HomeMy WebLinkAboutCI-17-198-02 •
The Commonwealth of Massachusetts
=:11r--4€ City\Town of
aroptra=' Ff= YARMOUTH
New and Renewal Certificate of Inspection
In accordance with the Massachusetts State Building Code,Section 110.7
Identify Name of Establishment Certificate No.
Issued to
Business Name:SOUTH YARMOUTH METHODIST CHURCH BLDCI-17-000198-02
Trade Name:SOUTH YARMOUTH METHODIST CHURCH PARISH HALL
Identify property address Including street number,name,city or town and county Certificate Expiration
Located at
318&324 OLD MAIN ST 07/28/2019
SOUTH YARMOUTH,MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-3 01st Floor 96 A-3 Amusement/Church/Gyn✓Library/Museum 96 PERSONS-TABLES
&CHAIRS
Allowable
Occupant Load
This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited
Name of Municipal Name of Municipal Mark Grylls Date of 4
7� y�
Building Commissioner Inspection J/
Signature of Municipal Signature of Munigpal � Date of /��
Building Commissioner ( /A7 / Issuance
�i Fee:$100.00
BLD_Certofnspection.rpt
' °i �R TOWN OF YARMOUTH
BUILDING DEPARTMENT
%jx 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
June 5, 2018 PAYABLE UPON RECEIPT
( X) Fee Required $100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: ?A' ' b\c\ \Arr&\vs c,-\..) 6- \ ct\cmOvmn M'{\ O2(061-1
Name of Premises: 6- \to.^(V'i\oviN \M(tec1 V\ tQ c)- Tel: sob. 33 1g,9
Purpose for which permit is used: C\i‘u.rch /(RiitSg- *5101-
License(s)or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
RECEIVED
S
■ UN 152018
Certificate to be issued to 5. tram -V\Uv Aecl Mek\vxkt%i- Tel: SOg :10t.lAtic612EPARTmENT
Address: Say O.d Main 'Sty 5. Vow.
aoas\hM
, N Oa(o(o9 -- -----
Owner of Record of Building I
Address 5av4-e_
Present Holder of Certificate tae
A. )41
to whom Title
Certificate is issued or his agent 613:1 g
Date
Email Address: 5, ‘.1a<mo. :\ vw‘cla \ e -.N\ Y \--
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth,MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof
to be certified. Application must be received before the certificate will be issued. The building official shall be
notified within ten(10)days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection#3LA^ — a-000/54.-02...
7/28/2018-7/28/2019
•
' Print Form ',
NOTICE = v NOTICE
TO =
-• �-
TO
.
r r!
EMPLOYEES 0 � � EMPLOYEES
IMP
yV
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900 - http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice
that I (we) have provided for payment to our injured employees under the above-mentioned chapter by
insuring with:
•
CHURCH MUTUAL INSURANCE COMPANY
NAME OF INSURANCE COMPANY
3000 SCHUSTER LANE, MERRILL, WI 54452
ADDRESS OF INSURANCE COMPANY
0261250-07-076071 1/1/18- 1/1/19
POLICY NUMBER EFFECTIVE DATES
NAME OF INSURANCE AGENT ADDRESS PHONE #
EMPLOYER ADDRESS
EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE
•
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the ser-
vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
•4
0
TOWN OF YARMOUTH BIIILDIN
FGIL
GAS
4y,, �,• 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING
Telephone(508) 398-2231,Ext.1261—Fax (508) 398-0836
SIGNS
-. - BUILDING DEPARTMENT
Inspection and License Report
Date
Address 8/8-nay dc//rutan ST BusinessName ,wo , /" c..lc ref
Contact_agyPhone S26 � ' rn' t
During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts
State Building Code),the Board of Selectmen,and/or thee Board of Health rules,the following vi
olation(s)weeree observed:71CO Q Emergency egress signageLocation ✓�/�fY//(J��� el LL y��It �–' f{Y��f• Emergeriryegresslighting LazrionS�CM f(or QQ,W,�'c? v" CYj`7u Rua'
❑Maintenance ofexits Location 2Ia.�, ila- Sill WO ofl
t7� ) (Poowc ce L 711-et nay
❑ Guards/handrails Location
4
Zoningc
❑ gas Location ale/ r sra/oyc c2/ lc]. .T/t9
CI Parking Location '/ J
❑ Other Location
Mechanical
❑Combustion Air Location
❑Storage in Boiler Room Location
❑Vents Location
❑Automatic door closures
on boiler room doors Location
a Clothes dryer vents Location
Other Location
The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined In Section 780 CMR shall be
responsible for proper maintenance.
In order to abate the above violation(s)you must.
o Make corrections immediately and contact this office for a follow-up inspection.
o Make corrections prior to opening and contact this office for a follow-up inspection.
o Make corrections prior to your next annjel inspection.
o Make corrections within {� / days and contact this office for a follow-up Inspection.
Local Official/Inspector BOO
Received By Title Sec. I-
Revised 2/8/13