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�MATTACHEES� �� � y��OUTH FIRE DEPARTMENT��
h��AGOaAlE0�6�
96 OLD MAIN STREET SOUTH YARMOUTH MASSACHUSETTS 02664
TELEPHONE (508)-398-2212 - FAX (508)-760-4858
FIRE AND SAFETY INSPECTION REPORT
DATE: C� G> �� TIME: "`�f.JC.: C��
Address of Inspection �c� `2-�� r -�� �c�� � �c�
Business Name: �/�n-,,,� `+>j�,�,l���,. �-/���� Te1No s��"— �/�-/���� •'yZ.
Contact Person: ��U( �� �3-�s �z,,.. Home ..�'c �-3�� — s���
Cell_ �'�v�- �Yf�3'`r��`i
Building Owners Name: �,!_}�,.,� Te1.No.
Owners Address:
Sprinkler System Wet Dry Lock Box.
UTILITIES LOCATION
Elect. Panel Gas meter OS&Y Valve Water meter
An inspection of the above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (�were observed and
noted for correction: �•
c , � � �
You are hereby ordered to abate or correct the deficiencies or violations immediately. Failure to
do so may result in civil and/or criminal complaints being filed.
VIOLATION ISSU (If YES,see back)
t ��'e`s , �
Signed: Title. °� ��� , t
Copy Recei ed By:
Original—Ow r/Ten Yellow Copy—Pire Department FPB OS-I
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RALPH J. PERRY, II\IC.
96 Falmouth Rd. (Route 28) • Hyannis, MA 02601 • Phone: (508) 775-FIRE • MA. LIC. #017 D.O.T. #A-850
SYSTEM I NSPECTION REPORT N° 1013 5 5
me D,�r < � _ ��� Date � �`�� Next[nsp.Due ��<�? �L�/(�
dress /� ��?� �`'�� �-/� Model# � ��
Mfg. ��r
�`�� ��� �'� #of Tanks l Wet �� pry
I To Annual�Semi Recharge New
ntact Phone Fusible Links: 360 � 450 Other
Fuel Shut Off: �/Gas "'��Elech-ic
od needs to be cleaned Refuses inspection
:ase accumulation: Excessive Heavy Moderate
CO2 Cartridge Nozzle Seals
ers need to be cleaned: Type���'� Parts replaced:
�king appliance location:Left to right:
C..-�'/�� �./ u� ��j��
Ralph J.Perry,I c.must be notifie if there is any change/movement in cooking equipment.
1. Are all appliances covered by nozzles �^ 17. Clean nozzles no.ofi,�duct�plenum,�appliance
2. Are hood and duct covered by nozzles L.�''- 18. Replace fusible links/Mfg.date -����1� �
3. Check positioning of nozzles i/" 19. Check cable,nut,and S-hook movement j�„�^
4. Hood and duct peneirations sealed �''"�� 20. All piping secured �„�
5. Is system U.L.300 ✓"� 21. All filters in place ;�i
6. Proper clearance flame to filters t-/ 22. Cartridge/N2 reinstalled/Safety pin removed �--��
7. Nozzle seals in place v-" 23. System reset and operational V
8. Are there seal tites in place ✓"� 24. All yellow seals in place c,,,/
9. Pressure gauges in proper range �""'" 25. Service and certification tag on system a✓'"
l0. Check cartridge weight L�-�"� 26. Portable extinguishers up to code �..�'
11. Hydrotest due -���V// 27. Class K extinguisher and placard installed ✓
l2. Inspect cylinder liquid and mount ✓"� 28. Reviewed automatic&manual operation ✓�
l3. Test for proper operation from terminal link �^''�� of system w/customer
l4. Test remote manual operation � 29. E�aust fan working �"'"��
l5. Micro switch in place _� 30. Customer instructed on required monthly v�
l6. Gas valve in place and working ✓" inspection of system
31. Customer performing monthly inspection
�ommendation:
�n-compliance issued: Yes / No Reason
m-Compliance systems/or systems with discrepancies may fail to extinguish/suppress a fire.
crepancies or deficiencies
ph 1.Perry,Inc.is not a hood/duct service compan .Any discrepancies should be addressed by a qualified hood/duct company.
tinguisher Inspections: Light Inspections Tota1#of Ext: Ext.due service:
RECHARGES/SERVICE NEW EXTINGUISHERS
ychem 2.Slb_Slb._101b_201b_6year_Hydro Drychem 2.Sib. Slb. 101b. 201b.
� K Class_6L_2.SG Hydro PW K Class 6L 2.SG
lotron 2.Slb._Slb._l llb._15.S1b._6 year_Hydro_ Halotron 2.SIb. Slb. _ l llb. _ 15.S1b.
