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HomeMy WebLinkAboutBLDCI-17-000280-02 The Commonwealth of Massachusetts 1t , � City\Town of . 1= Y 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:HABILITATION ASSISTANCE CORP. BLDCI-17-000280-02 Trade Name: HABILITATION ASSISTANCE Identify property address Including street number,name,city or town and county Certificate Expiration Located at 513 LONG POND DR 07/02/2019 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) 1-401st Floor 160 14 Institutional Day Care(More than 5) Administration-63 persons Allowable 1st floor-160 persons: Education&Institutional Occupant Load Total persons per the L BOH-160 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 7 )t/ n Building Commissioner /� Inspection G( Signature of Municipal Signature of Municipal /% Date of /� Building Commissioner Q / ,�'/// Issuance 9..//,/Q 7 Fee:$1000.00 B LD_Certofl nspection.rpt ur%-'!k ��-�'{'� ; ��\ TOWN OF YARMOUTH g(' � BUILDING DEPARTMENT O r . H �"\�;,.,��,s„/ 1146 Route 28, Yarmouth, may'T�,° South 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:llqen j Perna �:a I So stico yto N Name of Premises: I l02l ll,t 0 h b1'\ 1/2S1 Stan C-4, Tel: 50t1100 b© trno Purpose for which permit is used:Dag Habil/Son &030Crn License(s) or Permit(s) required for the .remises b . , - :.vernmental agencies: RECEIVED License or Permit Agency JUN 212016 BUILDING DEPARTMENT Certificate to be issued tot70bti14ailOh / SStStG'tc,e, Tel: COg.1100 gni..b Address: 430 Lon Porta Dr, So.4at11n v501-t. .MA- 0a6 Gil A Owner of Record of Bui ing 'ncM\ V.Se% Address t?)85 k Scree 'tT 't o al l keel PresentHooll.erofC; ific� Hab ;lc#(.tph g�}cync_ ��^ / //� TrC.�td � Signature of person to who \ Title Certificate is issued or hi ent �Q � >// t Date •! Email Address: QCC/llf'U 0 Se, e,Qyi 1-- 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# , t.�-/'7-c7T0aff0 Oz--i 7/2/2018-7/2/2019 Nor-2-22 12/28/2017 6:47:43 AM PAGE 2/002 Fax Server # 02N ^.""SDATE IMM/DD/YYYYI Art-t�tte CERTIFICATE OF LIABILITY INSURANCE nnnnnn TNI.aERTIFICATE 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(5),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: USI INSURANCE SVCS LLC PHONE FAX 75 JOHN ROBERTS ROAD (A/C,No,Ext): (NC,No): E-MAIL SOUTH PORTLAND,ME 04106 ADDRESS: 76W30 INSURERS)AFFORDING COVERAGE NAIC II INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY HABILITATION ASSISTANCE CORP INSURER B: INSURER C: INSURER D: 434 COURT STREET INSURER E: PLYMOUTH,MA 02360 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF NSURANCE UST ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTFICATE MAY BE ISSUED OR MAY PERTAM.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR ADD SUB POLICY EFF DATE POLICY EXP DAT! LTR TYPE OF INSURANCE L R POLICY NUMBER p/NRDMYYYY) IMMDDWYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ I CLAIMS MADE 0 OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ =POLICY 0 PROJECT IC LOC PRODUCTS-COMP/OP AGO $ AUTOMOBILE LIABILITY COMBINED SINGLE $ C ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) —UMBRELLA LIAB B OCCUR EACH OCCURRENCE $ — EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION $ $ A WORKER'S COMPENSATION AND %y WC STATUTORY OTHER EMPLOYERS LIABILITY Y/N UB-5B971484-17 11/132017 11/13/2018 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE El N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (MendMory In NN) EL.DISEASE-EA EMPLOYEE $ 500,000 e yes,debate ender DESCRIPTION OF OPERATIONS EeloW E L DISEASE-POLICY LIMIT t 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES)RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED'TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION AHOLD USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1385 HANCOCK ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR ATI.VE h?,,... 6.41-4t----L.,........ „ QUINCY,MA 02169 C.) ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORD CORPORATION. All rights reserved. ;o . . TOWN O F YARMOUTH BUILDING►. r`: GAS 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING G 1/21 Telephone(508) 398-2231,Ext.1261 —Fax (508) 398-0836 �tomsaesa SIGNS ; ;' BUILDING DEPARTMENT eYT, X265' Inspection and License Report D( D7- 9 415 Address 99 201/5v nd sk�, Business Name //8O 1 'r/nT -n /5/5v 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: ,Eggs V/ ) Epic?? CI /�Emergency egress signage Location S -ges 1 TJ C e ❑Energencyegresslighting Location '4-X' t— EM elyeCiiy .40M ❑Maintenanceofexits location �Ur/erS ll/CIef�,/SPeeirs_ c_0ia ❑ Guards/handrails Location ✓7/dnr %?,r I/00 gd &/lievrry /5/11-t- . ❑Signs Location ❑Parking . _ Location ❑ Other Location /4fechanka( U Combustion Air location Cl Storage in Boiler Room Location ❑Vents Location ❑ Automaticdoor closures on boiler room doors Location - -C ❑Clothes dryer vents Location allez Location The State Building Code,Section 10013-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 inunediately 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 a�pual inspection. o Make corrections within /3 days and contact this office for a follow-up Inspection. LocalOfficial/Inspector Fr Ao N%/W Received By �(�•.�_ /�,. I4.i„4_. Tide ?fCnt*ii yA i7rCt' Revised 2/8!13