HomeMy WebLinkAboutCI-17-002988-02 •
The Commonwealth of Massachusetts
wore. City\Town of
sa- �
®. (_ 1 YARMOUTH
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tie
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:OLIVER ORMON,INC.dba BLDCI-17-002988-02
Trade Name:OLIVER'S EATING&DRINKING ESTABLISHMENT
Identify property address including sheet number,name,city or town and county Certificate Expiration
Located at
960 ROUTE 6A 12/31/2019
YARMOUTH,MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 227 A-2 Nightclub/Restaurant/Bar/Banquet Hall 85-MAIN DINING
67-SMALL DINING
74-BAR-LOUNGE
Allowable TOTAL:227
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 Philip Simonian III Name of Municipal - Mark Grylls Date of //�/���
Fire Chief Building Commissioner Inspection
Signature of Municipal �/ / Signature of Municipal // Date of
Fire Chief / ` Building Commissioner _ _ a^, ' Issuance / 7J7)/.�/G
( !/' Fee::$150.00
•
BLD_Certofinspection.rpt
r drY'tR ._
;.: TOWN OF YARMOUTH
� D may, Tv BUILDING DEPARTMENT
+� w,e•s'� 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 $150.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: ? e) 'ou c CA
Name of Premises: CiLIVg '.s Tel: J8-3C2-6o ca
Purpose for which permit is used: -RES 17.112120/0%
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Certificate to be issued to Tel:
Address:
Owner of Record of Building CtExA 6a ht aA) ) b Ate O R-ri did
Address ,.SAµfE
Present Holder of Certificate S,etr RECEIVED
0wNFit. OCT 16 2018
Signature of person to whom Title BUILDING DEPARTMENT
Certificate is issued or his agent /D-//-/8 By-
Date
Email Address: boI,-t kJ . C$L/trC•%2S C? l allof STo Aim
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# eLDC7 - /7-' 24f OZ,
1/1/2019-12/31/2019
r
NOTICE gid_ NOTICE
TO TO
EMPLOYEES
c7:714-is---- i-' 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:
MA Retail Merchants WC Group Inc.
NAME OF INSURANCE COMPANY
PO Box 859222-9222 Braintree, MA 02185
ADDRESS OF INSURANCE COMPANY
014000502163118 1/01/2018 - 1/01/2019
POLICY NUMBER EFFECTIVE DATES
Rogers &Gray Ineance Agency 434 Route 134 South Dennis, MA 02660
NAME OF INSURANCE AGENT ADDRESS PHONE#
Oliver Ormon, Inc. 6 Bray Farm Road Yarmouthport, MA 02675
EMPLOYER ADDRESS
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
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
•,",..,�F....y"
TOWN OF YARMOUTH
BUILDING ELECTRICAL
GAS
'_ 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
11 = Telephone(508) 398-2231,Ext.1261—Fax (508) 398-0836 PLUMBING
SIGNS
" `••` - BUILDING DEPARTMENT
Inspection and License Report
Date
Address7f Dr Business Name C /'c
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:
gr_ex
❑Emergency egress signage Location 2h e dr, .SL`way---
O Emergency egress lighting Location / /Cc//i /76AM C 'f :ip — /7�
O Maintenanceofexirs Location dU�L�7—Q'odets 1?Aej
O Guards/handrails Location V b e y4/4 l ,
Att0.4
faSigns Location ./////c'5 %' Mea
<T
❑ Parking location
O Other Location
Mechanical
❑CombustionAir Location
❑
Storagein Boiler Room Location •
O Vents Location
O Auromaticdoor closures
onboiler room doors Location
O Clothes dryer vents Location
Otber 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)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 next annual inspection.
o Make corrections within /3" ( days and contact this office for a follow-up inspection.
LoalOfficiaUlnspectorr j:004 ' Ir
Received By -,2)V--"Al L`' Title
Revised 2/8/13