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HomeMy WebLinkAboutCertification of Inspection The Commonwealth of Massachusetts ,= City\Town of 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:SOUTH YARMOUTH METHODIST CHURCH BLDCI-17-000198-03 Trade Name:SOUTH YARMOUTH METHODIST CHURCH PARISH HALL Identify property address including street number,name,city or town and county Certificate Expiration Located at 318&324 OLD MAIN ST 07/28/2020 • SOUTH YARMOUTH,MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 96 A-3 Amusement/Church/Gym/Library/Museum 96 PERSONS-TABLES &CHAIRS 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 S Building Commissioner •-ction 7 Signature of Municipal Signature of Municipal ,/ Date of Building Commissioner / Issuance O•Z fn Fee:$100.00 BLD_Certofl nspecti on.rpt t qRO TOWN OF YARMOUTH O y BUILDING DEPARTMENT _ - MATTA M CSF " 1146 Route 28, Yarmouth,South MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION June 11, 2019 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: J Vs O\a, Mc,.‘v\ ' 1 ) S, \�p11‘.r M 0-UP L m Name of Premises: S. ye,•n, Nr\ Uo* Oted Mek\ (\ua Tel: 3`.3,`1'{ . Purpose for which permit is used: Wo.<<,*4 v-t\� �, cusses, sz-4<‘.,; License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit RECEIVED Agency ill_ 0 9 2019 6011 DING D:PARTME:NT t BY Certificate to be issued to 6. acrn0.AV ur•Aed. M'It Ck Tel: S 318.wqr Address: 521k CUL Mir �r 5�, �. �rU� v�h Mt\ OZtc(cM Owner of Record of Building --T.4\,..,a Address Mt1/4rn S8,1 yoetv‘o„,NN Mf\ o"..lda<-1 Present Holder of Certifi to %es: -rb,ar<rtvv, s C\.c:\X Rehr. Signature of person to whom Title Certificate is issued or his agent ('/C2 R1 Date Email Address: S v1uvvnLd 5 Q.0•t eccvc.A C 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 owl-IT -C0 f e&0 3 7/28/2019-7/28/2020 -,Accmwil CERTIFICATE OF LIABILITY INSURANCE DATE tIMMIBrrYrr) 8/212019 THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AM)COWERS NO RIGHTS UPON THE CERTWICATE HOLDER THIS CERTFICATE DOES NOT AFFMMATNELY OR NEGATIVELY AID, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTWICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I R(S), AUTHOR® REPRESENTATIVE OR PRODUCER,AND THE CERTFICATE HOLDER. IMPORTANT: I the certMcate holder is an ADDITIONAL MIMED,the poily(Ns)must have ADDITIONAL INSURED provisions or be endorsed. U SUBROGATION IS WANED,subject to the terms and conditions of the policy,chain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in hen of such endorsemeil(s). Patricia Smith Fr• ed Welknan Street Church InsuranceI FAX 41No,PHONEBet 978-458-1865 Nor 978-454-1865 EMAIL Lowell MA 01851 Anemem _con BLSURER(MAF ORDNGCOVERAGE i NAM 0 INSURER A:Chung 111111UtUild Insurance Company 18767 N SUR® to -1l The New England Annual Conference of the United Me DIMMER B: 411 Merrimack Street Suite 200 INSURER c Methuen MA 01844 INSURER D INSURER E: NSIaIER F: COVERAGES CERTIFICATE NUMBER 754994782 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. NOTWITHSTANDING 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. MISR ADOL GUBRI I POLICY EFF POLICY EXP LIR' TYPE OF INSURANCE NSD WVD POLICY NUMBER 1 I eVDJYYYY)I aNeDOIYYYYI 1 LASTS A X COIMBtCIAL GENERAL LIABILITY 026125002025281 8/12019 8/1/2020 EACH occuRRENGE i S 1,000,000 CLAIMS-MADE X OCCUR PREMISES acarrence) $300,000 LED EXP(Any ore person) $15,000 PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE ,$3,000,000 POLICY ri PRA [J LOG PRODUCTS-CO!P,OP AGG $1,000,000 OTHER • $ A AUTOM08lEL1ABIJTY 026125009022126 8I12019 8/1/2020 C{MIBINED SINGLE LIMIT $1,000 000 {Ea aodde+R) ANY AUTO BODILYA INJURY(Per person) I$ X!!OWNED SCFPDIAED I BODILY INJURY(Per ardent)'$ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ,_AUTOS ONLY —'AUTOS ONLY ! (Per accident) • A X UMBRELLA LIAB X OCCUR 026125081025282 , 8/112019 8/1/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAR CIp INS-MADE AGGREGATE '$10,000,000 DED X I RETENTION$in IW l $ A WORD COMPENSATION 026125007177048 1/12019 1/1/2020 •X rail; 1 AMI EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXEC U T1VE YNN N/A EL.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) • E.L.DISEASE-EA EMPLOYEE $500,000 •IT yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $500,000 i i [ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Evidence of insurance for the South Yarmouth United Methodist Church which is part of the New England Annual Conference of the United Methodist Church CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth United Methodist Church 322 Old Main Street AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 —1.------?—V.:\iy-----... ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 04/ °F TOWN OF YARMOUTH BUILDING UIL ELECTRICAL GAS `t 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING `11i� _ Telephone(508)398-2231,Ext.1261—Fax(508) 398-0836 SIGNS • BUILDING DEPARTMENT Inspection and License Report Address 3/e "" 52% O;.01/'# Business Name 5i y► . "Aa Sr-cite, Conrad Phone Duringthe Annual Inspection ofyour premises,performed in accordance with theprovisions of Section 110.7 of 780 CMR P (Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: - ECISE 0 ergency egress signage Location 1 j N ❑Emergency egress lighting Location t 7 S 41C." .e) ❑Maintenance of exits Location 9n77 •13( 71'!t` ❑Guards/handrails Location (T( & S ❑Signs Location ❑Parking Location fa Other Location ❑Combustion Air Location ❑Storage in Boiler Room Location • ❑Vents Location • ❑Automatic door dosures on boiler room doors Location ❑Clothes dryer vents Location Other Location • The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. In order to abate the above violation(s)you must: o Make corrections immediately and contact this office for a follow-up inspection. • o Make corrections prior to opening and contact this office for a follow-up inspection. o.Make corrections prior to your next annual inspection. o Make corrections within y� days jand contact this office for a follow-up inspection. Local Official/Inspector CO" �! `ys L� 1 Received By •-� t Title Revised 2/8/13