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Home My WebLink About2025-26ch No. qoq2aq LTcENSE FEE $ r 50 EH t/r/- 23 -/RA 7 TOWN OF YARMOUTH BOARD OF HEALTH 2025/2026 HANDLING AND STORAGE OF TOXIC OR HAZARDOUS MATERIALS LICENSE APPLICATION COMPLETE TTIIS APPLICATION AND RETURN IT WITH THE LICENSE FEE BY JI]NE 30, 2025 PLEASE COMPLETE ALL OUESTIONS NAME OF BUSINESS Deb's Hill Condominium 508 3 s +\ A ilrtFeltltrsD*&trBUSINESS TEL. # h Port, MA 02675 lreo ;olrnnDrive, y;rrrle{t Jl.tN 2BUSINESS ADDRESS IN YARMOUTH MAILTNG ADDRESS z5 H&qr t: EMAIL ADDRESS BEQIJIBED MANAGER/CONTACT PERSON TELEpHONE # 508-360-'1 557 mobile Paul Baron, Baron Property Management, LLC B.EQI]I8[D OV/NER NAME HOMEADDRESS Deb's Hill Condominium Association CORPORATION NAME (IF APPLICABLE)- CORPORATION ADDRESS .fEL. H TAX ID (FEIN OR SSN)REOUIRED 04€512436 LICENSES RUN ANNUALLY FROM JULY I TO JUNE 3O T IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY JUNE 30. FAILURE TO DO SO WILL RESULT IN CLOSURE OF YOUR ESTABLISHMENT UNTIL THE REQUIRED APPLICATIONS(S) AND FEE(S) ARE RECETVED. A HEARING BEFORE THE BOARD OF HEALTH MAY BE REQUIRED PRIOR TO REOPENING. Compensation Afndavit. If not apDlicable,please explain REGISTRATION FORM SIGNED AND COMPLETED C}IECK AND WORKERS COMP AFPIDAVIT ENCLOSED ALL SAFETY DATA STIEETS ON FILE YN ANY Nf,W CHEMICALS MUST BE PRE.APPROVED BY THE HEALTH DEPARTMENT. RENEWAI, APPLICATION X X X N APPLICANT'S SIGNATURE DATE: 06-18-2025 TEL,# MAILING ADDRESS- Town ofYarmouth taxes and liens must be pard prior to renewal or issuance olvour permits Please check appropriately ifpaid: yes-- no X nla _ Under Chapter I 52, Sec. 25C, subsection 6, the Town of Yarmouth is required to hold issuance or renewal of any license or permit to operate a business ifa person or company does not have a Certification of Workers Compensation insurance. As part ofthe renewal or issuance ofyour permits, you must complete the enclosed Workers NEW APPLICATION s:I ne Lommonweaur, (rt luat!;sacnu$erl5 Department of Industial Accidents Ollic e of I n ves tig atio n s Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111'1750 u,ww.mass.gou/dia Workers' Compensation Insurance Affi davit: General Businesses Deb's Hill CondominiumBusiness/Organization Name: Address: 27 Miriah Drive City/StatelZip . Yarmouth Port, MA 02675 Phonc #: 508-385-9499 Are you an employer? Check the oppropriate box: I - fl I am a employer with - employees (full and/ cr part-time).i 2. fl I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] :. E We are a corporation and its officers have exercised their nght of exemption per c. 152,$l(4),andwehave no employees. [No workers' comp, insurance required]* We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 4 x .AIry appliaant that chccks box # I lnust also fill out the seclion below showing their workcrs' conrpersati **lf thc iorporate o{ficer have exempted themselves, but lhe corpomtion has other employecs, a workers' organization should check box # I ol policy information. compcnsalion policy is required and such an Business Type (required): 5. n Rerait 6. ! Restaurant/BarlEating Establishment 7 8 Office and./or Sales (incl. real estate, auto, etc.) Non-profit 9. ! Entertainment Manufacturing Hcalth Carc Other l0 It l2 x I am an employer that is providing workers' compensation insurance for my employees, Below is the policy informalion, Insurance Company Name: Continental Casualty Company Insurer's Address P O Box 5600 Hartford, CT 06102City/State/Zip: 07 -13-2025 Policy # or Self-ins. Lic. #Expiration Date : Attach a copy of the workers' compcnsation policy declaration pagc (showing the policy numbcr and expiration date). Faiiure to secure coverage as required urder $ 25A i.if MGL c. 152 can iead to the irriposition of criminal pclalties ofa fine up to $1,500.00 andlor one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Oflice of Investigations of the DIA for i e coveragc verification. I do hereby nder the pains ond pernlties of perjurydl thc infotntation provided above is true and cotecl. Paul Baro Dar€: 0611812025 Phone #508 0-557 Permitll-icense # Phone #: 3.flCity/Tolyn Cterk 4. !Licensing Board Offcial use only. Do not h,rile in this area, to bc completed by city or town olficial. lssuing Authority (check one): lflBoard of Health 2.E Building Department 5[ S€lectmen's Office 6. fiOther Contact Person: Applicant Information PleaSg-tt!!!