)2 Slb. 101b_151b_201b._Hydro CO2 Slb. 101b. 151b. 201b.
�ts: Service Collaz Oring Pull Pin Batteries: Bulbs Misc.
2E EXTINGUISHERS ARE IN COMI'LIANCE WITH NFPA 10 CODE YES NO
ents
-, ..�
rvice Technician Lic.# Customer's Authorized Representative
Please read the Customer Acknowledgment on reverse side before signing.
this date,the above system was tested and inspected in accordance with procedures of the current NFPA 17A AND 96 edition and the manufacturers manual at time of installation
was operating according to these procedures with the results indicated above.
this date,the above fire extinguishers and fire equipment were inspected or serviced in accordance with procedures of the NFPA 10 and the manufacturers manual,with the results
icated above.
:above service technician certifies that the system/extinguishers were personally inspected and found conditions to be as indicated above.
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RALPH �I. PERR Y INC.
— PO BOX 339 • HYANNIS, MA 02601 • 508-775-3473
MA-CR#017 • DOT CERT#A-850
_
FIRE PROTECTION INSPECTION REPORT/WORK ORDER # jv� 14 5 6 3
>
AME � • .�, `� �"��c;.� - ��r��C/c�., G� DATE °�� < l �� � � � ACCOLJNT #
LOCATION '� � � ' - NEW CHARGE .X� COD
i ,�Ctrr�tc��.,�7(-,iJ���.1r�� ANNUAL�—NEW EQUIP SERVICE RETURNS
' TOTAL# OF EXTINGUISHERS -���
"ILL TO �,�� # EXTINGUISHERS DUE SERVICE NEXT YEAR �
CUSTOMER PO# 1NSPECTION DUE �''��''� ���
CONTACT �;��v►���:a PHONE ��(�;:,�- ;�'7��('" CELL SERVICE/LABOR � • S�
.. ': NEW EQUIPMENT
�RY CHEM 2 '/z ABC SAB(' lOABC 20ABC' l OBC 20BC IOP�20PK
)2 Slb 101b_151b 201b PW CLASS K HALOTRON/2 '/zlb Slb l l lb 15.S1b
'vrARINE SYSTEM EMERGENCY LIGHTS EXIT LIGHTS OTHER
;
° INSPECTION�RECERTIFICATION
)RYCHEM�K CLASS�PW HALON/HALOTRON CO2 COND TEST MARINE CYLINDER
1ERGENCY LIGHTS EXIT LIGHTS OTHER
RECHARGE/SERVICE/HYDROTESTING
3CHARGES SERVICE
�YCHEM 2%zlb Slb M 101b 201b 6 YEAR MAINTENANCE HYDROTEST
'W K CLASS .6L 2.SG HYDROTEST
\LOTRON 2%zlb Slb lllb 15'/zlb 6 YEAR MAINTENANCE HYDROTEST
>2 Slb 101b 151b_201b COND TEST HYDROTEST
Jotes
PARTS
.sRVICE OLLAR WALL HOOK M1-Slb Other
)RING_ � VEHICLE BRACKET M2-101b
."ECK STEM HEAVY DUTY BRACKET 201b
LL PIN BULBS REPLACEMENT COVER
�UGE BATTERIES BATTERY DISPOSAL FEC COVER
SIGI�IS/LABELS FI12S'I`AID
�OT OSHA PWMI 90 FIRST AID KIT 816�816�8163�-KIT—REFILL
�", SERIES VINYL TYPE EYEWASH STATION REFILL INSPECTA SHIELD
' SERIES PLASTIC TYPE OTHER
.�
FTRE EXTINGUISHERS ARE IN COMPLIAIVCE WTTl�N�PA 10 CODE< YES NO
COMMENDATIONS:
�ehis date,the above fire extinguishers and fire equipment were inspected or serviced in accordance with procedures of the NFPA 10 and the manufacturer's manual,with the results
�icated above. �-.�
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;RVI ETECFINICIAN LIC# �CU��ER'SAUTHOR[ZEDREPRESENTATIVE
`above service tec%nician certifies that tlxe fire extinguishers and einergency lights wer-e personally inspected and found conditions to be as indicnted above.
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RALPH J. PERRY, INC.
