, R./V.
ruce G.M�uPhY, S.,CHC)
Director of Health
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBFR: #OS-036 FEE: $75.00
Tlus is to Certify that Bea.chwood (".ondominiLma
b38 Route 28 West Yarmouth,MA
IS HEREBY GRANTED A PERNIIT
To Operate a Public, Semi-Public Swimming ar Wading Pool
At Beachwood Condominiums - OUTDOOR POOL
638 Route 28
West Yarmout MA
This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
e�ires December 31.2005 unless sooner suspended or revoked.
January 26 2005 BOARD OF HEALTH: B twy�. •
/��11�Ic$���C�ru-.�rs
=Re�i�aon:saf«y�e�t must be su��uY wirn applicati�. RoGwJlt�:B?o((�iL, G�le,t�
Board of Health Hearing,06/21/99-Do not nced CPR, �g�fy ��y� R�/
First Aid and Water Safety certifications• ��y f� � R�
7
ruce G.M hY, , .,
Director of Health
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� ' � � � 41 (� DD
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OF_Y'qk �'�. n_
2 e: �a TOWN OF YARMOUTH BOARD OF HEA
o,_ -'�y APPLICATION FOR LICENSE/PERMI U�C 2 4 2003
r ,,.;? �
* Please complete form and attach all necessary docur�nt��; e Fembe�3-1 C7EPT.
Failure to do so will result in the return of y��jp��c� 'on packet.
_ s�-� 7'
LaCATION ADDRESS: Co 3 Rou1'�. 28 v✓es� Y�rmo�h . MA
LVIA��ING ADDRESS• 5 (�, a r Renrrl � Na�tronl /''1A �2'7Co Co
QWNER/CORPORATION NAME•
M�ZIAGER'S NAME• �.n Gal l�,hQ n T # 781 389-��B2']
--- INGADDRESS: S ('�,�hT.Rnr� c� I�/t�Fttv�J MA !�2?Lo�,
POOL CERTIFICATIONS•
The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated
�I I�ovl aper�a�or�s�an�attac�a copy of the certification to this fUrm.
1. To M �� 2.
Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid
and Community Cardiopulmonary Resuscitation (CPR). Please list these employees be�ow and attach copies of
employee certifications to this form. The Health Department will not use past years' records. You must
provide new copies and maintain a file at your place of business.
1. �an �iA,l�a,�n CP��jiden� -no emplaye�l� 2.
3. 4.
FOOD PROTECTION MANAGERS - CERTIFICATIONS•
All food service establishments aze required to have at least one full-time employee who is certified as a Food
Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000.
Please attach copies of certification to this application. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your establishment.
1. 2.
_ __ _
- _ __ _ — _ =-- - _ -- --._ - _ ._ ,
-PERSON IN CHARGE: . '
Each food establishment must have at least one Person In Charge(PIC)on site during hours of operation.
l. 2. :
HEIMLICH CERTIFICATIONS:
All food service establishments with 25 seats or more must have at least one ernployee trained in the Heimlich
Maneuver on the premises at all times. Please iist your employees trained in anti-choking procedures below and
attach copies of employee certifications to this form. The Health Department wilt not use past years' records.
You must provide new copies and maintain a fle at your place of business.
1. 2.
3. 4.
R��TAURANT SEATING: TOTAL#
OFFICE USE ONLY
_L,ODGING:
LICENSE REQUIRED FEE PERMIT# L[CENSE REQUIRBD FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
_B&B $50 �CABIN $50 �—OOS _MOTEL S50
_INN $50 lCAMP $50 I SWIMMTNG POOL S75ea. ��3
_LODGE $50 _TRA[LER PARK $50 _WHIRLPOOL $75ea
FOOD SERVICE•
LICENSE REQUIRED FEE PERMIT# UCENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
0-]00 SEATS S75 _CONTINENTAL $30 NON-PROFIT a25
>100 SEATS $150 _COMMON VICT. S50 _WHOLESALE $75
RETAIL SERVICE•
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE R�QUIRED FEE PERMIT#
_<50 sq.ft. $45 _>25,000 sq.ft. $200 VENDING-FOOD $20
<25,000 sq.ft. $75 _FR07EN DGSSERT $35 _TOBACCO �25
NAME CHANGE: $to AMOUNT DUE _ $ t 2,5•OO
**k**PLEASE TURN OYER AND COMPLETE OTHER SIDE OF FORM***"*
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ADMINISTR.ATION '
Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal '
of any license or permit to operate a business if a person or company does not have a Certificate of Worker's E
Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE
AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR
CERT. OF INSURANCE ATTACHED � l
� ° e"'P�'s'ee� .
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK
APPROPRIATELY IF PAIDa '
YES`� NO
[
NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2003.
SEASONAL ESTABLISHMENTS ARE TO CONTACT TH�HEALTH DEPARTMENT FQR INSPECTION 7-10
DAYS PRIOR TO OPENING FOR THE SEASON. '
,
ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW ';
EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN.
�1DDITIONAL REGULATIONS �
`s
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POOLS
POOL OPEI�TING:All swimming,wading and whirlpools which have been closed for the season must be inspected
by the Health Department prior to opening.
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a State certified lab,prior to opening,and quarterly thereafler.
POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of
closing.
FOOD SERVICE
CONSUM_F.R A�VISORY:
Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post
Consumer Advisories.
CATEIZiNG POLIC�;,.
Anyone who caters vv�thin the Town of Yarmouth must notify the Yarmouth Health Department by filing the
required Temporary Food Service Application form 72 hours prior to the catered event. Thses forms can be �
obtained at the Health Department. �
_ FRI17fF�iIFCCFi2TC• -- ___ _ _ ___ — _ _ _ _. __ . _ — -- �
Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health '
Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the
above terms have been met.
OUT�JD� C�FFS:
Outside cafes(i.e.,outdoor seating with waiter/waitress service),�have priar approval frozn the Boazd of Health. "
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OUTDOOR COOI�NG: �
Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. �
4
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DATE: /2�i3 t� SIGNATURE: � -
PRINTNAME& TITLE: �n��e,� I', �q,�jQ�Q,� Pre.��dtn�`
r ,
10/22/03
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BEACHWOOD CONDOMINIUM ASSOCIATION
Dan Callahan, President, 508-285-3037, S Gary Road,Norton, MA 02766
Robert Francis Astle, Vice President, 508-778-1077,
Beachwood Condominiums, 638 Main Street, Unit#3, West Yarmouth, MA 02673
Marina Guidetti, Secretary, 508-339-7855, 333 Balcon Street, Mansfield, MA 02048
Jonathan Sides, Treasurer, 203-269-9883, 12 Deer Run Road, Wallengford, CT 06492
Meredith Keane, Member at Large, 508-587-2379, 56 Oscar Avenue, Brockton, MA 02302
February 23, 2004
Town of Yarmouth
Board of Health
1146Route28 � � � � a � � D
South Yarmouth, MA 02664-4451
Attn: Mary Alice Florio FEB 2 4 2004
Re: Workers Compensation HEALTH DEPT.
