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HomeMy WebLinkAboutBCOI-23-1794 o, YA � , TOWN OF YARMOUTH -7 -''I'''�: Office of the Building Commissioner �;f 1146 Route 28, South Yarmouth, MA 02664 � j 508-398-2231 ext. 1260 Fax 508-398-0836 NAUACHl(SE Ari /�C9RPpRATE ,b,�4 '�` APPLICATION FOR CERTIFICATE OF INSPECTION August 15, 2025 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: 6-be- ,So s � ��� Street and Number: k3 Gg VA"... , 37 + t) Name of Premises: q1 d cap. Qti` l e-`\ Tel: .5,8- 3/4--35kit Purpose for which permit is used: itkrAlAi. 0 Qoe_ r" License(s)or Permit(s)required for the premise§by otY er governmental agencies: License or Permit Agency Certificate to be issued to doe,LS /�4.A�. c. Tel: �&-,2.31,-940.5 Address: 'I3 �4e.S d�44._ 5o C `farl we Owner of Record of Building . �, (�—�,Rw.i t- Address 3 k u. Rork[— _ . 5t /arwtE-crat, Present Holder of Certificate 5amto Signature of person tow l� Title Certificate is issued or his agent 10/8 zS ate Email Address: -jrio(a I"(Ac.t ,GeriLe6 c.. Cowl R E C -r - i FID 1- 1 OCT 0 8 2025 BL t Nit;---- li I 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#_BCOI-23-1794_ 12/1/2025-12/31/2026 NOTICE NOTICE TO TO EMPLOYEES } _i , EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100,Boston,Massachusetts 02114-2017 617-727-4900-hUp://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: Ir14.6t" 1st©r3 A eir-t m1-sae i el 8 NAME OF INSURANCE COMPANY sEtrev o�-�Y2 nu�F�asf 21,5(-1:4 - Ckte0.-44 CiCk 1-4\t4 ADDRESS OF INSURANCE COMPANY • -w�3 $�1 i � � R�26/ POLICY NUMBER EFFECTIVE DATES Itielec, - e , arm Vie- Pius C 'n NAME OF INSURANCE AGENT"' ADDRESS- PHONE# c- 0-4i/titt3 1'aCFl� S cy- EMP LO ER 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 nee- snry 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 CAPC ceb -IvSP-i i liY-Pc1010 . ANk NAME OF HOSPf1 AL ADDRESS TO BE POSTED BY EMPLOYER The Commonwealth of Massachusetts Town ofY.'o�.YAK -� ItC41,0) YARMOUTH '� ' -,R 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: Mid-Cape Racquet Club Trade Name: Mid-Cape Racquet Club Restaurant BCOI 23 1794 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 193 WHITES PATH SOUTH YARMOUTH, MA 02664 December 31, 2026 Use Group Classification(s) Floor Occupancy_ Use Group Other 01 st Floor 34 A-2 Restaurants,Night Clubs,or 18-Bar Stools Allowable Occupant Load similar uses 16-Movable Chairs 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 Enrique Arrascue Name of Municipal Building Mark Gr Date of Inspection J 1' i Commissioner --� 1 __: / )_1 (, A,S Signature of Municipal Fire Li_ Signature of Municipal Building��-� /i,, Date of Issuance J Chief 7 /yam Commissioner ` � f ZkA —