-tpeibly 47 47P 19-4-24 Citv or Town: *ww.mass.gov/dia CTIA INSURER: CONTINENTAL CASUALTY CoMPANY A STOCK COMPA$Y VDAC WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC OO OO 01 ( A) POLICY NUMBER: (6ss9uB-4747PL9-4-24) RENE!{AL OP ( 6Ss9UB-4747P1,9 - 4 - 23 I NCCI CO CODE: 10243 1. INSURED: PRODUCER: DEBS HILI, CONDOMINIUM TIIE HILB GROUP OF NEW EN ASSOCIATION 973 IJYANNOUGH RD C/O BARON PROPERIY MANAGEMENT HYANNIS MA 02601 PO BOX 16 82 EAST DENNIS MA 02 641 lnsured is rRusr oR ESTATE Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 07-!3-24 to 07-13-2512:01 A.M. atthe insured's mailing address 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) 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 our liability under Part Two are: Bodily lnjury by Accident: $ s00000 Each Accident Bodily lnjury by Disease: g 500000 Policy Limit Bodily lnjury by Disease: S s00000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here COVER.AGE REPLACED BY ENDORSEMENT WC 20 03 068 D. This policy includes these endorsements and schedules: SEE LISTTNG OF ENDORSEMENTS - EXTANSION OF TNFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUAILY. DATE OF ISSUE: OFFICE: PRODUCER: 01 -01-24 wc R!'tD CNA 04.' THE HILB GROUP OP NEW EN 775CW ST ASSTGNT MA VDAC "/s-,GCNA ,,fw\ JUL I.r 2925 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICYHLTHDAo* TYPE AR INFORMATION PAGE WC OO OO O't ( A) POLICY NUMBER: ( 6ss 9IrB - 4747P19 - 4 - 2 s ) RENEWAT, OF ( 6S59sB-47 47919 -4-241 INSURER: CoIITINENTAL CASUAI,TT CoNdPNw A SIOCK COI{PAIr NCCI CO CODE: 10243 1. INSURED: PRODUCER: DBBS EII.L COTIDOMITIII'I{ TE8 EII,B GROI'P OF I'ET' BI ASSOCIATION 973 LIANNOI'g RD C/O BARON PROPER T XNIAG&EIIT ETAI$IIS IiA 02501 PO BOX 16 82 EAST DEI{NIS t{A 02641 lnsured is tRlrsr oR EsrtrE Other work phces and identifcation numbers are shown in the schedule(s) attached. 2. The poliry perird is from o?-13-25 to 07-13-25 12:01 A.M. at the insured's mailing address 3. A. WORKERS coMPENsATloN INSURANCE: Part one of the policy applies to the Workers Compensation Law of the state(s) listed here: I,IA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily lnpry by Accident S 500000 Each Accident Bodily ln!ry by Disease: S s00000 Policy Limit Bodily lnirry by Dasease: $ s00000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here COVBRAGE REPLACED BY ENDoRSET,IENT IIC 20 03 O5B D. This policy includes these endorsements and schedules: SEE I.ISTITG OF EXTDORSE!{ENTS - EXIEIISION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subFct to verficaton and change by audit to be made ArrlruAlry. DATE OF ISSUE: 06-24-2s wc OFFICE: Rt.D clIA o{JOora^t t-ED. dD^nD .\D N?t t?r, S? ASSIGN: IttA LICENSE FEE $I5O TOWN OF YARMOUTH BOARD OF HEALTH 2025/2025 HANDLINC AND STORAGf, OI.l'TOKC OR HAZARDOUS MATERJALS LICENSE APPLICATION COMPLETE THIS APPLICATION AND RETURN IT WITH TITE LTCENSE FEE BY JUNE 30, 2025 PI,EASE CONIPLETE AI,1, OI ESTIO\S NAME OF BUSINESS-Deb's Hill Condominium BUSINESS TEL, #508-385-9499 BUSINESS ADDRESS IN y6p1ygga11 29 Miriah Dr. Yarmouth Port,MA 02675 MAILING ADDRESS- , BIOUIB.EDOIVNER NAME Deb's Hill Condominium Association HOME ADDRESS- CORPORATION NAME O}' APPLICABLE) TEL-# TEL. # MAILING ADDRESS- rAx rD (FE[N oR SS$BSIIIJIBIID 046s12436 LICENSES RTiN ANNUALL Y FROM JULY I TO JUNE 3O T IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEE(S) BY JUNE 30. FAILURE TO DO SO WILL RESULT IN CLOSURE OF YOUR ESTABLISHMENT UNTIL THE REQUIRED APPLICATIONS(S) AND FEE(S) ARE RECEIVED. A HEARINC BEFORE THE BOARD OF HEALTH MAY BE RLQUIRED PRIOR TO REOPENING Town of Yarmouth taxes and liens must be paid prior to renewaI or issuance ofyour pemrils. Please check appropriately if paid: yes-- Under Chapter 152, Sec. 25C, subsection 6,the Town of Yarmouth is required to hold issuance or renewal of any license or permit to operate a business ifa person or company does not have a Certification of Workers Compensation insurance. As pafl ofthe renewal or issuance of your permits, you must complete the enclosed Workers no--X rua- C ation Aflidavit. If not licablc lease lain iectsrRarloN FoRM SIGNED AND COMPLETET) CHECK AND WORKERS COMP AFFIDAVIT ENCLOSED ALL SAFETY DATA SHEETS ON FILE l(_ ANY NEW CHEMICALS MUST BE PRE-APPROVED BY TIIE HEAI'TH Df,PARTMENT' RENEWAL APPLICATION X NEW APPLICATION-- X APPLICANT'S SIGNATURE. EMAIL ADDRESS B&QI]IBED MANAGER/CONTACT PERSON PAUI B1.ON' BATO" P'OPE'IY MAN TELEPHONE # 508-360-1557 mobile CORPORATION ADDRESS N N ptlE 06-18-2025