The URL can be used to link to this page

Home My WebLink AboutBldci-23-004125 The Commonwealth of Massachusetts } City\Town of r 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:Travis Hospitality Inc BLDCI-23-004125 Trade Name: Bayside Resort Identify property address including street number, name,city or town and county Certificate Expiration Located at 225 ROUTE 28 ( 2/4/2024 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 65 R-1 Hotel/Motel/Boarding House/Transient 65 Rooms-Swimming pool,lobby,Lady's-Men Sauna Room 63 Rooms Allowable 02nd Floor 63 R-1 Hotel/Motel/Boarding House/Transient 63 room Occupant Load 02nd Floor 51 B Business Hospitality RM-Nantucket RM 40 Harbor RM,Fitness RM 11 02nd Floor 147 A-3 Amusement/Church/Gym/Library/Museum Captains RM 125 Game RM 22 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 7 Date of ^ �� Building Commissioner Inspection �( Signature of Municipal Signature of Municipal - Date of Building Commissioner Issuance 2 % ;n BLD_Certoflnspection.rpt - • TOWN OF YARMOUTH yai VI\ iHj BUILDING DEPARTMENT c4�`. ,_., 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTION JAN 2 0 2023 January 1,2023 PAYABLE UPON CEIPT (X) Rid IIt@tj R $'4' /!`661,1T v ( ) cc Cquired-- 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: 2,7,5 j20 11 e- Z Name of Premises: 127a S. ►b-e- c02( Tel: 5 775—cZoc 7 Purpose for which permit is used: -G License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to luvis )(Vsyd-A I //1c.. Tel: 5VJ -?7S-SC f Address: 2-z r POZTre -YitTztujv7tf 114 62co73 Owner of Record of Building AWt4-6 p Address C-A-1 �= Present Holder of Certificate ,11 vVt A/ - Sign person to whom Title Certificate is issued or hik agent /• I'7 Z:i tier cl2b c_Zevt r(4-( Date Email Address: /24 Q 13a cis/ C LN , 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 CA O ISjSUE YO ' ERTIFICATE OF INSPECT ION. Certificate of Inspection# tea, 0' i f y/�� / 9 02/04/2023-02/04/2024 • �av 6tij, ---- - - --- - WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. I WMZ-800-8003721-2022A PRIOR NO. WMZ-800-8003721-2021A ITEM 1. The Insured: Travis Hospitality Inc DBA: Bayside Resort Hotel Mailing address: Rt 28 FEIN:""-"""7972 225 Main Street West Yarmouth, MA 02673-0000 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 04/01/2022 to 04/01/2023 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 000362922 INTER SEE CLASS CODE SCHEDU_E Minimum Premium $276 Total Estimated Annual Premium $12,313 GOV GOV Deposit Premium $3,214 STATE CLASS MA 9052 State Assessments/Surcharges $13,005.00 x 4.1800% $544 This policy, including all endorsements, is hereby countersigned by 1 --'"P • 03/21/2022 Authorized Signature Date Service Office: Baldwin Krystyn Sherman Partners LLC dba 54 Third Avenue 410 University Ave. Burlington MA 01803 Westwood,MA 02090 WC 00 00 01 A (7-1 1) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. OF 1 • The Commonwealth of Massachusetts _ ' City\Town of mir IA �, �= - M YAROUTH ', 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:Travis Hospitality Inc BLDCI-23-004125 Trade Name:Bayside Resort Identify property address including street number,name,city or town and county Certificate Expiration Located at 225 ROUTE 28 2/4/2024 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) R-1 01st Floor 65 R-1 Hotel/Motel/Boarding House/Transient 65 Rooms-Swimming pool,lobby,Lady's-Men Sauna Room 63 Rooms Allowable 02nd Floor 63 R-1 Hotel/Motel/Boarding House/Transient 63 room Occupant Load 02nd Floor 51 B Business Hospitality RM-Nantucket RM 40 Harbor RM,Fitness RM 11 02nd Floor 147 A-3 Amusement/Church/Gym/Library/Museum Captains RM 125 Game RM 22 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 ( 2kDate of Building Commissioner Issuance 274 . 4 BLD_Certofinsspection.rpt