Loading...
HomeMy WebLinkAboutApp, WC & License The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-15-2308-06 Issue Date: 1/1/2021 Mailing Address: Location Address: CHARLES WHITE MANAGEMENT INC. 345 CAMP ST RAVENSWOOD CONDOMINIUMS WEST YARMOUTH. MA 02673 345 CAMP STREET WEST YARMOUTH, MA 02673 IS HEREBY GRANTED A 2021 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2021 unless sooner suspended or revoked and is not transferable. Conditions OUTDOOR SWIMMING POOL *RESTRICTION. Safety report must be submitted annually with application. Board of Health Hearing, 04/23/01 -Do not need CPR, First Aid and Water Safety Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman Of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston A / Bruce G. Murphy, PH, '. ., CHO Health Director °` ►,,` TOWN OF YARMOUTH BOARD OF HEALTH APPLICATION FOR LICENSE/PERMIT - 2021 Please complete form and attach all necessary documents by December 18, 2020. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME: 44 Lt0 ee ' 06 L TAX ID: 6.5-0 /6,4,917 LOCATION ADDRESS: y (j��w �) //e, TFL.#: ; cs y/Vr3-MAILING ADDRESS: 4s � ye4;:e E-MAIL ADDRESS:__ likor&WeV�O/aOWNER NAME: C 42#'C u211i ; 7rz CORPORATION NAME (IF PPLICABLE): MANAGER'S NAME: C '� • �P-ar/ TEL.i x&?ece MAILING ADDRESS: .ri. y/PC) .e‘ Air, POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator, as required by State law. Please list the designated Pool e_.eer2Operator(s) and attach a copy of the certification to this form. - 2 Pool operators must list a minimum of two employees currently certified in standard First Aid and Community Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at all times. Please list the employees below and attach copies of their certifications to this form. The Health Department will not use past years' records. You must provide new copies and maintain a file at your place of business. 1. ae4e 1Jam✓lam'/cogv /-2.,-4%(//V/i 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who is certified as a Food Protection Manager, as defined in the State Sanitary Code For Food Service Establishments, 105 CMR 590.000. Please attach copies of certification to this application. The Health Department wil Ise )ast years' records. You must provide new copies and maintain a file at your establishment. ", J�% io I. 2. JU y 24 PERSON IN CHARGE: HEALTH DEPT Each food establishment must have at least one Person In Charge (PIC') on site during )ours o I. -- 2• — ALLERGEN CERTIFICATIONS: All food service establishments are required to have at least one full-time employee who has Allergen certification, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.009(G)(3)(a). Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain a file at your establishment. I. 2 HEIMLICH CERTIFICATIONS: All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich Maneuver on the premises at all times. Please list your employees trained in anti-choking procedures below and attach copies of employee certifications to this form. The Ilealth Department will not use past years' records. You imrst provide new copies and maintain a file at your place of business. I. 2. 3. 4. RESTAURANT SEATING: TOTAL // OFFICE USE ONLY LODGING: LICENSE REQUIRED PGI: I'I•:RMI"i ll 1.1('1?NSI RI•:Q(IIRI.I) I lil: I'I:RM1I i1 LICENSE REQUIRED ITE PERMIT Il ADMINISTRATION Under Chapter 152, Section 25C, Subsection 6, the Town oiYarmoulh is 11oW required to hold issuance or renewal of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR CERT. OF INSURANCE ATTACKED Oil WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: YES ✓ NC) MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or I lotel use,Transient occupancy shall be limited to • the temporary and short term occupancy, ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of residence elsewhere. Transient occupancy shall generally refer to continuous occupancy of not more than thirty(30)days, and an aggregate of not more than ninety(90)days within any six (6) month period. Use of a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise, as defined in M.O.L. c. 64G or 830 CMR 64G, as amended, shalt generally he considered Transient. POOLS POO1. OPENING: All swimming, wading and whirlpools which have been closed for the season must be inspected by the I lealth Department poor to opening. Contact the Ilealth Department to schedule the inspection three (3) days prior to opening. PLEASE NOTE,: People are NOT allowed to sit in the pool area until the pool has been inspected and opened. POOL WATER TESTING:ING: I he water im(ist be tested for pseudomonas, total coliform and standard plate count by a State certified lab, and submitted to the I leallh