HomeMy WebLinkAboutBldci-22-003878 The Common ' `,•al '1 of Massachusetts
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New and Renewal Certificate of Inspection
In accordance with the Massachusetts State Building Code, Section 110.7
Identify Name of Establishment I Certificate No.
Issued to
Business Name: CULTURAL CENTER OF CAPE COD BLDCI-22-003878
Trade Name: CULTURAL CENTER OF CAPE COD
Identify property address including street number, name, city or town and county Certificate Expiration
Located at
307 OLD MAIN ST 12/31/2023
SOUTH YARMOUTH, MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s) -
A-3 01st Floor 200 A-3 Amusement/Church/Gym/Library/Museum Owl Hall-80 standing or
60 seats
Culinary Art Kitchen-15
Allowable Standing or 12 seats
Occupant Load 01st Floor A-3 Amusement/Church/Gym/Library/Museum Art Studios 20
Basement/Lower A-3 Amusement/Church/Gym/Library/Museum
Studio-30
Note:Aggregate Total
shall not exceed 200 for
entire complex
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 Grylls, Date of /-�
Building Commissioner — -Inspection
Signature of Municipal Signature of Municipal P ate of
Building Commissioner Issuance / •I/ -Z
Fee: $100.00
BLD_Certoflnspection.rpt
* •0,�\ TOWN OF YARMOUTH
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r, , BUILDINGDEPARTMENT
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,' .:t T_,:s�" 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
January 1, 2022 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-namo ed premises ocated at the following address:
Street and Number: I b q Dia v V la 1n S-
Name of Premises: 0„c„t„ htim,1 Cif el: 5 ,10
Purpose for which permit is used:
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
ea
5 3Certificate tS�be issue to 1: [''( ��
Address: ;..(Y1 0)4 Mal ` (Fivi 7 o` L
Owner of Record of Building Y � -OS
Address I,VN-, �
Present Holder of Certificate Sit V ,
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Signature of person o whom Titl
Certificate is issued or his agent j (Q 19-9- RECEIVED
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Email Address: V Vt , _ JAN 10 2022
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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#
02/06/2022-02/06/2023
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NOTICE NOTICE
it TO W •a:: TO
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EMPLOYEES ��¢ EMPLOYEES
WOgV'
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111
(617) 727-4900 — 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:
Wesco Insuance Company
NAME OF INSURANCE COMPANY
800 Superior Avenue East, 21st Floor, Cleveland,OH 44114
ADDRESS OF INSURANCE COMPANY
WWC3530797 6/1/2021 to 6/1/2022
POLICY NUMBER 11801 Grand River Rd. Brighton,MI EFFECTIVE DATES
Mackinaw Underwriters, Inc. 48116 (978) 691-2470
NAME OF INSURANCE AGENT ADDRESS PHONE#
Cultural Center of Cape Cod, Inc. 307 Old Main St, South 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 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
he eby notified that the insurer has arranged for such attention at the
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NAM OF OF HOSPITAL6,,rt DDR E S
TO BE POSTED BY EMPLOYER
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