HomeMy WebLinkAboutCI-16-005966-06 0
CO o 0
r
z g E ,I. *
El
IS. CNI
w K o
Q W N 0 co c 0� � dC 1 �LL 3 o
' � i 0.
0
't2 4 .+�6 ` U
` a.V J C
co t� j a To' h E.
CD O d I Oa U O
L CtyL C
.a + _ Cco � C Na a),
U 0
.5 = Q U mf7 a
I
wO O w CO CI
0 b O C co
�i a ai 'C!
rig E a. :'9
a> o -w
OCA
`
V U 0.4
00 "0 \
14
as w a
I po.
O 3 E .�
O11
co ° �a k%
COI NI0 0 O y v "
I�.I U
O W ++ W2 v a o .b c
v m Q
O E u_ 0 a ON E po `ti
co
�y �i t Oz i zo 0 t3 2 Ca
�I O 1„1 CO m O Q O cn .
44 R H CC E d y
V /4 0U C cnI . o '� F o
i.d W V a C = Q' 0 y O U N f0
it
r.,..� 3 0 m m n a d E "o. c o
V cu E 0U iiiE Z = y au, u�
O �" 1° m C W - . a A c E E
Z 5 O c9 d� °q c c 0 0
:a n mU � U
E 'C coz = UQ Q `� q o c
A z Ili
>- E °� 'v c
CD ~ a 8• a cEa 5 rn•7
m c zm in
0 o a, a d
CO a� 0 m a o
r� �- o
o 0 •0 —,
ai p a,L. , 0 '00 4.
Cl) a n. Q GL
ti
0 0 0 N LO b 0
C 'C 0 U'5 0y
co..
Mtg 43
coE S
6 0
co O 0
co O •
iA G w .0
1.5 II
c C. V t.
N
U vCi cn
0
co4-1
cn co a W
v Ts •
C
co
-C o w 7 c m o , a) n
o .0 J
II1IIr <{r 41 3 m 0 3 C �s a c
1
h c h o " a o a ch L. 5
4 d Q M
,,,,fitm.1„ ,
c 12 J y a U •
bOq O
f0
i31111Iu � ,, c co
a, cm
z in
\yawT I ' _ OUTH
19 INC E.
RECFIVED
1146 Route 28, South Yarmouth, MA 02664 508-398- 2, ext. 1264
APR 03 2023
APPLICATION FOR CERTIFICATE OF INSPECTION _.
GUILDING DbPAF TMENT
March 1, 2023 PAYABLE UPON RECEIPT
( ) Fee Required
(X) 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: 0269 7 Pl^e S Ycvihc
S fo
Name of Premises: C-41-7 Gre c AO of C1-\ Tel: JV `i-72 2
Purpose for which permit is used: e, i f 'r6/Yr i A S-/1V1(-Q
License(s) or Permit(s)required for the premises by other g ivdrnmental agencies:
License or Permit Agency
e0(1(ArL 1_)i- Cepr 1/e42.4h
/44zo—esie7.-r ,/+ vl 11
Certificate to be issued t (JOCal-Sic/Jr aSAAc+ / Tel: sd'J6/ 1/7e2 2
Address: 02 Y k I�ac✓ .(' 7 r/koJ\ 414' M/9 O‘"6?f'
Owner of Record of Building
Address
Present Holder of Certificate 5 -
Sign ture of person to wh m Title
Certificate is issued or his agent 2/o294&O_Z
Date
Email Address: fitic/` -e/, rile 0 Cc-644p e
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#
04/24/2023-04/24/2024
NOTICE 2f1; NOTICE
TO TO
EMPLOYEES 8I' EMPLOYEES
lin
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
Lafayette City Center, 2 Avenue de Lafayette, Boston, Massachusetts 02111
800-323-3249
As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give you
notice that I (we) have provided payment to our injured employees under the above mentioned
chapter by insuring with:
A.I.M. Mutual Insurance Company
NAME OF INSURANCE COMPANY
P.O. Box 4070 Burlington, MA 01803-0970
ADDRESS OF INSURANCE COMPANY
VWC-100-6014316-2023A 03/31/2023- 03/31/2024
POLICY NUMBER EFFECTIVE DATES
973 lyannough Road
Dowling and 0 Neil Ins Agcy Hyannis, MA 02601 (508)775-1620
NAME OF INSURANCE AGENT ADDRESS PHONE
Cape Cod & Islands Council Inc Boy Scouts of 227 Pine Street Yarmouthport, MA 02675
EMPLOYER ADDRESS
03/13/2023
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
NEAREST AND BEST MEDICAL FACILITY
HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
--n-- BOY SCOUTS OF AMERICA
CAPE COD CI ISLANDS COUNCIL, INC. #224
March 29, 2023
Mark Grylls, Building Commissioner
Town of Yarmouth
1146 Route 28
South Yarmouth MA02664 --_
RE: Inspection of Camp Greenough
Dear Mr. Grylls:
We would like to schedule the annual inspection of Camp Greenough at your earliest
convenience. Since the property is often unattended,please call us at 508-362-4322 or email
michael.riley@scouting.org to make an appointment.
Enclosed is a copy of our Workers Compensation Insurance information.
Thank ou.
Michael R. Riley
Scout Executive
247 Willow Street
Yarmouth Port MA 02675
P(508)362-4322
F(508)362-4323
www.scoutscapecod.org Prepared. For Lifer