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HomeMy WebLinkAboutBldci-22-002222 The Commonw :'. 1 i of Massachusetts
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Ci ,T t'vvn of
' ' YA 'VI1'1UTH
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.
Identify Name of Establishment Certificate No.
Issued to
Business Name: Baxter Innkeeping LLC BLDCI-22-002222
Trade Name: Chapter House Cape Cod
Identify property address including street number, name, city or town and county Certificate Expiration
Located at
277 ROUTE 6A 12/31/2022
YARMOI ITH POET MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 36 A-2 Nightclub/Restaurant/Bar/Banquet Hall Bar: 10 Persons
Screened Porch:
26 Persons
Allowable
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 Philip Simonian III Name of Municipal Mark Grylls Date of //�n���
Fire Chief Building Commissioner Inspection Oc
Signature of Municipal Signature of Municipal % Dllte of
Fire Chief .A4' �uilding Commissioner � Issuance ✓7. 2 /
" Fee: $100.00
BLD Certoflnsoection.rnt
BUILDING DEPARTMENT
1146 Route 28, South 'Yarmouth, MA 02664
508-398-2231 ext. 1260 Fax 508-398-0836
LICENSE INSPECTION APPROVAL LOG - 2022
NAME: Chapter House ADDRESS: 277 RTE 6A
This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your
building/premises. When all signatures are obtained, this log shall be presented to the License &
Permits office and/or the Health Department in order to obtain your license. Licenses will be
withheld until all inspectors have signed.
Building Commissioner ep. Date Comments Approved for
License_Issuance
oLo2 2( es No
Fire Department Rep. Date Comments Approved for
C A TT oQ 1 Z3 Z i License Issuance
Yes No
Board of Health Rep. Date Comments Approved for
License Issuance
Yes No
Plumbing/Gas Inspector Date Comments Approved for
// Z S z Licence Issuance
Yes/ No
Electrical Inspector Date Comments Approved for
License Issuance
Yes No
Taxes Paid Yes No
Rev.Sept.2003
�r`a° iYN TOWN OF YARMOUTH
(., t 21.,>,
./ A \c'-,
o .ja, BUILDING DEPARTMENT
�a<,�MATTACM CS[= :?�
;� 1146 Route 28, South Yarmouth, MA 02664 S08-398-2 E I V E D
APPLICATION FOR CERTIFICATE OF INSPECTION OCT "5c 2021
CI� l t
October 1, 2021 PAYABLE ONALRP PITARTMENT
(X) Fee Requ L.TOff88----- _
( )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: 2 7-7 "20 J rE. 6 4
Name of Premises: CHAcPr iz htGr!IC ek,e c o.o Tel: 3 1 c' g 7 7 c. 6 4
Purpose for which permit is used: 4t,L or/o c-i c- "81, i, _,y-c jt S
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Li?A-- 2-I O o `t & /4-Am 0v:)i- 6i ceN ji,/`-Ase, "
/7 aJ--2s9
L/CA-- tti - oe lc? Tot.✓ri 4.o- 7i1q 1o✓tcO/-
,c�
Certificate to be issued to 134-Ki iZ by/vie-et-AA-et-AA4 t:t Tel: 3 i C) 8 7 7 S, 6
Address: Po 8 0)e / ra? � -fr- /l4-NN I S / (-f 14- 0 2. 6 It
Owner of Record of Building A-s/r A 7/4-i)-ot,9 0 a-pi- Po 2 r- /4-DC,4 f,6 6 y / C.(...C,
Address 'PO N2X /f'o 3 6,4t i 04E7vn45 ` ail- 49 - 6 tt t
Present Holder of Certificate R,4--T fL 1 N/= Pt i • u.G
l �!,✓y a ActAiiti4- e 2
Signs a of person to whom Title // - u
Certificate is issued or his agent
Date