Dear Mary Alice;
We at the Beachwood Condominiums are a privately owned condominium and do
not have any employees requiring the above-described coverage. Therefore no Affidavit
or policy is in effect.
Thank you for your assistance.
Sincerely,
����n�//,�yf-��, �l�,G�?►'�
Daniel F. Callahan, President
i
BEACHWOOD CONDOMINIUM ASSOCIATION POOL RULES AND
REGULATIONS
1. The pool season will be from Saturday, June 19,
2004 (tentative) thru Sunday, September 27, 2004 .
2 . The pool hours of operation will be from 10 : 00a.m till
8 : OOp.m.
3. The authorization for use of the pool is limited to
the pool and the immediate adjacent area only. The wood
deck will not be utilized. Any use of this deck will be
considered a violation of these Rules and Regulations .
4. The authorized users will be Owners and their
immediate family and/or guests accompanied by the owner or
the immediate family member.
Tenants will be allowed pool privileges, and will
receive a key from the Board of Managers, when they provide
to the Board of Managers a valid CPR certificate, a valid
First Aid certificate, and a valid Town of Yarmouth Water
Safety certificate. Tenants eligible for consideration of
pool privileges are only those tenants listed on the lease
provided to the Association. In addition only those tenants
listed on the lease may accompany an authorized tenant in
the pool area. Authorized tenants may not invite guests to
the pool area and may not invite tenants from other Units
to the pool area. Owners that do not want this privilege
afforded to their tenants must put this restriction in the
lease and notify the Board of Managers of this clause.
For all Units the Treasurer must verify that all
monies owed to the Association for said Unit are paid in
full and a current lease is on file with the Association.
Only two keys will be issued per Unit.
If at any time during the season an owner, guests
and/or tenants should become delinquent in maintaining
their positive status with the Association all privileges,
for the owner and/or the tenant will be revoked until such
time as the specific shortcomings are rectified.
5. The minimum age for any person unaccompanied by a
responsible adult is 18 years of age.
i
6. The pool gate will be locked at all times, even when
the pool area is occupied by users. Each entrant as well as
each user departing will be responsible to assure that the
gate is locked behind them. Under no circumstances is a
user to open the gate for another party. It is each
individual' s responsibility to provide their own key and to
police themselves.
7 . All users and guests are required to sign in and out
of the pool area. A log book will be provided for this
function.
8. If an authorized user should leave the pool area for
any reason (including to utilize lavatory facilities) all
parties in the pool area with that authorized user then
become unapproved users and must leave with their host.
9. Although it is strongly recommended that no individual
swim alone (alone being without another responsible adult
accompanying them) any person possessing the three required
certifications will not be held to this requirement. All
non-certified users will require a responsible adult
poolside at all times while utilizing the pool for
recreational purposes .
10. Any perceived violation of these Rules and Regulation
will be submitted to the Board of Managers by the person
interpreting the offense. The Board of Managers will review
the submission with both the submitter of the complaint and
the party against whom the complaint has been lodged. If
the Board of Managers after conferring with both parties
deem that a violation has occurred Article 11 will be
invoked. There will be no appeal process for this
proceeding.
1
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� 11 . Any violation of these rules and re ulations will
� g
result in the following penalties:
FIRST OFFENSE: 24 Hour Suspension from
Privileges .
SECOND OFFENSE: $50 . 00 Fine. *
THIRD OFFENSE: Revocation from pool privileges
for the remainder of the season
as well as $100 . 00 Fine. *
*Monetary fines will be assessed to the Owner of
the Unit in Violation.
RF�'M�ER UTILIZATION OF THE POOL UNDER THESE GUIDELINES ARE
A PRIVLEDGE OF THE VARIANCE AWARDED BY THE YARMOUTH BOARD
OF HEAI,TS. IN THE PAST THE POOL HAS BEEN UNDERUTILIZED. WE
ARE RESPONSIBLE OWNERS AND WILL BE TREATED AS SUCH UNTIL WE
PROVE OURSELVES OTHERWISE.
� . s
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THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
! PERMIT NUMBER: #03-085 FEE: $75.00
This is to Certify that Beachwood Condominiums
; 638 Route 28. West Yarmoutfi, MA
IS HEREBY GRANTED A PERMIT
To Operate a Public, Semi-Public Swimming or Wading Pool
At Beachwood Condominiums - OUTDOOR POOL
638 Route 28
West Yarmout MA
1
� This pennit is gi-anted in confrnmity with Article VI of the Sanitary Code of The Commoriwealth of Massachusetts,and
! expires December 31.2004 unless sooner suspended or revoked. -
February 5.2004 BOARD OF HEALTH: Be�tsn �. �oit, 1��. "
. p/����_`�����/���v����e��
*Aest�iction:Safety report must be submitted atmually with application. K`O,o�'_l��� `�►�. BhC�/M�L� (�ffB++jR
Board of Health Heating,06/21/99-Do naR need CPR, d�L �l�� iC�.
First Aid and Water Safely cer[ification4.
4
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� 1'1106 . Uip H,R. .,
Director of Heal
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YA►RMOUTH
BUARD OF HEALTH
PERIVIIT NUMBER: #U4-008 FEE: $50.00
This is to ce�tify that Beachwood Condominiums ,
638 Route 28. West Yarmouth, MA
HAS BEEN GR.A�tTTED A LICENSE TO
�
� '' OPERATE CABINS
This Lieense is issued in confc�rmity with the authority�ted to the Board of Health,by Chapter 140,Sections 32A,32B,
32C,32D and 32E as amead�,and is subject to the provisions of the Laws of the Commonwealth vf lvfassach�relaUng
thereto,and upon such terms and canditians,and to th�rutes a�d regulatioas in reg�to said Cabins�licensed as a�opted
by the Board qf Heatth,and eapires Deeember 3 2,20Q4 unless sooner saspended or revoked.
���a3.aoo� ao�o��,�: B�$. � �l.�l. .
P�A/o`.�1�ett, ?J:c+��ras�a
����G'l�
� R�tV.
ruce G. MuiPhY ,RS.,CHO
Director of He
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The Commonwealth of Massachusetts
� � Department ojlndustrial.-1 ccidents '
� o Of/ICOOI/�CSII�f�II�
� 600 Washington Street '
, �= B�ston.Mass. 02111
��'"' "�y V4'orkers' C�a:m�en��tion (nsurance Affidavit
Aoolicant information: p'IesseYltiNTTe�h'W� ';
namc� �.' �OM �e 1 C' C1�n�/'(Z�C� GUt �Gii �f. i'ZO
em �e
� � � � �� � � �i
' ` ' # I
� 1 am a homecwner pertorming all w�ork mysetf.
� f am a sole proprieror��.'. ha�e no one ��orkine in am•capacit�• '
� I am an employer pro�i�ing w�orkers' compensation for my emplo��ees workine on this job. �
-- . - - - _ _ i
compan�• name�
address
citv• ehone N• '
insur�nce co policy#
� i am a sote proprieror. zenerai contractor. or homeow•ner(circ/e onel and ha�•e hired the contractors listed below ��ho ha�e ,
the follo��in� ��orker� ,ompensation polices:
som a�nv n�me•
-ddress•
cin�- �}hone�t•
insur�ncc co Qolic�•#
somp,�ny name• — '
addres••
.;�• nhoee M•
insurance co R9�Y�
�
failure to secure covenge as�equired uoder Secnoo 2SA of MGL IS2 a�iad to the iopaitioa ot erisi�l peadtles of a O�e op to 51,500.00 a�d/or
one yean'imprisonment u w•ell a�civil pendda io the form of a STOP WORK ORDER asd�liee otS100.00 a dty apimt ma i udersta�d ebst a
copy of thy statement may be fonvarded to the 0fliee of lnveetigfdom of t6e DU for eoven�e veri8atio�.
I do hrreby cerrif}�under rhe pains and prnalties ojpery'�ry thqt ttie injornmtion providtd obov�t is tntt and eontet
Signaturc ��
Print name Phone M
., oRcial use onlv do not M rite in this�rea ta be completed by eiry or town oflleial
citv or town• Y�M�� _ permitAieeax a n8uildiog Department
' — �Lietosiog Board
�eheek if immediate response is required 261 QSdeetmen'�OlTiee
�Heatt6 Departmeot
;
contatt person: p��K;_ �508) 398�2231 ext. nOther
.. ._� :<a,.,
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i
BEACHWOOD CONDOMINIUM ASSOCIATION ��►� � 3 Z�03 i
Daniel F. Callahan, President HCALTH DEPT.
5 Gary Road
Norton, MA 02766
i
i
January 4, 2003
Board of Health ' �
Town of Yarmouth �,t
1146 Route 28 � v
South Yarmouth, MA 02664-4451 '�
Re: Request for Variance
Dear Mr. Murphy;
�
As President of the above described association I am requesting that
we be granted a variance from the Town of Yarmouth's regulation requiring
a pool attendant who is certified in Water Safety, CPR, and First Aid to be
on site during all pool operations. We feel we are justified in this request for ;
the following reasons. �
1. The pool is for the private use of owners, residents and guest ;
only and at no time are there any public uses allowed. Thus
the pool is similar in use to a residential (privately owned)
recreational appurtenance.
� 2. We maintain a tight security system by having the pool
secured by a gate locked with a combination lock. We
change the combination regularly and make the code known
to owners only. It is their responsibility to pass this code
onto tenants if they so desire. We feel this gives us complete
control over access whereas it is our opinion that a key
entry, even if non-duplicable, still allows the ability to pass
the key on with less effort then consistently having to update
�
�
the entry code. Also if an owner whishes to restrict the usage
of a tenant it is much easier to withhold the code then
retrieving the already issued key.
i
3. We are responsible and utilize Tom Ho to manage our pool f
for sanitary purposes. He vacuums the pool every five days �
and chemically treats it every three day. We keep a log of �
routine testing every time someone unlocks the facilities and
enters the pool area (even if that person has no intentions of ;
utilizing the pool). It is our health that is of concern to us
and we do not want to endanger ourselves or any guest.
4. We have strict usage regulations and anyone (owner, tenant,
or guest) violating our policy results in a fine levied against �
the owner. Unpaid fines automatically constitute denial of
pool privileges. ,
5. The minimum age for unaccompanied swimmers is 18 years ',
and is clearly posted at the entrance to the pool area.
6. Currently there are four owners and one tenant who are '
certified in all three requirements and, I being one of them,
have no intention of relinquishing the obtained
certifications. Admittedly we are not always on site, and we
do not feel that owners, tenants, and/or guest should be '
restricted to our schedule. We do oversee all usage when we '
are available.
7. Finally we are a privately owned complex, we do not rent by .
the day or weekend as do other businesses (which we feel ;
the regulations are adopted for) we are mainly utilizing our
privately owned pool. Requiring the certified personnel to
utilize our own investment establishes an unfair hardship on
the owners. We do not have the ability that a commercial
endeavor has to recoup our expenditures. These expenses
limit our ability to maintain the type of complex that is both
an asset to the owners and the Town of Yarmouth.
Any consideration you and your Board can afford us will be greatly
appreciated.
�
In closing I will make myself available for any meetings required to
evalu�te this request.
Thank you,
Daniel F. Callahan, President
t
; � .
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
; PERMIT NUMBER: #03-085 _ FEE: $75.00
�
;
' This is to certify that Beachwood Condominiums
638 Route 28 West Yarmouth, MA �
IS HEREBY GRANTED A PERMIT �<
To Operate a Public, Semi-Public Swimming or Wading Pool
At Beachwood Condomnuums - OUTDOOR POOL %
638 Route 28
,. , West Yarmouth MA .
This per�it is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of l�assachusetts,and
� expires:December 31,2003 unless sooner suspended or revoked.. _,
'; . ` March 10.2003 °, ; BOARD OF HEALT'H: ���s�, i��, 1��,.., _,
' $'e�c�a+riiK D. Ciozalor�, '�.2�.. `l/tee '
�'Restriction:Safety report must be submitted annualty with applicatioa. � f�0��. �?OQwlt.,�l� . �,
Board of HealU►Hearing,06l21/94-Ilo not�ed CPR, �Q�NC���rLs
First Aid and Water Safety certiScations. � i��'f..
ruce .Murp y, ,R. ., O
' Director of Healt
THE COMMONWEALTH OF MASSACHUSET�S:
,a
TOWN OF YARMOUTH :
BOARD OF HEALTH
PERMIT NLJMBER: #03-007 , _ FEE:$50.00
This is to Certiry that Beachwood Condominiums _
638 Route 28, West Yarmouth,MA - .
HAS BEEN GRANTED A LICENSE TO '
, OPERATE CABINS
This License is issued in confor�nity with the authority granted to the Board'of Health,b}t C3�apter 140,:Sections 32A,32B,
32C,32D and 32E as amended,and is subject to the provisions ofthe I.aws ofthe Commanwealth ofMassachusett�relating
thereto,and upon such terms and conditions,and to the rutes and regulatio�.in regard#A said Cabins so licensed as adopted
by the Boazd of Heaith,and e�ires December 31,2003 unless sooner suspended or revoked.
March 10,2003 BOARD OF HEALTH: (�`�f. �el�i, ��x�c
�'e.��a.�iiNc�. �6ozdaar. �/iee �afiurr�c
�a�it�. �'�toaoac. �
�aartek?�e'D�
�feleu S .72.
ruce G.Mu hy, S.,CHO
Director of Health
i - • �/��� "j/0� C9-r� 6�9c.(�FWo�a Coiv Dd.
i !� � , , .
i 4��; � TOWN OF YARMOUTH BOARD OF HEALTH ; .