— PO BOX 339 • HYANNIS, MA 02601 • 508-775-3473
MA-CR#017 • DOT CERT#A-850
_
FIRE PROTECTION INSPECTION REPORT/WORK ORDER # N° 14 5�3
,
AME �-A,�, _� t�c..�'"..1�;1 - �C����rC.l��>, ���.. DATE ��� < I �1 � �' �� ACCOUNT #
LOCATION � '� � � �' - NEW CHARGE� SOD
t �r'��'�'''���`��;�� ~-�" � ��1�- ANNUAL_�NEW EQUIP SERVICE RETURNS
—' TOTAL# OF EXTINGUISHERS -���
"iLL TO_ � �� # EXTINGUISHERS DUE SERVICE NEXT YEAR �/�
CUSTOMER PO# INSPECTION DUE �'��'`` �'�'�
CONTACT����1..., PHONE ,'�(��,,�- ,�1��'`" CELL SERVICE/LABOR 1 � r
... NEW.EQUI�MENT ,
�RY CHEM 2 %z ABC SABr lOABC 20ABr IOBC 20BC IOPK-20PK
)2 Sib 101b_151b 201b PW CLASS K HALOTRON/2 %zlb Slb l l lb 15.S1b
VrARINE SYSTEM EMERGENCY LIGHTS EXIT LIGHTS OTHER
INSPECTION/RECERTIFICATION `
,
)RYCHEM��K CLASS�PW HALON/HALOTRON CO2 COND TEST MARINE CYLINDER
1ERGENCY LIGHTS EXIT LIGHTS OTHER
RECHARGE 1 SERVICE/HYDROTESTING
?CHARGES SERVICE
�YCHEM 2'/zlb Slb 101b 201b 6 YEAR MAINTENANCE HYDROTEST
'W K CLASS .6L 2.SG HYDROTEST
\LOTRON 2%zlb Slb l l lb 15'/zlb 6 YEAR MAINTENANCE HYDROTEST
`>2 Slb 101b 151b_201b COND TEST HYDROTEST
lotes
PARTS
...RVICE OLLAR� WALL HOOK M]-Slb Other
>RING � VEHICLE BRACKET M2-101b
"TECK STEM HEAVY DUTY BRACKET 201b
LL PIN BULBS REPLACEMENT COVER
�rr1UGE BATTERIES BATTERY DISPOSAL FEC COVER
SIGNS/�..ABEI.S FI�ST AID
�OT OSHA P� 90 FIRST AID KIT 816�816Z_8163—J-KIT—REFILL
'", SERIES VINYL TYPE EYEWASH STATION REFILL INSPECTA SHIELD
' SERIES PLASTIC TYPE OTHER
...�
FIRE EXTINGiIISHERS ARE IN COIVIPLIANCE WITH N�FA 10 CUD� YES ' NO
COMMENDATIONS:
1-ehis date,the above fire extinguishers and fire equipment were inspected or serviced in accordance with procedures of the NFPA 10 and the manufacturer's manual,with the results
iicated above. �,1
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'. VI ETECHNIC[AN LIC# CUS,(�MER'SAUTHOR[ZEDREPRESENTATIVE
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�bove se�vice technician cer•trfies that tl:e fire extiiaguishers and emergency lights were personally inspected und found caxditions to be as indicated a6ove.
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PERMIT
DIG SAFE NUMBER
City or Town: Yarmouth
Date: 05/02/2007 ,
, Start Date:
Permit Number(if applicable) 001293
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: Sandy 8 Will Rubenstein
For permission to: Ceremonial Bonfires 527 CMR 10:23 (1)
Restrictions: Strict and complete compliance with all federal,state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
At: 79 White Rock Road/Camp Wingate/Kirkland/YarmouthPort,
Fee Paid $ $20.00 This permit will 're on 05/02/2008
/ ._
Signature of Official Granting Permit C.�..��.- -- Title �� �;/L.��^---'-"
�
This permit must be conspicuously posted upon the premises
�
O��Y``��4,,�
�� �'' ,, [
� MATTACMEES � �
� ���ApORA7f0�b�� YARMOUTH�FIRE DEPARTMENT
96 OLD MAIN STREET SOUTH YARMOUTH MASSACHUSETTS 02664
TELEPHONE (508)-398-2212 - FAX (508)-760-4858
FIRE AND S FETY INSPECTION REPORT
a, � � t
DATE: w.� � �� ;: � !; TIME: � �
; ,
Address of Inspection � �' ���/� ,'����'..�� v�'G�
Business Name: '�4/�:�' ���� fa✓ Te1No ,'c� � �L� l- .� �� �
�-� ` e� �� � �
Contact Person: (��� C � -� ��+ *-�c�1� �U�K�J ��Iome
� C�
Cell_ �l'.�r�" ,� �/� � / �
Building Owners Name: �' a4 �2 �-' Te1.No.
Owners Address: � �' �-E-'
Insurance Co.
