The URL can be used to link to this page

Home My WebLink AboutCI-16-004160-01 f • • The Commonwealth of Massachusetts Jr, City\Town of ""ng YARMOUTH 'sK�S 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:HOLLY TREE CONDOMINIUM TRUST BLDCI-16-004160-01 Trade Name:HOLLY TREE MOTEL Identify property address including street number,name,city or town and county Certificate Expiration Located at 412 ROUTE 28 02/16/2019 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-t 01st Floor 8 R-1 Hotel/Motel/Boarding House/Transient 8 UNITS 160-167 76 UNITS MAIN BLDF. Allowable 02nd Floor 76 R-1 Hotel/Motel/Boarding House/Transient 76 UNITS MAIN BLDG. Occupant Load 01st Floor 46 R-1 Hotel/Motel/Boarding House/Transient MNGRS.OFFICE& LOBBY SWIMMING POOL SQUASH COURT -.10 BREAKFAST ROOM-36 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 G C) Date of / -/ !,� Building Commissioner r~�, %��Inspection (t� ! -, Signature of Municipal Signature of Municipal /6/ Date of Building Commissioner 4 ' '< ' Issuance /ft? , er Fee:$322.00 BLD_Certotlnspection.rpt TOWN OF YARMOUTH yY fof\ BUILDING DEPARTMENT k�A1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION February 21 2018 PAYABLE UPON RECEIPT (X) Fee Required 322.00 32,5 ( ) 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: `4\2- \N\ �t Name of Premises: ` t' ' ' { \ � 4 Tel: —1� � l7 Purpose for which permit is used: V _ License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agency SEP 04 2018 BUILDINGNG 3E cRTITENT. Certificate to be issued to `1 1 t �-GL_ Tel: 77 Co� 1 Address: � 4 \ry Owner of Record of Building Address C tSi \ 4 Present Holder of Certificate S Vt!"- >• l 1 � -� Signatu . 'person to who Title Certificate is issued or his agent ?S(J( 1 ^Nen,0 k3 Chaze- J Date 'n Email Address: \� `C p Ev \`r `� (�A0.��e ,t�" `dU .t 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 1/ &LDel - /6- oef y/64—o l 2/16/2018—2/16/2019 Workers Compensation And Employers Liability Insurance Policy WC 00 00 01 A Coverage Is Provided In: •1 �� L1be Policy Number. The Ohio Casualty Insurance Company IXWO(19)57 85 57 75 I Mutual. Prior Policy Number. INSURANCE ,Prior (18)57 85 57 75 • NCCI Co.No. 1113631 MA Risk ID 01382081660 Workers Compensation and Employers Liability Insurance Policy Information Page — ITEM 1:The Insured &Mailing Address Agent Mailing Address&Phone No. HOLLY TREE CONDOMINIUM TRUST (310) 530-0099 DBA: HOLLY TREE RESORT THE ARMSTRONG COMPANY INSURANCE 412 MAIN STREET CONSULTANTS WEST YARMOUTH, MA 02673 2780 SKYPARK DR STE 440 " — TORRANCE, CA 90505-7518 _individual_Partnership X Corporation or Assocation or other ORG FEIN:043109049 NAICS.721110 _ Other workplaces not shown above: a - ITEM 2 The policy period is from 04/012018 to 04/01/2019 12:01 amStandardTimeat theinsured'smailingaddress. ITEM 3 A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $1,000.000 each accident Bodily Injury by Disease $1,000,000 policy limit Bodily Injury by Disease $1,000,000 each employee C.Other States Insurance: Part Three of the policy applies to the states, If any, listed here: See Extension of Information Page 0.This policy includes these endorsements and schedules: See Policy Forms and Endorsements Summary ITEM 4 The premium for.this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Premium Basis-Total Rate per Estimated No. Estimated Annual $100 of Annual Remuneration Remuneration Premium See Extension of Information Page(s) s Total Estimated Annual Premium $9,284.00 • Total Surcharges and Assessments $393.00 Minimum Premium $317.00 MA Total Estimated Cost $9,677.00 If indicated below, interim adjustments of premiums shall be made. Deposit Premium $9,677.00 Countersigned by: Issue Date 03/29/18 To report a claim, call your Agent or 1-800-362-0000 WC 00 00 01 A (WC 30 10 E) 1987 National Council on Compensation Insurance, Inc. 03/29/18 57855775 N0060283 280 GCA0PPNO INSURED COPY 801823 PAGE 7 OF 40 Alt,„.. BUILDING TOWN OF YARMOUTHELECTRICAL ,so" _, 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 GAS lit Telephone(508) 398-2231,Ext.1261 —Fax(508) 398-0836 PLUMBING SIGNS --- - BUILDING DEPARTMENT Inspection and License Report !l Date �lJ/ //e3 Address 7/•2 /&,e'm c f5h� freer �'” Business Name Conran Phone S /^.>/ — Ge l7? 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 vrioation(s)were observed: Qergencyesignage Lcation 4U67t'7L47 IfS15)61*"-OA; A ( d ❑Emergency egress lighting Location ride.-- Crain • H?) Ceedie/ Tim=e( ,'r t/FtFrs � ❑Maintenanceofeurs Loadon ❑Guards/handrails Location Al.Y d "Proffitt7101 / N Of/9/al C 5e—r/l arrirr LJ�1 ;A4j f/�C ❑Signs Location 17✓S 0 6' J G , v Location / ��.:z�� c / � 4) SGL Di Other Location/" 9 4/T Mechanical ❑Combustion Air Location ❑Storage in Boiler Room Location �/ t r jrl e,/ ofr71 ❑Vents Location ❑Automatic door closures , on boiler room doors Location ❑ Clothes dryer vents Location Other 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. Jit order to abate the above violation(s)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 nextypnual inspection. o Make corrections withi )Q/) day,and contact this office for a follow-up inspection. Local Official/I )�" - Received By J t'� �' -� v�._- Tide Revised 2/8/13