HomeMy WebLinkAboutBLDCI-23-002676 The Commonwealth of Massachusetts
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I — �,, i City\Town of
�- is YARMOUTH
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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:Oliver's and Plank's Tavern BLDCI-23-002676
Trade Name:Oliver's and Plank's Tavern
Identify property address including street number, name,city or town and county Certificate Expiration
Located at
960 ROUTE 6A 12/31/2023
YARMOUTH, MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 227 A-2 Nightclub/Restaurant/Bar/Banquet Hall 85-Main Dining
67-Small Dining
74-Bar Lounge
Allowable Total 227
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 PhilipililimmlapIN Name of Municipal Mark Grylls Date of /�
Fire Chief Sc�e+.�c� Building Commissioner ��, Inspection
Signature of Municipal Signature of Municipal Date of
Fire Chief Building Commissioner er,"--' Issuance /2,71yAt,
Fee:$150.00
B LD_Certofl nspection.rpt
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1260 Fax 508-398-0836
LICENSE INSPECTION APPROVAL LOG - 2023
NAME: Oliver's Restaurant ADDRESS: 960 Route 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 Rep. Date Comments Approved for
License Issuance
LL'el___5 No
Fire Department Rep. Date Comments Approved for
// % 1IEELicense Issuance
/2 12�Z No
Board of Health Rep. Date Comments Approved for
License Issuance
Yes No
Plumbing/Gas Inspector Date Comments Approved for
License Issuance
Yes No
Electrical Inspector Date Comments Approved for
License Issuance
Yes No
Taxes Paid Yes No
Rev.Sept.2003
° a�o TOWN OF YARMOUTH RECEIVED
y/s y BUILDING DEPARTMEN
�4.....•�'� $ 1146 Route 28, South Yarmouth, MA 02664 508-398-22 1 ext10016115 2022
BUI r � T�AENT
APPLICATION FOR CERTIFICATE OF INSPECTION By:
September 16, 2022 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: 6() r o e I N) rf A - 6 A MM r lY�� PJ r l Oc 6�S
Name of Premises: 01,tJPev puJv P ,DPJC S TAU2Cr.3Tel: Spy 60 602,
Purpose for which permit is used: ArvnivA L- Lkq vox" LAC PO Se PPS PAY A r\)1"
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
�6 5 - RS - ) lS?
t_ rquot 1. icQJ e
Certificate to be issued to Wpw,Del sort) coo,/ ,( O Tel: 4-4-6\ - 5 4a,.D 5
Address: �o�, 6P 01_ P�r-ro ►� oc H�1PstJ �rS �� t 0 03
Owner of Record of Building
Address
Present Holder of Certificate \Jp143 Q11 sc 3 c;i) ei.
y\JPf\JLOB <c)I10 CO D o\J P\Rc
Signature of person to whom Title
Certificate is issued or his agent
0
Date
Email Address: nZ}� (� �5��S (fin/�;r5, CO N1
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 # LOCI a3-000Wo-7
- 1/01/2023 - 12/31/2023
NOTICE . NOTICE
TO rigorTO
EMPLOYEES EMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MASSACHUSETTS 02111
617-727-4900 - http://www.state.ma.us/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:
MA Retail Merchants WC Group Inc.
NAME OF INSURANCE COMPANY
PO Box 859222-9222, Braintree, MA 02185-0000
ADDRESS OF INSURANCE COMPANY
014005035572122 08/01/22 - 01/01/23
POLICY NUMBER EFFECTIVE DATES
RogersGray 434 Route 134, South Dennis, MA 02660 O
NAME OF INSURANCE AGENT ADDRESS PHONE #
Oliver's & Planck's Tavern 6 Bray Farm Road, Yarmouthport, MA 02675-0000
EMPLOYER ADDRESS
08/02/2022
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 services 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 hereby notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER