HomeMy WebLinkAboutCertificate of Inspection N
The Commonwealth of Massachusetts
1 :ice I City\Town of
rid= M
YAROUTH
1 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: MARINER MOTOR LODGE BLDCI-16-007002-03
Trade Name: MARINER MOTOR LODGE
Identify property address including street number,name,city or town and
Located at county Certificate Expiration
573 ROUTE 28 06/22/2020
WEST YARMOUTH, MA 02673
Use Group Floor Occupancy Use,Group
Classifications(s) p Other
R-1 01st Floor 50 R-1`Hotel/Motel/Boarding House/Transient
50 Units ,,.;: a�
Lobby&Office
Allowable 02nd Floor 50 R-1 Hotel/Motel/Boarding House/Transient
50 Units
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 G lls
rY Date of ���
Budding Commissioner ection
Signature of Municipal Signature of Municipal 4 0 ir 'gate of
Building Commissioner Issuance
Aire f " ?ii Z./,'
Fee:$370.00
B LD_Certofl nspection.rpt
1
YTttmr.
YaRo TOWN OF YARMOUTH
o I VS BUILDING DEPARTMENT
C MATTA 1 cs,
�, �•o.«a�-0 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
May 3, 2019 PAYABLE UPON RECEIPT
(X) Fee Required 370.00
( ) 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: 7) 6-(/(h 2 9'
4 ' %
Name of Premises: 1"la`�l�- ��� Tel:
Purpose for which permit is used:
License(s) or Permit(s)required for the premises pxher..g�mernmental agencies:
Agency
License or Permit a
1 LAN 2019A
BUII.
-IJ!NC; O�__P/ RTMENT
Certificate to be issued to rita6t Gc4.0111 Maio/LLC Tel: civ(k I-MI
Address: 5 3 1Z044, , 2-g- f,t)- Qt.4144 Mt b24;?q-3
Owner of Record of Building
Address
Present Holder of Certificate
MO°lit
Signature of person to whom Title
Certificate is issued or his agent 061011,
Date
Email Address: 7 rdbi.P7OtO 71 'I mc*. ,'00 n
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#
6/18/2019-6/18/2020
I
NOTICE NOTICE
anaimurt TO
T011fwf[fv.
5A f�ff Yf s!
EMPLOYEES - '
EM PLOYE�S
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 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:
NORFOLK & DEDHAM MUTUAL FIRE INSURANCE COMPANY
NAME OF INSURANCE COMPANY
222 AMES STREET, DEDHAM, MA 02026
ADDRESS OF INSURANCE COMPANY
WE158500A 07/22/2017
POLICY NUMBER EFFECTIVE DATES
215 MAIN STREET PO BOX 330
G.H. DUNN INSURANCE AGCY, INC BUZZARDS BAY, MA 02532 PHONE#
NAME OF INSURANCE AGENT • ADDRESS
573 ROUTE 28
MAA GAYATRI MARINER LLC WEST YARMOUTH MA 02673
EMPLOYER ADDRESS
07/07/2017
EMPLOYER'S WORKERS'COMPENSATION OFFICER(IF ANY) DATE
M ED 1CAL TREATM ENT
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
Form WC 88 20 01 C Printed in U.S.A.
INSURED COPY
Yq,0.2)%441f9 TOWN OF YA R M O U T H ELLEECTTIRIICAL
�. GAS
,r 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
"6"4i1 Z PLUMBING N
..., ...,..
�� Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836
1� ,;.:' SIGNS
BUILDING DEPARTMENT /L.�°
Inspection and License Report �f �? G�
Date / ✓�/
Address 5-7/ I?UC�TC 41;'�1 Business Name /719 /Jk,( /)Z 'X 241:/✓ g7_
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:
-do- (�/Q ,4A_
Ewe / / A' 11 I /UC / /./
Li Emergency egress signage Location 7.�' v / �yV
❑Emergency egress lighting Location )i 17(766 /"//5/- Zei,.1
❑Maintenance of exits Location / �/
"� la Location 1 �4 i'I/4 ,CE' e e fs POour7s'
1:11 Signs LocationZ, mot te'/ 1� T Ie 4:1--- ,
w ❑ r e✓'S `G s c1Q,p/dam
Location
❑ Other Location l 2 e,,//7f leve"7- 2e,t 'C
Mechanical
❑ Combustion Air Location 4e4/ - e-7/ 55 '.)l..0 / c4�C1',';_
❑Storage in Boiler Room Location
❑Vents Location
❑Automatic door closures
on boiler room doors Location .
rj Clothes dryer vents Location
fther 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 ,�.7 days and contact this office for a follow-up inspection.
Local Official/Inspector Pu ...2"' ,
Received By *4 / Title
Revised 2/8/13