; �� � 4'; APPLICATION FOR LICENSE/PERMIT-2002 = �
I • �. ��;,m Y:, ; ��� 1 7 L��1
. * Please complete form and attach all necessary documents by December 31, 2001. Failu�tn do so-?�vill res�lt in
I the return of your application packet. � - �
' AME OF ESTABLISH NT: n TEL. # � -? -
LO ION : 3 l�Ot�n �
MAILING ADDRESS: �a►'�C
WN R/ O
GER'S N A, TEL. # /-8 -
LIN RESS: � •
POOL CERTIFICATIONS:
The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated
Pool Operator(s) and attach a copy of the certification to this form.
1. Yorh �0 2.
Pool operators must list a minimum of two employees currently certified in basic water safety, standard First Aid
and Community Cardiopulmonary Resuscitation (CPR). Please list these employees below and attach copies of
employee certifications to this form. The Health Department will not use past years' records. You must
provide new copies and maintain a fde at your place of business.
1. Dc�.n CA.IIa,��n 2.� Z. �c�rQ»r�,
3. 4.
FOOD PROTECTION MANAGERS - CERTIFICATIONS:
All food service establishments are required to have at least one full-time employee who is certified as a Food
Protection Manager, as defined in the Sta.te Sanitary Code for Food Service Esta.blishments, 105 CMR 590.000.
Please attach copies of certification to this application. The Health Department will not use past years' records.
You must provide new copies and maintain a file at your establishment.
1. 2.
-- P�,RS�N I1�fi C'HAR�"iE:-_ _. -- _ _. -- - -=--—__ _ _ _____ _ .__--_ _
Each food establishment must have at least one Person In Charge(PIC) on site during hours of operation.
l. 2.
HEIMLICH CER'�IFICATIONS:
All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich
Maneuver on the premises at a11 times. Please list your employees trained in anti-choking procedures below and
attach copies of employee certifications to this form. The Health Department will not use past years' records.
You must provide new copies and maintain a file at�your place of business.
1. 2.
3. 4.
RESTAURANT SEATING: TOTAL#
OFFICE USE ONLY
LODGING•
LICEN3E REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
BBcB $50 � CABIN $50 �O o��3 _MOTEL $50
_INN $50 _CAMP $50 �SWIMMING POOL$SOeb��¢.���
LODGE S50 TRAILER PARK $50 WHIRLPOOL $25ea.
FOOD SERVICE:
LICENSE REQUIRED FEE �jtMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
_0-100 SEATS $75 ;� _CONTINENTAL $30 _NON-PROFIT $25
>100 SEATS SI50 =� COMMON VICT. $50 WHOLESALE $75
,--r — —
— �
RETAIL SERVICE: `�
LICENSE REQUIRED FEE PERMIT# � LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
_TOBACCO $20 `_<25,000 sq.ft. $75 _TOBACCO ` $20
_<50 sq.ft. $45 >25,000 sq.ft. $200 _FROZEN DESSERT$35
NAME CHANGE: $10 AMOUNT DUE _ $ /OD. OO
*****PLEASE TURN OVER AND COMPLETE OTHER SIDE OF FORM*****
1
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i
ADMINISTRATION - i
" I
. �
Under Chapter 152, Section 25C, Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal �
of any license or permit to operate a business if a person or company does not have a Certificate of Worker's i
Compensation"Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE '
AFFIDAVIT MUST BE COMPLETED AND SIGNED,OR
CERT. OFINSURANCE ATTACHED
�
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED
Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK
APPROPRIATELY IF PAID: f
YES V NO
NOTICE:Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 31, 2001.
SEASONAL ESTABLISHMENTS ARE TO CONTACT TI�HEALTH DEPARTMENT FOR INSPECTION 7-10
DAYS PRIOR TO OPENING FOR THE SEASON.
ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN.
ADDITIONAL REGULATIONS
POOLS
POOL OPEIVING:All swimming,wading and whirlpools which have been closed for the season must be inspected
by the Health Department prior to opening.
POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count
by a State certified lab,prior to opening, and quarterly thereafter.
POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within se�en(7) days of
closing.
FOOD SERVICE
CONSUMER ADVISORY:
Each food establishment which serves or sells ready-to-eat,raw or undercooked animal products are required to post
Consumer Advisories.
r.aTFR�NG POLICY:
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the
required Temporary Food Service Application form 72 hours prior to the catered event. Thses forms can be
obtained at the Health Department.
_ _--_ __ - - _------ ------- —----- -_ _ __ _ ------___ _
FROZEN DESSERTS:
Frozen desserts must be tested on a monthly basis by a State certified lab. Test results must be sent to the Health
Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the
above terms have been met.
OUTSIDE CAFES:
Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Health.
OUTDOOR COOKING:
Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited.
G�� �/� /
DATE: 1 Z !0 p � SIGNATURE: ,� � �' L-/i'���'��'^�
PRINTNAME& TITLE: !,'ani�� �. (�t.��ahCJ� /J���.r�den�
09/11/O 1
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• Jun-YA-200Z Of:lip� Fra- . T•IZ2 P.D02/002 F-T2T
DeP�rlwrenl of lndr�trial.�tttld�n
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690 WmJ��1oN Stree�
B�ston.�11�u. 121!1
WOrken' Colnpeafaion IlqYesnee AAId� ��
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p I om �homeoMrnar per:orn�ing oii v�roric my�slf.
� I am a sole proprir�or 3r�ho�e no vne�orkin�in an�cspacieY
� 1 an+ an ernployer pto�i�ie���oNtKs' COenpelllOtion for my emplo}�s w'orlcin� shii job.
0 I �m �sols p�op��tior, genera!eeeer�eto�. d�ho��owner(clrcb on�� and h�tiY ired the coMractot�if�[ed below �ho ha�
the falluN•ingµ�orl��rt' �ompensacion policK:
.
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.u�.�ro��e�n ewer�p��n�.l►ee���er 9eNw t!A MCL 1�i a. u��IIM liM.M�rq�� ���
eu re�rs'i�piw�e�f u wd u d+�il pINIMq N IMt�e►*K�!'iOr M�K 4��u
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THE COMMONWEALTH OF MASSACHUSETTS
! TOWN OF YARMOUTH
� BOARD OF HEALTH
' PERMIT NUMBER: #02-003 FEE: $50.00
'rhis is to Certify t�at Beachwood CondonLin�i um
� 638 Mai_n Street/Route 28YWest Yarmouth_MA
HAS BEEN GRANTED A LICENSE TO
OPERATE CABINS
This License is issued'm canformity with the authority granted to the Board of Health,by Chapter 140,Sections 32A,
32B, 32C, 32D and 32E as amended, and is subject to the provisions of the Laws of the Commonwealth of
Massachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regard to said
Cabins so licensed as adopted by the Board of Health,and expires December 31,2002 unless sooner suspended or
revoked.
March 8 ,2002 BOARD OF HEALTH: , vZ��. ����a�ca�c
,� � �raar�c, �
�a�Ke+�'��os.xot'L�
��
Bruce G.Murp R.S.,CHO
' co 0
TAE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBER: #02-014 FEE: $50.00
'I1�is is to Certify that Beachwood Condominium
638 Route 28/Route 28 �Vest Yarmouth,MA
IS HEREBY GRANTED A PERNIIT
To Operate a Public,Semi-Public Swimming or Wading Pool
At Beachwood Condominium -OUTDOOR POOL
638 Route 28
West Yarmouth,MA
This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31.2002 unless sooner suspended or revoked.
�h s ,2002 Ba.�oF�ai.�: �'�D�C%�. .��;e
,�odait� �c, (�k
�adttek��r�rrot�
� s �n
ruce . y, , •,
Director of Health
1
� -� •, �I�ChV�.Y�C� CD rY.�OV�n���t,t�n=
�
TOWN OF YARMOUTH BUARD Q�'I�ALTH � (� � (� (s � M (� t�
� APPLICATION FOR LICE1��1�'�RMY'�'-200Q��j`�'�,
. ��� ;� , ��� ������ �� �� FE B 0� 7 2000
� *Please complete form and attach a11 necessary documents by Z?eceiCn�er 31, 1999�F u�����su in
the return of your application packet. '
------------------------------------------------------------ ----------------------------------------------------------------------------------•
F E ' � . # �'d,� ;
L AT . � ,
N
' � - #
��
D �
, .
POOL CERTIFICATTC�NS:
The pool�supervisor must be ccrtified as a Pool Operatar, as rer�uired by new State law. Please list the
desi�nated Pool Operator(s) and attach a copy of the certification to tlus form.
1. `��� Ry,,� 2.
� Pool operators must list a minimum of two employees currently certified in basic water sa.f'ety, standard First Aid
� and Community Cardiopulmonary Resuscitation (CPR). Please list these employees below and attach copies of
; employee certifications to this form. The Health Department will not use past years' records. You mus't provide
; new copies and maintain a file at your ptace of business.
�
1. ��'� 2.
3. ������ �P���-�, � .�.,�-� ' "'C�'"`"
�
All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich
Maneuver on the premises at a11 times. Please list your employees trained in anti-chokmg procedures below and
attach copies af employee certifications to this form. The Health Department will n t use past years' records.
' You must provide new copies and maintain a fde at your place of business. ���
�
1. 2.
3. 4.
_ RES'�'AURANT SE��G: 'FOTA�,-# -- NOA�SMB��TCr S�4TS:-�O�'A�.;#�---__-- -- --
--------___�_----------------------------------------------------------•---r------------------------------------------_--- -�------------•
OFFICE U.,�E O�L
LODGING:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
B&B $50 �CABIN $50 YZ.�,-q
INN $50 CAMP $50
LODGE $50 TRAII.,ER PARK $50
MOTEL $50 �SVV]QVINIING POOL $50ea. 2 C-
VVIi�LPOOL $25ea.
FQOD SE�VICE:
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT#
� 0-100 SEATS $75 �CONTINENTAL $30
� >100 5EATS $150 NON-PROFIT $25
_COMMON VICT. $50 � WHOLESALE $75
R�TAII. SERVICE:
LICENSE REQUIRED FEE PERNIIT # LICENSE REQUIRED FEE PERMIT#
�
_<50 sq.ft. $45 _TOBACCO $20
_<25,000 sq.ft. $75 FROZEN DESSERT $35
>25,000 sq.ft. $200
NAME CHANGE: $10
AMOUNT DUE = $__I ��---
*'""'PLEASE TURN OVER AND COMPLETE OTI�R SIDE OF FORM""""
1
r.�...=ry. ' I
'
� ,µ� ADMINISTRATION
UNDER CHAPTER�52, SECTION 25C, SUBSECTION 6, TI�TOWN OF YARMOUTH IS NOW REQUIRED
TQ H(3LD ISSUANCE bR RENEWAL OF ANY LICENSE OR PERMIT TO OPERATE A BUSINE=SS IF A '
P�RSO�T��EE.11�,,CQ,�P�A1�TY DOES N4T HAVE A CERTIFICATE OF WORKER'S COMPENSATIQN
INSUK�'NCE: 'THE���1�"TACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT '
MUST BE COMPLETED AND SIGNED, OR
CERT. OF INSURANCE ATTAC�D
� t
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED
TOWN OF YARMOUTH TAXES AND LlENS MUST BE PAID PRIOR TO RENEWAL OR ISSUANCE OF
YOUR PERMITS. PLEASE CHECK APPROPRIATELY IF PAID:
YES_� NO
NOTICE: PERMITS RUN ANNUALLY FROM JANUARY 1 TO DECEMBER 31. IT IS YOUR
RESPONSIBILITY TQ RETURN TI� COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY
DECEMBER 31, 1998. �
SEASONAL ESTABLIS�IlVIEN'TS ARE TO CONTACT'THE HEALTH DEFARTMENT FOR INSPECTION'1-10
DAYS PRIOR TO OPENII�TG FOR THE SEASON. '
ALL RENOVATIONS TO ANY FOOD ESTABLIS�-IlVIENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIPMENT,ETG.),MUST BE REPORTED TO AND APPROVED BY TI-�BOARD OF HEALTH PRIOR TO '
CONIN�NCEM�NT. RENOVATIONS Mt�Y REQUIRE A SITE PLAN.
ADDITIONAL REGULATTONS
POOLS
POOL OPENING: ALL SVVIlVIlVIING, WADING AND WHIRLPOOLS WHICH HAVE BEEN CLOSED FOR
THE SEASON MUST BE INSFECTED BY THE HEALTH DEPARTMENT,AND'THE WATER TESTED FOR
PSE�DOMONAS,TOT�4I:;COLI�4RM AND STANDARD PLATE C�UNT BY A STATE CERT�i�D LAB,
PRIOR TO OPENING, AND QUARTERLY TI-�REAFTER. .
POOL CLOSING:EVERY OUTDOOR iN GROUND SWIlvIlVIING POOL MUST BE DRAINED OR C4VERED '
WITHIN SEVEN(7)DAYS OF CLOSING.
FOUD SERVICE
�TERING POLICY:
ANYONE WHO CATERS WITHIN THE TOWN OF YARMOUTH MUST NOTIFY TI�YARMOUTH HEALTH
DEPARTMENT BY FILING THE REQUIRED TEMI'O1rARY FOOD SERVICE APPLICATION FORM 72
HOURS PRIOR TO TI-� CATERED EVENT. THESE FORMS CAN BE OBTAINED AT THE HEALTH
DEPAR.TMENT.
�ROZEN DE� S�
FROZEN DE5SERTS MUST BE TESTED ON A MONTHLY BASIS BY A STATE CERTIFIED LAB. TEST
RESULTS MUST BE SENT TO TI�HEALTH DEPARTMENT. FAILURE TO DO SO WII..L RESULT IN TI-�
SUSFINSION ORREVOCATION OF YOURFROZEN DESSERT PERMIT UNTIL THE ABOVE TERMS HAVE ,
- -
BEEN MET. _ _ „
OiJTSIDF CAFES:
OUTSIDE CAFES(i.e., OUTDOOR SEATING WITH WAITER/WAITRESS SERVICE), MLTST HAVE PRIOR
APPROVAL FROM TI�BOARD OF HEALTH. '
QUTDOOR COOKING:
OUTDOOR COOKING,PREPARATION, OR DISPLAY OF ANY FOOD PRODUCT BY A RETAII.OR FOOD !
SERVICE ESTABLISHMENT IS PR4HIBITED. �
DATE: �s�,� , 1-�, �D� SIGNATURE:
` \
PRINT NAME& TITLE: C-��,���,v� c�o�,�.ri ��,ti�c��n,�o _°� ���,���e,vti� �I
_
11l12/99
�
� . � 4-�; ��ct.�,a-.�. ''
The Commonwealth of Massachusetts � � "� �a�;,�,�
� � Department ojlndustrial.-�ccidents ��=> �.@' �-��._�. �,@,1;
J Of1IC0 0//OI�CSIlOfdllf ����,►> !,�.t�c����
- o C__ \ ,.
. ; 600 Washington Slreet �, , ������ '
' •� Bnston. �lass 02111 ���n��--`.�i J
�'~ '��y W'orkers' Compensation Insurance Affidavit
A,Rnlicant information: P'IeascPR�7'�7�r `a:, �-� �-(�
nam�:
locatian�
�� nhone�
� I am a homeowner pert�rming all w�ork myself. ;
� f am a sole proprieror ��,: ha�e no one ��orkin_ in am•capaciry
� I am an empio}er pro>idino workers' compensation for mv employees w•orlcir�e on this job. — - - �
comoan�• name•
address:
�ih" nhone H•
insurance co. policy#
� I am a sole proprieror. generai contractor. or homeowner(ci�cle onel and ha�•e hired the contractors listed below ��ho ha�e '
the follu��in� ��orker ;ompensation polices: '
com�anv name•
address•
tity: phone M•
insur�nce co. Folicy#
__ ___ comoany namr __I
ad d resr
c�: nhoee It•
insurance co. p�,y�f '
t
Failure to seeure coveraee as�equired uoder Secnon 2SA of MGL 152 n�lad to tbe iopaiUo�o(criei�f!pe�dtla ota O�e op to 51�00.00 a�d/o�
oae yean'imprisonment a�w•ell a�eivil peaalda io the form of a STOP WORK ORDER aad a tiae of 5100.00 a dar Kaiott me. I a�dersn.d ma�a
eopy of tha st�tement m�y be fonvarded to the Ofiice of Inveatigsdom of the DU tor eoven�e veritfatia.
/do hrreby cerrif}•under�he pains and prnal�ies ojperjury�har 16t injorniatinn provrdtd above is trrre and eorrtd
Signature Date
Print name Phone 1!
., olTicial use only do not..�ite in this a�ea to be completed by cih or town oAltial
ciry or town: YA��IITQ _ permitAieease M nBuiiding Departmeut
pLieeasiog Board
�check if immediate response ie required 261 �Selectmen's ORee
�Healt6 Depanment
contact person: phonrN:_ �508y 398-�?231 egt. nOther
.. < �,,;
THE COMMONWEALTH OF MASSACHUSETTS
• TOWN OF YARMOUTH
, BOARD OF HEALTH
PERMIT NUMBER: Y2K-9 FEE: $50.00
This is to Certify that Beachwood Condominiums
638 Main Street. West Yarmouth. M�
HAS BEEN GRANTED A LICENSE TO
OPERATE CABINS
This License is issued in conformity with the authority gcanted to the Board of Health,by Chapter 140,Sections 32A,32B,
32C,32D and 32E as amended,and is subject to the provisions ofthe L.aws ofthe Commonwealth of Massachusetts re(ating
thereto,and upon such terms and conditions,and to the rutes and regulations in regard to said Cabins so licensed as adopted
by the Board of Health,and expires December 31,2000 unless sooner suspended or revoked.
Februarv 8 ,2000 BOARD OF HEALTH: Ed� �et�ed, �iavuxa�
� F. .$�e�. �?Z. �/Ecc (�eelraica�c
�a�e�rt� ��toawr, ��
��s�oer�rim
�
Bruce G.Murphy,MPH, .S.,
Director of Health
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NLJMBER: . Y2K-79 FEE: $50.00
Z7►is is to certify that Beachwood Condominiums
638 Mam Street. West Yarmouth„ NLA
IS HEREBY GRANTED A PERMIT
To Operate a Public,Semi-Public Swimming or Wading Pool
At _ Beachwood CondomirLums -O TDOOR POOL
638 Mam Street
West Yarmouth.MA
1t►is pe�mit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31.2000 unless sooner suspended or revoked.
Februarv 8 ,2000 . BOARD OF HEALTH: EaG� '�u�ed, �(iavt�xc�i
� � s�K. ��t. v� ��
��� �
o -�
' Director of H�ealtt�i �
,
' ' TOWN OF YARMOUTH B ALTH �Q � �� � � �d D
.,��, , �, D
APPLICATION FOR�.I(� ,,�f�',� � ,�- 1999 ������ti`��,� �U N z 9 �9�g
� � ���
* �� �
Please complete form and attach ali necessary docum�nts`�y December 31, 1998. Failure t '11F��i',
the return of your application packet.
i -------------------T�--I------------ -- ��w__ -------------------------------------c�;�`�—.����,-r---�- _
b
O ATI N D , -Z��
��' LI
� _ �
ER' N �,
� � .
�
� F���...t"����;TION�• -------------------------��___�___________�
The poot supervisor must be certified as a Pool Operator, as rec�uired by new State l�tw. Please list the
designated Pool Operator(s) and attach a copy of the certification to tlus form.
;
�. Rf,c� �e-� �rcCas'K� 2.
i Pool operators must list a minimum of two�loyees currently certified in basic water safety, standard First Aid and
' Commuiuty Cardio�ulmonary Resuscitation( PR). Please fist these employees below and attach copies of emgloyee
, certifications to this form. The Heaith Departmeat will eot use p�tst yeara' r�cords. You must provide n�w►
' copiea and maintain a file at your ptace of buainess.�.
� 1. 0 SEr� � 2.
3. � 4.
,''
� HEIMLICH RTi�I ATION �
All food service establishments with 25 seats or more must have at least one employee trained in the Heimiich
i Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and
attach copies of employee certifications to this form. The Health Department will not use past years' recorda.
You must provide new copies and maintain a file at your place of business.
l. 2.
3. 4.
; RESTAURANT SEATING: TOTAL #
NON-SMOKING SEATS: TOTAL#
_______ �__________________��---------------------- '
------------------- --------------------_
; ___ — ---__ ,---—_----����.�;��i: _�, _ ---
. . 'ul't' ls�+• . _ . -....-.__ .. ___..._—. ... _.. ... ....