UTILITIES LOCATION
Elect. Panel Gas meter OS&Y Valve Water meter
An inspection of the above captioned property was conducted by the undersigned, during
which the following fire or safety deficiencies (D) or violations (V) were observed and
noted for correction:
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You are hereby ordered to abate ar correct the deficiencies or violations immediately. Failure to
do so may result in civil and/or criminal complaints being filed.
VIOLATION ISSUED• (If YES,see back)
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Signed: ''. � ��F��' ,�`'�."�� ��. ,�' Title: � , �-�--�
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Copy Received By: ���Lo-�t,. �-, �i,� �-���1,;�,-�
Originai—Owner/Tenant Yellow Copy—Fire Department FPB OS-i
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�i � - YARMOUTH FIRE AND RESCUE
� _ - 96 OLD MAIN STREET
�- _ _ =_- SOUTH YARMOUTH,MASSACHUSETTS 02664
_ = Telephone: (508) 398-2212 Fax: (508) 7b0-4858
� = MEMO
__ _:
TO: Sandy and Will Ru6enstein
.. q
3"
FROM: Captain Robert Kelleher
'` RE: Spring Compliance Inspection Camp Wingat 'rkland
� 79 White Rock Road Yarmouth Port
f
`
DATE: 5/31/06
�
I am writing to commend you and your staff on the quality and readiness of your facility for the
coming season, I found no major deficiencies and the addition of Carbon Monoxide detectors in
`, all living areas not only satisfies the new regulations it will provide an extra margin of safety. I
have included here a fire permit for the season and encourage you to contact myself or any of our
s�ff if we can be of any service. Have a safe and happy surnmer.
`.
�.
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- _�.: -, _- YARMOUTH FIRE AND RESCUE
� - 96 OLD MAIN STREET
` -_ , , `^_- _ SOUTH YARMOUTH, MASSACHUSETTS 02664
_ - ' = Telephone: (508) 398-2212 Fa�: (50$) 760-4858
` > � _ _
= MEMO
-_ TO: Camp Wingate/Kirkland
� _:_ _,;
- 79 White Rock Rd Yarmouth Port
` FROM: Captain Robert Kelleher _�
,,��,,.-._.._
� RE: Yarmouth Fire Department Response
�
DATE: 6/08/06
�
Camp Wingate Kirkland is located at 79 White Rpck Road in Yarmouth Port,MA. Emergency
services are provided by the Yarmouth Fire Department.
i.. The Fire Prevention Division of the Fire Department annually inspects all habited siructures for
comp�iance with existing regulations.
The closest manned Fire Station is located at 340 Route 6A Yarmouth Port,less than 1 mile from
�- the Camp. That sta.tion houses a manned 3 person ALS Engine/Ambulance Company. There
are similarly manned Fire Sta.tions in South and West Yarmouth less than 4 miles away.
� All emergency transport victims are taken to Cape Cod Hospital in Hyannis for immediate
`- treatment; some critical cases may be flown directly to medical centers in Boston by aero medical
helicopter.
i Emergency cal,ls are routed to the Fire Department by a Yarmouth Police 911 operator; calls are
" received in the Enhanced 911 format. The emergency number should be posted on all phones at
the camp. It is always important to be specific regazding the location and nature af the
exnergency as well as a cail back number.
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MICHELE C. TUDOR, P.E.
Co�nsuiting Structural Engineer
123 Cottonwood Lane•Centerville,Massaehusetts 02632-1979•(508)771-7601 •Fa�c(508)771-7163
�ctudor@co�cast.net
June 17,2005
Town of Yarmouth .
Building Dept
1146 Route 28
So.Yarmouth,MA 02664
Attention: Mr. Andrew Arnault
Building Inspector
RE: Saction 1028 Maintenance of Exits,Mass.Bldg. Code 6th Edition
Wingate Kirkland at Elisa's Pond,79 WWte Rock Rd.,Yarmouth Port,MA
Dear Mr. Amault,
Please be advised that the above captioned project has been inspected on May 04,2005 and again on June 03 and 1�
2U05 to review repairs compieted.
This office has inspected all exterior bridges,steel or wooden stairways,fire escapes and egress balconies for
� `� stiuctural integriiy and safety,and finds them adequate,as ainended.
I trust that the above addresses your needs at the present tune. Should you have any qi�estion on any of the above,
please do not hesitaxe to call.
incerely,
����"�—` ' �
Michele C.Tudox . . `� •
,
/2005-85 .
cc: W.and S.Ru'benstein �
. _ � M�pNE ESS�cyG
. ; o� � N�
�� 7UD�R �`
�J No.34774 c�n
- gT�UCTURO
�
� 9FGIS'!�Q'�!�4�
� � roN�-�;
.. . _
� .
