HomeMy WebLinkAboutBLDCI-17-002233-02 The Commonwealth of Massachusetts
Yg�
71 City\Town of
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:MID-CAPE RAQUET CLUB BLDCI-17-002233-02
Trade Name:MID-CAPE RAQUET CLUB RESTAURANT
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
193 WHITES PATH 12/31/2019
SOUTH YARMOUTH,MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 34 A-2 Nightclub/Restaurant/Bar/Banquet Hall 18-Bar Stools
16-Movable chairs
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
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 Gryl Date of /7 _7-787Fire Chief Building Commissioner Inspection 7
Signature of Municipal /// Signature of Municipal Date of
/
Fire Chief / / '/G Building Commissioner // Issuance /2 /7 a r L
4,1 Fee:$100.00
BLD_Certoflnspection.rpt
•
BUILDIN
. -__ TOWN OF YARMOUTHAL
~ GAS
.• / c 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
Telephone(508)398-2231,Ext.1261 —Fax(508) 398-0836 PLUMBING
SIGNS
`-- .. BUILDING DEPARTMENT
Inspection and LicensegReport
�/ Date /4 /7 -19
Address //3 wMie s "/TI Business Name 9/ / A9COCT
Conrar r 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
7vviollad:
ation(s)were observe
Q ergencyegresssignage Location eine ��� "/y�/ (>
❑Emergency egress lighting Location
❑Maintenance ofexits location
❑Guards/handrails Location keI
Zoning
❑Signs Location
•
❑Parking location
❑ Other Location `y/
Mechanical
❑CombustionAir location •
.❑ Storage in Boiler Room Location
❑
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.
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 L r//ddays and contact this office for a follow-up inspection.
LoalOfficialInspeaor 13 0440 -74%1 ey
Received By Title
Revised 2/8/13
o•Y9R; TOWN OF YARMOUTH
o..
0 y^ -H BUILDING DEPARTMENT
°s>,x .•.,.,•� ca! 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 foruthe below-named premises located at the following address:
Street and Number: IR 3 `K(`CJ( e �. �p`�e
Name of Premises: 1(1 C4(32 A--Kketc Lbst.10 Tel: 5-C8 'ate}' 36 I I
Purpose for which permit is used: 1-rukk,. eurposp r-c i`iav`_
License(s)or Permit(s)required for the .rree ises by-9lhcj g•vernmental agencies:
License or Permit R!ui159 VCUAgency
tC 2016
pUiLOWf -CC-NT
Certificate to be issued to $ '< -C Tel: 50$ .344.361(
Address: lq3 u Lks ?ate,
Owner of Record of Buildingi kr'\<ocJ v
Address 13'5t gcLat. C 5.-ictrwto,cit, Act .
Present Holder of Certificate 3oae_
Signature of person to whom Title I
Certificate is issued or his agent tzl t I c
1 n •
Date
•Email Address: bob > VYL\ & �t\ [c. . Cowl
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# Z.W -/7-07 Qa33-u Z
1/1/2019-12/31/2019
NOTICE NOTICE
TO TO
EMPLOYEES g +9+. EMPLOYEES
fiy
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 Genera 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:
Technology Insurance Company, Inc.
NAME OF INSURANCE COMPANY
800 Superior Avenue East, 21st Floor, Cleveland, OH 44114
ADDRESS OF INSURANCE COMPANY
TWC3734583 9/20/2018 to 9/20/2019
POLICY NUMBER EFFECTIVE DATES
Maguire Insurance Agency, Inc. One Bala Plaza,Bala Cynwyd,PA 19004 (800) 873-4552
NAME OF INSURANCE AGENT ADDRESS PHONE#
Mid-Cape Racquet&Health 193 White's Path, S. Yarmouth,MA 02664
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
services 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