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Home My WebLink Aboutbldci-16-003439-02 (2) The Commonwealth of Massachusetts A '=— =% CitylTown,I= of •�. ', YARMOUTH .Oil l i• . waves • t) ...,1 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. Issued to Identify Name of Establishment Certificate No, Business Name:YARMOUTH LODGE 2270 BLDCI-16 00343902 Trade Name: LOYAL ORDER OF MOOSE Identify property address including street number,name,city or town and county Certificate Expiration Located at 769 ROUTE 28 12/3112o19 SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classificatlons(s) A-2 Other 18 A-2 Nightclub/Restaurant/Bar/Banquet Hall OUTSIDE PATIO Allowable 01st Floor 315 A-2 Nightclub/Restaurant/Bar/Banquet Hail 115 persons-large bar Occupant Load 32 persons-smoking bar 168 pis=function TOTAL-333 This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specifie ' petted 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 Ili Name of Municipal Mark Grylls Date of Fire Chief Building Commissioner / Inspection Signature of Municipal Signature of Municipal - Date of Fire Chief 1/1 .' Building Commissioner G' Issuance ' o6 f Fee:$150.00 BLD Certoflnspection.rpt YARo. TOWN OF YARMOUTH o -y BUILDING DEPARTMENT • ; a c,. 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 $150.00 ( ) 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 r 2T g. Name of Premises: YM/4OtJ Z0619/ f. 7 Q Tel: ?7V-,212- S.v3 eS <<- Purpose for which permit is used: L( QUog. �1c EA,-S6-- License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit RECEIVED Agency NOV 14 2018 1 i BUILDING DEPARTMENT t3 Y' Certificate to be issued to Tel: Address: Owner of Record of Building Address Present Holder of Certificate •=6- }Tg- Signs a erson to whom Title Certi cat s issued or his agent I)-/ 1- /r Date Email Address: Lad 3 E e At VG Sc- TT _o(1G- 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# - 0 Z, 1/1/2019-12/31/2019 NOVA Casualty Company 7 / - 1 .:VA A STOCK INSURANCE COMPANY •li, /j_� 726 Exchange Street Suite 1020,Buffalo,NY 14210 ..; CASUALTY L'U�[PA.1Y s 1-866-633-69454 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE POLICY `4). INFORMATION PAGE NCCI Company No. 14191 POLICY NO. LFR-WK-10001335-00 RENEWAL OF: LFR-inc-0012469-2 ITEM 1. NAMED INSURED AND MAILING ADDRESS: AGENT NAME AND ADDRESS: ^YAARMOUTH MOOSE LODGE #2270 LOCKTON AFFINITY,LLC. BOX 186 P.O.BOX 410679 SOUTH YARMOUTH MA 02664-0186 KANSAS CITY,MO 64141-0000 LODGE2270@MOOSEUNITS.ORG AGENT NO. 10071 LEGAL ENTITY: NON PROFIT ORGANIZATION OTHER WORKPLACES NOT SHOWN ABOVE: SEE NAME AND LOCATION SCHEDULE ITEM 2. POLICY PERIOD: From: 12-15-2017 To: 12-15-2018 Effective 12:01 A.M.Standard Time at the Insured's mailing address. ITEM 3. COVERAGE: 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: $ 100,000 each accident Bodily Injury by Disease: $ 500,000 policy Omit Bodily Injury by Disease: $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: ALL STATES EXCEPT ND, OH, WA, WY AND STATES DESIGNATED IN ITEM 3A D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE OF FORMS AND ENDORSEMENTS ITEM 4. PREMIUM: The prerrium for this Policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to verification and change by premium adjustment or audit_ Minimum Premium: $ 212 (MA) Total Estimated Policy Premium: $ 894 Audit Period: ANNUAL Deposit Premium: $ 894 Issuing Office:WINDSOR, CT Issued Date: 10-09-17 WC 00 00 01 A 0615 'Includes copyrighted material of Nations!Council on Compensation Insurance with it's permission- MUSED E ; eel ' `` °� TOWN O F YARMOUTH M O U T H LEcriNG ,i. ram`--_ `1. ELEc'1TtICAI. ,s, GAS 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSh11S 02664-4451 �' _' PLUMBING''� Telephone(508)398-2231,Ext.1261 —Fax (508) 398-0836 -_. � -. SIGNS BUILDING DEPARTMENT Inspection and License Report Late /D2` 5-- /8 Address Z 74 viz 2 7 6 Business Name //7:2 2 "44— Coma 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: Awl Emergency egress signage Location // 'I S ZiDo- 664-(iL Gd- /4'si--ip- arouelai El Emergency Emergency egress lighting Location /rir �� .Si�e - ❑Maintenance desks Locauon J )4N / ,// rlr" /7 r >, l ❑Guards/handrails Location O/ C (,L ref/(.0 ;ri07^•c� actin 44r Jon IV i> dfAi" .# i' 2 ❑Puking Location AD/ C/ cr/7/ .--±J 14I i.-- `ti [] Other Location '1 G45 � 47) � A Mechanical• ❑Combustion Air Location ❑Storage in Boiler Room Location I]Vents Location ❑Automatic door closures on boiler room doors Location Clothes dryer vents Location a tr 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 abovesiolation(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 f45 daysand contact this office for a follow-up inspection. LoalOfiicial/Inspector70, Z 44/ 'e Received By Title Revised 2/8/13