_= ;� �I -__ YARMOUTH FIRE AND RESCUE
- FIRE PREVENTION OFFICE
- _�R�=- _ 96 OLD MAIN STREET
�" _ - - = SOUTH YARMOUTH, MASSACHUSETTS 02664
= ' �''' = Telephone: (508) 398-2212 Fax: (508) 760-4858
= = = LIEUTENANT 1NSPECTOR MATTHEW C. BEARSE
_._
DEPUTY CHIEF PETER A. RAISKIO
Date: May 19,2005
Camp Wingate/Kirkland
Off Whites Path
Yarmouth Port,Ma 02675
Dear Sirs:
Camp Wingate/Kirkland located in YarmouthPort,is under the protection of the
Yarmauth�ire Dept. This Department grnvides fre grotection far the c�mg. Z'he�re Dept.
requires that all campers and staff be evacuated from the area in the event of any fire, and
� follow your emergency plan.
The Yarmouth Fire Dept. also provides full Advanced Life Support Ambulances to the
camp.The Rescue only provides emergency transport to the Cape Cod Hospital Emergency
Dept.
The Town of Yarmouth operates under the Enhanced 9-1-1 system,so you can use this
numbex for any emergency,and it should be posted by every telephone.
Yours in Safety,
�. �` ` �`�- ---�.
Matthew C. Bearse
Lieut�aant/�nspector
�
RALPH J. PERRY, 1 NC. WORK ORDER#
96 Falmouth Rd. (Route 28) • Hyannis, MA 02601 • Phone: (508) 775-FIRE
MA. LIC. # 017 D.O.T. #A-850
� � SYSTE�M INSPECTION REPORT
Nam ,f�f'/t� j�" �
Date�_�`�—%��---(j �, Inspected by: �
-�r�� y f Model#s�.� Mfg ��r—
Address�7 LC��i��-t°��C�r�� #of Tanks �_ Wet � Dr y
� �T� 7`�1 Annual Semi Recharge New
Fusible Links 360�450 500 Other
Contact ' Ph�n��-_3��_ Fue l S hut O ff_� Gas � Electric
Cooking Applianc Locations:Left to Right
— . `,f � � �tic' i-ze°°..�",
Ralph J.Perry,Inc.must be notified if there is any change/movement in cooking equipment
I. Are all appliances covered by nozzles _� Hood needs to be cleaned %��
2. Are hood and duct covered by nozzles , � Grease accumulation
3. Check positioning of nozzles Excessive Heavy Moderate
4. Hood and duct penetrations sealed � Filters need to be cleaned�_Type �
5. Is system U.L. 300
6. Proper clearance flame ro filters Refuses inspection
7. Nozzle seals in place. Parts had to be replaced
8. Are there seal tites in place _l/
9. Pressure gauges in proper range _�/ ��'��� r ���-
10. Check cartridge weight ,_�—
11. Hydrotest due �Q��
12. 6 year maintenance due �� Liquid change
��. Inspect cylinder liquid and mount
� Test for proper operation from terminal link
15. Test remote manual operation NON-COMPLIANCE ISSUED
]6. Micro switch in place Reason
17. Gas valve in place and working /Il�
18. Clean nozzles no.of�duct�plenum�pliance
19. Replace fusible links _�
Ralph].Perry,Inc.is not a hood/duct service company.
20. Check cable,nut,and S-hOOk movement Any discrepancies should be addressed by a qualified hood/duct company.
21. All piping secured � Discrepancies or deficiencies
22. All filters in place . Type
23. Cartridge/N2 reinstalled/Safety pin removed � ��,��
24. System reset and operational �
25. All yellow seals in place —�
26. Service and certification tag on system _ ;,/
27. Portable extinguishers up to code —� *Non-Compliance systems/or systems with discrepancies may fail
28. Class K extingnisher and placard installed � to extinguish/suppress a fire. ,
29. Reviewed automatic&manual operation _� Next inspection due � ' �
of system w/customer �
30. Exhaust fan working Recommendations:
31. Customer instructed on required monthly �
inspection of system
Comments
�l�G,�r O°d�� /}l"("` _
On this date,the above system was tested and inspected in accordance with procedures of th NFPA 17, 17A,96,Cha •10 2001 edition and
man�fa r��rPr°�manual at time of installation,and was operated according to these pr ures with t 'cated above.
� �� �
Service Technician Lic.# Customer s uthorized epresentative
Please read the Customer Acknowledgement on reverse side before signing.
T'he above service technician certifies that the system was personall inspected and found conditions to be as indicated above.
A copy of this report will be forwarded to the local fire department.