Department three(3) clays prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven (7)clays of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the I lealth Department prior to opening. Please contact the health I)epartment to schedule the inspection three (3) days prior to opening. CATERING POLICY: Anyone who caters within the 'town of Yarmouth must notify the Yarmouth health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. "these forms can be obtained at the Health Department, or from the 'town's website at www.y_armouth_ma_us under Health Department, Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter,with sample results submitted to the I lealth Department. failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e., outdoor seating with waiter/waitress service), must have prior approval from the Board of I!calih. OUTDOOR COOKING: Outdoor cooking, preparation, or display of any food product by a retail or food service establishment is prohibited. TOBACCO PRODUCT PERMIT CAI' A tobacco permit holder who has failed to renew his or her permit within thirty (30) days of the previous year's permit expiration date is considered an expired license, and the tobacco license cap is reduced. NOTICE: Permits run annually from January 1 to December 3 I. IT IS YOUR RESPONSIBILITY TO RETURN ri�I rnnnn( CT(7rl I)I 1CU1iAI nnni iC'A l'Innerc\ A MIA r rriimi.n i.►:i,ic\ rev nrCi tiPI l? 12 1 -on July 7, 2021 Town of Yarmouth Board of Health Yarmouth Town Hall To The Controlling Authorities: The owners (Charles White Management) of the Ravenswood Condominium complex, 345 Camp St. W.Yarmouth respectfully request a variance regarding the local regulations pertaining to the 55,000 gallon pool and surrounding activity area for the following reasons: 1.) A high degree of security is accomplished by a six foot stockade fence surrounding the entire facility, accessible only by one gate that is always locked. 2.) The signage includes rules for conduct, hours of operation, (10:00am to 8:00pm) and two separate panels stating"NO LIFEGUARD ON DUTY SWIM AT OWN RISK" in large red letters. 3.) The two live-in managers are Water Safety certified and either one is on site at any given time. 4.) Week day usage is minimal, averaging 10 bathers a day max. 5.) Daily maintenance, monitoring, and modifications are performed by the Mgr, a CPO 6.) This pool is PRIVATE in that it is used exclusively by the residents of Ravenswood and their guests only. The Clubhouse is off limits to all with the exception of the managers and thereby does not provide access to the pool or recreational area Thank you for your consideration on this matter, we at C.W.M. always appreciate the Town's efforts on our behalf and look forward to future collaboration for the benefit of all. Sincere , George M. DeRa eau, Prope y Manager Ravenswood Condominiums 345 Camp St. West Yarmouth MA. (508) 889-1445 ( y/j) Zge1j 1 _ /Q3------1 /41t/4 _— m CHARWHI-03 JLOOMIS .A�o,I20 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDl YYY) 7/8/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jane NAME: K Loomis, CISR,CIC The Corcoran 8 Havlin Insurance Group PHONE 781 235-3100 241 FAX 781 235-1622 287 Linden Street (A/C,No,Ext):( ) (A/c,No):( ) Wellesley,MA 02482 ADDRESS:JLoomis@chinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartford Fire Insurance Company 19682 INSURED INSURER B: Charles White Managed Properties Corp. INSURER C: 330 Commonwealth Avenue1 INSURER D Boston,MA 02115 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSTMPD CONDITIONS OF SUCH POLICIES. D oSI sLIMITS SHRVE BEEN REDUCED PCA INSR POLICY EFF POLICY EXP LTRD POLICYNUMBER Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAE TO RENTED PREMISESLEaoccurrence) _$ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER. $ COMAUTOMOBILE LIABILITY (Ea acSINED INGLE LIMIT accident) $ ANY AUTO BODILY INJURY(Per pqrson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY_ INJURY(Per accident) $ - - HIRED NON-OWNED I PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE AGGREGATE $ DED RETENTION$ I $ A WORKERS COMPENSATION I X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 08WBCLD6253 2/2/2021 2/2/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? IN I N/A1 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE.$ If yes,describe under500,000 DESCRIPTION OF OPERATIONS belowI E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) f� l cj IN/r;� RE: 345 Camp Street,West Yarmouth,MA U V 6=V JUL 08 2021 HEALTH DEPT, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth,Board of Health ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE r ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD