HomeMy WebLinkAboutBldci-23-003758 The Commonwealth of Massachusetts
__ City\Town of
u YARMOUTH
NH1"ims 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:Cultural Center of Cape Cod BLDCI-23-003758
Trade Name:Cultural Center of Cape Cod
Identify property address including street number,name,city or town and county Certificate Expiration
Located at 2/6/2024
307 OLD MAIN ST
SOUTH YARMOUTH,MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-S 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 ' Date of
Building Commissionerett Issuance 7,/2,,
Fee:$100.00
BLD_Certofl nspection.rpt
,�Q�•YqR.�,
'�o TOWN OF YA�OUTH
a( ', :� iy BUILDING DEPARTMENT
�•�\�MATTACM�/S� ' 1146 Route 28 South Yarmouth M. A 02664 508-398-223.1. ext. 1260
R.
APPLICATION FOR CERTIFICATE OF INSPECTION
January 1, 2023 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-named located at the following address:v
Street and Number: do 7 D 13 V a. 14 St—
Name of Premises: 0.Ai,i z1A,ial Ce A't i (Q COJ Tel: WPO 1IW
Purpose for which permit is used:
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
RECEIVED
t be is d
01Certificate . efiklex- : Sic 3 id JAN 0 9 2023
_
Address: Uto� LA Qr A-14- D t " f j BUIL - - ,ENT '
Owner of R cord of Building '� ro.vvi , 5 — 1 I --
Address
Present Holder of Certificate S`OOA�
Nee- ► {
Signature of person to whom Title
Certificate is issued or his agent I I b OS
I Date
Email Address: ND L l I d�,fled ^ce 'r,,
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#
02/06/2023-02/06/2024
NOTICE NOTICE
TO
TO
%
` �` �" EMPLOYEES
EMPLOYEES ; _l _
-4ri
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
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:
Wesco Insurance Cmpany
NAME OF INSURANCE COMPANY
800 Superior Avenue East, 21st Floor Cleveland, OH,44114
ADDRESS OF INSURANCE COMPANY
WWC3590185 06/01/2022-06i/01/2023
POLICY NUMBER EFFECTIVE DATES
Gabriel DeSouza Same as below(MMISI AGENCY)
NAME OF INSURANCE AGENT ADDRESS PHONE#
Murray&MacDonald Insurance Services, inc. 550 MacArthur Blvd, Boume, MA, 02532
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
hereby notified that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER