HomeMy WebLinkAboutBCOI-24-13 2025 The Commonwealth of Massachusetts
Town of
g} YARMOUTH
New and Renewal Certification 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 BCOI-24-13
Trade Name:Cultural Center of Cape Cod
Identify property address including street number,name,city or town,and county Certificate Expiration
Located at 307 OLD MAIN ST February 6,2025
SOUTH YARMOUTH,MA 02664
Floor Occupancy_ Use Group Other
01st Floor 200 A-3 Lecture halls,dance halls, Owl Hall-80 Standing or 60 Seats
churches and places of religious Culinary Art Kitchen-15 standing or
worship,recreational centers, seals
terminals,etc.
Use Group Classification(s) 01st Floor 20 A-3 Lecture halls,dance halls, Art Studio 20
churches and places of religious
Allowable Occupant Load worship,recreational centers,
terminals,etc.
Basement/Lower 30 A-3 Lecture halls,dance halls, Note Aggregate Total shall not exceed
churches and places of religious 200 for entire complex
worship,recreational centers,
terminals,etc.
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 line safety features.This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned.Failure to post or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal Chief Name of Municipal Building Mark Gryll Date of Inspection 3/I(,.//�4
Commissioner _
Signature of Municipal Fire Signature of Municipal Building gale of Issuance 3/l`�/2
Chief Commissioner /a
(ori, YaR� r l b`��`'�_ o TOWN OF YARMOUTH oin
y BUILDING DEPARTMENT �G
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
January 1, 2024 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 premises located at the following address:
Street and Number: 30-1 C 0- Mai V. . '
CAA-I�u� -[ Cevu-erCMG r' 7/6Name of Premises: Q� Tel: ��'�
r
Purpose for which permit is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
f P. E C 0 V E D
License or Permit Agency "
FEB 05 2024
Certificate to k`e sued to L � (�- (e4,1-0 (,(J� Tel: 0�'3C1�' 7
Address:/ �V' � �'C DO ()OVA-
Owner ofl(ecord of Building
Address
�.4. '�et e5
Present Holder of Certificate "iQ o
t6)
Signature of person to whom T tle
Certificate is issued or his agent L d'-fr
Date
`n� II
Email Address: Y V l.D I t I i i " CM-en
Instructions: Make check payable to: Town of Yarmouth g.)/'"c '7 — I
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 # 6 C bl of y-13
02/06/2024-02/06/2025
NOTICE w= l NOTICE
TO irk! _,sue
TO
EMPLOYEES EMPLOYEES
.4 `�
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 COMPANY
NAME OF INSURANCE COMPANY
800 Superior Avenue East, 21st Floor Cleveland, OH 44114
•
ADDRESS OF INSURANCE COMPANY
WWC3651183 6/1/2023-6/1/2024
POLICY NUMBER EFFECTIVE DAl'ES
MURRAY& MACDONALD INSURANCE SERVIii 550 MACARTHUR BLVD, BOURNE, MA, 02532 508-540-2400
NAME OF INSURANCE AGENT ADDRESS PHONE #
CULTURAL CENTER OF CAPE COD 307 OLD MAIN ST, SOUTH YARMOUTH, MA, 02664 508-394-7E
EMPLOYER ADDRESS
EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DA l'E
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 noti ied that the insurer has arranged for such attention at the
fi
r- 64,/gre 14044611A- ukoi
11°
QFH.SPIT ! °
ADDRESS
TO BE POSTED BY EMPLOYER