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Home My WebLink AboutBLDCI-17-000333-02 •` The Commonwealth of Massachusetts ' =_ tll= l City\Town of _ (= YARMOUTH 144, 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:CAPTAIN FARRIS HOUSE BLDCI-17-000333-02 Trade Name:CAPTAIN FARRIS HOUSE Identify property address including street number,name,city or town and county Certificate Expiration Located at 308 OLD MAIN ST 08/31/2019 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 4 • R-1 Hotel/Motel/Boarding House/Transient 4 Bedrooms,1 kitchen, 1 living room,1 dining room,library Allowable 02nd Floor 4 R-1 Hotel/Motel/Boarding House/Transient 4 Bedrooms Occupant Load Other 2 R-1 Hotel/Motel/Boarding House/Transient Annex-1st-2 Bedrooms 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 613....43 ��y— �t Building Commissioner / Inspection J /� Signature of Municipal Signature of Municipal / aate of Building Commissioner Issuance Z(d�/� J Fee:$100.00 BLD Certoflnspection.rpt = f • TOWN OF YARMOUTH BUILDING ELECTRICAL . • GAS •Iff\ i 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING I'A Telephone(508) 398-2231,Ext.1261 —Fax (508) 398-0836 '' • SIGNS --- -_ BUILDING DEPARTMENT 10 Inspection and License Report C�-- Date T3/3 //8 /•6l Address Sok O/C) //7.1 s/i Business Name rg ; ,6 I?JZ `S /AC— Contact Phone 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 the Board of Health rules,the following violation(s)were observed:()ft: 7a location (3ryK2/l�y 45,/ )522i 7 l) a ❑ Emergency egress lighting Location 1/4y4k:5 S 627 cull t,w —£e 77*. i 'h eL«4.= ❑ Maintenance ofexits Location ❑ Guards/handrails Location oam ❑ Signs . Location ❑ Parking Location Cl Other Location ' Mechanical , Combustion Air L on riot ,1/ $57CS' ❑Storage inBoiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents Location QSL 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 an�ual inspection. o Make corrections with' days and contact this office for a follow-up inspection. LocalOffrcial/Ins r • s A A ' Received By / 4 Title Revised 2/8/13 r�o�t TOWN OF YARMOUTH • H;^.� � $ BUILDING DEPARTMENT 1146 Itlute 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION July 1, 2018 PAYABLE UPON RECEIPT (X) Fee Required $100.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named` premises located at the following address: Street and Number: 30$ Oka. Main Si . 7a n NiOSMo . MA Name of Premises: C.a6gV( cater \--‘tuSQ Tel: 50 $ 'l too Purpose for which permit is used: Bea. t 't3reakc4si- License(s)or Permit(s) requiretle1~ y.pireti lies h�ytother governmental agencies: t License or PermitAgency ZO'g JU 16 �U Ra t-0451A5 Limns— orfltt . COMMON Vt CA"J o..l(er S LI i/ rr3 thPARI MI � goer(' ti BY Certificate to be issued to CGP3-0. t% crrty 4bQ)fe.-- Tel: 50%-7(,D-2-$1'S Address: 308 old, Mr,IN ST. j S. or MA 01.61e'( Owner of Record of Building SCt„t E M re r's-h Address So,p-t Present Holder of Certificate_es -1-acirtt t-foc.2t<— 0 up war- Signatur f person to whom Title Certificate is issued or his agent 11131 t& Date Email Address: CACO,; tni Sor\ 57@ 9M('1tL• C-Oitfl I 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# -/7-COO 3 33-O2' 8/31/2018-8/31/2019 t • Associated Employers Insurance Company Insured: 5018780 Producer: 10083-002-001 JCW Enterprises Inc Dowling &O'Neil Ins Agcy 308 Old Main Street 973 lyannough Road South Yarmouth, MA 02664 Hyannis, MA 02601 • Insured FEIN: "'"""9195 Issue Date: 05/29/2018 Policy Number: WCC-500-5018780-2018A Endorsement Effective Date: 05/04/2018 Policy Period: 05/04/2018 -05/04/2019 Endorsement Number: 1 AMENDMENT OF INFORMATION PAGE Name- Insured Name Endorsement Change in Premium: $0 Nothing herein contained shall waive,alter,or extend any condition or provision of the policy other than as above stated. Countersigned by — MISC(07/11) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 0( •\ (Ed.7- 1) POLICY INFORMATION PAGE ENDORSEMENT The following item(s) ❑X Insured's Name(WC 89 06 01) ❑ Item 3.B. Limits(WC 89 06 12) ❑ Policy Number(WC 89 06 02) ❑ Item 3.C.States (WC 89 06 13) ❑ Effective Date(WC 89 06 03) ❑ Item 3.D.Endorsement Numbers(WC 89 06 14) ❑ Expiration Date(WC 89 06 04) ❑ Item 4.'Class,Rate,Other(WC 89 04 15) ❑ Insured's Mailing Address(WC 89 06 05) D Interim Adjustment of Premium(WC 89 04 16) ❑ Experience Modification(WC 89 04 06) ❑ Carrier Servicing Office(WC 89 06 17) ❑ Producer's Name(WC 89 06 07) ❑ Interstate/Intrastate Risk ID Number(WC 89 06 18) ❑ Change in Workplace of Insured (WC 89 06 08) ❑ Carrier Number(WC 89 06 19) ❑ Insured's Legal Status (WC 89 06 10) ❑ Issuing Agency/Producer Office Address (WC 89 06 25) ❑ Item 3.A.States(WC 8906 11) is changed to read: JCW Enterprises Inc • DBA-The Captain Farris House 'Item 4.Change To: Premium Basis Rate Per$100 Code Total Estimated Estimated Classifications No. Annual of Annual Premium Remuneration Remuneration Total Estimated Annual Premium$ Minimum Premium$ Deposit Premium$ All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 05/04/2018 Policy No.WCC-500.5018780.2018A Endorsement No. 1 Insured Premium$1,580.00 JCW Enterprises Inc Insurance Company Countersigned by ern__ Associated Employers Insurance Company WC890600B (Ed.7-01) ®2001 National Council on Compensation Insurance,Inc.