Email Address: f Vi c`_ ri 714-KTe 0-0-0 S P/—0K-i r(, Co w
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# 8L )C I -. a,
12/31/21-12/31/2022
•
No.: 06268-HT-1518
LICENSE
ALCOHOLIC BEVERAGES
THE LICENSING BOARD, TOWN OF YARMOUTH, MASSACHUSETTS
HEREBY GRANTS A
Annual Innholder All Alcoholic
License to Expose, Keep for Sales, and to Sell
All Kinds of Alcoholic Beverages
To Be Drunk On The Premises
To: BAXTER INNKEEPING LLC Date: 08/05/2021
DBA: CHAPTER HOUSE Ref: LICA-21-0048
277 ROUTE 6A
YARMOUTH PORT, MA 02675
Fee(s): 1,762.50
License Duration Type: Annual Manager: PHILIP E. BAXTER
License Conditions
THE INN CONSISTS OF 21 GUEST ROOMS IN TWO BUILDINGS - CARRIAGE HOUSE 2 FLOORS,
10 GUEST ROOMS AND MAIN HOUSE 3 FLOORS, 11 GUEST ROOMS. IN ADDITION TO THE
15,628 SF OF INDOOR SPACE THERE IS 1,085 SF ON A DECK. THE FIRST FLOOR OF THE MAIN
HOUSE AND THE DECK IS WHERE THE BAR AND RESTAURANT ARE LOCATED.
On the following described premises: 277 ROUTE 6A, YARMOUTH PORT,MA 02675
This license is granted and accepted upon the express condition that the licensee shall in all respects,conform to all the
provisions of the Liquor Control Act,Chapter 138 of the General Laws,as amended,and any rules or regulations made expires
December 31,2021, unless earlier suspended,cancelled or revoked.
IN TESTIMONY WHEREOF,the undersigned have thereunto affixed their official signatures.
The Hours during which Alcoholic Beverages LICENSE
may be sold are From: granted by:,;
f
8:00AM - 1:00AM -
Weekdays& Saturdays AI
10:00AM - 1:00AM Sundays 9
OUTDOOR HOURS ON LAWN UNTIL 8:00PM LIVE I THORI' IES
DECKS & PATIO UNTIL 10:00PM /
This License Shall be Displayed on the Premises in a
conspicuous position where it can be easily read
411.1.4
ALL NOISE TO BE CONTAINED WITHIN THE BUILDING
Fe 105.00 THE COMMONWEALTH OF MASSACHUSETTS
No.: LIC-22-0049 TOWN OF Yarmouth, License For
WEEKDAY ENTERTAINMENT:
INNHOLDERS,COMMON VICTUALLERS AND
OTHER KEEPERS OF RESTAURANTS AND OTHER ESTABLISHMENTS
In accordance with the provisions of Chapter 140, Sec 183A of the General Laws as amended by Chapter 299 of the Acts of 1926 and amended thereto,
LICENSE is hereby granted to:
Name of the establishment: BAXTER INNKEEPING LLC dba: CHAPTER HOUSE
Manager: PHILIP E. BAXTER
Location: 277 ROUTE 6A,YARMOUTH PORT, MA 02675
License granted for: Live Band-Number of Pieces:3;Live Music
Applicable Date(s)and/or Time(s): 1:00PM - 10:00PM MONDAY - SATURDAY
LICENSE is granted to conduct the amusements as herein described in connection with his/her regular business of innholder, common victualler,or
owner,manager or controller of a cafe, restaurant or other eating or drinking establishment,on the premises to:
Owner: PHILIP BAXTER
Expiration Date:12/31/2021
Description of Premises: BAR AREA OF THE CHAPTER HOUSE INN
This LICENSE is granted as subject to the provisions of the General Laws,Chapter One Hundred and Forty, Sections Twenty-Two inclusive, and of
Chapter Two Hundred and Seventy-Two, Sections Twenty-Five to Twenty-Seven inclusive, and amendments thereto,and shall not be valid for a
location other than herein described.
LICENSE granted by: •
/�
rrs
NSINC14151140RITIES
(See conditions of this license on reverse side)
Conditions:
THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE ON THE PREMISES
Inspection Report
Tel: 508-398-2231
Location: Inspection Date:
277 ROUTE 6A, YARMOUTH PORT, Barnstable, October 1 , 2021 at 12:17:19
MA, 02675, United States PM
Record Type: Record ID:
Use and Occupancy BLD-21-006770
Inspection Type: Inspector:
Building Final Brad Inkley
Result:
Passed
Comments:
Handrail room 304
Repair holes in basement ceiling
Clearance in front of panel
Violation Summary:
Inspector Contractor
4
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-500-5024303-2021A
PRIOR NO. NEW
ITEM
1. The Insured: Baxter lnkeeping LLC
DBA: Chapter House Cape Code a/o Baxter Yarmouthport
Mailing address: PO Box 1503 FEIN:**-"'0520
East Dennis,MA 02641
Legal Entity Type: Limited Liability Company
Other workplaces not shown above: See Location
2. The policy period is from 02/11/2021 to 02/11/2022 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 $ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 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 Of Annual
Remuneration Remuneration Premium
INTRA 111111111
INTER SEE CLASS CODE SCHEDULE
Minimum Premium $276 Total Estimated Annual Premium $3,331
GOV GOV Deposit Premium $858
STATE CLASS
MA 9052 State Assessments/Surcharges
$2,878.00 x 3.5100% $101
637
This policy, including all endorsements,is hereby countersigned by 01/29/2021
Authorized Signature Date
Service Office: Dowling and 0 Neil Ins Agcy
54 Third Avenue 973 lyannough Road
Burlington MA 01803 Hyannis, MA 02601
• WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with Its permission.
Associated Employers Insurance Company
Insured: 5024303 Producer: 10083-002-001
Baxter Inkeeping LLC Dowling and 0 Neil Ins Agcy
PO Box 1503 973 lyannough Road
East Dennis, MA 02641 Hyannis, MA 02601
Insured FEIN: **-***0520 Issue Date: 01/29/2021
Policy Number: WCC-500-5024303-2021A Endorsement Effective Date: 02/11/2021
Policy Period: 02/11/2021 - 02/11/2022 Endorsement Number:
ENDORSEMENT SCHEDULE
The forms listed below are included in this policy:
Form No. Form Description Applicable States Policy Effective Date
WC 00 00 00 C Policy Conditions 02/11/2021
WC 00 03 10 Sole Proprietors, Partners, Officers and Others 02/11/2021
WC 00 03 11 A Voluntary Compensation and Employers Liability 02/11/2021
WC 00 04 04 Pending Rate Change End. MA 02/11/2021
WC 00 04 14 Notification of Change in Ownership 02/11/2021
WC 00 04 22 C MA TERRORISM RISK INSURANCE PROGRAM MA 02/11/2021
WC 20 03 01 MA Limits of Liability Endorsement MA 02/11/2021
WC 20 03 02 A MA Assessment Charge MA 02/11/2021
WC 20 03 03 D MA Notice to Policy Holder Endorsement MA 02/11/2021
WC 20 03 06 B MA Limited Other States Insurance Endorsement MA 02/11/2021
WC 20 04 05 MA Premium Due Date Endorsement MA 02/11/2021
WC 20 06 01 A MA Cancellation Endorsement MA 02/11/2021
WC 20 06 04 MA Policy Definition Endorsement MA 02/11/2021
EndorsementSch(04/11)
Associated Employers Insurance Company
Insured: 5024303 Producer: 10083-002-001
Baxter Inkeeping LLC Dowling and 0 Neil Ins Agcy
