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HomeMy WebLinkAboutBLDCI-22-004332 t The Commo a th of Massachusetts n } fft Ci own of IV i . g 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: Baxter Innkeeping LLC BLDCI-22-004332 Trade Name: Chapter House Identifyroeincluding1 property rty address street number, name,city or town and county Certificate Expiration Located at 277 ROUTE 6A 2/27/2023 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 02nd Floor 6 R-1 Hotel/Motel/Boarding House/Transient 6 Rooms Allowable 03rd Floor 5 R-1 Hotel/Motel/Boarding House/Transient 5 Rooms 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 Name of Municipal Mark Grylls Date of Building Commissioner Inspection Signature of Municipal Signature of Municipal ? Date of Building Commissioner Issuance Z tn r Fee:$100.00 BLD_Certoflnspection.rpt TOWN OF YARMOUTH a8; . z9) BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION January 1, 2022 PAYABLE UPON REC ' (X) Fee Requ',ed$100.00 ( ) No Fee R-; ' -• 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: 'Zi.7 T 6 — CAS rr ' G hou S'2 Name of Premises: e NA 1->r n, 4 u v l& Tel: a Sj' 1 5/ 6 4 Purpose for which permit is used: License(s)or Permit(s)required for the premises by other governmental agencies: RECEIVE ® License or Permit Agency FEB 03 2022 BUIL6I Y t C rtificate to be issued to ?4)(T7 A INNete Pi A d "C C Tel: 3 I C / 7 1 3 C y iti Address: 2-77 R o' L ,4- , z(¢/ ! o t)4- o P4—;4-/4- 'Owner of Record of Building 9 r4-xTE a. z'�4-R,<<-(ouTlrl- Poo. i+o 'Jv 6 S L . C Address 70 "FfO X /( ' f 4-f/ /)t/vN/t ,&-1 Present Holder of Certificate f 4,t'T'n (Ni i/ tt-Q,,1f . a. e- 1, Ow"./A: /2— /Signatur of person to whom Title Certific to is issued or his agent Z/?l2 L ✓Date Email Address: ?if t u 9 13 A X i r [1, t+o S? ►T41-i 17"- . c o 1'-. 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# S(hI... J _ )(3433 3 f 02/27/2022-02/27/2023 �,\ The Commo e th of Massachusetts we��= Ci own of �* 1! M qt. YAROUTH Z �l = Y 11ii- 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: Baxter Innkeeping LLC BLDCI-22-004332 Trade Name: Chapter House Identifyroeincluding1 property rty address street number, name,city or town and county Certificate Expiration Located at 277 ROUTE 6A 2/27/2023 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 02nd Floor 6 R-1 Hotel/Motel/Boarding House/Transient 6 Rooms Allowable 03rd Floor 5 R-1 Hotel/Motel/Boarding House/Transient 5 Rooms 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 Name of Municipal Mark Grylls Date of Building Commissioner Inspection Ot o�+� Signature of Municipal Signature of Municipal \) 7:7 Date of Building Commissioner Issuance 37z/tt ,-- - Fee: $100.00 BLD_Certoflnspection.rpt 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-•500-5024303-2021 A 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:'Y"'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 This policy, including all endorsements,is hereby countersigned by "--- C- 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. The Commo th of Massachusetts Ci own of YARMOUTH _ I Y 4 _ 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: Baxter Innkeeping LLC BLDCI-22-004332 Trade Name:Chapter House Identify property address including street number, name, city or town and county Certificate Expiration Located at 277 ROUTE 6A 2/27/2023 YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 02nd Floor 6 R-1 HoteUMotel/Boarding House/Transient 6 Rooms Allowable 03rd Floor 5 R-1 Hotel/Motel/Boarding House/Transient 5 Rooms 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 Name of Municipal Mark Grylls Date of Building Commissioner Inspection OL-074027azga. Signature of Municipal Signature of Municipal ) Date of Building Commissioner Issuance J Z/tn _ L_______ c/ Fee: $100.00 BLD_Certofl nspection.rpt M ru+crK._ -- TOWN OF YARMOUTH AT^* Ii =s r BUILDING DEPARTMENT ‘c,q�...,� ,1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION January 1, 2022 PAYABLE UPON RE IPT (X)Fee Requ' d$100.00 ( ) No Fee Req • 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: Z l l o u T F_ 6 Name of Premises: C t14 P Tel: 3t 0 $'7 7 r 6 N J Purpose for which permit is used: License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency RECEIVED • FEB 03 2022 ✓Certificate to be issued to ' K't72, /,(JN/( PI/Y 6 t Tel: 3n/d 07-7 1?6 Address: 2-71 Rou7-L� G.4- /4 2.*o J T{- PC4T 1 f4- : atifk.NT Owner of Record of Building 4-KTE P, 1/4414-1(4ounf t1 a (-2)t C) 7Address f o 3 0, / 3 /)6irAv I S f/i4 4 G' 4( iv-Present Holder . Certificate '34-y & /A/N K E P(jV 6 L cr t / Signature f person to whom Title ,/ Certificate is issued or his agent 2 /3 ) �-o c-'L- �/Date Email Address: Vt-t!L. 4-CTf 12-41 5 P 1 14-t-t T-/ . C o t'-( 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# &i) J- .. 330? e 02/27/2022-02/27/2023 ' 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-500-5024303-2021 A PRIOR NO. NEW ITEM 1. The Insured: Baxter Inkeeping 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 SCHEDU�E 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 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.