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Home My WebLink AboutCI-19-578 • The Commonwealth of Massachusetts ', • =;y1=: City\Town of 47 -rtsl= _lMi = 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:MAPLEWOOD AT MILL HILL BLDCI-19-000578 Trade Name:MAPLEWOOD AT MILL HILL Identify property address including street number,name,city or town and county Certificate Expiration Located at • 164 ROUTE 28 08/21/2019 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 48 A-3 Amusement/Church/Gym/Library/Museum 48 persons Allowable 02nd Floor 48 A-3 Amusement/Church/Gym/Library/Museum 48 persons Occupant Load Total occupancy:96 persons 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 Grytls Date of Q J�_� Building Commissioner Inspection t� Signature of Municipal Signature of Municipal e -Date of Building Commissioner Issuance i Fee:$150.00 BLD Certoflnspection.rpt • °F ` = TOWN OF YARMOUTH EEUELEC�IRICAi - -, r Q4 GAS '' r ' '+-. 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 �\ �' _ n.11 Telephone(508) 398-2231,Ext.1261 —Fax(508) 398-0836 PLUMBING SIGNS BUILDING DEPARTMENT /'• Cli(/-1 • Inspection and License Report Date e-/9-/e Address 7 �l_ � Business Name /p ' Conran Acmg/tt7 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: Egress Aria roc/ cwrf.ere Sj1Qb S CI Emergency egress signage Location-- �c�,� / ,�/ q y,. �j �' ❑Emergency egress lighting Location '4 7e 9' �,/ll v�� /Gf � ornee , (�l)l�ls ❑Maintenance ofexits Location ❑Guards/handrails Location Zoning ❑Signs Location ❑Poking Location ❑ Other Location Mechanical ❑ Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents Inrarion Otlser 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 annual inspection. o Make corrections withindays and contact this office for a follow-up Inspection. Local Ofdsp al/Inector /.3411) Received By k - k Title Revised 2/8/13 . o�% TOWN OF YARMOUTH RECEIVED • `y } ° BUILDING DEFARTMCN o 4440;11-73 ,,�_. ,t4tii2G1 9 2017 1 cc, 4.f '� 1146 Route 28,South Yarmouth, MA 02664 508-398-7,`23' e BUILDING DEPARTMENT I By APPLICATION FOR CERTIFICATE OF INSPECTION : i PAYABLE UPON RECEIPT July 1,2018 ' 1 (X) Fee Required $150.00 ( ) 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 followin: address: O n, I Hr?COtC 7-- C- . t h / dA • .. Lto 1 3• I Street and Number: ��^ O �� Name of Premises: L ?tow cl 4' - L ifi Tel: 2KPurpose for which permit is used: Licenses)or Permits)required for the premises by other governmental agencies: • 42 OI �� Agency �� y� License or Permit -tetomivriv,1* � f Ir. Per it it ii Tel: / 4 10 1—.��4 Address:ertificate to be' d to , ; j� � a. 3 �. i •. � 1 � , .� . . . Owner of 'ecord of Building =rar, ' � F O 8 o Address 200 an _ iii_ �j� � . fgt`njd Present Holder of Certificate al, 'v' il a ikil ff; WL• "rlir tture . person to whom Title Cet I, care is issued or his agent Da /a ' IOeN1/X-1 e Email Address: mWoh bar Ltra fp /e S/• Town of Instructions: Make check payable to: 1146 Route Yarmouth,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 anyychisnge in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR�RSC TE OF INSPECTION. Certificate of Inspection# 5Ln • 9' • 8/21/2018-8/21/2019 ..Y zgpvfnrictbk NOTICE NOTICE TO =sea TO EMPLOYEES • EMPLOYEES 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: MEMIC Indemnity Company NAME OF INSURANCE COMPANY 1750 Elm Street, Manchester,NH 03104 - ADDRESS OF INSURANCE COMPANY 8/1/2018-5/31/2019 3102804908 POLICY NUMBER EFFECTIVE DATES M&T 101 S.Salina St.,4th FL, Syracuse, NY 13202 NAME OF INSURANCE AGENT ADDRESS PHONE# EMPLOYER ADDRESS 8/1/2018 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 Carewell Urgent Care Patriot Square,484 Rte 134 NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER NOTICE The undersigned, an employer within the meaning of the Workers' Compensation Law of the State of Massachusetts, hereby gives notice to employees that the employer has secured the payment of Compensation to its employees and their dependents in accordance with the provisions of said law, by insuring with MEMIC Indemnity Company 1750 Elm Street Suite 500 Manchester, NH 03104 Policy No.: 3102804908 Effective: 6/1/2018-6/1/2019 Maplewood Senior Living, LLC Employer i el Dated 5/31/2018 s (41111r Da , Pagel of WC 7818a(6-91)