PO Box 1503 973 lyannough Road
East Dennis, MA 02641 Hyannis, MA 02601
Insured FEIN: **-***0520 Issue Date: 01/29/2021
Policy Number: WCC-500-5024303-2021A Endorsement Effective Date: 02/11/2021
Policy Period: 02/11/2021 -02/11/2022 Endorsement Number:
LOCATION SCHEDULE
Insured Unit:001 Workplace:001
Business Type:Limited Liability Company Business Type:
Chapter House Cape Code a/o Baxter Yarmouthport
277 Route 6A
Yarmouthport, MA 02675
TAX ID:854310520
Business Type: Business Type:
Business Type: Business Type:
Business Type: Business Type:
Business Type: Business Type:
Business Type: Business Type:
(11/11)LocationSch
Associated Employers Insurance Company
Insured: 5024303 Producer: 10083-002-001
Baxter Inkeeping LLC Dowling and 0 Neil Ins Agcy
PO Box 1503 973 lyannough Road
East Dennis, MA 02641 Hyannis, MA 02601
Insured FEIN: **-***0520 Issue Date: 01/29/2021
Policy Number: WCC-500-5024303-2021A Endorsement Effective Date: 02/11/2021
Policy Period: 02/11/2021 -02/11/2022 Endorsement Number:
CLASSIFICATION CODE SCHEDULE
Policy Unit: 001 Unit State Code: MA
Policy Unit Name: Baxter Inkeeping LLC Billing Plan:4 Equal Quarterly Payments
Classification Class Payroll Rate Estimated
Description Code No. Amount Per$100 Premium
HOTEL:ALL OTHER EMPLOYEES & 9052 216,400 1.33 2,878
Deviated Premium 2,878
Excess Employers Liability 1.00% 29
EEL Minimum Premium Adjustment 21
Premium Subject to Exp Mod 2,928
Standard Premium 2,928
Expense Constant 338
Terrorism Act Surcharge 65
Total Estimated Premium 3,331
DIA ASSESSMENT 3.51% 101
Total Estimated Premium & Surcharge(s) 3,432
ClassCodeSch(04/11)
Associated Employers Insurance Company
Insured: 5024303 Producer: 10083-002-001
Baxter Inkeeping LLC Dowling and 0 Neil Ins Agcy
PO Box 1503 973 lyannough Road
East Dennis, MA 02641 Hyannis, MA 02601
Insured FEIN: 854310520 Issue Date: 01/29/2021
Policy Number: WCC-500-5024303-2021A Endorsement Effective Date: 02/11/2021
Policy Period: 02/11/2021 -02/11/2022 Endorsement Number:
INSTALLMENT SCHEDULE
Units Billed to this Unit:1
Policy Unit No: 001 Billing Plan:4 Equal Quarterly Payments
Policy Unit Name: Baxter Inkeeping LLC
Installment/ DIA Total Amount Due Date Billed
Endorsement No. Assessment
Down Payment $25 $858 02/11/2021 Billed
Installment 1 $25 $858 05/11/2021
Installment 2 $25 $858 08/11/2021
Installment 3 $26 $858 11/11/2021
Total $101 $3,432
InstallmentSch(04/11)
•
Associated Employers Insurance Company
Insured: 5024303 Producer: 10083-002-001
Baxter Inkeeping LLC Dowling and 0 Neil Ins Agcy
PO Box 1503 973 lyannough Road
East Dennis, MA 02641 Hyannis, MA 02601
Insured FEIN: **-***0520 Issue Date: 01/29/2021
Policy Number: WCC-500-5024303-2021A Endorsement Effective Date: 02/11/2021
Policy Period: 02/11/2021 -02/11/2022 Endorsement Number:
POLICY RATING SUMMARY BY STATE
Massachusetts
Deviated Premium 2,878
Excess Employers Liability 1.00% 29
EEL Minimum Premium Adjustment 21
Premium Subject to Exp Mod 2,928
Standard Premium 2,928
Expense Constant 338
Terrorism Act Surcharge 65
Total Estimated Premium 3,331
DIA ASSESSMENT 3.51% 101
Total Estimated Premium & Surcharge(s) 3,432
Total Estimated Premium & Surcharge(s) $3,432
RatingSum(01/12)