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HomeMy WebLinkAboutCI-16-1564-02 4\ t' The Commonwealth of Massachusetts 1:_ r City\Town of I. _w (= YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code,Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:ST.PIUS X CHURCH BLDCI-16.0o1564-02 Trade Name:ST.PIUS X CHURCH Identify property address including street number,name,city or town and county Certificate Expiration Located at 97 STATION AVE 09/01/2019 SOUTH ygnnou7N, Aft"- Use ft}Use Group Floor • Occupancy Use Group Other Classifications(s) A4 01st Floor 1184 A-3 Amusement/Church/Gym/Library/Museum Allowable Occupant Load 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 life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited Name of Municipal Name of Municipal Mark Grylls Date of —/ Building Commissioner Inspection Signature of Municipal Signature of Municipal / Date of Building Commissioner 2teric_if, _/�Issuance 9 jG Fee:;50.00 BLD_Certotlnspection.rpt toyiYaRi. TOWN OF YARMOUTH •/ BUILDING DEPARTMENT %,:t. :..;•s•e? 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION August I,2018 PAYABLE UPON RECEIPT (X) Fee Required $50.00 ( ) 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: • : - ' . , 4 - , - • - - • - a Street Name of Premises: St_ Pius x rhurrh Tel: Purpose for which permit is used: _Religious sery i req License(s)or Permit(s)required f. •- • -mises by other governmental agencies: ; License or Permit I V E Agency AUG 2 9 2018 Certificate to be issued to St. Pius x rhurrh Tel: cnR_3g8_2248 Address: 5 narbarn Street Owner of Record of Building Roman Catholic Bishop of Fall River Address 4 . , ' . . . . . s - - • , nr :. - - - ,,A 02722 Present Holder of Certificate Revs Paul A C'nrnn p„ Pastor Si a ,Lture of person to whom Title I Certificate is issued or his agent $I I 1 K Date Email Address: stpiusxoffice@comcast.net 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 C RTIFICATE OF INSPECTION. Certificate of Inspection# ape_y, - /6- as -S -0-2.) 9/1/2018-9/1/2019 ,I �-.1.1 ROMACAT-02 LSOUZAI fSCOR0" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `----- 08/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER License#1780862 NQm€ACT Lucia Mendes HUB International New England HO NNo,Eall:(508 235-2210 FAX 222 Milliken Boulevard ( ` ) INC,No): Fall River,MA 02721 ADDRESS:Lucia.Mendes@hubintemational.com INSURER(S)AFFORDING COVERAGE NAIC R INSURER A;Associated Industries of Massachusetts Mutual Insurance Compan 33758 INSURED INSURER B: Roman Catholic Bishop of Fall River, INSURER C: Corp.Sole , INSURER D: P.O.Box 2577 Fall River,MA 02722 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WYD IMMIDDIYYYYI IMMIDDNYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR DAMAGE TO RENTED PREMISES fFa occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY STT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE UABIUTY (COBBINdeenED SINGLE LIMIT $ _ ANY AUTO BODILY INJURY(Per person) f — OWNED SCHEDULED AUTOSEEONLY _ AUTOS SSyyNEo BODILY INJURYD (Per accident) $ _ AIRTOS ONLY _ 05STE (fgerecddent)AMAGE $ $ UMBRELLA WIB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS f A AND WORKERS COMPENSATION STATUTE ERN- WMZ80080066832018A 0710112018 0710112019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EL EACH ACCIDENT $ Wigging M EXCLUDED? 1,000,000 antlatory n ) EL DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLESACORD 1D1,Additional Remarks Schedule,may be attached N more• ce is required) RE:SL Pius X Church/Parish Hall Religious Education 94 and 98 Station Ave,South Yarmouth,MA 02664. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth BuildingDepartment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE I (/ v ?ja ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD