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Home My WebLink AboutCI-17-2046-01 • C The Commonwealth of Massachusetts it Ei; ,� City\Town of • t. cxe YARMOUTH New and Renewal Certificate of Inspection In accordance with 780 CMR, Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Business Name: BAYSIDE RESORT BLDCI-17-002046-01 Trade Name:MOBY DICK PUB Identify property address including street number,name,city or town and county Certificate Expiration Located at 225 ROUTE 28 12/31/2019 WEST YARMOUTH,MA 02673 Use Group Floor Occupancy Use Group p Other A-2 Gist Floor 36 A-2 Nightclub/Restaurant/Bar/Banquet Hall 36 PERSONS Allowable 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 I by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited • Name of Municipal Philip Simonian III Name of Municipal Mark G Fire Chief Date of /// e Building Commissioner Inspection Signature of Municipal ��///Qf- /D Signature of Municipal �1.._./ ate of Fire Chief `e�� ,Y /J' '``r Building Commissioner a�� IDssuance //�1 /� it Fee:$100.00 B LD_Certofi nspection.rpt ING 114 °F 49. - TOWN OF YARMOUTH ELECTBLELDRIC AL GAS W,i` i3 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 O,li Telephone(508) 398-2231,Bat-1261 —Fax (508) 398-0836 PLUMBING SIGNS --_ BUILDING DEPARTMENT Inspection and License Report // / /Q � � �J !� Dare O'- Address—C 1 a �P,TF Business Name AVoay �/� POR 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: fgrat ❑Emergency egress signage Location � 13 `G'Emergency egress lighting Location Li`/�C ❑Maintenance ofexits Location ❑Guards/handrails Location Zoning ❑Signs Location ❑Packing Location ❑ Other Location Mechanical ❑Combustion Air Location ❑StorageinBoilerRoom Location Vents Location ❑Automatic door closures on boiler room doors Location ❑Clothes dryer vents Location l2Fhcr 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 violations)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 j��5' days annd contact this office for a follow-up inspection. Loral Official/Inspector� x&}67 yeti/ t i/ l Ley tfO r Received By `Ia re, `411 ` Title Revised 2/8/13 TOWN OF YARMOUTH t#--)51 BUILDING DEPARTMENT i, :N 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION October 3,2018 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-n� premisesprrlocated at the following address: Street and Number: 'ZZs 12- r e 2 2 Name of Premises: ' 1 /I VC" On.i b ic1. Qt c'Tel: c-7.)2 -'7'7g - c&1 9 Purpose for which permit is used: t-t�T�l� License(s)or Permit(s)required for the premises by other :overnmental agencies: License or Permit RECEIVED Agency OCT 16 2018 BUILDING DEPARTMENT 8y:.___-----_ Certificate to be issued to a u,S ■ *Cs( -I' i of L Tel: SO&-7?S-Scrr4 Address: Z7 C Re T7t 2K W ec# 0 p2vi"oar1-1 IAA* e24=`7 3 Owner of Record of Building kulit P(2n per14-ee, Address 2Zr al-- 28 iAt-_s-1— `I art,t"t L %MA ergo-73 Present Holder of Certificate C An.“e `' -rte CLt." AMA , Signature of person to whom Title Certificate is issued or his agent I 14 I 1 Date Email Address: 1250 ba Liride resoA--. 0 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." LEASE 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# BLD a - 77 fl Az, -c.q 1/1/2019-12/31/2019 p5' P WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 4d' INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO.,. WMZ-800-8003721-2018A PRIOR NO. WMZ-800-8003721-2017A ITEM 1. The Insured: Travis Hospitality Inc DBA; Bayside Resort Hotel Mailing address: Rt 28 FEIN:**-***7972 225 Main Street West Yarmouth, MA 02673-0000 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 04/01/2018 to 04/01/2019 12:01 a.m.standard time at the insured's mailing address. 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 liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 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 Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 362922 INTER SEE CLASS CODE SCHEDU_E Minimum Premium $292 Total Estimated Annual Premium $15,264 GOV GOV Deposit Premium $4,005 STATE CLASS MA 9052 State Assessments/Surcharges $16,584.00 x 4.5600% $756 This policy,including all endorsements, Is hereby countersigned by �l ` —� 03/09/2018 Authorized Signature Date Service Office: Rogers&Gray Insurance Agency 54 Third Avenue 434 Route 134 Burlington MA 01803 South Dennis, MA 02660 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. 1/1, Bay8ide Q.e8ort Yarmouth Fire Department 969 Old Main Street South Yarmouth, MA 02664 October 3, 2018 To Whom It May Concern, This letter certifies that the dollar bills hanging from ceiling located at the Bayside Resort Hotel— Moby Dick Pub are treated with a fire retardant chemical from Universal Fire Shield— Papershield P-3000TM. This is a high grade fire retardant chemical for all paper and fiber surfaces. The dollars are re-treated annually. Sincerely, Rod Sroczenski, GM Bayside Resort Hotel 225 Route 28,West Yarmouth,Cape Cod,Massachusetts 02673 508-775-5669 www.BaysideResort.com