HomeMy WebLinkAboutBCOI-24-46 2025 The Commonwealth of Massachusetts
Town of
IT 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:Boy Scouts of America BC0I-24-46
Trade Name:Camp Greenough
Identify property address including street number,name,city or town,and county Certificate Expiration
Located at 0 GREENOUGHS POND April 24,2025
YARMOUTH PORT,MA 02675
Floor Occupancy_ Use Group Other
01st Floor 177 A-3 Lecture halls,dance halls, Camp Masters Lodge-4 Admin
Use Group Classification(s) churches and places of religious Building-10
worship,recreational centers, Maushop Lodge-19
terminals,etc. Dining Hall-Tables&Chairs-112
Allowable Occupant Load Bunkhouse/Sleeping-32
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 Building Mark G e of Inspection S/)7I I
Name of Municipal Chief Commissioner ,
Signature of Municipal Fire Signature of Municipal Building Date of Issuance S/L� ZJJ
Chief Commissioner /
TOWN OF YARMOUTH
--
•
r, t' BUILDING DEPARTMENT
're"."""OIIA're".""." 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
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APPLICATION FOR CERTIFICATE OF INSPECTION
March 1, 2024 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: 'Pint, � \i/oki-iyi_ 0(}4-1_ Poo-,
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Name of Premises: Cavvit G Ve: (l O \ Tel: -3 4--/,307o,
Purpose for which permit is used: C\r‘ k\CCI,VP:r15 Caiiip
License(s) or Permit(s) required for thepremises byother overnimental agencies:
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License or Permit Agency
R E DF I V E D
C\A 1 Coca'? \
F v L HR 2120;
kte..cd-Jous J V BUILDING
Certificate to be issued to 47 M 6 ‹t° Tel: - -
Address: yi 1 . tQ , 3- yanyi„.1.4), oi+) mA (o '- '-
Owner of Record of Building
Address
Present Holder of Certificate 5 o_tvu-e,--•
tt eW /5exetLt
Signature..of rso o whom Title
Certificate ri ' sued or his agent %3 .`")
Date
Email Address: ( rn ' c 2 �ci (D3C,c)J YI r0C
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 # (2fQJ
04/24/2024-04/24/2025
•
NOTICE NOTICE
TO g a TO
EMPLOYEES a EMPLOYEES
TheCommonwealth
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 247 Willow 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
--2N BOY SCOUTS OF AMERICA
' CAPE COD Cu. ISLANDS COUNCIL, INC.#224
March 13,2024;
Town of Yarmouth
Building Department
Re: Application for Certificates of Inspection
Enclosed are our Application for Certificate of Inspection and workers Compensation Certificate.
We would like to schedule the inspection at a mutually agreeable time. Please contact our office at
508-362-4322 to make arrangements.
Sincerely,
7(4 ts)._
Amy Zahn
Scout Executive
247 Willow Street
Yarmouth Port MA 02675
P(508)362-4322
F(508)362-4323
www,scoutscapecod.org Prepared. For Life:t