LODGIN�
LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERNIIT#
_B&B $50 �CABIN $50 9 ► Q
—.� $50 CAMP r $50
_LODGE $50 _TRAILER PARK $50
_MOTEL $50 �SUVININIINGPOOL $SOea. �—�Q3
FOOD SERVI .F• w�-P�OL $25ea,
LICENSE REQUIRED FEE PERNIIT# LICENSE REQUI1tED FEE PERNIIT#
_0-100 SEATS $75 CONTINENTAI, $30
_>100 SEATS $150 NON-PROFIT $2g
COMMON VICT. $50 WHOLESALE $75 '
�AII.SERVI • '
LICENSE REQUIItED FEE PERMIT# LICENSE REQUIRED FEE PERNIIT#
_<50 sq.ft. $45 TOBACCO
: $20
_<25,000 sq.ft. $75 ^FROZEN DESSERT $25 '
_>25,000 sq.ft. $200 �
NAMF C AN =F• $10
� AMOUNT DUE _ $_ '��� � 10��,"-�
""••"pLEASE TURN OVER AND COMPLETE QTHER SIDE OF FORM
.....
�
;
�
. ___� , ._ ___ _ -=--.� r .
e �
� � ADMINISTRATION
UI1iDE�C�HAPTER 152,"SECTION 25C, SUBSECTION 6,THE TOWN OF YARMOUTH IS NOW REQUIRED
T HQ��$�J��,�JR RENEWAL OF ANY LICENSE OR PERMIT TO OPERATE A BUSINESS IF A `
J
PE S�i`"��OMPANY DOES NOT HAVE A CERTIFICATE OF WORKER'S COMPENSATION
INSURANCE. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT �
MUST BE COMPLETED AND SIGNED, OR. ��- !
� �
CERT. OF 1NSURANCE ATTACHED
�
WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED
TOWN OF YARMOUTH TAXE5 AND LIENS MUST BE PAID PRIOR TO RENEWAL OR ISSUANCE OF
YOUR PERMITS. PLEASE CHECK APPROPRIATELY IF PAID:
YES NO ,X ,_
NOTICE: PERNIITS RUN ANNUALLY FROM JANUARY 1 TO DECEMBER 31. IT IS YOUR
RESPONSIBILITY TO RETURN 'THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY
DECEMBER 31, 1998.
SEASONAL ESTABLIS��NTS ARE TO CONTACT THE HEALTH DEPARTMENT FOR INSPECTION '.
7-10 DAYS PRIOR TO OPENING FOR THE SEASON.
ALL RENOVATIONS TO ANY FOOD ESTABLIS��VVIENT, MOTEL OR POOL (i.e., PAINTING, NEW
EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY'THE BOARD OF HEALTH PRIOR '
TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A SITE PLAN.
ADDITIONAL REGULATIONS
POOLS
POOL OPENING: ALL SVV�[MMING, WADING AND WHIltLPOOLS WHICH HAVE BEEN CLOSED FOR `
THE SEASON MUST BE INSPECTED BY TI-�HEALTH DEPARTMENT,AND THE WATER TESTED FOR
i�.�ii:;v,�v�ivi�'ii�vv.ci, i vir�ii.�t�ii�u��ivi tiivt�''i �JTiu�V�t�iti�' �''Lt'�1� l�.�J€lJ'ZV 1 IS��t1 f�[il�l.��Cl��i�j..�� +
PRIOR TO OPENING, AND QUARTERLY THEREAFTER.
POOL CLOSING: EVERY OUTDOOR IN GROUND SWIMNIING POOL MUST BE DRAINED OR COVERED
WITHIN SEVEN (7) DAYS OF CLOSING.
FOOD SERVICE ,
CATERING POLICY: '
ANYONE WHO CATERS WITHIN THE TOWN OF YARMOUTH MUST NOTIFY THE YARMOUTH
HEALTH DEPARTMENT BY FILING THE REQUIRED TEMPORARY FOOD SERVICE APPLICATION
FORM 72 HOURS PRIOR TO THE CATERED EVENT. THESE FORMS CAN BE OBTAINED AT THE
HEALTH DEPARTMENT.
FROZEN DESSERTS: '
FROZEN DESSERTS MUST BE TESTED ON A MONTHLY BASIS BY A STATE CERTIFIED LAB. TEST
RESULTS MUST BE SENT TO THE HEALTH DEPARTMENT. FAII.,URE TO DO SO WII,L RESULT IN
TI� SUSPENSION OR REVOCATION OF YOUR FROZEN DESSERT PERMtT TJIVTII,TI-�E A��VE T�ERMS �
HAVE BEEN MET. '
QUTSIDE CAFES: '
OLTTSIDE CAFES(i.e.,O[JTDOOR SEATING WITH WAITER/WAITRESS SERVICE),�T HAVE PRIOR I
APPROVAL FROM THE BOARD OF HEALTH.
OUTDOOR COOKING:
OUTDOOR COOKING,PREPARATION,OR DISPLAY OF ANY FOOD PRODUCT BY A RETAII,OR FUOD �
' SERVICE ESTABLISHMENT IS PROHIBITED.
p� `�,
DATE: �Q r� -\ SIGNATURE: '�J
PRINT NAME& TITLE: G �
��������
. � � �
The Conrmonwealth ojMossQchusetts
� � Department ojlndustrial.-1 ccidents
� o ofllceol/er��los�is
� 600 Washington Street
, ,,•� Bnston, Mass. OZlll
" �� W'orkers' Compensation lnsurance Affidavit
namr� �=Erf.,�`_i�.��>> � S
�
LQC1t1��1: lA�: �/=j-; �� \
�it� W �if'�� � Ov'�`l'��\Jul h o \\Wv ♦ l� �,�� phone� ��� "��e oZ." c�..���
� ( am a homeow�ner pertormin;all work myself.
� ( am a sole proprieror_�� hatie no one u�ori:ine in anv capacin�
� 1 am an empioyer pro�idins workers' compensation for mv employees workine on this job.
� vJ a wc e, a��q��a-�'�cs�-�- � �� d���.c ar� w��c�c h�c'� 1'�v��s��'�.�.
� .� _._ "
������5•
_
citv: � nhone q• '
insurance co, olicy#
, � I am a sole proprietor. generai contractor, or homeowner(circle onel and ha�•e hired the contractors listed belo� �tiho ha�e
the follu�.in_ �+orkzr�� ;ompensation polices:
com�anv n�tne: :
address• �
��'• phone 1!•
insur�nce co. Folicp# _
�Qmoanv namr.
z�dt_e�s:
�'� nhoee+��
insurance co. ��n,*
w
Failure to secure covenge as required uoder Secaoo ISA of MGL lS2 tae iad to t0e iopaitioe oluisi�fi peaaltles of a O�e op to 51�00.00 a�d/or
one vean'imprisonment as w•ell a�civii penaltia io tbe form of a STOP WORK ORDER aed a Ifae otS100.00 a d�y qainst ma t a•dersa.d ma�a
eopy of this statement may be fonvarded to the 011iee of Inveatig�tioo�of the DIA f�eoven;e verititatie�,
/do hrreby cenif}•under rhi poins and penalties ojperjury thal tht injornmtion provided abovt is tnte and corrtci
.
