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HomeMy WebLinkAboutCI-17-000544-02 • The Commonwealth of Massachusetts 1 =;5•' City\Town of =war= YARMOUTH it, f' 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:CAPE COD CHILD DEVELOPMENT BLDCI-17-000544-02 Trade Name:CAPE COD CHILD DEVELOPMENT Identify property address Including street number,name,city or town and county Certificate Expiration Located at 367 ROUTE 28 08/05/2019 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) 1-401st Floor 100 1-4 Institutional Day Care(More than 5) CLASS 1-15 CLASS 2-16 Allowable CLASS 3-16 CLASS 4-50 Occupant Load 3 PERSON OFFICE, KITCHEN NOTE:NO CHILD UNDER THE AGE OF 2 YEARS 9 MOS. NOTE:CELLAR DOOR • SHALL REMAIN LOCKED AT ALL TIMES 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 Building Commissioner _ Inspection O Signature of Municipal Signature of Municipal / ' Building Commissioner ``/�/tzIssutateanceof •2-1/6.-- • v Fee:$100.00 } or °5l"="k,�. TOWN OF YARMOUTH i e. sse .bo; o' (y BUILDING DEPARTMENT � , m"�,"'��'� 1146 R 'ute 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 ,4 �SiFY 1 APPLIICATION FOR CERTIFICATE OF INSPECTION July 5,2018 PAYABLE UPON RECEIPT (X) Fee Required $100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 3c 7 niC/. 2 i e LieJ+ Ywn 4' in Name of Premises: die `00t,- a 'e ertzr ✓ < Tei• (ro&)i 7 r 'aaVO Purpose for which permit is used: 8Lr'fd�1, OerriAtotigE L, V License(s)or Permit(s)required for the premises by other governmental agencies: EDI License or Permit Agency r---- JUL 17 2018 I I BUILDING DEPARTMENT nn� - �1 / y /�, By: Certificate to be issued to l�Ye Cd c4 L frt% /t7e,C$el: ("e') 7'r-4 a 90 Address: 06 7,rJ. at lJatl- YanmheiC Owner of Record of Building i tom .._ - Address e3 7e..4.-/ 444r'J'1444- var;• I Present Holder of Certific. - • eCad 2 a 7.5¢K42„ tyt Signature of person to whom Title Certificate is issued or his agent -VRle Date • Email Address: /77Sea r ellen '&W'Ece/ "O' Instructions: Make check payable to: ; Town of Yarmouth 1146 Route 28, South Yarmouth,MA 02664 Return this application to: i . Building Inspector's Office I Please note: Application form with acicompanying 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# 34/z-/9-oz,scq-oa.,/ 8/5/2018-8/5/2019 ------.11 CAPECOD-82 KDOYLE g ACOKO CERTIFICATE OF LIABILITY INSURANCE D IDDTYYYYI t��r- 07/09o7/oslzol e THIS,CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER jO2ApoT Rogers&Gray Insurance Agency,Inc. _PHOO Ne Eae): I we Ne:(877 816-2156 434 Rte 134 South Dennis,MA 02660 IMss:mail@rogersgray.com _ INSURER(SISFFORDING COVERAGE NAIQY_ NSURER A:Philadelphia indemnity IndemnItyrance Company 16058 INSURED INSURER B: Cape Cod Child Development Program,Inc INSURER C; 83 Pearl Street INSURER 0: Hyannis,MA 02601 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSQ WVD POLICY NUMBER IMWDDNYYYI 1MMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR R/O PHPK1672764 06/2512018 06125/2019 DPREMIGSFS fF:qu ENDeDw)_S 100,000 MED EXP(Any one person) § 5,000 PERSONAL IADV INJURY 3 1,000,000 — GEN'L AGGREGATE LIMITqAPPLIES PER GENERAL AGGREGATE _§ 3'000'000 X POLICY! I jELOT LOC PRODUCTS•COMP/OP AGG § 3,000,000 OTHER E COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY lEa acogenu $ — ANY AUTO I��� R/O PHPK1839981 06/25/2018 06/25/2019 BODILY INJURY(Per person) $ _ OWNED SCHEDULED I^I AUTOSSWULNEEDp BODILY INJURY(Per accident) E 1'DDO'000 X AUTOS ONLY II 1 AUOTOS ONLY Pelf e�enli GE S E A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE E 1,000,000 EXCESS LIAR ^ CLAIMS-MADE RIO PHUB589222 06/25/2018 06/25/2019 AGGREGATE § DED X RETENTION$ 10,000 § WORKERS COMPENSATION STATUTEPER Eµ T TH- AND EMPLOYERS'LIABILITY -- ANYPROPRIETOR/PARTNER,EXECUTNE pi NIA EL EACH ACCIDENT $ a' OFFICER/MEMBER XCLUDED? I I (Mandatory In NH) El. DISEASE•EA EMPLOYEE § If yea,describe under DESCRIPTION OF OPERATIONS below E L DISEASE•POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional RemaM.Schedule,may be attached If more specs Is required) CERTIFICATE HOLDER CANCELLATION bar SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664-4451 AUTHORIZED REPRESENTATIVE7 I L ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD M ,.,,pF...--y49_ BUILDING F3�• Y TOWN OF YARMOUTH ELECTRICAL Q‘,<141)1111 GAS 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 MI Telephone(508)398-2231,Ext.1261 —Fax(508) 398-0836 PLUMBING SIGNS ,.. BUILDING DEPARTMENT Inspection anti License Report/� }� Q Date Li Address 7 7 / 10U/� 2 Business Name C•Cr 0,X47, L><'M P Contact M Phone During the Annual Inspection of your premises,performe ' accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or th oard of Health rules,the following violation(s)were observed: ❑ Emergency egress signage Ioauon ty7e5C 6)(1 Emergency egress lighting Location ❑ Maintenance ofexits Location ❑ Guards/handrails Location ,tonin, ❑ Signs Location ❑ - Parking Location ❑ Other Location Meehan/ea/ ❑ CombustionAir Location ❑ Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location • ❑ Clothes dryer vents Location Qt er 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 violations)von 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 nstazinual inspection. o Make corrections with idn �daay�s and contact this office for a follow-up inspection. Localomciainns? r `flo "r'7 k`lcy �q Received By 9 Tide MGi 111 Revised 2/8/13