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HomeMy WebLinkAboutCI-16-7002-02 4 • The Commonwealth of Massachusetts �='=�. • City\Town of 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: MARINER MOTOR LODGE BLDCI-16-007002-02 Trade Name:MARINER MOTOR LODGE Identify property address Including street number,name,city or town and county Certificate Expiration Located at 573 ROUTE 28 06/2212019 WEST YARMOUTH,MA 02673 • Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 50 R-1 HoteVMoteVBoarding House/Transient 50 Units Lobby&Office Allowable 02nd Floor 50 R-1 Hotel/Motel/Boarding House/Transient 50 Units 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 GI tC a ate of Building Commissioner In�spection Signature of Municipal Signature of Municipal �. :rate of Building Commissioner _ , Issuance 9 nv Fee:$370.00 • • BLD_Certofl nspection.rpt V"k\ik;IttistTOWN OF YARMOUTH � BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION May 1, 2018 PAYABLE UPON RECEIPT (X) Fee Required 370.00 ( ) 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: Rot 2g ''n�,� Name of Premises: a Ata Tel: ©&r`/ �I' 'l1 Purpose for which permit is used: O License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agenc iZ E G E I V E I D JUL 26 2018 .1 BUILDING DEPARTMENT Certificate to be issued to Maes. 67aI atema.(. L� Tel: 6-0g '1 • Q Address: 3 R o4t. 24S cLi y&.lmo�. , M k 0249- 3 Owner of Record of Building Address Present Holder of Certificate I Sig t+t re of person to whom Title Certificate is issued or his agent Date ►1Q Email Address: rb-INex m //oan (ootr.G a; cow 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# 7LddJ —/L- n'7az -O, \ 6/22/2018-6/22/2019 Te NOTICE __:_ NOTICE gri TE TOIIMIS — t TO x# EMPLOYEES a _' t_f- EMPLOYEES 11, WAIL' E The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/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: NORFOLK & DEDHAM MUTUAL FIRE INSURANCE COMPANY NAME OF INSURANCE COMPANY 222 AMES STREET, DEDHAM MA 02026 D E A SURANCE COMPANY WE158500A 07/22/2017 POLICY NUMBER EFFECTIVE DATES 215 MAIN STREET PO BOX 330 G.H. DUNN INSURANCE AGCY, INC BUZZARDS BAY, MA 02532 pHONE# NAME OF INSURANCE AGENT ADDRESS 573 ROUTE 28 MAA GAYATRI MARINER LLC WEST YARMOUTH MA 02673 EMPLOYER ADDRESS 07/07/2017 EMPLOYER'S WORKERS'COMPENSATION OFFICER(IF ANY) DATE M ED ICAL TREATM ENT 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 Form WC 88 20 01 C Printed in U.S.A. INSURED COPY } C71- in elt-----k-471-4( - 4 tii/ ' oF..._- rq TOWN OF YARMOUTH BUILDNG ELECTRICAL GAS '~ �iw •r`i 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451- ,.P'L'UMBING lili Telephone(508)398-2231,Ext.1261 —Fax (508) 398-0836 SIGNS / cite,BUILDING DEPARTMENT 1\✓/J Inspection and License Report Q Date '/ �Q Address •73 ROUTE e Business Name 71 AIR)i.Ft!C MCC< 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 and of Health rules,the following violation(s)were observed: ❑ Emergency egress signage Location CO ` 0(aak I T r « Ji � ' DI Location /M 7 y 41744 %114I4V /C '9 ❑Maintenance ofa its Location 1170/6 N /" /9 f (,{)� !LL{{Jr`o/fits* "Zeal ❑ Guards/handrails Location 41 'npi'(L./fr deem, Zany Si"; % - 1��T �, +❑ S' Location❑Parking Location L-!(itr214 e7 � 'azt CiZect e �C_'ir' 4 `, ❑ Other Location 1 � Dar!« �i�/ ,q `mil 0f' 752 it ❑Combtun'onAir Location .455 /o ilfre aton Aa nn`ri1 ❑ Storage in Boiler Room Location / f77er (&*x m&✓ �y I ❑Vents Location ' r(S fits1/06927 . .,$/erx ❑Automatiedoorclosures '1 //.57'. / " /?d1 e dd�— m�`�J � " `� on boiler room doors Location �//•/7 ❑ Clothes dryer vents Lova.,. ii /Qe +f-it # - // tip * ice, n , Other Loath. .: Pad-r P� � fc fp*� r/ — ' sqr 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 within �S d /aysand contact this office for a follow-up inspection. Local Oficial/Inspector 8 tit _ rci 4`e/ Received By I i.►�«1 , Title Revised 2/8/13