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Home My WebLink AboutBLDCI-17-002519-02 • c "" The Commonwealth of Massachusetts I- e ' _,-,: h=•�� City\Town of ' ' • •= fAl YARMOUTH ZAIIM New and Renewal Certificate of Inspection i In accordance with the Massachusetts State Building Code,Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:PLANET FITNESS BLDCI-17-002519-02 Trade Name:PLANET FITNESS Identify property address including street number,name,city or town and county Certificate Expiration Located at 17 LONG POND DR 10/01/2019 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A3 . 01 st Floor 186 A-3 Amusement/Church/Gym/Library/Museum AEROBICS RM-49 EXERCISE AREAS-137 Allowable Other 15 A-3 Amusement/Church/Gym/Library/Museum15-MEZZANINE 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 Grylls rN Date of /7-19-453 / ' 78 Building Commissioner Inspection Signature of Municipal • Signature of Municipal Date of Building Commissioner / A / Issuance Cigi,001 Fee:$100.00 BLD_Certofl nspection.rpt "Rt TOWN OF YARMOUTH o `'CR y BUILDING DEPARTMENT 5 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION September 1,2018 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: 11 Lopc3 PrM Rome, Name of Premises: Plane V14Y eSS Tel: 50611-2300 Purpose for which permit is used:�t1V�d111ot SS gh,G4in License(s)or Permits)required for the premi'se�s by other governmental agencies: RECEIVED License or Permit Agency f I SEP 28 2018 J BUILDING DEPARTMENT By' Certificate to be is ued to & Ft}111f5J Tel:•S02)100-2.300 / {/ Address: "1 h O Y1 d goat k - - J Owner of Record of Buil g �/ Address Present Holder of Certificate Si:FltirOf person to whom T lle Ce V. is issued or his agent qto Date Email Address: 3 be\Ane e( Q l;Qaf Vn.covn 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# J DC Z -/7- .2:519-0 -2_,, 10/1/2018-10/1/2019 Technology Insurance Company, Inc. 800 Superior Avenue East,21st Floor Cleveland,OH 44114 Policy Change Endorsement Core Fitness of Walpole LLC USI Insurance Services, LLC 166 Grove Street 12 Gill Street, Sutie 5500 Franklin, MA 02038 Wobum, MA. 01801 Enclosed is a Policy Change Endorsement for Policy Number:TWC3700888 For Policy Change Endorsements, please retain one copy for your files and provide the second to the policyholder. For questions, please contact our Underwriting Office at:877-528-7878. 5/8/2018 VA AmTrust North America An AmTrust Financial Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B POLICY INFORMATION PAGE ENDORSEMENT Insured: Core Fitness of Walpole LLC Policy No: TWC3700888 Policy Period: 4/16/2018 to 1/31/2019 Endorsement No: 2 Carrier Name: Technology Insurance Company,Inc. Endmt Effective: 4/16/2018 Authorized Rep: ro C The following item(s) s Insured's Name(WC 89 06 01) ❑ Item 3.B.Limits(WC 89 06 12) o Policy Number(WC 89 06 02) ❑ Item 3.C.States(WC 89 06 13) o Effective Date(WC 89 06 03) o Item 3.D. Endorsement Numbers(WC 89 06 14) o Expiration Date(WC 89 06 04) o Item 4.'Class,Rate,Other(WC 89 04 15) o Insured's Mailing Address(WC 89 06 05) n Interim Adjustment of Premium(WC 89 04 16) o Experience Modification(WC 8904 06) 0 Carrier Servicing Office(WC 89 06 17) o Producer's Name(WC 89 06 07) ❑ Interstate/Intrastate Risk ID Number(WC 89 06 18) s Change in Workplace of Insured(WC 89 06 08) ❑ Carrier Number(WC 89 06 19) o Insured's Legal Status(WC 89 06 10) D Issuing Agency/Producer Office Address(WC 89 06 25) o Item 3.A.States(WC 89 06 11) Is changed to read: Additional named Insureds and physical locations are added to the policy per the attached form. . Technology Insurance Company,Inc. WC 99 00 01 B • 1of1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: Core Fitness of Walpole LLC Policy Number: TWC3700888 EXTENSION OF INFORMATION PAGE FOR ITEM#1 ITEM 1: NAMED INSURED and WORKPLACES NAMED INSURED: Core Fitness of Walpole LLC Fein:270066304 WORKPLACES: Location Number 1. Location Number 2. 