Signaturc ��31�
.
Print name one�l �Q� -- �G i�,`-' `o��
., otTiciai use onl� do not..rite in this area to be completed by ciN or towa oflleial
ciry or towe: Y�M�DT� _ permiNicense p nBuildiog Departmeot
pLicensiog Board
�cheek if immediate�esponse i�required 261 �Selectmen'�ORiee
(508) 398�?231 eat, �Healtb Departmeat
contact person: phone M;_ _,_ _ nOthtr
i
� , .
6
, THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBER: 99-10 FEE: $SO.QO
This is to Certify that__ Beachwood Condominium
_ 638 Main treet/Route 28 West Yairmouth, MA
HAS BEEN GRANTED A LICENSE TO
OPERATE CABINS
This License is issued in conformity with the authority granted to the Board of Health,by Chapter 140, Sections 32A,
32B,32C,32D and 32E as amended and is subject to the provisions of the L,avvs of the Commonwealth of Massachusetts
relating thereto,and upon such terms and conditions,and to the iules and regulations in regazd to said Cabins so licensed
as adopted by the Board of Health,and eapires December 31, 1999 unless sooner suspended or revoked.
June 29 , 1999 BOARD OF HEALTH: �d� �et�, ��rau
� �. .S�aF�va�c. �12., 7/ice (�u�
�a�t� b'�rouMc. L�
� .S -r�oufiied
�.C�
Bruce G. Murphy, MPH, . ., O
Director of Health
__ ._ e.�.___.._.��w___�__......,s._,_��.�.�.�.
THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NLJMBER: 98-103 FEE: $50.00
This is to Certify that Beachwood Condomnium
_ 63 8 Main Street/Route 28, Wect Yarmouth. MA
IS HEREBY GRANTED A PERMIT
To Operate a Public, Semi-Public Swimming or Wading Pool
At Beachwood Condominiums - O OOR POOL
63 8 Masn S reet/Roi�te 28
West Yarmo �th MA
This pernut is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires December 31. 1999 unless sooner suspended or revoked.
_ June 29 , 1999 BOARD OF HEALTH: Ed 71L. �et�, �4aGronast
� �a�rt �' ,�1Z., Y/ice elavc.xa.c
�
' S -?��
0;�'
nice
Director of H�ealt]i ' . ''
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_ The Commonwealth of Massachusetts
� W Department ojlndus�rial.-lccidents
� o olllce o/%s�/�sdiis
600 Washington Street
� Boston, Mass. 02111
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"' "� W'orl:ers' Compensation Insurance Atfidavit
A�olicant information: PtessePRINTTed��
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nam�� �E� G�IDL�D (�/��/��C.%N/GC./7�'
location: ���V Lr���
cit� 1�,�� � �i �LC./ i� �,�'• phone# ��I�-
� I am a homeowh r pertorming all work� //
�(am a sole proprietor�:;� ha�e no one��orking in am�capacity —� v �71i0
� I am an employer pro�iding w�orkers' compensation for my employees w•orking on this job.
�Om�ny name•
�ddress• /Y��F-
. T�
��•• phone q•
insur�nce co policy#
� I am a sole proprieror. general contractor, or homeowner(circle one/ and ha�•e hired the contractors listed below ��ho ha�e
the follu��in� ��orkzr� ;ompensation polices:
c9m a�nv name•
:.ddress•
�Sy' phone�• -
insur�ncc co policy#
som a�n,y�ame•
_ __ __ __ _-- - _ __ _ _ _ _ _ _ _ — —-_ ;
addr�ss• - —
sjty• �hoee i�• --
insurance co p�Y� -
Failure to secure coverage as�equired under Sectioo 25A of MGL 1S2 ea�lad to t6e iopaidoa of erisi�al pe�dtla of a ti�e op to 51�00.00 a�d/or
one yean'imprisonment s�w�ell as civil penaldea io the form of a STOP WORK ORDER�sd a Ifne of 5100.00 a day apiost ma I a�dersa.d ma�a
copy of thy statement may De forwarded to the Oflice of Invatigatioo�of tbe DIA for eovenge veri6eatia.
/do hrreby c rrijy�under the pains and pena/ties of pery'ary tha!�6t injorniation providtd above is true and eorrt
Signature su G T�
Print name 2f.��1!�� �iCL/K-/�Rt� Phone N �7.�r'���T
,. oRcial use onl�� do not w rite in this area to be completed by ciry or town ofllcial
city or town• y�M�IITQ _ permitAiecnse N nBuildiog Departmeot
OLiccosiog Board
�eheck if immediate response is required 261 QStlectmen's Otiiee
�Health Departmeat
contact person: phone p;_ �508� 398--2231 egt. nOther
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� THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBER: . 98-100 FEE: $50.00
This i�to cerafy that Beachwood Condominium Association
, 638 Main Stree oute 28, West Yarmouth, MA
! IS HEREBY GRANTED A PERMIT
I To Uperate a Public, Semi-Public Swimming or Wading Pool
At Beachwood Condominium Association - OUTDOOR POOL
638 Main StreetJRoute 28
West Yarmouth. MA
This permit is ganted in conformity��ith Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
e�ires December 31. 1y98 unless sooner suspended or revoked.
June 26 ; 1998 BOARD OP H�ALTH: �cl� .}e%f�se� ��aairmun
�oan � �u[1iv�zn�K.1(.� Vice (��iairman
. �o�ert.}. Y�rorun
a�rielfs�a�io(��Z�-�htoope:c
' �Q��' u���,�
Director of Healtti � �
THE COMMONWEALTH OF MASSACHUSETTS
� TOWN OF YARMOUTH
BOARD OF HEALTH
PERMIT NUMBER: 98-10 FEE: $50.00
This is to Cerafy that Beachwood Condominium Association
638 Main Street/Route 28,West Yarmouth;MA
HAS BEEN GRANTED A LICENSE TO
OPERATE CABINS
This License is issued in c�nfomuty with the authority granted to the Board of Health,by Chapter 140,Sections 32A,32B,
32C,32D and 32E as amencled,and is subject to the provisians of the Laws of the Commonwealth of Massachusetts relating
�xo,aud upon su�ch terms and conditions,and to the rules and reg�ilations in regard to said Cabins so licensed as adopted
by the Board of Health,and expires December 31, 1998 unless sooner suspended or revoked.
June 26 , 1998 BOt�RD OF HEALTH: GiI��l. ,}ettea, t,�iai+�man
� �oan � JaL[ivart�K./!•, Vice C.hairman
Ko�rt� 9�rouia� C.fer�
abrieL[e�a�role�Z�ooPee
• ��0' o��.�,,.
ruce G.Murphy,MPH, S.,
Dir�tor of Health