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Home My WebLink AboutCerticiate of Inspection The Commonwealth of Massachusetts , :v,__ ►r. City\Town of yY YARMOUTH 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: CAPTAIN FARRIS HOUSE BLDCI-17-000333-03 Trade Name: CAPTAIN FARRIS HOUSE Identify property address including street number,name,city or town and county Certificate Expiration Located at 308 OLD MAIN ST 08/31/2020 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 4 R-1 Hotel/Motel/Boarding House/Transient 4 Bedrooms,1 kitchen,1 living room,1 dining room,library Allowable 02nd Floor 4 R-1 Hotel/Motel/Boarding House/Transient 4 Bedrooms Occupant Load Other 2 R-1 Hotel/Motel/Boarding House/Transient Annex-1st-2 Bedrooms 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 Gry Date of 72.3Building Commissioner Inspection 707 Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance Fee:400.00 B LD_Certofl nspection.rpt 01'.Yak TOWN OF YARMOUTH O . _H BUILDING DEPARTMENT MATTA n Sf ��••.•,••• ;a 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION August 9, 2019 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: .' C 8 O t a ff Pr NJS I S G . /ceN c%u MA Name of Premises: C 0\p a car,(--+ S Tel: ±5C b 0 -- I S . f Purpose for which permit is used: ?De cL .r&k 4 o 1 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency i 1, Lc,�ll.l LtC� ;I �uG�� r A1t Wm. locrd Certificate to be issued to Cc +Ck,,r, e-cc�� J)—< Tel: S C D- '6 Address: 3u e 0 kc1 I��.�,, St . s• y 67,4 Ci-b" / Owner of Record of Building 5 Cv‘1 --I- Address Present Holder of Certificate AN 0 9 2019 /� BLJILENGDEPARTMENT BY Signature person to whom Title Certificate is issued or his agent �j' () Date Email Address: GZ: J U'�e S � �� lr.�X ' (Oj 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# 3&i .7- /7 000333-0-3 8/31/2019-8/31/2020 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 40959 POLICY NO. WCC-500-50187802019AI PRIOR NO. WCC-500-5018780-2018A ITEM 1. The Insured: JCW Enterprises Inc DBA: The Captain Farris House Mailing address: 308 Old Main St FEIN:•*-•'•g195 South Yarmouth,MA 02664 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 05/04/2019 to 05/04/2020 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 $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 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 Ot Annual Remuneration Remuneration Premium INTRA 001057635 INTER SEE CLASS CODE SCHEDULE Minimum Premium $306 Total Estimated Annual Premium GOV $1,430 STATE CLASS Deposit Premium $368 I MA 9052 State Assessments/Surcharges $997.00 x 3.8300% $38 This policy,including all endorsements,is hereby countersigned by r --��-- 04/05/2019 Authorized Signature Date Service Office: 54 Third Avenue Dowling and 0 Neil Ins Agcy Burlington MA 01803 973 Hyannis,nis,Mugh Road MA 02601 WC 00 00 01 A(7-11) Includes used with its copyrighted material of the National Council on Compensation Insurance, Permission. I _ - °F Yq = ING TOWN OF YARMOUTH ELECTRICAL 164 g=° GAS „ ,1 ♦ 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING 2 11 Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836 SIGNS BUILDING DEPARTMENT Inspection and License Report _ Date 3 // Address 368 aLD M,4 J'! St Business Name PT• /41` a I S /VerG SL 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: Egress ❑Emergency egress signage Location ❑ CeiZ /d45 - w' W Emergency egress lighting Location h4,4'Tt"� /�-!' e"C"` /17 XT ❑Maintenance of exits Location ❑ Guards/handrails Location Zatthe ❑Signs Location ❑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 plixt 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 das and co tact this office for a follow-up inspection. Local Official/Inspector BM2 ji/ By +{ ;` c'i,,� I Received �i�- 7/� ,j ! '�/%�l/1 Tide I � �'�- ,� � } ; /s,,� ' � G Revised 2/8/13