166 Grove Street 7 Neponset Street Franklin, MA 02038 Worcester, MA 01606 NAMED INSURED: Core Fitness of Wareham LLC Fein: 812543205 WORKPLACES: Location Number 3. 2991 Cranberry Highway Wareham, MA 02538 NAMED INSURED: Core Fitness of Braintree, LLC Fein:463315272 WORKPLACES: Location Number 4. 749 Granite St Braintree, MA 02184 NAMED INSURED: Core Fitness of Norwood,LLC Fein:462418758 WORKPLACES: Location Number 5. 418 Walpole Street Norwood, MA 02062 NAMED INSURED: Core Fitness of Medford, LLC Fein:465343642 WORKPLACES: Location Number 6. 696 Fellsway Medford, MA 02155 NAMED INSURED: Core Fitness of Worcester, LLC Fein:454548670 WORKPLACES: Location Number 7. 68 Stafford Street Worcester, MA 01603 NAMED INSURED: Core Fitness of Natick, LLC Fein:272103577 WORKPLACES: Location Number 8. 215 West Central St Natick, MA 01760 NAMED INSURED: Core Fitness of Dedham LLC Fein:264550339 WORKPLACES: Location Number 9. 695 Providence Hwy Dedham, MA 02026 NAMED INSURED: Core Fitness of Marlborough LLC Fein:261259225 WORKPLACES: Location Number 10. 21 Apex Drive Unit A Marlborough, MA 01752 NAMED INSURED: Core Fitness of Shrewsbury, LLC Fein:455117065 WORKPLACES: Location Number 11. 100 Boston Turnpike Rd Shrewsbury, MA 01545 NAMED INSURED: Core Fitness of Walpole, LLC Fein:270066304 . WORKPLACES: Location Number 12. • 7 Neponset St Worcester, MA 01606 NAMED INSURED: Flextime,LLC Fein:043567024 WORKPLACES: Location Number 13. 166 Grove St Franklin,MA 02038 NAMED INSURED: Core Fitness of Brockton, LLC Fein:475517284 WORKPLACES: Location Number 14. 715 Crescent St. Brockton, MA 02302 NAMED INSURED: Core Fitness of Newton, LLC Fein:811340602 WORKPLACES: Location Number 15. Location Number 16. 191 Watertown Street 191 Watertown Street Watertown, MA 02472 Watertown, MA 02472 NAMED INSURED: Core Fitness of Webster, LLC Fein: 811259307 WORKPLACES: Location Number 17. 112-120 E. Main Street Webster, MA 01570 NAMED INSURED: Core Fitness of North Attleboro, LLC Fein: 821007644 WORKPLACES: Location Number 18. 40 Cumberland Avenue North Attleboro, MA 02760 NAMED INSURED: Core Fitness of Falmouth, LLC Fein: 814650403 WORKPLACES: Location Number 19. 9 David Straights Road Falmouth, MA 02540 NAMED INSURED: Core Fitness of Middleboro, LLC Fein:823179716 WORKPLACES: Location Number 20. 10 Merchants Way Middleboro, MA 02346 NAMED INSURED: Core Fitness of South Yarmouth, LLC Fein:824166149 WORKPLACES: Location Number 21. 17 Long Pond Dr. South Yarmouth, MA 02664 NAMED INSURED: Core Fitness of Waltham, LLC Fein: 824135071 WORKPLACES: Location Number 22. 10 Colematis Ave Waltham, MA 02453 I. f• ,'t TOWN OF YARMOUTH BUILDING ELECTRICAL 10 Y S • .ry`r ' 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING Telephone(508) 398-2231,Ext.1261 —Fax (508) 398-0836 SIGNS BUILDING . DEPARTMENT Inspection and License Report. //".9"-/gAddress /7 �I f q /al Date / O Business Name ��lT ,z2TWA:55 Contact Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 1103 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: Ryes, ❑Emergency r eerlr� Emetgenegresssignage Location AVF+� 1:3Emergency egress lighting Location 4"/�r /� m /, CI Maintenance ofexits Location _04 d nct / r'w c& 4 %r • ^. .. ❑ Guards/handrails Location /5'!Ctv"C rA6r ih _...ant w. :.»� - Y ❑ Signs Location eizai ❑Parking' Location • ❑ Other Location Mechanical ❑ Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑Clothes dryer vents Location Dtber 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 �Q /S da ss and contact this office for a follow-up inspection. LoalO$tcial/Inspecttoor' &M0 —22":"/X/7 Received By ('1 `-` Title Revised 2/8/13